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HomeMy WebLinkAboutT12N R3W SEC 15 LT 70 freer 0 ,?' 12'031-- h.iohorage VJe,i 8. pump Sar 9072430742 p.1 Developre nt Services Department g Safety Division c s Fst Can -Site Water A Wcstewater Program 4700 E;more StreetMotto' P.O. Box 196650 , nchorage, AK 99519-6650 s E r i',ern B�g;ch , lt�H�l6:' VI W W , to J ni Dr cr o t`.5 i'8 (907) 343-7902 Pump installation Log WL11 Drilling Perrnit Number; _ Date of Issue: -�_- Parcel Identification Number: d 15-053- Leval Description Block Lot Proper", OwnerNarne & Address:) � ���' Sec 1 �? �� j Futrip Installation mate: - - C' Pune- Intake Depth bElow 'T'op of Well Casing: ,�c� feet Parratp Manufacturer's Narr:__-- Purrrp Model: Pump Size _ `i lip Pitless Adapter Burial Depth: _ 4 feet Pithcss Adapter Manufacturer's :Same: Pitiss Adapter Installer: Well Disiofectcd Upon CoVP plerion? '-' s 71 !'pro Method of Disinfecdoj3: % Ctsulmeuts: Pump Installer Name: C�ayrtrlxarsy': 'i--i�{•1 �_l•'�•�_,`i_c:��_ L'�, t � `..� � _.��.S.t:.�.� 4f.�'r.'?�� Mailing Address: _lel Cly: State: _ ' Zip: AtteutiDn: The pur,p insrulle- shah pv.)vide a purnp inscaliatioa log :c DSI', witir, 30 days of p-Lmp installation. MUNICIPALITY OF ANCHORAGE D£ XrMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L.' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL OES~lpJlO~i LOT LINE TANKS [] DISTANCES SEPTIC ABSORPTION TANK FIELD WELL SEPTIC [] HOLDING TYPE OF SYSTFM /'~TRENCH ~] BED ~q W. DRAIN [] OTHER FI ,ST ,5- WELLS Fl FT Fl [] PRIVATE [] OTHER (Identify) REMARKS: [:l]l]JCJl]aJ olld $1at~/gguJdolinco ill ollocl ~l: lhio datc: __ ~--~--~- ;Z) ~ ~ ~ ]~ ~-- / ? j [ 72-013 ceHil¥ Ihat Ihis inspection was Iledormod according to all ENGINEER'S SEAL L.I&(3AL l:)[i:!i:~(.:',l:~ I J::' ~: S!IB:01 ? ]: S :1: [::]lq: N iA I...O'I ." BI._M 7C) BL.EICI::: :~ N/A SECT i ON l.(] t' S i ZI::: Zl6;TCx} (SQ. F: ,, O1::;: ACI::~EE;) MAX BE OR[/)EiMS: I..ist(,::,d l:)e)i.c)~.~ ar'~, 'Lb(:) opt:i,c)l~s ,'~va:i.],al:)].(:~? 'Lo you Jl'i d[a~B:i, gn:ing your" se:,p'Lic: syuH:(:,m,, Cl'u:)os(..) fhe ol:]L~oll 'l'.l'h':'ct. x-~ t'Alxtl< MfJSI' t'1~'~\/1!!: Al I.I:ASI ]'WO C[]MI::'ARfT'IE:NTEi :1: (:::(:!l' t' :i. f y tl')a'l'. ~ :1: am famiiJar' w:l. Lh I:..ltf:) i'c.)[]tt:il'(..)lnc~nl:.!:i fc:)t" fot"tl't by LI'~(~ Mun:iCll:)a1:i'~.y of hrH:::hc~r'ag~=, (MI]A) and th(.~ StaLe of A].a':~ka,, ;:2, ]: ~,~:J.:l.:l. :[nsf. a]] Lhf..) system Jl'~ ::,. I w:iiJ a(ll'~(:,P(.:~ ~'.~::) a:l] HOA and SI:.a'[,E~ oF Alasl.;:a I'~,)~(::ll.,~:il"l':,~lli(:,~l'"l[.~ ~(:)1' '~.['i(~ u~=:,t back iF A t...N:::I SFAIlON :I:S INSTAI.I I:D IN APl AREi:A C;OVE]:('.[.::D BY MDA BUILD:I:IxK:) It-lIEN ( :i ) AN lEI .ECTF:(:[CAI.. F:'E:I:Qfl ]: I AND :t:NSI:::'ECT WJ:t.I 190'1 BE AI::'F:'F(OVE~D WI ['H[]~J'I' AN I:I_.E[]tI::(ICA[_ :!:NSPF:C]"ION REF'[)R't ~ AND (3) THE I~H..]:C;f'RICAI.. WORI< I"[US-I' BI:: DJ)NE BY A I..:[CE]qSI~D S ]: (i}N E ~) r'-t t t..1 .,alii , 4 Municipalily of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S ~/~L) PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: %~ ]~- ~/z 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O ~? SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Waler Aller ~onDerino? Date: Readin§ Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (mmutes/~nch) PERC HOLE DIAMETER __ TEST RUN BETWEEN Fr AND F1 COMMENTS .~'~,'t -/~/~ -~ '~o /~///~ .~ c.~'~v¢~/~¢, r.~7~ ~'/- )~'-4D ~ z//~c__j PERFORMED BY: /f'~ ~ ~ 3-/- ~; e~ Z?~ i ~./,~".~//.~-~"~,/.