HomeMy WebLinkAboutT12N R3W SEC 27 LT 69 S2 MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH AND HUMAN SERVICES / A ~%~ I~',, C)NLX/ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264~4720 ~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TANKS [~/ SEPTIC ~ HOLDING ST L._j TC'P TYPE OF SYSTEM [ ITRENCH Eg BED [] W. DRAIN [] OTHER WELLS PRIVATE ~ OTHER fldentifv) WELL LOT LINE FOUNDATION DISTANCES SEPTIC TANK ABSORPTION FIELD WELL FT FT REMARI(S: I 0 I __ ~"'"~ certily 1hat this mspectiorl was pedormed ascordinD Io a~l Date. Health Deparlment Approval: .~ 72~013 (3/85) 9950:1 ],, ]i ,:ti~) ~E:IIIi:~]~.&~i' kJ:l.!h 't,Ji() I'E)Cjt.tJPl.]'l¥iE!ltt!~ {I:;)l" Ol'u'!~i:iJc'! ~;~(::.H,,~(]r'% all(:[ w~,~:l:ls as ~c~"'Lh l:~y 't'hc, Fh.tr~:Lc:ipa!:ity c)f' Arlc:hcmagc, (I"IOA) and fi)c{: S'l:.a'L0? (::)[ Alaska. JIF A I..]:F:I S!A'I'IOI',I IS ]ZI',ISrAI. J.I!;D IN AN AREA COVEF;,'IED BY MOA BU]:I.D:I]I',t(,.; 'tl-iliN (:J) AN ~:I. Ei:]'II:~ICAI I:::'ERH] AND tlqSI::)EC'I ION HtJS ~ ~l~i: OBIA I,,! I i IIqC)! B[~: AF:'F:'ROVIED W]i]'l"l. iOtJ]' AN i~:I..EC'I'R]]CAL. ;[ NSPEC I' ]] [}Iq I:~t~}:I::'E)R'I; AND (:5) 'lille !:].I::[TI'I::;:]C;At. I*J[::~l:~['::: tqt/~;f [~IE DE)Iql}~. E¢¢ A I,.ICiEIqSED AF'I:'I .ZCAhl I n ? ~! ..AS GRE ,,ER ANCHORAGE AREA BOR,. JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-51TE SEWAGE DISPOSAL SYSTEM NAME tF:/J/'}~"~'( /~'~ t'J _ _ __ MAILING ADDRESS DISTANCE FROM WELL __ MANUFACTURER MATERIAl_ NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH_. %~"E'__ LIQUID DEPTH _ "~_ ~_ L QUID CAPACITY ,~'¢..~¢) GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /¢~i.j. FOUNDATION ,'?¢') ? NEAREST LOT LINE NUMBER OF LINES '~ DISTANCE BETWEEN LINES __-./~-'__ TRENCH WIDTH .~'~IN. ABSORP¥1ON AREA ~//~) _. _ SO, FT. LENGTH OF EAClt LINE //~,~'f ~ DEPTFI OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE~ MATERIAL BENEATH TILE TOTAL LENGTH OF LINES TOTAL EFFECTIVE IN. ABOVE TILE .~/ IN. WELL: TYPE ~-~/~/J///(O CONSTRUCTION ~:)p/C)z~Y~)~.f'~ ......... DEPTH BUILDING ¢ NEAREST t NEAREST ~ SEPTIC I SEEPAGE FOUN[3ATION~_~% LOT LINE /f~ SEWER LINE ~!)-¢ TANK "~'~¢'~J' SYSTEM__.¢ CESSPOOl OTIRE R SOURCES APPROVED __DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: /'~/'*-:,?~F.. SEWER LINE DEPTH: PIPE MATERIAL: z~/9,s ~' LOT SLOPE: /;:.,'..,,.,;, , Form DIAGRAM OF SYSTEM b 0 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISI'ANC:ES, REQUIREMENTS FOUNDATION TO SEPTIC TANK DIAGR~'~ OF SYSTEM , SEEPAGE PIT ALSO CONSIDER AREA WELLS. . SEEPAGE PIT ¢ , ORA+N--FrEED" / SEPTIC TANK __ -, SEEPAGE PIT TO NEAREST LOT LINE. WELL TO 'l/~c.tt TO RIVER, LAKE. STREAM. CAST [RON INTO AND OUT OF SEPTIC TANK AND iNTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURI3ED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE P}T FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-60 AND THAT THE ABOVE September 10, 1975 R & M No. 562112 Charles Fitch SRA Box 341-B Anchorage Alaska 99507 RE: Test Hole and Soil Log Report for Sanitary System Lot 69~ Section 27, T 12 N, R 3 W, S.M. Dear Mr. Fitch: We are submitting herewith the test boring results and our comments regard- ing soil conditions encountered at the subject site. This investigation was performed in accordance with your request of September 9, 1975, and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmen- tal Quality. A single test hole was put down within the Lot 69 area for the purpose of defining general subsurface soil