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Home My WebLink AboutT13N R3W SEC 22 LT 46AOnsite File i Sll A( S1• • _ ~/ . ~- GENERAL INFORMATION Complete legal description Location (site address or directions) Pi;~p~rty Owner Bill- Peake Mail?g address ' 521 9 E. 26th Ave. t~'e~ing agency 5219 E. 26th Avenue Mailing address Age~t-' Alan Wa~d/ Romax Pro~rtSes · '~ · Dayphone. 276-2761 Address ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: IndividuaT well xx Community well ' Public water · · NOTE: If community Well system, provide written cbnfirmatiOn.f~om State~ADEc att&st- i lng to the ~egalitY-~nd status ofsYStem. ! ' ~'., :~. ~ ~'~" .... ' ~' ":.."i" ':/. ' . 4.TYPE OF WASTEWATER DISPOSAL: · NOTE ;If community · . :': d~: ~!!'~:;~'~". ~: ~'~::~;~'~ ~,".~':'"~ ~'~!"' ; " As cert~hed by:.my:,seal:aff~xed ,._hereto a~d as of thev~ahdabon date shown:~elow I ven~ that my investigation 0f~thi~::Mealth';AUthbHty;'~pproval apPlicat on shows that the oh:Site water SuPPly ;: a~'8/~.W~StbWat~¢.di~bsai ~ystem i~safe, fu cti%Ai' and ade~(~ ~or {~e '~bm'ber'0fseSr0OmS, ~: an~ {~¢~.o~ s?uctur~ indicated:he[ein~ i fuAher Verify that based on the informati0n ~btained from the MuniCipality of Anchorage files and from my inv~Sfigafi°n' a'~d inspeCti0~; ~h~ 0n:sitb wa{er : ' ~uppl~'a~d/°¢ wasteWater dis6bSal system is id complia~e~ff~:~liMunicipai and State COdes, ordida~es,:ans~mg~lafl0ns in ~ffect on the date of this inspe'~ti°~.: , ' : Address 6~ ~L~,~ ~n§ineer's signature Alaska Water & Wastewater Consultants, Inc. lihall be PAID $ ¢o ._ of prior to, clos!ng for the Engineering Services Provided~ 6. DHHS SIGNATURE ~/ Approved for bedrooms. TE 2B Date Disapproved. Conditional approval for 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 profesaional en gineer registered in the State of Aleska. The DH H S does this es a courtesy to pu rchssers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or, analyze, dat~a before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ~l~ j~ ('J:u [~/f~ n DEPARTMENT OF HEALTH & HUMAN SERV/OES ~, v Environmental Services Division-~-- - ~ 825 L Street, Room 502. Anchorage, Alaska 99501~° ['907)~ ~,~3~4744 Mu~]icipality of Anchorage ~-~ / ~/ ~-~- ~ 6~.~?_~._ Health Authority Approval ~l~Pe~J~h & Human Services Legal Description: '7'[~/~ ~.~ 'W/ ?)~.~_ ,~c~ ~:~ ,~Z- z~'~, Parcel I.D.: 6 A. WELL DATA '/L/~lo'/~'d~/~'~~///~1 Well type ~'~- If A. B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) 1-~'~ Date completed pr/Df'~'7/D ~/'/~/~-~'" / / Total depth ~,~ / Cased to Z/(~) -4- Casing height (above ground) c~ ''/- · Sanitary seal ~/N) Date of test Wires properly protected (~N) AT INSPECTION / Static water level Well production J WATER SAMPLE RESULTS: Fluid depth (ins) Minutes later: Peroxide treatment (past 12 mOnths) (Y/N) 72-026 (Rev. 3/96)* FROM WELL LOG g.p.m. Coliform '~ Nitrate (~. o~ /~,~ ~-~ Other bacteria '-~ Date of sample: ~/r-~/--//~ Collected bY:~/7~' ~{.~' ~' ~ ';J/'7~--' ' D~ ~ Tank size Number of Compa~ments Cleanouts (WN)~ ~u~ti~ c~) ~ Depression (WN) High water alarm (Y/N) Da~ ~ Pumping ~ Pumper C. ABSORPTION FIELD DAT~ '~ ' '" Date installed .... ~ (g.p.d./~= or ff=/bdrm) System type ~ Length ~ ~ _Width ~~~ess below pipe ~ Total depth Effective absorption area ~ri~ ~~~)~ Depression over field (Y/N) ~ Date of adequacy test ~ ~Es (~ail) ~ For ~ ~ ~ bedrooms Fluid depth in absorption field before test (in.); Immediatel~ gal. water added (in.): Absorption rate =~ q.p.d. If yes, give