~'~/~ _'_~-~E R ~ F y T H A7 T HiS TEST WAS pE R FO R M E D i N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT HIS DATE. DATE: ~2 008 {Rev. 4/85) 5O ~80.25 ~ ~" 0 z~ ~_ 5o Corn p N 89~57'47"'W 28, 230.09 0 ("% ~) 79.4 280,08 660,52 WRN~A 280,10 280.09 Comp 280.08 Comp 37 / / / ./ JR. R ANCHORAGE AREA B()Rk Department of FnvironmentaJ Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-51TE SEWAGE DISPOSAl. SYSTEM LOCAl ION LEGAL - SEPTIC TANK: DISTANCE FROM WELL //0 INSIDE LENGTFI MANUFACTURER __-- INSIDE WIDTH NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY//-~'~GALLONS. DISTANCE FROM WELL NUMBER OF LINES -- ABSORPTION AREA DEP1H: 'FOP OF llLE TO FINISH GRADE TOFAL LENGTH FOUNDATION ._.NEAREST LOT LINE OF LINES DISTANCE BETWEEN LINES TRENCH WlDllfl___ IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACN LINE DEPTN OF FILTER MATERIAL BENEATH TILE _IN. ABOVE TILE IN. WELL: ~X'(~/F'W'*- / BUILDING FOUNDATION CESSPOOL OTHER SOURCES APPROVED . .. DISAPPROVED DISTANCES: _CONSTRUCTION NEAREST NEAREST LOT LINE SEWER LINE DEPTH__ SEPTIC SEEPAGE TANK .... SYSTEM REMARKS DIAGRAM OF SYSTEM DISTANCE FROM: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ-O32 GREA 2R ANCHORAGE AREA BOl~ JGH ~l~J~¢_/: ~5-/')-/)~¢' PERM~NO, SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT SOil TEST RESULTS NO're= THIS PERMIT IS NOT VALID WITHOUT ~iOlL TE$1' COMPLETION DATE ANTICIPATED _ ~ /~[t~~ ~ '~t~ ~ FINAL INSPECTION: g4 HOUR I~IOTIGE REQUIRED, BACI~FILLINO OF' ANY SYSTEM WITHOUT FIIXlAL INSPECTION BY THE DEPARTMENT OF ENV[RONMENTAL QUALITY AUTNORITY WILL BE SUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS FOUNE~ATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ---- --, DRAIH FIELD SEPTIC T~NK TO SEEPAGE PIT WALl SEPTIC TANK ,SEEPAGE Pit TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAfN FIeLO WATE~ MAIN TO sePtIC TANK G~AVEL BACI(FILL, 'i i ' ' ' - : 1 ; MUNICIPALI'rY OF ANCHORAGE DEPARTMEN~F OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section 'P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALT~ AU'FHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ~ -L'-~ ~.z~ 1, GENFRAL INFORMATION Complete legal description Lo~ 70, Se.c. 15, F12N, R3W, S.M. Location (site address or directions) Property owner H.U.D. ¢111-036604--203 Mailing address Day phone Lending agency Mailin9 address. Day phone 2, . NUMBEFI OF BEDROOMS: 3, NOTE: TYPE OF WASTEWATER DISPOSAL: Agent ~,,~n Rh~2~ A_qRr)f~IATFD RRr)KFRS Day phone Address 640 We~ 36th Av¢,nue. Suite 0nc. AnchoraBe., Alaska 99503 Unless otherwise requested, HAA will be held for pickup. TYPE O1:; WATER SUPPLY: Individual well XX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. NOTE: Individual on-site X× Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1/91) F~ont MOA **21 5. STATEMENT OF INSPECTION BY ENGINEER 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 application 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. Name of Firm Address S & S ENGINEERING 17034 Eagle Ri.vet Loop Road No~, 204[ Eagle River, AJaska 99577 Phone Engineer's signature DHHS SIGNATURE Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Rev. 1/91) Sack MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORrrY APPROVAL CHECKLIST Legal Description:/,0¢ ~D~<~,¢-15:"?'Z/0)~-~'D;~-~- Parcel I.D. A. WELL DATA If A, B, or C attach ADEC ,etter. ADEC wat?:ystem number .,/_/~- ;. ,,~ Log present (Y/N~h¢,, ~) P Date completed (2~_~(~_~ Driller_ Totaldepth~ ~+ ¢~¢~¢cg ~Casedto ~O"r Casing height Sanitary seal (Y/N) ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Dateoftest ~ ~ ~ -/Z-~ l Static water level ~ ~ ~ Well flow g.p.m. ,~ Pump level ~ ) SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main k.~ Public sewer service line WATER SAMPLE RESULTS: Coliform ~_~'~ h~ .~¢~qC~ ?c~ Date of sample: _ Nitrate ; On adjacent lots ! ©O '¢- ; On adjacent lots l (70 + Public sewer manhole/cleanout /O/~ Petroleum tank ^)D¢¢~ f.%'~ O ~J ,'d Other bacteria Collected by: __,=..