conditions for the proposed sanitary sys- tem. Excavation was accomplished with an auger type drilling rig and the test hole was extended to a total depth of 20.0 feet below ground surface, ~he final log prepared for the test hole has been included in Drawing A-01o -~rOu,,d ,wk~-~a~--nct anecuntarad iL, th~--~est k~i-~. ~roo~D ~J~ ~/~ We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. ~J:es W. Rooney Vice President JWR/WED/j a xc: GAAB TH-1 9-9-75 0.0~ SILT, TRACE SAND TRACE ORGANICS 2.0' 6.0' WD ~ GRAVELLY SAND TRACE SILT (SP) 13,0' SILT, TRACE GRAVEL SO~ SAND 20.0' T.D. Log represents area of test boring Lot 69, Section 27, T12N, R3W, S.~l. Consultonts Inc. ANCHORAGE FAIRBANKS A LASI<A JUNEAU C~RLES FITCH PROPERTY Log of Test Hole Anchorage, Alaska .0_~.r~_~_._9_~-__10__-7._5 [s.c.at.E 1".~_3' .__,_low~ eY [v~CD lCHKD SY WED _lPmo,~. ~o. 562112 lows ~o. A-01~ CH~C~ SH£E B~FORS ~ALLING FOR INSPECTION MINIMUM DISTANCE. BETWEEN $~DEWALLS OF TRENCHES IS.~x WIDTH OF h<ENCH IS~'' '- 4' MINIMUM LENGTH OF P~RFORATEO PIPE IS 20' MAXZMUM SINGL~ RUN LENGTH OFPERFORATEO Is 7o' [] MINIMUM 5' CAST IRON INTO UNOISTURB£D SOIL CAST IRON ¢~EANODT WITH AIRTIGHT CAP s-oO ~, P.D. A~u~/- ~-Lo c/W/~ WITH AIRTIGHT CAP ALL CLEANOUTS MUST COME AT LEAST TO GROUND LEVEL [] PERFO~T£D PIPE INSTALLEO LEVEL GRADE ON PIPE LEADING INTO TANK NOT GREATER THAN 2% FOR LAS~ ~0' SEEPAGE TRENCH ~NSTALL~D SO~k T~ST [~ ,) SEPTIC TANK ~OROUGH APPgOV£D iWATgRTIGIffINLET AND OUTL~?[~ O~ .i MINIMUM WELL DISTANC BOTTOM OF SEEPAGE TRENCH 4' MINIMUM ABOVE WATER TABLE 6' MINIMUM ABOVE 5EDROCK T£D PIP~ (PERFORA¥IONS UP) - 8" PIPE WIT} AIRTIGHT CAP /2" WEEP HOLE OR PLUG MINIMUM ~ TO NgAREi LOT LINE' BEFORE INSYALkIN~ G~Vgg ~ INDIVIDUAL: TO TANK lO0' [] TO SEEPAGE TR£NCH NO SEW~ LINE j~UBLIC: TO TANK 200' [] TO SEgPAGE'TRENCH 200' 100' - 200' ONLY CAST IRON SEWER LINE [~ ~ lO0' NO SOURC~ OF CONTAMINATION [] Neol Hffusom .: No, 168G-~: 4" ~0 6" ,' MINIMUM 4' ARTH BACKFII ~,~4--' PERFORATED PIPE tUILDING PAPER SCR ENE G VEL - 2'llg" DEPT. OF EN¥1RONMENTAL C'ONSERVAT~ON Anchorage Municipality Anchorage, Ak 99507 Subject: Sewer Disposal System- Charles Fitch Property Gentlemen: This is to provide the cl~ufification~ requested by your office regarding the sewage disposal system for the subject property. We have no o~Je~on to the bottom of the perforated pipe being the/~f~e[3above the water table as proposed by Mr. Fitch. HoWever in the future in such cases a finer gra.ined material pould be preferable to the washed rock. Sincerely, ~C~er~ ~nvirorm~ental Regional Supervisior kz  MUNICIPALITY OF ANCHORAGE ~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) T12N R3W Section 27 S½ Lot 69 Location (address or directions) NHN Cannon Road Doug Bloom (b) Property owner Mailing Address PO Box 110343, Anchorage, (c) Lending Institution Mailing Address Telephone: (home) 345-1989 Business 349-6965 Alaska 99511 Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here [3, if hold for pick up.) List contact person and day phone number below: 2, TYPE OF RESIDENCE Number of bedrooms four (4) Single-Family ~ 3. WATER SUPPLY Individual Well:4~:× Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4, SEWAGE DISPOSAL On-siteF~×× 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. 72-025 (Rev 7/88) Page 1 of 2 5. 