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HomeMy WebLinkAboutBERNARD BLK 4 LT 5ABernard Block 4 Lot 5A #060-321-26 (Casttfte' arttttng log by DOC CO. ee, SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 •TELEPHONE 688-2759 OWNER OF LAND' ,/%.V4I S" kg/s-/.ell( ADDRESS' LEGAL DESCRIPTION: LO c4 DATE: ' 17 06 PERMIT NUMBER: (740•.) 3c/ Date of Issuei.- �2 TAX IDENTIFICATION NUMBER' ni 0 - - ;16 Is well located at approved permit location? Cr es U No Method of Drilling: Q-eir rotary O cable tool Depth of well. 3 0 o Casing Type ' 77761- / Diameter C-' Liner Type' JO �• Wall Thickness inches, depth i. 3 feet rrs v inches J 45 Casing Stickup Above Ground* .' feet Static Water Level: 5< feet Recover Rate' 4 gpm Method of Testing' /-71//2._ Welt Intake Opening Type: Li open end CLepen hole 0 Screened; Start feet Stopped feet 0 Perforations Start �f((eee. Stopped feet N, , •/i, J Grout Type: ,-r //•�N i Volume 75-t /; S Depth: from L) feet to .71 J feet Well Disinfected Upon Completion? `9'1es 0 No ata I Method of Disinfection' ..c, .v. Comments: BORE HOLE DATA DEPTH From To ✓ !T .71 Ci ei )S %e7 e'. - .,: //d //o 1'f) if) /71 /7/ !7.3 /75 -in- ' i)/1 , I i 5 ).h -PC ; 2 cl ,!;c1 ,l ., /)/ i v.J Driller's Name C'4I,-Li‘ :.c_g Jr/ 3 /4, r 64,/“4.. deg 4V, -J /1 Fel,/ CJ.?,'i'Gr i. ,:.t h r /4cO 'JC& Jaet-1 / L7r` /-/t /S;Q,sOCL. QM" QJ?c,74 Sedm_5 !?,-vf,C.c. (,e di ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW060034 Legal Description: Bernard Block 4 Lot 5A Design Engineer: 0000 None Required Owner Name: DENNIS H. KENDALL Owner Address: 7823 STEWART MOUNTAIN DRIVE EAGLE RIVER , AK 99577 - Date Issued: Mar 14, 2006 Expiration Date: Mar 14, 2007 Parcel ID: 060-321-26 Site Address: 7823 Stewart Mountain Drive Lot Size: 51357 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy ❑Q Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). g, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEE THE ATTACHED SHEET PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IT IS THE BURDEN OF THE PROPERTY OWNER TO DETERMINE THAT THE PROPOSED WELL WILL NOT HAVE ANY ADVERSE IMPACTS ON ADJASCENT WELLS OR SEPTIC SYSTEMS AND DETERMINE ANY EXISTING WASTEWATER PERMITS EFFECT THE LOCATION OF THE PROPOSED WELL. IF THERE ARE ANY QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received By: Issued By. Date. S//. AC, Date: ? t V6 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. hLrrO - 9).21 -e lo Property owner(s) Nt 4S 14 • KE.-aSt:411_ Mailing address Site address 1Rola L tX LCf - 8 Day phone 6 /G OS z K Zip Code Zip Code 9959' Legal description (Sub'd, Block & Lot) 1 Legal description (Township, Section & Rangel-622i I o r u 4 I �A Lot Size 5 1 35-4 Sq. Ft. Number of Bedrooms 'i THIS APPLICATION 1S FOR (®all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage 0 0 0 THIS APPLICATION IS AN: Initial Upgrade Renewal 0 0 0 I certify that the above information is correct. I further certify that this application is being made for a Single - • mily Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or author - • • gent) Permit/Rush Fees: 195 DIinIb6 Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: iii ?S Fl oOS 62861 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: DENNIS KENDALL Legal description: BERNARD BLOCK 4 LOT 5A The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. O Discrepancy in information submitted. O Topographic information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test information needed. O Water sample unacceptable. ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ O Other. The application shall be on a form provided by the department. It shall be signed by the property owner or authorized agent attesting that the well will be sited, drilled and completed in accordance with standards and provisions in AMC Chapters 15.55 and 15.65. The applicant shall submit an accurate site plan signed by the property owner or property owner's agent drawn on an 8-1/2 by 11 inch sheet (or larger if necessary) to a scale not smaller than 1 inch to 50 feet. The site plan shall show: 1. Legal description of the lot or parcel; 2. Location of the proposed well; 3. Lot lines, roads, rights-of-way and easements on or adjacent to the lot; 4. Location of all proposed or existing structures on the lot; 5. Measured distance to all existing water supply wells within 50 feet of the proposed well site and the location of all wells within 200 feet of the subject and adjacent properties; 6. All applicable protective welt radii; and 7. The location or proposed location of all components listed below and areas containing hazardous waste or other potential pollutants within 150 feet of the proposed well. MUNICIPALITY OF ANCHORAGE Hea' and Environmental Protea >ra Fourth Floor West, 825 L Street Anchorage, Alaska 99501 279-251.1, x 224, 225 SPECT1ON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME....R9€ta_... Q.&�J -* MAIL ft (; !�.()I;RLSS -22a C5L GSA)rtgtyi 1I F(;,\ 1:F SCRIPTION 5�/"t ` �` Q k I OC A T I OI';' � u.r-+�s r -k ____ �-t- _ _ _. � _ _ . _ _lam r� _ �� SEPTIC TANK:•,l DISTANCE /iO7 ! 0./ FROM WELL. ____—._------____ MANUFAC: i U PL INSIDE LENGTH__ __._.._.._._ Ta TILED AIN FIL1 O: _ INSIDE_ WIDTI P.11TF RIA( �1.JIIi DI P144 �r p f _ .. 'UMBER OF 1 IQIJIF) CAPACITY GALLONS. TOTAL LEN^TF? DISTANCE FROM WF LL _.i. F=OUNDATION .-- API ,l l OF LINE /S // OF L INF of Lines /. .___ DISTANCL E .1ldi.l:F l_I[;f__5 / TRENCH WI[JTEI 6IN. TOTAL_ LFFECTIVF. ABSORPTION ARL:A 7_.4 V su 11. l LNG TFI ()1 ;,,Cr1 l iNr l)F_F'T1 Of F !ETI R DFP111: TOP OF TILE TO FINISH GRADE. MA1 E f?I/o {;i NL Ai T ft6c2_6c2_IN_ ABOVE TILE fN. SEEPAGE PIT: DI MET EP OR 4. NG' H DFPTI Log Crib Rings Crib Size: DIAMETER _DE_PTH. DISTANCE FROM: WELL__.._�_ TOTAL. EFFECTIVE BUILDING FOUNDATION , NEAREST LOT LINE __.___._____.. ABSORPTION ARTA (WALL AREA) SQ. E Well Class: „SA)cL Depth: Qrf Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: 3L+. # of Bedrooms: Installer: �^ Remarks: I E4(Wi(�C(((((( I .. f - .- 77APPROVI 111Jr-4ICIF OF" LEPHRTMENT pr- HEALTH AND ENVIRONMENTAL npOTECTION 825 ' STREET, ANCHORAGE, HK 9 - 279-2511 ""=on ��� ��_���� ����� ������� �"��, ��.. ��.� �-_/_' _ .�` �r s- � � ( Y APPLICANT ROGER JOH5DN 42203 WILSON ST. SP22 c��- 277-618] PERMIT Na ( 77644 ) LOCATION SOUTHFORK RD. LEGAL LT 5-A BLK 4 BERNARD S/D TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ������� LAE����1��4= �� ���������_ E>EE��FA THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (%N FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RAFEIDUIIRE:E) -17"Fir4K 7:75.12:E:= AL2F5'21 CAFILA_Dr4SE: LOT SIZE 50000 5QUHRE FEET SOIL RATING (SQ FT/BR)= R5 --------- IF"FiCA<FikalElf ��IL_Fir-4111- IDIF•TICINI _______ H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1.EITHER A CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2' A CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. -TWO �:;:2> IINIEE:F>FECI-ICIF-41S F:FEOUIFREEAD BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT W,ILL BE SUBJECT TO PROSECUTIOW MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��R.Milr �XF'IRIIEF_S �)E.DCE:MBIeR.! I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE'ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: APPLICANT R DATE _ /( VI0 Municipality of Anchorage POUCH 6-650 ANCHORAGE, ALASKA 99502 (907) 279-2511 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Street) August 3, 1977 #76589 Poger Joh^on 4203 Wilson Street Space 22 Anchorage, Alaska 99503 Subject: Permit Expiration Dear Mr. Johson: A permit issued by this department for well and/or on-site sewer installation on Lot 5A Block 4 Bernard Subdivision has expired since the issue date exceeds one (1) year. In the event you still plan to install the well and/or on- site sewer system, a new permit is required. The original soil test may be used to obtain a current permit. If the well has been drilled, a well log should be sent to this department to document the installation date. If you have any questions regarding the above matter, please do not hesitate to contact this office immediately at 279- 2511, extension 224 or 225. Sincerely, Les N. Buchholz, R.S. Sanitarian LNB.1jh �It::: 1: it I -IF "-Jr' Li IC1-1101117F.RIF"ii IEE DEPARTMENT [ |EHLTH AND ENYIRONMENTHL [ TECTION 2516 E }UDOR RD., Elk' CHOP. HGE, HK. 9�.