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HomeMy WebLinkAboutT12N R3W SEC 22 LT 10A 'i~) ' MUNICIPALITY OF ANCHORAGE /~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ / ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 PHONE M~ILING ADDR~S LOCATION ~' Absorption area Dwelling PERMIT NO. ~ ~ DISTANCE TO: [ [ ~ ~ Liq. capacity in gallons ' ' Inside length Width Liquid depth IF HOMEMADE: ~ ~ DISTANCE TO: Well DweBing PERMIT NO. O ~ ( Manufacturer Material Liquid capacity in gallons ~ Well F°undati°~o~/~/~ Nearest]otline ~ PERMITNO. ~--~ ~ Trench width ~ No. of lines / Length ~ line Total ,eng~)ine, 3~ inches Distance between. ~ ~ Top of tile to finish grade.z/ Material b~neath tile ~ Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Buildln~ foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot llne PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: QTHER PIPE MATERIALS p~s~~ / '~ . l'-lLIr,t I C I PRL I TY OF Ft[-ICHORRGE ¢~- . DEPRRTMENT OF HERLTH RND ENYIRONMENTRL PROTECTION /' 825 ~L' STREET, RNCHORRGE~ BK. 9~5~ 2~4-4729 O[~--S Z TE SEb~ER LIF'GFtRDE PERH [ T PERMIT NO. RPPLICRNT DR. DENNIS RLBERT 222i E. N. LIGHTS LOCRTION MILE~.'" 2 O"MBLLEY RORD LEGRL LOT 18 R T12N R~H SEC 22 TYPE OF SOIL ~BSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 4 SOIL RRTING THE ' REQUIRED-SI~ OF THE SOIL' -8BSORP~¢ ~Y~EM- ~ 272-7211 LOT SIZE 40000 SQURRE FEET (SQ FT/BR)=?i DEPTH= ~1.2 LENGTH= 46 'ORRis'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF B TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVBTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET>. PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPBRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY BND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TWO ( 2 ) I [-;SPECT IONS RRE REI~-IU I RED E:RCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION AND RPPROYRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECOTION. MINIMUM DtSTRNCE BETWEEN R NELL RND RNY ON-SITE SEWBGE DISPOSRL SYSTEM IS i00 FEET FoR R PRIVRTE NELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE.TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM 8 PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO ~ COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICBTIONS AND CONSTRUCTION DIBGRRMS RRE ~VRILRBLE TO INSURE PROPER INSTRLLRTION. F'EF--' r~l I T EXP T RES DECEi'dBER _?..--I .. CERTIFY THRT IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET .=ORTH BY THE MUNICIPRLITY OF RNCHORRGE. I WILL INSTRLL THE SYSTEM IN BCCORDRNCE WITH'THE CODES. I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE ~ESIDENCE IS REMODELED TO INCLUDE MORE THBN 4 BEDROOMS. . IGHED:_ _i 7'" c J , ~/PLI¢-BNT ~/ PENNIS 8L~/E~RT .... GI~,~TER ANCHORAGE AREA BOROU'~ HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279~2511 N°. 55 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME SEPTIC TANK: MAILING LEGAL DESCRIPTION DISTANCE FROM WELl LIQUID CAPACITY /~'~:~ NUMBER OF / MATERIAL ~;?~.~</'~-~-~'-~ COMPARTMENTS LIQUID GALLONS. INSIDE LENGTH /INSIDE WIDTH ~ DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL ~' OUTSIDE DIAMETER ~ OR WIDTH -~3 / ~ / ~/ / , LENGTH /~ , DEPTH , BUILDINg FOUNDATION ~'-~:~ ~' NEAREST LOT LINE ~ ~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT. TILE DRAIN FIELD: (~'~~ ~ TOTAL LENGTH DISTANCE FROM WELl / .FOUNDATI~. , NEAREST LOT LINE ~ ~OF LINES ~DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE , WELL: Typ E~/~_~_~-~ DEPTH ,,~-'--~ ~ LOT LINE /~ ~'~, NEAREST ~ SEPTIC · SEWER LINE ., TANK DISTANCE FROM ~ WATER . / ' .BUILDING FOUNDATION ~.~'2 SAMPLE ./b/~ , NEAREST ~,~ ~- SEEPAGE --- / OTHER . SYSTEM /-~ ;~,CESSPOOL ~,, SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED _ ' '~ ~" GAAB-HD-2 GREATEII " ,NCHORAGE AREA F' )ROUGH HEALTH DEPARTMENT ~, / --7~$ ~ / ~// 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL sYSTEM - APPLICATION & PERMIT RES DENCE ADDRESS/~/~ 2 ~fl'~/.