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 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 Telephone Address Date Engineer's Seal 6. DHHS APPROVAL Approved for four ( 4~)edrooms by Approved -/~" Disapproved Terms of Conditional Approval Conditional Date November 22, 1988 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-028 (Rev. 7/88) 8ack Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) T12N R3W Section 27 S½ Lot 69 Location (address or directions) NHN Cannon Road (b) (c) Property Owner Doug Bloom Telephone: Home 345-1989 Business 349-6965 Mailing Address PO BOX 110343, Anchorage, Alaska 99511 Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: or; Check here El, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family [~:× Number of Bedrooms four ( 4 ) 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 [2~x Public [] Community [] Holding Tank [] Note: If community well system, must bare written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/861Fronl 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 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 end 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 Telephone Address Date Engineer's Seal DHHSAPPROVAL .~"~'~"'/'~'/'"'~ ~ Date December 4, 1986 Approved for four (4) bedrooms by Terms of Conditional Approval as per Memo of July 15, 1986, until June 15, 1987. CAUTION 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 DH HS does th is as a courtesy to purchasers of homes and their lending institetions 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 Jn the professional engineer's work. Page 2 of 2 72.o25 trey 8861 Rack 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 Data ~ 181 1~~0~:~ GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~¢,o¢ ~¢,0,¢ Telephone:Home L]¢~=/¢¢% Business Applicant Address ~. ~¢~ /Z~.~ ~--~/~ -- Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer D; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Compaey and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other 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. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must bave written confirmation from the State Department of Environmental Conservation attesting to the legality and status. :,'¢ '"' Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION Ac--sea,f !ed by-my~a!affi,,'$3d herete sRd-a~!ien dstc shewn be!ow.! ~ut~~h~c an sitc wa~cr sup~stcwa~c~ispasa~ ~ ' ' ' f~eh~~frcm m~e~and ' ' ' Jia~ce with si! ~2~ a~d State t~ ...... Name of Firm ~ ~~ ~ ~ Telephone Address ~~__ ~ I~ Date _~ DHEP APPROVAL A~d for ./r~¢,., (¢?_ bedrooms by '/~- ~'~' *~ ~.~oi'-~6'~ Date '~ ~/~' __. Approved Disapproved ~ional& ¢~ Terms of Conditional Approval ~?~'U¢~/~-'~L~ ~ ~/~(t - (t ,(~_/~h~:~ ~, 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 horrres and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not condnct inspections or analyze data belore 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 (~ 1/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: WELL DATA Well Classification Well Log Present (Y/N) Total Depth. hO 4 Cased to Static Water Level ~. Casing Height Above Ground __ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed '~'.,~ l~& ~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) - Depression Around Wellhead (Y/N) 1%/ To Nearest Edge of Absorption Field on Lot ~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ; On Adjoining Lots . N 0 /~" _ To Nearest Public Sewer ~'~)~2:''~' To Nearest Sewer Service Line on Lot ;Date SEPTIC/HOLDING TANK DATA Date Installed ~'/~'/,~"~' Standpipes (Y/N) -T 