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Home My WebLink AboutT12N R3W SEC 33 LT 102 SW4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAI~ PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL~ INSPECTION REPORT PHONE IE~NEW NAME ~AILING ADDRESS EGAL DESCRIPTION LOCATION NO. OF BEDROOMS PERMIT NO. Well Absorption area Dwelling W dth' '~''~ Manufacturer C~,~j~..~ No, of compartments~.~ Inside length Liquid depth Liq. capacity in gallons IF HOMEMADE: Well Dwelling PERMIT NO, DISTANCE TO: Total length of lines DISTANCE TO: Well Length of each line No. of lines I Jb ,~ · Top of tile to finish erode Material7 Nearest Jot line Trench width inches inches Length Wldtfi -L~quid capacity in gallons PERMIT NO. Total effective ab~ tion area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Deptl] Driller Distance to lot line DISTANCE TO: Sewer line Building foundation Septic tank 0 T FI E R PIPE MATERIALS SOIL TEST RAT NG INSTALLER REMARKS DATE LEGAL 72 013 (Rev, 3/78) E ~ t"I:.~ X :2!;zt.?. E/I'Z=; ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Stroot, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: / ~,/~ ~ LEGAL DESCRIPTION: ~¥~ ~/ 1 2 3 4 5 6 7 8 9- 10- '11 13- 14 15 16 17 18 19 20 SLOPE SITE PLAN ENCOUNTERED? IF YES, ATWHAT DEPTH? PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT COMMENTS CERTIFIED BY: DATE: 72 008 16/79) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ttEALTH DEPARI%4ENT OF HEALTH AND .~NVIRON~iENIAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 10 General Iufo~aation Application Date r--/ 2J ~"5- (a) Legal Description (include lot~ block, subdivision, section, township, far,ge) ..'._ ./'e z '~ '-~ ;-,-% .22 ~d_2~_ ~v2~i .5. ,~. 4 ,c. Location (address nr di~°ections) (b) Applicants b~ame U~-~g~ /-/~o Telephone Home Business Applicants ~Jdress (c) Applicant is (cheek one) Lending Institution Buyer Li~iI ~ O~he~ [~ (explain>; (d) Lending institution '- Tel~?hone Address (e) Reai Estate Coo a Agent Address '~1tl (f) Telephone Mail the HAA to the following address: 2o T~L~e__~ Residence Single-Family~ Number of Bedrooms blulti-FamilYL~[ Other (describe) Note: If community well system, must have vrritten confirmation from the State Department of Enviromnental Conservation attesting to the legality and status. Onsite ~[ Public E~--~' Commueity ~Z llolding Tank Note: If community well system, must have ~itten confirmation from the State Department of Enviromnental Conservation attesting to the legality and status. [Page 1 of 2] tions in affect on the date of this inspection° Name of Firm E~n~_ineel'ing Firm Provid'.ln~g...~n~spe__ctions, Tests~z__File Search, Data and Inforatation As certified by my seal affixed hereto and as of the validation data sho~ra 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 ~micipality of Da~choz~age files and from my investigation and inspection~ the on-site water supply and/or ~stewater disposal system is in compliance ~¢ith all Municipal and State codes, ordinances, and regula- I)_~.E P A___p_p2-_?; Approved f~or ./h,~z~'.',) bedrooms Telephone Approved --__ DJ. sap proved ..... Co nd i t iongl .~_~__~ Terma of Conditional Approval ~j~..~ "'C' ~': ~-'~ '~' CA~YFION THE NUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PAILAGRAPH 5 AEOVE BY DaN INDEPEkrDE~T PROFES~-I~ONAL' ENGINEER LEGISTERED IN TIlE STATE OF ALASKA. T~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- NEVI'S. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° THE bfONICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OHISSIONS IN THE PROFESSIONAl, ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALI'[y OF DEpF, OF Ii,Al. III & F-NV~RoNM'cNIAL ?i~G (i~CTiON A. WELL DATA Well Classification ~,~0a~ ~'4~. Well Log P~.esent (Y/N) // Total Depth ~G / Cased to Static Water L~vel -- Casing Height Abov~ Ground ~ ~ Electrical wiring in Conduit (Y_~/N) Separation Distances f~cm Well: ~jL> /q '~ = To Septic/~Iolding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot___~'~/ ~ _; On Adjoining Lots To Nearest Public Se%~ Line ~)/t' TO Nearest Public Sewer If A, B, c~ C, D.E.C. App~oved~Y~/N) -- Date Completed -~ Yield ~ ~?g~z,_ ~ Depth of G~outing ~ Pump Set a~____~ -- -- Sanitary ~al on Casing (~_ ~p~ession ~ound ~l~ead ~ Cleanout/Manhole Wate= Sample Collected By Wate~ Sample Test ~sults Con, rents To Nearest Sewe~ Se=vice Line on [~t SEPTIC/HOLDING T~ ~TA ~te Installed /~ ~'/~-'-/~ Si~ /~ U No~ of C~nts ~- / Foundation Cleanout (Y~) Standpims (y~) ~/ Ai~-tight Caps ~r ~p~ession ove~ T~ (Y~) ~ ~te r~st P~d / ~- ~ D P~ping~aintenan~ Cont~a~ on File ~) ; f0L' Holding Ta~ High-Wate~ Ala~ (Y~) __ Tem~a~y Ho!di~ Tank ~rmit To~P~ati°nwate~-SupplyDiStan~S~ll ~%'(>'~Pt ic~oT~i~>/{- ToTank~ildi~: F~ndation ~ ///3 ~ / To P~ope~ty Line '~ c> To Water Main/Service Line To Disposal Field. ~%//z To Stzeeam Pond, Lake, c~ Majo~ D~ainage Corm~nts [Page 1 of 2] 2~:1.5~8z/ Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /o / (.. Width of Field Square Feet of ~so~ption ~ea ~p~ession ove~ Field (Y~) Results of ~st ~e~a~ ~st Type of System Design Length of Field Depth of Field Gravel Bed Thickness A Cz( Standpipes P~esent (Y/N) Date of Last adaquacy Test ~./~/~ Separation Distance f~omAbso~ption Field: To ~te=-SupplyWell To Building Foundation Lot To Ware= Main/Se=vice Line To P~ogerty Line To Existing or Abandoned System ; On Adjoining Lots To Cutbank(if present) To St~eam/Pond/Lake/~ Major D~ainage Co~utse To D~iveway, Pa=king A~ea, (~ Vehicle Storage A~ea Corarents ~/5~-x~ D. ~IPT STA~ON- Date Installed Size in Gallons "Pump On" Level at High Wate~ Ala~mLevel at Tested fo~ Electrical Codes(Y/N) Din~nsions Manhole/Access .(~/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. ~4~ets MOA Con~aents ** Check Permitted Bed~ocnl Rating~Against HAA Request ** I certify that I have checked, 'verified, o~ ~onfo~fed to all MOA HAA on the date of this inspection. Signed ~ ~.3~.~.~ DateJ ./ //./~r~. Company ~e'~-~-.,<~ :/~o,~ MOA No. KB1/dS/s nes in effect [Page 2 of 2] 2-15-84 Location: BE~$E, EPPS & P(TfTS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WA~ER WELL Subdivision: Lot: Block: Client's Name: Add~ess: Tester: Initial Reading o~ Meter: GALL(I~S . GAL[~INS TIME GPM Z% VOLU6~ TOTAL VOLUI,~ Production Rate: .~ GPM 24-Hour Capacity. ~ Gallons unxc p , ty o¥ Anchorage ,'",.NC dORAGE ;*1 AuK/~ {~ ,u? 065(J (907) 26,1 -il: ~ DEPARTMENT OF ItEALTIt AND ENVIRONM[NIAL PROTECTION November 15, 1984 TO: Whom It May Concern Subject: T12N R3W Section 33 SW¼ Lot 102 Inspection of tbe well on the above property bas shown that required construction items have been completed. The casing has been extended and sealed and the pit filled in and the ground graded away from the casing. No water sample was taken. If there are any further questions, p]ease call this office at 2C4-4720. Sincerely, Susan E. Oswalt Sanitarian SEO/ljw D & S UNLIMITED 7800 DeBarr tJ206 ANCltORAGE, ALASKA 99504 Phene 337-6763 ,,o~os^~ su,~.~ ro ,.,o,~111/ 1 ........ DAT} )BP, SSP,. ~ ]P, PPS & PC~; ~NGT~i'f,:h;RING ~49 6Z~51 8/ ~-~ .............. jOB NAM~ ~20 [,:, 88TH ON BITE' SEPTIC~ " SYSTE~ ANCHORAGES, Ai,ASKA 9950'/ S',%~ LO'.[' 102 SEC~ ~ 'f12N R~i ,.e.k.; AK. ON ~a 2, ?,?,VER SYSTEM ,?Z'2h 1~000 GAi,~ P COHi% gEPTZG TANK~ 70 [.~F~ 4" TYSEAL ~z 5 ~'~'P~ ~' "~ '~-'~ dill1 ~ ROCK ~[.~,A:TOU].,.~ , AND ~ a,o~.' , ~.,,,f AG,. [l?E:ql.d 10 FEET ])EEP ' "~ ' i;'EEg? oUk~-~ :,~ C()]~S~ ~' ~ :,VIN~['i,]R CO~iS'['RUC'].'IO!