~-~c'J~/ LOCATION OF INSTALLATION 5~/~,*J/ ~<'~'/7 LEGAL DESCRIPTION .~'~'/~,~ -,3'~"~ ~'z- ~-"/~/V' ,,~ APPLICATION TO INSTALL: SEPTIC TANK fi(' , SEEPAGE PIT ,X' , DRAIN FIELD TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH PERCOLATION TEST RESULTS PHONE , OTHER TO BE INSTALLED BY ~_,~/~/~/',,'~ ~ ~,'~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT AS DEscRIBED BELOW. SIZE OF UNIT TO BE SERVED ~ ,~,.,/ '~" ~/. SEPTIC TANK SIZE /~D~ TYPE (~a~C'¢/-~t~ SEEPAGE AREA /7</,')¢-'~ ~' " ,TYPE DIAGRAM OF SYSTEM DISTANCES: ~ H.AL.TJ4 A'UTHOR ,~~ i certify that I am familiar with the requke~nents of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. A,~CH ....... - .... CASh EEALTIi 397 AN ChORA':~,, ALASKA Was Ground Water Encountered? ////d) if Yes~ At :'~ *' 13e tt Reading Date Gro¢$ T~me Location Ske't c.h De,~t,h To H20 Net Dro~ ~ r;r':'. "/ Test Performed MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~)~_ ~L~\ - L~ ~ HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10A; Section 22, T12N, R3W, S.M, Location (address or directions) 4820 O'M~ley Road (b) Property owner A.H.F. (~. # 23113 Mailing Address 520 EaSt 34th Avenue Telephone: (home) Anchora~ A,~aska' 99503 Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent HERITAGE REAL ESTATE ATTN: Address 3230 C Street Suit~ 102 Anchora.q~, Ak. ..,Telephone Kit Greene 99503 (e) Mail the HAA to the following address: (or check hereJ~'if hold for pick up.) List contact person and day phone number below: '.S & S ENGINEERING 17034 Eagle R|,ver Loop Read Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Familyj;~ Number of bedrooms 4 3. WATER SUPPLY Individual Well ~ 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-site~ Public [] Community [] Holding Tank [] Note: If comm~Jnity 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, lverifythat 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 flies 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. Telephone (~ ~'z¢'---~..~ ~ ¢ S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eaa. le River, Alaska 99577 Name of Firm Address Date Approved for ~___ bedrooms b py~'~//'~¢'~/~'~te Approved ~ Disapproved Conditional Terms of Conditional Approval ,,/q,,~"~- 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 satisfycertain federal and state requirements. Employees of DHHSdo 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. 7/88) Back Page 2 of 2 '~ ~.~ MUNICIPALITY OF ANCHORAGE (MOA) ~xhO~-.~,~ Health Authority Approval (HAA) ~.~, o%"'~-~_ ~/ CHECKLIST- FEBRUARY'1984 _~,'~ ~ ,%~ ... Leg? Description: [-c,T' ¢J ~0 t2P,~L~ A d (Y/N) Well Log Present (Y~j~ t~ Date Completed ~ ~,c~-~ (2 Yield Total Depth~ ,0¢ Cased to Depth of Grouting Static Water Level ¢"¢%'~ Casing Height Above'Ground ~,'~ Electrical Wiring in Conduit Y~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ._~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Pump Set At LSt4- Sanitary Seal on Casing~l) .V Depression Around Wellhead ('~) ~ ; On AdjOining Lots ¥ c~-,;~~' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ~-~ Water Sample Test Results Comments '~ '~t~'¢',~'~,-~-~ B. SEPTIC/HOLDING TANK DATA Date Installed ~-~-~O Size i?.,?~''~ No. of Compartments Standpipes ~/N) ~ Air-tight Caps (~N) Depression over Tank (Y~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ,~ To Property Line ~,c To Water Main/Service Line To Strea .rr~nd, Lake or Major Drainage Course Comment~¢-- ~¢~--~ FOU ndatio.~,Cleanout~N) Date Last Pumped ~ ;for Temporary Holding Tank Permit (Y/N) ~ To Building Foundation TO Disposal Field 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field . Type of System Design Length of Field Depth of Field Square Feet of Absortion Area Depression over Field (Y~) Results of Last Adequacy Test Gravel Bed Thickness /.