date ~ Date installe~",,,-. ~ Size in gallons Manhole/Access (Y/N) "'~'"~- "Pump on" level at*~ "Pump off" level at* High water ~ ~~ Cycl~ s~tes~e d E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank or~ lot Absorption field on lot Public sewer main __ ~--,~ ~'~ /~' / Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON / IoO Property line Absorption field Water SEPARATION DISTANCE FROi~ Surface water/drain~ ON LOT TO: Wells on adjacent lots Property line Bull, line Surface water Curtain drain Driveway, parking/vehicle storage~"a'fe~ Wells on adjacent lots F. ENGINEER' IceRifythatll are effect on this date. Signature __ Eng Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number · ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section : P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # 1. GENERAL INFORMATION Complete'legaldescription Iq 90] of w60' of N180' of Lot 46; Sec 22; T13N;R3W Location(siteaddressordirections) 5219 E. 26~h Avenue .Anchorage, AK Property owner Bill Peake Day phone 384-3524 5219 E. 26th Ave. Anchorage, AK 99508 Mailing address Lending agency Day phone Mailin. g address Agent Allen Ward/ Remax Properties Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well xX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ~ng to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XX NOTE: If community wastewater eystem, provide written confirmation from State ADEC attesting to the legality and stafus Of ~ystem. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of th6 validation date shown below, I verify that my investigation of this Health Authori!¥ Approval application shows th&t 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 th~),e inspection. Alaska Water & Wast · Name of Firm Phone Address Engineer's signature rcle DHH$ SIGNA'rURE Approved for ~- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date /- 2~'- ~ 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 requiraments. Employees of DH HS 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. Municipality of Anchorage R E DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division SEP 825L Street, Room 502. Anchorage, Alaska 99501 ' (907~4~4°fAnch°rageese&~h~ Human ServiC Dept. Heakn Log present (Y/N) Total depth Sanitary seal (Y/N) /Av~. ,z:~c.~. AY-- Health Authority Approval Checklist Legal Description: 'Tt?--~) ~--,,~Jj ~-~/,.. ~) L~) Parcel I.D.: O~--~ ~ ~7--000 ~0~o~ o~ ~1~0 A. WELL DATA ~/ Well ~pe ~V ~' If A. B, or C, aKach ADEC leffer. ADEC water system number ~ Date completed ~10~ ~ ~l~ ~ / Cased to ~ / ~ Casing height (above ground) Wires properly protected (Y/N) '~..~ FROM WELL LOG AT iNSPECTION Date of test J c~/~,./(~ Static water level J ~ Well production g.p.m. , ~ g.p.m. WATER SAMPLE RE/~L¥S: ~ ~ Coliform ~ Nitrate . I~ Other bacteria Date of sample: ~ /z~/c~ Collected by: 'Z~r'~Jt~ ~-- Date insta'~Dd,, Tank size _ Number of Compartments __ Cleanouts (Y/N) Foundation cieano~ Depression (Y/N) __ __ High water alarm (Y/N) Date of Pumping __ ~~ -- C. ABSORPTION FIELD DATA Date installed ~g (g.p.d./fF o~ System type __ Length ~el th'mkness belo~,,,,,,~__ Total depth __ Effective absor~;t (Y/N) _ ~over field (Y/N)_ Date of adequ~ults (Pass/Fail) For Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Immediately after Absorption rate = bedrooms __ gal. water a~ · g.p.d. ~ Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. L I ~.