/ [!5 h50 O0 ]tIl' ~rt~pn!~t' hereby to furnish material m~d labor complete in accordance with above specifications, for the sum of: [.~OU~A I!),1 G ,P i[[Ji'!I)RED FIt,"PY A['(I) O0/00 ,4~ 850~00 - (%~mer,( iob~ made as f6-1low~, - dollars ($ ) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON~ENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date ~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~A~f- 7~YO Telephone % !Inme Business Applicants Address (c) Applicant is (check one) Lending Institution Buyer ~ ; Other ~ (explain); _~_~£w;ouf (d) Lending Institution ~. %3~.~ ~7'. ~. Telep~ Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the NAA to the following address: 2° ~_~9~ Residence Single-Family~ Number of Bedrooms Multi-Family~--~_ Other Jdescripe) W~ater_____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~ Holding Tank~ 4. Sewage Disposal Community ~-~ Note: If community well system, must have written confirmation from the State Department of Eavironmental Conservation attesting to the legality and status° [Page 1 of 2] ~%eerin_~ Firm Providing Ins~ections~_~_Tes.t.s.~ Fil____e__Search2 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 wmstewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection, Name of Firm Address ~/~-0 Date (ENGINEER SEAL) DHEP Approval Approved for///~..~ bedrooms By Approved ~ Disapproved __- Terms of Conditional Approval Conditional CAb"lION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDE~£ ]PROFESSIONAL ENGINEER [LEGISTERF~D IN THE STATE OF ALASKA. THE DHEP DOES %~IS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DNEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TIlE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OFANCHORAGE (MOA) HEALTH AUTHORITYAPPROVAL (HAg) CHECKLIST - FEBRUARY 1984 Legal Description: Well Classification ~/~L~ ~4.... Well Log P~esent (Y/N) A/ Total Depth ~5~' Cased to 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 Sewe~ Line NOIJD~lOad 3¥1N~WNO~IAN~ ~ HIqV~H ~O ~W~O~DNV 40 ALI3VdlDINhW Date Completed ; On Adjoining Lots /~D~- ; On Adjoining Lots To Nearest Public Sewe~ Cleanout/Manhole //.~ To Nearest Sewe~ Service Line on Lot _ Watel~ Sample Collected By ~.,,,3. ; Date_ Wate~ Sample Test Results Standpi~s (Y/N) .. ~ Ai~-tiGht Caps (Y~) ~ .. Foundation Cleanout (Y~) ~ . . ~p~ession ove~ Ta~ !Y~) ~ ~te ~st P~d Pu~ing~aintenan~ Con,act on File (Y~) ~ ; fo~ Holding Ta~ High-Wate~ Ala~ (Y~) ~ Ternary Holdi~ Tank Pe~it (Y~) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well_ ,'~/~d To P~operty Line To Water Main/Service Line Co%Lr se To Building. Foundation ,~ ~ / To Disposal Field -~ ~ / To Stream, Pond, Lake, c~.Majo~ D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~" /~F~/z/yz~. Type of System Design Length of Field Depth of Field Square Feet of Absorption A~ea /v'~'~ Depression over Field (Y/N) ~z Date of Last Adequacy Test Results of Lest Adequacy Test Separation Distance f~om Absorption Field: To Water-Supply Well ~eo-;- To P~operty Line ~/{' To Building Foundation ~-/~ / To Existing or Abandoned System Lot ,~/0o-~ ; On Adjoining Lots ~ ' To Water Main/Service Line ~/~ To Cutbank(if present) To St=eam/Pond/Lake/c~ Major D~ainage Coarse To D~iveway, Parking Area, or Vehicl~ Storage Area ,~/~ Standpipes P~esent ~ D. LI~T ........ 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) "P~ Off" Level at Vent .(Y/N) Pumping Cycles du~ing Adequacy Test. Meets Co~ents ** Check Permitted Bed~oc~ Rating Against HAA Request ** I certify that I have checked, verified, o~ eonfc~med to all MOA HAA Guidelines in effec6 on the date of this iryspeetion. Signed .~ ~ Date~ Company ~ ~'A~7~ MOA No. ! KB1/d5/s [Page 2 of 2] A clao age ! 