~ Statndpipes Present ~N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation I~ ~' Lot To Water Mai~/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION Da~ ~ Dimensions Size in Gallons ~ Manhole/Access (Y/N) ~/'-- On" Level at ~ .~ "P~ "Pump High Water Alarm Level at ~~ Vent (Y/N) __ Tested for ~. Pumping Cycles during Adequacy Test Meets MOA E~ "'""'"~ ' **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, l~(le~ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & s ENGINEER · 17034 Eagle River Loop Road No. 204 Signed Company Date :>/¢~ MOA No. ¢--~ ,~¢ ~" ~:~ ~2.-.,G~ Receipt No. Date of Payment Amount:$ // ~.~ ~, 72-026 {Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE,ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 AUALY$iS P, EPOR? B? ~M.~PLE fez I'7ork O~dez ~, 26968 Date Report Printed: SEP 6 90 ~ 08:05 Client N'~me : $ & S E}]GINEgRING Client Acct: St~SENGP P.O.~ NONE !ECEIYED Req $ Ordered By : 1. SH~,FER Client Sen',ple ID:LiOA T12t[ R$?I $EC22 PWSID :UA Collected $EP 4 ~0 @ h~s. Received SEP ~ 90 ~ 16:SO I~. P~e~erYed with :AS REQUIRED Analysis CompJ~ted :$EP 5 90 Send R~port~ to: Che~'~!ab Ref=: ~ 903423 Lab $mp]. ID: J_ ,~{at~ix: WATER f',i!owe, b].e Peramet e~ Tested ?,eeult Units ~fethod Limit ~ NITRATE-N 0.46 ~g/i ~PA %3.2 10 1 ?e~ts Performed ' See Special Instructions ~boTe UA~Un~vai!~ble tlD= Non~ Detected "See SaI~ple Remarks Above NA= Not Analyzed LY-Les8 Than, GT~Gzeatez Than MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING /--~ / ,~'" /'lC / ¢ / HAA# '"~L¢'--°¢~ c~ / ~-~" 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Telephone: (home) .. Business Mailing Address (c) Lending institution Mailing Address Telephone (d) Real Estate Company and Agent ¢-~,,--~ ~-~..~ o ~'[ ~v'z//''c'~. ¢. · Address '~,~.. ~ "0" S ~ Telephone (e) Mail the HAA to the following address: (or check here/~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms ¢ 3. WATER SUPPLY Individual Well ~(' Community [] Public [] Note: Ifcomrhunity/' well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~/ Public [] Community © Holding Tank [] Note:/'17 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 025 IR~', z/881 Page 1 of 2 5. ENGINEERING FIRM PRQVIDING 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. i"~[¢Jc.e~ ~)d-¢~c.l.¢..~;2 ~. ~_~ Telephone ~"~e- ~'/~ Name of Firm Address ~O '~ ~ /~'/L~ Date /~.4.,~[ ~)_,_.~ ~ ~ ~o ~ Engineer's Seal 6. DHHS APPROVAL Approved for ~;?' _bedrooms by Approved ;~__ __ Disapproved Terms of Conditional Approval Conditional '" ~ ' ' ' ..¢1~Ei[0]¢ - ¢~)'~ 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. A. WELL DATA Well Classification Well Log Present (Y/N) ~ MUNICIPALITY OF ANCHORAGE (MOA) (,*,~[~/~,/ Health Authority Approval (HAA) ~,~--.~^LI~'Y CE ^i~iI, IEGK~IST. FEBRUARY 1984 EN'~f'MENTAL SERVICES DIVISION343-4744 ,'PR 2 8 1989 RECEIVED h,~ Dste Oompleted Total Depth ~-¢~'-~ t' Cased to r~~'~0 + Depth of Grouting Legal Descriptior~: If A, B, C, D.E.C. Approved (Y/N) Static Water Level ~..¢¢ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Pump Set At ,~.& o + Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) r..I ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole N/'~. ;Date Comments B SEPTIC/HOLDING TANK DATA Date Installed ~ Size bO--~O No. of Compartments Standpipes (Y/N) Ot~/'Lc-~'- Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on Fi!e (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 To Stream, Pond, Lake or Major Drainage Course Foundation Cleanout (Y/N) ~_ Date Last Pumped 2'/2..~/~ ~) ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIFLD DATA Soils Rating in Absorption Strata Date Installed I c~ ~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design ,¢'~---~? Length of Field Depth of Field I 1 Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~-,-~(--3 ~ To Property Line ~, To Building Foundation I .CeO :.'