~ Date installed "'"~.., ~~ Manhole/Access (Y/N)~ ~ "Pump off" level at* E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station STANCES FROM SEPTiC/HOLDING TANK ON LOTTO: Foundation % Property line Absorption field~ Water main/service line ~/drai~ ~ent lots SEPARATION DISTANCE FROM ABS~ TO: ;:~Pa~Y~ia~ r ~ Driveway, p ar kin~'dlFd'~~n/s ea r~"~eline _ ENGINEER'S CERTIFICATION/ I certify that l h/,~a~le~ ~n,?~tpu~ie. ld inspections in conforrnal/ce wit~/¢~ ~ ~A~gu_~iTlines in effect on this date. Signature ~ _ .~._./~. ~ '-"r Engineer's N~m~ ~/ '1 J~"'/.¢~ Date ~/~'/ ~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650. hltp://www.ci.anchorage.ak, us February 2, 1999 Jeff' Garness, PE Alaska Water & Wastewater Consultants, Inc. 6901 De Barr Road, Suite 2B Anchorage, Alaska 99504 Subject: Waiver Request for T13N R3W Section 22 N90', W60', N180' of Lot 46 Waiver Request #WR990004 Parcel ID #006-323-27 HAA# HA980290 Dear Mr. Garness: Your request for a waiver of the Yequired 50 feet horizontal separation from the public sewer trunk to private well has been apprgved. The approved separation distance is 33.0 feet. This waiver approval applies to the existing public sewer trunk to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site Water Quality Program RECEIVED MAR 1 8 1999 Municipality Of Anchorage ANCHORAGE WATER & WASTEWATER UTILIT'~'lum¢~Pah~Y ot Ancnorag~ Oopt. Health & Human Servioe~ MEMORANDUM DATE: November 24, 1998 TO: THRU: FROM: Jennifer Bagley, Budget Analyst, Finance Division, AWWU Vause, Manager, Engineering Division, AWWU ~7'Ek3n Keefer, Planning Supervisor, Engineering Division, AWWU SUBJECT: Payment of On-Site Services Fee to DHHS for Health Authority Approval Waiver, well to public sewer Please transfer an amount of $920.00 from AWWU account 9497-4005-0001 to DHHS account 2570-9426 for payment of the on-site services fee for a Health Authority Approval waiver, well to public sewer, per AMCR 15.05.001 .F. This fee payment is specific to a waiver sought for an existing private well/public sewer separation distance at: S90' of the W60' of N180', (BLM) Lot 46, Section 22, T13N, R3W, SM Street address: 5219 E. 26th Avenue, Anchorage, Alaska Property Owner: Bill Peake Both the private well and community sewer line appear to have been functioning since 1967. Any waiver of regulation separation distance that may or may not have been granted and issued previously at the time the community sewer line was constructed could not be located in record files ofADEC, DHHS, AWWU or the property owner. \\adamnt\groups\Engineering~Planmng\DCK;WAIVERS\BLM 46 - BPeake doc MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wa'iver Review Worksheet 006-~-27 HA9 HA980290 Permit Date Received: Jan 21, 1999 Legal Description: T13N R3W Section 22 N90' W60' N180' of Lot 46 Engineer: Jeff Garness, P.E., Alaska Water & Wastewater Consultants, Inc. 6901 De Barr Road, Suite 2B, Anchorage~ Alaska 99504 Applicant: William Peake Waiver Requested: Waiver of 33 feet from the private wm] ] Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: ~ List Conditions or Reasons Waiver is NOT Granted: for above: ~M ~~ By: ~/~/ Name of Reviewer Rec ~: ~- ~\~q% Amount: $ ~'~5 Date Paid: V~RTER TFU~rE ~RR~mwtT A1 .?. c] ,.O;~'-tSo _.]}.: ..0~:~ At 2-;th o:.'...:o:f.i':'.cc .. ';_'bo Jrn?.rz';,r 21, 19f¢5 .. oL;: 0] Old .[o]% Kolo ,,~..~ r.~,.