66b0 ANC, I tOR/',GI;, /'q ASKA Q' (907) 264 ,1111 November 15, 1984 TO: Whom ]it May Concern Subject: T12N R3W Section 33 SW¼ Lot 102 Inspection of the well on the above property has shown that required construction items have been completed. The casing has been extended and sealed and the pit filled in and the ground graded away from the casing. No water sample was taken. If there are any further questions, please call this office at 264--4720. Sincerely, Susan E. Oswalt Sanitarian SEO/ljw G"'"~,TER ANCHORAGE AREA BOROI'~H HEALTH DEPARTMENT 327 EAGLE ST, ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM N? 264 ADDRESS SEPTIC TANK: DISTANCE FROM WELl ,, ~;~/ ' ~/'~ LIQUID CAPACITY '/--~ ~;' ,~) GALLONS. MATERIAL ~'> -;-~F~--' NUMBER OF COMPARTMENTS / LIQUID INSIDE LENGTH ¢":-:'~INSIDE WIDTH. ,~ .DEPTH~ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LO1 LINE ~/' OUTSIDE DIAMETER / OR WIDTH___ . LENGTH /~" -, DEPTH__,~ -~' ''~"~ DISTANCE FROM WELL Z . BUILDING FOUNDATION ~'/ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -~ / ~ SQ. FT. TILE DRAIN FIELD: NUMBER OF LINE~S,// DISTANCE BETWEEN LINES_ TRENCH WIDTH ABSORP~ N~N~ARAREA__ SQ. FT. LENGIH OF EACH LINE N`. DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOIAL LENGTH _, OF LINES IN. ABOVE TILE .~)j DISTANCE FROM . ~) c'b WATER , ~..,~ WELL: TYPE ~-~-"?~ J~='P?" DEPTH_ _, BUILDING FOUNDATION - ~ SAMPLE - - . NEAREST LOT LINE /~. NEAREST SEPTIC - / SEEPAGE ~ / OTHER . SEWER LINE /~ ,TANK ,-~ Z~ ~ , SYSTEM , CESSPOOl '~, SOURCES DISTANCES: DIAGRAM OF SYSTEM HEALIH AUIHORI[¥ GREATE1 327 Eagle St. ANCHORAGE AREA HEALTIt DEPARTMENT Anchorage, Alaska 99501 9ROUGH 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT MAILING ADDRESS ,~_0 //~,~/~,./~ . PHONE NO.~?f RESIDENCE LEGAL 9ESCR PTION>~tM~'~ ZcL/~ ~, ~ T/~h' ~ ~(.u ~/ APPI. ICATIONTO INSTALL: SEPTIC TANK ~ _,SEEPAGE PIT~_~ ,DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY , ~&~ PERCOLATION TEST RESULTS b~f,.~ ANTICIPATED DATE OE COMPLETION '2 ~A,/ ~q; BELOW TO RE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS · SEPTIC TANK SIZE '~'~g5 ~&,cZl,~.u~ , PERMIT TO INSTALL A -G'~'~' ~'}~/~-'~-~- AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ,~ ~/~'~f~ T' "" ~'~'& SEEPAGE AREA~/~ Type ~'~//~ . ~'~-ZZ~I]IAGRAM OF SYSTEM /'~'~ ~' DISTANCES: I ~6rtify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the BATE ~/~ APP U CA NTS SI6 NATU GAAB ~D-¢ GREATEI 327 Eagle St. . ,NCHORAGE AREA' ItEALTIt DEPARTMENT Anchorage, Alaska 99501 )ROUGH 279-2511 SEWAGE DISPOSAL SYSI'EM - APPLICAIION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS ~/'~J/~' LEGAL DESCRIPTION MAILING ADDRESS /'~x..,~.~/w..~..~'~ PHONE NO. LOCATION OF INSTALLATION ~Oz:.//~,,'~'~..-o.Z> ~..,~. APPLICATION TO INSTALL: SEPTIC TANK /~9~,~¥SEEPAGE PtT ?' _,DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY ..~ FINANCED THROUGH TO BE INSTALLED BY PERCOLATION TEST RESULTS ~'-~c~o ~ ANTICIPATED DATE OF COMPLETION BELOW TO RE FILLED OUT 8Y HEALTH DEPARTMENT THIS IS TO SERVE AS , PERMIT TO INSTALL A AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE TYPE __ SEEPAGE AREA. TYPE DIAGRAM OF SYSTEM DISTANCES: Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATURE ..... ~A-T~ RECEIVED INSPECTION APPOINTMENTS ~-~--~D~ ~-d~__~ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DEPT, OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTeCtION . ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ( ENVIRONMENTAL SANITATION DIVISION ~E~UEST FO~ APPROVAL OF INDIVIDUAL ~ATE~ AND ~E~E~ FAOILITIE8 DIRECTIONS= Complete all parts on page 1. Incomplete requests will not be processed, Please a~low ten {10) days for processing, 1, PROPERTYOWNER ; ~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above} : PHONE ~AILING ADD~ESS 3, LENDING INSTITUTION PHON~ MAILING ADDRESS 4, REALTOR/AGENT PHONE MAILING ADDRE~ ' ' STREET LOCATION 8. TYPE OF RESIDENCE NUMBER OF~BEDROOMS r~ [] One i[] Four 81NGLEFAMILY [] Two i I [] Five [] MULTIPLE FAMILY [~ Three_. ~ [] 8ix [] Other 7. WATE UPPLY ~, INDIVIDUAL* * ATTACH WELL LOG. A we!l I~g is required for all wells drilled [] COMMUNI'FY since Juue 1975. For wells d~illed prior to that date, give well [] PUBLIC UTI LITY depth (attach Icg if available.) ; 8. SEWAGE DISPOSAl. SYSTEM r~ INDIVIDUAL/ON,SITE** I ~'70 o~ '7 [ 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 ~ , · ' 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemed give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX [] OTHER PERMIT NUMBER DEPTH OF WELL 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR ~ BEDROOMS I~ONDITIQNAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) ALASKA enulR0r~melqTAL COFITROL ~nr~,Hr'Q~,n~.~ o, ..~.o,.~ ~1)~1~ /~. OF HEALTH & ~Min¢¢rin~ 8 ~nuJronme~l~l Studies ENVIRONMENTAL PROTECTION O0T ~ ~980 RECEIVED 1220 U]¢sl 251b Aucnu~ · Anchore% Alosb 99503 · (907) 276-1361 825 "1." STREET ANCHORAGE, ALASKA 99501 (907) 264 4111 GEORGE ~,4. SULt IVAN, N~AyoI{ Ward/Hutto Property October 7, 1980 Ruth Y. Ward Star Route A Box 488W Anchorage, Alaska 99507 Subject: T12N~R~ Se~ct~o~ 3 Approval for your lndividua].~wer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. (2) The well casing extended twelve(12) inohes above ground level. The depression or pit around the ~p~ well casing needs to be filled with impervious type ~ /~^0~ soil so that it slopes away from the well casing. The ~se tip~i~a~with a receiD~'~kmitted to thiskdepar~~T[%e ~tal nu~m~be.r ~f gall~o~__u~d ~{-i~'~L~ need ~q~be~/h--t~-~ re~p~t~rl-'~~~_t~-~-~ t~k%~. ~'~s/will need to ~verif~ed by a registered : reek. Therefore (4) The leaching area is to close to the c · it will need to be relocated so that it is one-hundred feet away from any creek and one-hundred feet from any well. (5) Prior to upgrading the leaching area, a permit must be issued by this department. A soi].s test will need to be obtained so that the leaching area can be designed to meet specifications. Ruth Y. Ward October 7, 1980 Page Two If there are any further questions, department at 264-4720. Sincerely, please call this Robert C. Pratt, R.S. Associate Specialist CC: Century 21-Shennum Realty 209 West Dimond Boulevard 99502 Mr/Mrs. Frank Hutto % Schlumberger 500 West International Airport Road 99502 REQOEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplic&te) We]fl data: a. Type , ,, .7 d. Distance f~om we],! to closest existinE oP pmoposed: p 5, roperty L~ne_~. 6.O~her sources of Poss~le contamlna%ion, z.e., ~eR houses, barn~ drainage ditch, etc. 7. Sewage disposal system. b. Septic tank capacity in gallons ...... ~x ~ '~ ~, 1. If "home made' show dzagmam' on revemse side of this' fo~m. 5. Wate~.Analysls: Name of person requesting approval , . e, Percolation. Test ~esults ...... . ....... , f. emcolatlon Test performed by_~.__._ .... ~ .... . the reverse .side of th~s fo~m tc show dlafpam, Dl.::~mam should include ~ followin~ ~nfo~at~on: p~opePty l~.nes~.well location, house locat on, ~tic tank location, disposal area ].ocation~ local:~n of pemcolation tes~, a~.dtPec'tion of ~pound slope, 9, The ~fo~atlon on this form is tpue and comPeo~ 'to the b~:t of my knowledge, To BE FILLED OUT BY HEALTH DEPA~.~!.1I:,NT PERSOHNEL ~e above described sanitary facilities are heweby approved, s_!u~j~.9~_~o the ~illowln~ eond~'ions ~ Conditions: The above described sanitary facilities az, e dis~pproved for the following - Approval is valid for one yea~ fol]owing the date of approval. ..- CPJ:cw 1399 19'/0 Thc