.'E. To Existing or Abandoned System on Lot ~/A'~'' ..¢~ '_.-%./'..~ _/?.4.. ; On Adjoining Lots To Water Main/Service Line /"///-~' ~'~¢/'Z~¢ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /0'O D. LIFT STATION /'~/Z~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Company Date MOA No. Engineer's Seal Receipt No, ¢~''~ , ¢¢///d~2 ~ ~ Z/'(~ Date of Payment ~-¢ (~" ¢(/7 Waiver Fee: $ Amount: $ /~. ~E2 Date of Payment 72-026 (Rev 7/88) Back Page 2 of 2 ¢ iNSPECTION APPOINTMENTS C~L~c -'i~l ME ' TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE DEPT. OF ]:7.~,LTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENL~kL ) ENVIRONMENTAL SANITATION DIVISION APR 8 1980 MAI LING ADD R ESS MAI LIN G ADDR ESS MAI LING ADDR ESS 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [~"~' Four [] Other__ J~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUP~°LY [~ iNDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) S. SEWAGE ?SPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY r 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ', 'E~ SINGLE FAMILY [] ONE '~ THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER -~ INDIVIDUAL/ON -SITE DATE INSTALLS[ ~PUBLIC UTILITY Connection Verified INSTALLER ~Septic Tank or ~Holdin~Tank Size: ~. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4, DISTANCES WELl_TO: 212tSeptic/H°lding~:Tank¢ Absorption~Area,~ Sewer Line Nearestl~,Let Line Absorption Area to near*~st Lot Line 5, COMMENTS ~ CONDITIONAL APPROVAL (letter must~ompany certificate) ~DISAPPROVED 72-010 (Rev. 6/79) Dr. Dennis L. ,~lbert 601 E. Northern Lights - Haynes Center, Suite Anchorage, Alaska 99503 ~ phone 272-7211 ~rch 11, 1976 To Whom It May Concerns The house ag mile 2.2 on O'Malley Ro~d will be used as a 3 bedroom rather than a 4 bedroom residence. DLA,jj The above residence will not be sold ~s ~ four bedroom.. ? sTATE~NT ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) ' 62].8 Quinhagak Street ANCHORAGE, ALASKA 99507 DATE Phone 344-0114 CREDITS GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality ~//(/~ '3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~! ~;~F~'~ ~)l~l Date Received February 23, 1976 ~ uf ~>~C~O 9,.,.]~. Time of Inspection ~1~! Date °f Inspecti°n ~/~-/~)/~ C,/~, REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Approval requested by: Peoples Bank and Trust Company Mailing Address: Pouch 7-007, 99510 Phone: 2. Property Owner: Bernard A. & Gladys Cos~er Phone: Mailing Address: Star Route A Box 1735 99507- 279-7511 3. Legal Description: Lot 10A Section 22 T12N R3W S.M. ,4. Location: Mile 2.20-Malley Road ;5. Type of facility to be inspected '6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Single Family No. of bedrooms 4 l. Absorption Area Total length of lines B. Depth D. Bacterial Analysis On-site system. B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area ., Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re/~st for Approval of Individual . .r & Water Facilities Legal D'escription Lot 10A Section 22 T12n R3W S.M. Comments Approved Disapproved~~//.~ Date ~'~/-' 7~ Approval Valid for one year from datelined . Greater Anchorage Ar~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 (l/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 -- 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing AdcLress: ,~ Mailing Address: 4. Name of Lending Institution: Mailing Address~(J ~ 5. Name of Realtor or Agent: FHA Day Phone Mailing Address: CONV ~(/'/ Day Phone Phone Legal Description: Location: 7. Type of Facility to be inspected: (L~. ,~ ,.