�7 276-2221 II, �IC: .. _ F1 T> IL J fr,11 :SS: :1 JAE: 1E4,HE: �r7.! -T- PERMIT NI1 ( 76589 ) APPLICANT LOCATION SOUTH FORK ROAD LEGAL L5H B4 BERNARD SUB ROGER JOHSON 4203 WILSON ST SP 22 2776183 TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH ' ^^~.-^^..^^ ^...._. "� "�""""�� `������� MAXIMUM NUMBER u� BEDROOMS _ LOT SIZE 50000 SQUARE FEET SOIL RHTING (SQ FT/BR)- 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYIS: ^� / THE LENGTH DIMENSION IS THE LENGTH (4�ET) [' THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DIST ��CE /�ETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (N F�ET), THERE IS NO SET WIDTHFOR TRENCHES, THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GR VEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCHYHTIOh (IN F ET). BACKFILLING OF ANY SYSTEM WITHOUT DEPARTMENT WILL BE SUBJECT TO P K�11-'11K_U_K����� NSPECTION AND HPPROML B�r THIS MINIMUM DISTANCE BETWE�N H WELL AN H Y ON SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE 4ELL OR 200 -EE FOR H PUBLIC WELL WELL LOGS ARE REQUIRED f 4D MUST BE |TTURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETIOR SPECIFICATIONS AND CONSTR.CTION DIHiRHMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTION I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODEa ]: I UNDERSTAND THAT |HE ON SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. ? �1F;;;;!! F.E.: K;i7, 1111� SIGNED:__ APPLICANT ' R[3 �R JOHSON ISSUED BY 3o- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 5/1/86 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5A, Block 4, Bernard Subdv. T14N R1W Sec. 19 Location (address or directions) Hiland Road (b) Applicant Name Rodger Johnson Telephone: Home 694-3305 Business N/A Applicant Address SR2 9127A, Eagle River, AK 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ®; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Alaska Mortgage Telephone 562-5626 Address 4790 Business Park Blvd Anchorage, AK (e) Real Estate Company and Agent N/A Address Telephone (f) Mail the HAA to the following address: pi cknp 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 14 3. WATER SUPPLY Individual Well ❑ Community El Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ❑ Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDINU INSPECTIONS, TESTS, FILE SEARCH, DA i ,. i ei AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. could not verify 4water table separation. Name of Firm Address Date S/i,/(s- EAGI F RIVER ENGINEERING SERVICES Telephone EAGLE RIVER, AK 99577 P. 0. BOX 773294 6. DHEP APPROVAL 5,1j Approved for Approved 691 5195 bedrooms by Disapproved Date Conditional - Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MO.., HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Log Present (Y/N) /11)4 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 11986 Legal Description: 2° f" .49e i- i✓ 4 r d *Cs 6cly If A, B, C, D.E.C. Approved (Y/N) y Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed /777 v Size / S ° 71' No. of Compartments Standpipes (Y/N) / Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) 4" Date Last Pumped 4114fr Pumping/Maintenance Contract on File (Y/N) /V/4 ; for Holding Tank High -Water Alarm (Y/N) 4"//# Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well '`?uo ' To Building Foundation To Disposal Field S N To Property Line Bio To Water Main/Service Line tie? To Stream, Pond, Lake, or Major Drainage Course "4-0¢ Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /9 . U✓ r / rr t2r,..'r Type of System Design Length of Field 4'2 / Width of Field 3� Square Feet of Absorption Area 4/3', Depth of Field 8 