~ B. SEPTIC/HOLDIN6 TANK DATA Date installed ~-- ~ [ - '~' J¢ Cleanouts (Y/N) _ ~ High water alarm (Y/N) Date of pumping Tank size (rDOO ~'~ I _ Compartments Foundation cleanout (Y/N) ~J Depression (Y/N) /O/fA Alarm tested (Y/N) /',)/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK 'TO: Well(s) on lot ~ -'~ __On adjacent lots To property line ~-~O Absorption field Surface water/drainage f CO /fi' Foundation /~, Z. ~- .Water main/service line 72 026 (Rev 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons-- Vent (Y/N) 'Pu'~p on" level at High water alarm level Meets MOA electrical codes (Y/N) '%, DISTANCE FROM LIFT STATI~C~TO: SEPARATION Well on lot On adjacent I% D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water Date installed Length =~O _Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for ~ / ~'(~ Rb/~~¢-- System type Total depth If yes, give date ~/~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I / ,~ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots I ©(::) t Propertyline / '-¢-. ~ To existing or abandoned system on / Cutbank ~ lA, Water main/service line Driveway, parking/vehicle storage area bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines date of this inspection. Signature Engineer's Name Date S & S ENGINEERING 17034 Eagle River Looj~ Road No 204[ Eagle River, Alaska 99577 HAA Fee $ //¢~.~ ~0 Date of Payment ¢%~0. ?/ Receipt Number r~ ~ ~ ~ -- ~ ?¢ 72026(Rev 3/91) Back MOA21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2843 ADAI, TRIS REPORT BY SAHPLE £or WORDo~de~f 30,104 Date Report P~lntod: REP 11 91 § L6:15 FAX: (907) 561-5301 Client Sample ID:LTO SEC 15 Ti2R R3W SM PWSID :UA Collected REP 9 9J @ 17:10 Received REP 10 91 ~ 14:26 bye. Preserved vlth :AS REQUIRED Client Dame :S ~ 8 ERGIREERIDG Clisnt Aect :8DSEHGP BPO { PO ~ RODE RECEIVZD Req { Ozde~ed By :R. MIFFED Chemlab Ref {: 914715 Lab Smpl ID: 5 ~{at~ix: ~A~ER Allowable Pa~ametoY Tested Result UpJte Method Lindts DITRATE-D ND(O,iO) mU/1 EPA 353,2 10 Sample ROU~IDE SAMPLE COLLECTED BY: R.D.J. Remarks: i Tests Performed ' See Special Instructions Above UA-Unavailable )ID- None Detected "See Sample Remarks Above DA- Dot Analyzed LT-Less Than, G~-G~oater Than Membar of the SGS GFOUp (oo¢i~6 G~n~ale de SurveillanceI MUNICIPALITY OF ANCNORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4?20 GENERAL INFORMATION (a) (b) Application [)ate Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name__ Applicant Address (c) Applicant is (check one): Lending Institution [::]; Owner/builder ~1; Buyer []; Other [] (explain); _ (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to tile following address: _ TYPE OF RESIDENCE Single-Family [~'"'Multi-Family [] Other Number of Bedrooms __~Z WATER SUPPLY Individual Well/[~ Community ~ Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE. DISPOSAL Onsite/J~ Public [-1 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 Ul,84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 sa pply 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 Municipalily 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 (late of this inspection. Nameof Firm_ /~/%~,~ ¢ /,.~',-~,-~__£-).r ~,'.__~L, ~ " _Telephone .~z,~'l-z/L.-~-"7 ~1 Address .___ '~ / :~ ~? ~'~ .~- ~L/~2-~/~ ) ~ t, ,- j~_, ~;.~,, , ,'~ .;~ ~ WATER WELL NOTE: This Nealth Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests shewed no presence of coliform bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authorfty Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Departnmnt of Nealth and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy ef the on-site sewage disposal system, Construction data reported on buried system components is from MOA files and was not verified during this inspection. DFIEP APPROVAL Approved for Approved _ Disapproved __ _ 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 certificale 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) WELL DATA? '~i~ ~'~' Well Classification Well Log Present (Y/N) _,,~/ Total Depth _~/~' · Cased to Static Wster Level ~(¢) '~ Casing Height Above Ground /Z,/'' Electrical Wiring in Conduit (Y/N) _ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: If A, e, C, D.