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 /~ ~' To Property Line '~) To Water Main/Service Line _ Course Size /,~ ~0 NO. of Compartments 7 Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N) ~ Date Last Pumped J~/~ 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¢1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I SO Date Installed ,~ ~ l ~' "/~ Width of Field ""~ f'~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~$"1~,~,~ Separation Distance from Absorption Field: 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 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Da, te of Last Adequacy T. est __~ , To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,~ To Cutbank (if present) D. LIFT STATION N~)j~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, ver. ifiedlC2conformed to &Il MOA and HAA guidelines in effect on the date of this inspection. Signed ~.~----¢'¢~. Date Company / MOA No. Receipt No. ~'~ Date of Payment Amount: $ Page 2 of 2 72~026(11/84) Engineer's Seal z//~, /,BE5 ALASKA ~F/UIRORm~FiTAL COi~TROL SeRUIC~S, lilC. ~n~inccrin9 ~- ~auironme,~lal $1udics 1200 [Uesl 33rd Auenue, Suite [~ · Anchorc~qe, Pi[askn 99503 · (907) 276 1361 MUNICIPALITY OF ANCHORAGF. DEPT. OF HEAL[H & ENVIRONMENTAL PROTECTION July 26, 1976 JUL 2 7 1976 2518 East Tudor Road Anchorage Municipality Anchorage, Ak 99507 Subject: Sewer Disposal System- Charles Fitch Property Gentlemen: This is to provide the clarification, requested by your office regarding the sewage disposal system for the subject property. We have no objection to the bottom of the perforated pipe being the E~.~'~, ~ee~ above the water table as proposed by Mr. Fitch. How~v$~'In the future in such cases a finer grained material would be preferable to 'the washed rock. Sincerely, Kyl2-,~J. Cherry P.E. Environmental Regional Supervisior kz {unicipalitYoi Anchorage P,O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES July 15, 1986 Doug Bloom P.O. Box 110343 Anchroage, Alaska 99501 Subject: T12N R3W Section 27 S~ Lot 69 Dear Mr. Bloom: I have been in contact with Bruce E~ickson at ADEC regarding the subject property, tie agreed that even though the current State law requires a four foot separation to ground water from the bottom of the system, at the time your system was installed the measurement was from the bottom of the perforated pipen Normally the State "grandfathers" this kind of non- conformance, and that was what Michael Lewis attempted to put in writing for you. His unfortunate use of the word "waiver" was misleading and should have been "grandfather rights". However, once any modification is made to the system, these rights are voided. In your case, the exchange of septic tanks has voided your grandfather rights. The Muncipality is currently gearing up for a major emphasis on locating and eliminating sources of ground water pollution. Your system certainly has great potential for creating the type of silent pollution we are attempting to eradicate. Therefore, the Municipality must require the system to be upgraded. I am sympathetic to the confusion you have felt with responses from us as well as the State. I must apologize for both. Due to the unusual circumstances of this case, I am prepared to extend your Conditional Health Authority to June 15, 1987. Please let me know if this extension is acceptable. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw APPLI~. ~IT FILLS OUT UPPER HAl, ONLY Phone Buyer ~,~ Zip Code Address Lending Institution f~ A~I~ ¢ ~)OET(~&~ Phone Realty C~. & Agent Address LegalDescript~on ~lj% ~OT ~ ~1~ Z F %)~g ~ -~ Street Locati~ &/~O~) ¢(),~,~ ¢ ~ F CF Type of ReslCnce ~ Single Family ~ Multiple Family NO. of Bedrooms~_ Water Supply ~ Individual ATTACH WELL LOG. A wall log is required fo~ all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal Year Individual Installed: ~ Public Utility When Connected to Public Utilii~. ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date inspector Inspector Inspector Inspector ¢IIKIIK'!PAIJTY OF /,NCH©PA~E /./~, ~¢ ' ' ..... RECE VtSD Z~) ~ 'CONDITIONS OF APPROVAL ( APPROVED BEDROOMS { ) DISAPPROVED ( ) CONDITIONAL APPROVAL" , ~AT~ ~F' Soils Rating Date ~wer Instahed Well To Absorption Area / ~: ~ Well Log Received Well to Tank , ~¢ (2 Septic T~k Size ~lovai~ar 29, 1977 Charles Fi.rob ~ost Offtco Box 4~2145 Anohorage, Alaska 99509 SubJaot~.· tel2N R377 Section 27 S~ Lot 69 Befor(~ thJ.:~ departmc, nt %qill approve your request for sewer water approval~ ~ will head avideno~ of a maint~nan(~e office at ~64~4720. Sanitarian f~O I I:C I I 011 c) 9 5 0 ] m~t:c_, l(ec'.etvad: ._Nov. amber 21_,. 197_7. rI - Da he 11.~_2-77 Tuesday Date .~-~[~.-~_%.._~)~!l i)a he ..... P, Ii:(~U],iSq2 FOP, A.E'PRGVAIh Ot ]H,II)IVIDUA!', SF, WER ANI) WAT]O( At [ I Ii. 1. Realty Center % ~--~s~ I, end J ng ' ' Requestt Hai].J nO Addres:i 2. Propex. ty Owner: Charles..E...PiLch Phone:: ..... 3~-_288~, . . . .'pnT ._ffice ~-2145 MailLJng Addi.'ess: ~t 0 3. Legal: r)e:<~,::i.l)hion: T12N R3W Section ~7 S~ L9~_..~9_ ................... 4: Sing.le I.'ami]y 1,~..~d..nc . (x) PJt!] tz ~.]j)] 0 l"D. Itl:] ] 3' 1.1,.:,.:3 idenc(2: ( Number weill Syst:enl: [ndJ.vJdLN~]. WP]] (x) CommnnJ t:y/P',l.h] Jc Syskem ( ) Pc~rnd. t. ~ Depth o( We] ] ...... ~ ..... Wo].I Log on F:ill. e ( ) Consl:ruct'ion .... ........ . .. tNtcherJ.al Analysis Sewage )):isposa]. Sysl:cml: On-' :ira 'JysLonl (x) Public ULi].LI:y ( ) PermJ. i: It ]nst:,:t I led 1.~76 ..... install, er Sept. Je ~['ank o', ~ A 353or}.>tliorl /kllC~& ................ SOl ] s Rake ................. Hal;eYJal hi_nc tk.a~.(, I I,OL line Absol-ph'ior] Area l:o NoaFcst ]hot ' .INIC[PALIrY OF ANCtIO,qAGE ~n~ ~ ..... ' Anchorage, Alaska 99501 26 i--'I720 _lqa ti illg /\dnlTeSS; ./~ 2 N~m© of IRlynr: ........... Hail lng ;',ddt:ess: Lend ing Iai ] J ng ]nst Ltution: ......... ; ...................... [5. SJnqJe Pami. kv Re!;idencc: ~) Number o~ 1R~droonis: !.hllt::ip]e F'am~ ].y Residence: ( ) Nunb~,r o~ Bedrooms Wa her Supply: ~: lnd .vi cilia] Nell (~ ]?klb] iC/(JO!iIIRtIll t ky Syslton/ ( ) llfl indyividua] Well, well depth ..~F_ l[~ Cornn'luriJtV Syshc:nl, na]P,o o{ sy~;t:em Oh ,.n~e System (')~ Public SysL(:m~ ( ) Sewage Disl)osa] System: '~" '-~ ' ' ff On-site System, date *NO'PE: A well log is required or! ALL we]h; drilled since 6/75. test J s requJ rod hy thJ s depat:in~enL. A fee of $25.00 RtL1St acco~fipa!ly each request b(!ffore pro efsJrlq can be ih[I iai_ed. 3/77 Rccl~c'.;t JO~ ApplTI)va]. o~d Tl~dJv.idtla] c, ,.~ ;n( 'v,'aLe~ Fac .' i : c-~ Charl[~s ['~tar Route~, A BOX ~%nchoraqe~ Al. aska 99507 .J~i~ ~[epar~,%ent ha~ no objt~o'hions to the of a I~250 gallon septic tank in plac(~ o~ th~ ~ulti-fflo unit. A permit is required, the f~ is $20.00, If 2h~3r~ are any further questions, please contact this office at 264~4720. Les t':I. Buchho.1,~z ~ R.,:,. ~enio~' ]~nviron~ental Specialist SERVICf[ CO. ~UNICIPALI'fY,¢,F ~'' ,- r' ? DEP~, OF t4b,',.,:;~ MAR ~"