~O~-JCJ 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, data of installation Individual No. Bdrms. z~_ Individual (on-site) EQ-037 (1/74) STATE O~. ALASKA Dr'~ARTMENT OF HEALTH:AND WEI/~'RE DIVISION'OF -PUBLIC HEALTH BACTERIOLOGICAL WATER ANALYSIS PUBLIC [] NAME '~DDRESS SEMI-PUBLIC I 'l INDIVIDUAL '~[~J OTHER '- · RE~ORT ~E;SULTS TC' cIYY ADDRESS ' SAMPLE COLLECTED BY Well- [] Dug [] Driven [] Drilled ~] Bored SOURCE: ~ Spring [~' Cislern D Olher Dug Well or Cistern, Constructlon: Brick or Wails - [~ Woad [] Concrete E] Mela [] Tile [] Concrete Top - ~1 Wood [~] Cor~refe [] Mela [] Open Top When? Diameler at Well DeDrn Feet Well Casing Malerial Diameler Depth__ Length al Waler Denth Drop Pip~ From Bottom Feel READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lab. No, OFFICE ~,/Analysis shows Ibis Water SAMPLE to be: yo~ should take immediate aclion os recommended below. ' 1. Notify consumers waler is polluied. Bo~l or chemically Ireaf thi~ water as oullined in the enclosed leaflel "Drink If Pure." 2. ncrease chlorinalio~ sulflciently 1o meel recommended residual standards a safe waler supply al all times. · ,- 3. Check chlo'rinalinn and other mechanical equipment. Make cerlain it is 4 a er cbecbng eqummem a disinfecting residual is hal obtained, pl~b~e wire Ibis office for en~ergency assistance or advlsorv service~ 5. This is c~ surface water source and subjectto Dollulion by man and anim~ls. An approved waler supply source should be developed, 6. Improve your -~ [] spring [] dug well [] driven we!.[ ' - [~ drilled well [] cistern. '~- 7. Relocate your well ~o a safe' location in relationship to your sewqge S. Sample Ioo long in Iransif= sample should not be over 48 hours old af -- examination Io indlcole reliable results, please send new sample, SANITARIAN'S REMARKS Date Received BACTERIOLOGICAL WATER ANALYSIS RECORD EMB AGAR IMost probable No, per 100cc.) Absenl · Presem Lactose Broth ' .~ l~)cc 1Oct 10cc 10cc 10cc 1,0cc I 0.1cc 24 hours - 8rilllont ·Green [' Awchova4 e 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M, SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION April 16, 1980 Dr. Dennis Albert 2221 East Northern Lights Anchorage, Alaska 99504 Boulevard Subject: T12N R3W Section 22 Lot 10A Approval for your individual sewer and water facilities can not be granted until the following items have been' completed: (1) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office. (3) An adequac~y test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A li~ting of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 3128 99501 Curt Carley % Totem Realty 'RE2 REID ENVIRONMENTAL ENGINEERING SRA BOX 1584R ANCHORAGE, ALASKA 99507 (907) 344-1205 276-.I. 361 APR];L :!.3 1980 ~Uk, .).:LV.~, ]..~r,~ ......... ~.N c,~...OC,,- ~,3~ LOT"- I OA T H E '~' v ....... ' ........ ~ '~ " ~.r~. OF AI,c~Or~,::,,.~.0N SYSTEH ZS A F:']:"~ N]:'TH AN Ak...A OF . (, A,...i... 0 N,., THE QUANT]:TY OF NATER ,.:~:,SOr~u=.D DURZNG THE '~'EST HAS 100 THE ,.~O..d_o R~TZN(.: OF' ~r'.~: SYSTEH AT CONSTRUCT:ION ~S 1~' AND NON HOME HAS z~6 SQF'i'~ '~'" ~,..,.~,DATA Trh. ctV:~F'~ '" ' '"" '? ~' " 1¢., .I) UPON THE "c'c'"- ~"',.,,,,,_,, ].~ NOT AL,[,c.F A_I...L F'OR A HOI~. OF' z~ DEDROOHS. MUNICIPALITY OF ANCHORAGE . , 'CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. · ,~J,~, ' ' TELEPHONE (907)-279,4014 ANCHORAGE INDUSTRIAL CENTER TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name Phone No. City State MO. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ) [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. ,r r 4 I i Time Collected Collected By TO BE COMPLETED BY LABORATORY Aoalysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results Please send new samDle, Date Received ' '' Time Received Analytical Method: [] Fermentation Tube [] Membrane Filter Lab Ref. No. Result* Analyst I ~ I ~ I ICI *NC of colonies/100 mi. or No. of Positive oortron! READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 {b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collect ecl Source 24 Hours 48 Hours confirmatory