[.C. Approved {¥/N) Date Completed ///¢'/f"/C~Z~.,4/ (f.~6*~*}Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well; ~.J~'*" ~'*'~ To Septic/Holding Tank on Lot ,~,~ · ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~,~ ~ ; On Adjoining Lots To Nearest Public Sewer Line ~ _ To Nearest Public Sewer Cleanout/Manhole _ ~/~ To Nearest Sewer Service Line on Water Sample Collected by _ ~~ ; Date 2- Water Sample Test Results ~' f' B. SEPTIC/HOLDING TANK DATA Date Installed .~'~..~/~ '~.'?~. Standpipes (Y/N) _t//,~5[ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding 'Tank High-Water Alarm (Y/N) _ ~.~ Separation Distances from Septic/Holding Tank: To Water-Supply Well _~ / .CF' To Property Line __ To Water Main/Service Line _.),l~/~' Course _ Size ,'Y~¢)¢ ~2-~g/-.- No. of Compartments Foundation Cleanout (Y/N) ;for Temporary Holding Tank Permit (Y/N) _ ~/~' To Building Foundation ~ '-~ To Disposal Field _~, / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(i1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~/./v/~.~/~/~ ~L) Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~/~ ~ Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~__~¢~-.. ~ ~.~ Separation Distance from Absorption Field: ~,~.'~.,"~'..4/,d~,4/ "~ '~ Type of System Design -5'"~"~,,~.4~'~ /2/'T"~"X" Length of Field ZY.,U'xf"..,I/~ZO/O To Property Line .~'d~" · To Existing or Abandoned System on ; On Adjoining Lots .-~'¢ ! To Cutbank (if present) To Water-Supply Well To Building Foundation Lot ."¢/'~¢.'¢/~·'~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t h a..LI, ~¢ e/~e ~/k e d ,~v ¢if i e d, or conformed to all MOA and NAA guidelines in effect on the date of this inspection. signed Date Company /~'~.~ '~-'~- ¢¢¢'~'MOA No. Page 2 of 2 72-026 (11/84) ,~ ', ~, GRI'ATER ANCHORAGE AREA BOROUGH · ~,, ~.~' ~,( .~ - Departmentof Environmental Qual lty ~~'~il',:~' 'i][~'3~0 "C" Street, Anchorage, Alaska g9503 274-4561 , ,q ~ ' Date Received F ~., '~. '=' Time of Inspection ~.~ Date of Inspection 1. Approval REQUEST FOR APPROVAL OF INDIVIDUAl. SEWER & WATER FACILITIES FOR _ _ requested by: /~z~.._ '_ 4, 5. 6. Mailing Address: Property Owner: Mailing Address: .... Legal Description: Location: ~m~-~ Phone: Phone: ~c/--~'?~'~, Type of facility to be inspected No. of bedrooms Well Data: A. Type .. __ c. Construction Sewage Disposal System: ! B. Depth_ ~ m~ D, Bacterial Analysis <~' 4 A. Installed __/~'~ B. Installer C, Septic Tank: D. Seepage Pit: E. Disposal Field: 1. Size /gg~/_) 2. Manufacturerc2~/..z~ 1. Absorption Area m~:~ 2. Material_ Total 'length of lines Distances: A. Well to: Septic tank _//~) , Absorption area ./~ Nearest lot line /OC~- , Other contamination B. Foundation to septic tank //[~ ~ , Absorption area C. Absorption area to nearest lot line , Sewer Lines //2 LQ-034 (1/74) Page 1 of two pages Page 2 o¢ two pages - Re Legal Description ./~d/~ for Approval of Individual . & Water Facilities Comments App~ow~l ~al.id for one year from date signed · Greater Anchora~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water 'facilities and these facilities are operating satisfactorily, SIGNED Date EQ-034 (1/74) ,a'F Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWERF~RWATER FACILITIES 1. Approval requested by: /~/m~-~.-~/ ~ Go Mailing Address: ~ /~ ~ Z~ ~:~ Phone: Mailing Address: ~ ~ ~/ ~,~ ~. 