Gravel Bed Thickness Depression over Field (Y/N) Results of Last Adequacy Test S4 t''�' � "7"-,* Separation Distance from Absorption Field: To Water -Supply Well —1-0,)'7‘ To Building Foundation /1' Lot 4//4 Standpipes Present (Y/N) Date of Last Adequacy Test . q/.9/S6 To Property Line /o To Existing or Abandoned System on ; On Adjoining Lots To Water Main/Service Line " To Cutbank (if present) .20 To Stream/Pond/Lake/or Major Drainage Course 4J�`% To Driveway, Parking Area, or Vehicle Storage Area Comments /1/0 S��/ /off o+� f. Le S D. LIFT STATION Ai/A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $e€ /g T7`dr r/..Tp.��6 Signed Company S' Receipt No. Date 9/2a/ed MOA No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) 5 I—s„, C j G✓ 0 tr,.. s ) A '.fid . (,,,-• o° a� c`' c0 a ' .. . aoa ',1 ®Engineer's Seal i) cam.-- --,� ..... iv) ;6"417pe•0•e a®• so owl, a ami t, a¢ "_ Vj a `•iC ? . Louis A. 3uiern : 4;..(5) -6, CE700 F. -6736 < o; EAGLE RIVER ENGINEERING SERVICES P.O. BOX 773294 EAGLE RIVER, AK. 99577 694-5195 April 30, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 REF: Lot 5A, Block 4, Bernard Subdivision Dear Mr. Morris: On behalf of my client, Mr. Bernard Stewart, I am submitting the information necessary for a determination of Health Authority Approval for the above referenced lot. The septic system absorbtion rate has been tested and found adequate for a 4 bedroom use. The leachfield was installed in 1977 by Mr. Stewart and was inspected and approved by the Municipality at that time. A search of your files has not produced a soil log. As the system was previously approved by MOA the matter of verification of 4' vertical separation to water table, and resulting approval is left to your determination. If there are any questions or if additional information is required please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. Encl: HAA application Water system approval inspection report INSPECTION APPOINTMENTS DATlr RECEIVED TIME TIME TIME pp IA e I Agl 4` e Q DATE DATE DATE -io- SC) 'QDA0ryta INSPECTOR INSPECTOR INSPECTO MUNICIPALITY OF ANLl1UKA43I` MUNICIPALITY OF ANCHORAGE DEPT. OF I' ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTETTMONMENTAL i-„kJTECTION • 825 L Street - Anchorage, Alaska 99601 i a IA AY ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 EE C E REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES 1 19$0 t` r E V DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER �- tr. 1 &4 i f s©� PH NE (7 7/,'7- iMAILING MAILINGADDRESS s t - ` - z5.9,c q( 7A e /5n, d a.5-e,gq-Lf 7) PROPERTfi RESIDENT (If different from bove) PHONE 2. BUYER / PHONE MAILING ADDRESS 3. LENDING INS UT J�/L / i o e-oZri j�cff 0 MAILING DDDRESS 1C ---a. / t1 t.' .0, // Kriet *f.--‹? 4. REALTO GENT PHONE MAILING ADDRESS CRJPTION 5. LEGAL DESS'/ c/57 c I ..te ,-#1.4s,.-1 -5-2"/14, e & 4.9 AXe__ ..,- • Lt./ 4eti 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS IN One • Four IN Other SINGLE FAMILY INI Two IIIN Five • ' MULTIPLE FAMILY 21. Three - Six 7. WATER SUPPLY N INDIVIDUAL* * ATTACH WELL LOG. A well logis required for all wells drilled j21 COMMUNITY since June 1975. For wells drilled prior to that date, give well • PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM $' INDIVIDUAL/ON-SITE** /9' 77 YEAR ON-SITE SYSTEM WAS INSTALLED. N PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ TWO • SINGLE FAMILY s THREE • FIVE e OTHER El FOUR IN MULTIPLE FAMILY • SIX 2. WATER SUPPLY PERMIT NUMBER DEPTH OF WELL ■ INDIVIDUAL • COMMUNITY DATE DRILLED • PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM • INDIVIDUAL/ON -SITE PERMIT NUMBER DATE INSTALLED ec 1 • PUBLIC UTILITY Connection Verified INSTALLER .1&t. IN Septic Tank or IN Holding Tank Size: QS-6If Tank is homemade SOILS RATING ' cls'._' give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 4 tX APPROVED FOR 3 BEDROOMS certificate) (letter must accompany • CONDITIONAL APPROVAL • DISAPPROVED DATE BY 72-010 (Rev. 6/79)