4. Location: q ~ ~/ ~~,- ~A 5. Type of facility to be inspected No. of bedrooms Wel 1 Data A. Type B. Depth C. Construction 7. Sewage Disposal System: A. Installed D. Bacterial Analysis B. Installer C. Septic Tank: l. Size 2. Manufacturer D, Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line ., Absorption area , Other contamination , Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line I EQ-034 (1/74) Page 1 of two pages ~.~§~ 2 of two pages - Re~ ~t for Approval of Individual . :r & Water Facilities Legal Description ~/~ ~/~ ~z~ /~f 7-/~/L)~ /~m Comments Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 3330 L,~d:A'I'ER ANCHORAGE AREA IIOROUL, II Department of [nvironmental Quality ' "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES ' "'. Type of Inspection: CMRO VA ~./~ FIIA CONV .. l . -., , Nsme Of Lending Institu,ion: h/a,~<. F C~ Name of Realtor or.Agent: </- ~ ' Type of Facility Water Supply Type of Supply: If Individual, If Individual, Sewage Disposal Public Utility number of dwellings presently served depth of well ~_~ Sys ~eln jType of System: Public Utility \ If Individual,, date of installation Individual (on-site) P.O, ,~©X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOW! ES. MA YOI? DEPARTMENT OF HEALTH & HUMAN SERVICES September 9, 1986 Neil Hawthorne, P.E. NHawthorne-Engineering 7127 Old Seward Highway Anchorage, Alaska 99502 Subject: T12N R3W Section 15 Lot 70 Waiver Request. WR86-129 Dear Mr. Hawthorne: Your request for a waiver of the 100 foot separation required between the septic tank and well on the subject property has been granted. This distance has been waived to 89 feet. This waiver is valid for the existing two bedroom single family dwelling only. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/lhw NHAWTHORNE-ENGINEERING 71 27 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 007-344-4711 td.D .f~..~ (,4,/,~- 0 E' (.-,/ (_.L :~y '5.~ .,'V [> Carol M. Larson Hydrologist Water Management Section Clifford spOhnholtz M-W DRILLING, Inc, P.O, Box 110370 ®!10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG (address of:Township, Range, Section, if known; or distance main road 240 of Hole, r,240 -feet ~)" fbelow) land surface. Cased to 238 + feet :i: Finish of well (cheek one) o~ ~nd ( X size Of material, COlOr Per~orated .( ~) (r~inute) for---~ ); ABBOTI' 120AD LILLESTON ~T _'1 SUBJECT Hidden Lake Area Re[erence Map-Pl2 153 ~ 163 27,~45~I De. cefaber 1 ~ 1975 Kassle~r a~ld ~iompany 9621 Ca~'lson ILoad Th~ wrater supply is via an approvad dr'lll~,~d uel]. fo{)<is ~o ~nsta]l ~ septl~ tank by Ou.~ ]~ ]976. t35. Les M, Buc:hhot~ San'ltaria~ D~,par4~me~t of H~a~th. and Environmental Prot~otion LOT 70 Sotion Nov. ~8~ 1975 Spohnholz Mr. Roll Stviokla:nd! I Andyc Ch~istens*n know there is no septie tank in at this time but that there i~ one to ~ ~nstalled this spying from escrow funds So i ~ell not hold the ~partment o~ health and ~viro~ntal Proteotion responsible for a~ thing that mit arise from it DEPT. ~ EN*'I~RONMENTAIL ~ONSERVAT~,N : $OIJTH££N?RA~ REGIOIVA~ November 21, 1975 Mr. Rolf Strickland Dept. of Health & Environmental. Protection 3330 C Street ANCHORAGE, Ak. 99503 ,~UBJECT. Lot 70, Section 15, T12N, R3W, ( Spohnhol z ) Dear Mr. Strickland: We have no objechion to waiting until spring to instal]_ the septic 'ha~k in front of the present cesspool. This is pre- dicated on your November 21, ].975, ca].], requesting this letter. ~our request would appear to be in conflict with a letter from Robert Pratt dated November 20, 19'75, and our no objec~ tion is based on your department's agreement with the requested approach. Sincerely Ky].e J. Chez . cc~ Clifford Spohnholz 4.1 Lot 70 ~t Stnce~e'ly, Envteonmeatal Co)~trot Off,car 33;10 C .~t~t