-~e"~*,,_, ..... ~ :3~md ~..._o.:.. Clay 0I 35~ 99' ......... :,.'ocs J: cc-a~:,~.) :':or ~.,.';~ 3,7 FIRST mortgage ~:ee s/_mple title FIRST mortgage ' ~ee s:mple title ~TR~ mortgage Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 January 19, 1999 Municipality of Anchorage Dept. of Health and Human Services Attn: Dan Roth P.O. Box 196650 Anchorage, AK 99519-6650 RECEIVED JAN 2 1 1999 Municipality of Anchorage Del>t. Health & Human 8erviee~ REFERENCE: T13N; R3W; Sec 22; Lot 46, N 90' of W60' of N180' Dear Mr. Roth, We request the issuance of a waiver for the separation distance between the subject well and the public sewer line to 32 feet. According to MOA records, the house was constructed in 1963. It is assumed that the well was drilled at that time. An informal well log is on file at DHHS. Per AWWU records, public sewer was installed in 1967 (or 19687). The well existed prior to the sewer llne. At that time there was no regulatory standard regarding th~ separation distance f~om the well to the sewer service linc. The required separation distance from the well to the public sewer main/manhole was 50 feet. Based upon the asbuilt survey (which shows the well) and AWWU record drawings, it appears that the sewer main is only 33 feet from the subject well. The topography in the area is very flat. Recent water samples indicate that there is no bacteria in thc water and nitrate levels are undetectable. Aider extensive research, we were unable to locate any other well logs inthe area. Since the existing condition has existed for over 30 years, and the water quality is unaffected, it seems that a waiver is justified. If you require additional information, or have any questions, you for your considen on of this matter. E., M.S. Presfdeht v please contact us. Thank JAG/gd 7320 East Chester Heights Circle N Anchorage ~ Alaska 99504 Phone (907) 337-6179 N Fax (907) 338-3246 September 14, 1998 Municipality of Aa~chorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Subject: HAA for Private Well at T13N, R3W, Sec 22, Lot 46, S90, of W60 of N180. 5219 E. 26th Ave. To whom it may concern: The subject lot has a 2 bedroom house on it which is served by a private well and public sewer. The results of the field investigation and adequacy test are summarized as follows: The static water level in the well was measured on 9/4/98 to be 40 feet below the top of the casing (BTC). Over a period of 6.5 hours, 1195 gallons was pumped, which corresponds to a flow rate of 3.06 gallons per minute. The maximum drawdown was 1 foot (to 41 feet BTC). Based upon our test results, it was determined that the capacity of the well exceeds the Municipal requirements for a 2 bedroom house (.21 gallons per minute), and FHA requirements, in that it will produce 3 gallons per minute for at least 4 hours. It is important to note that seasonal fluctuations in the well flow may occur, and that future performance is not guaranteed. According to MOA records, the house was constructed in 1963. It is assumed that the well was drilled at that time. A informal well log is on file at DHHS. Per AWWU records, public sewer was installed in 1967 (or 19687). In short, the well existed prior to the sewer line. At that time there was no regulatory standard regarding the the separation distance from the well to the sewer service line. The reqnired separation distance from the well to the public sewer main/manhole was 50 feet. Based upon our the as-bnilt survey (which shows the well) and AWWU record drawings, it appears that the sewer main is only about 33 feet from the subject well. In short, it appears that AWWU should have applied for a waiver at the time the sewer main was constructed. Recent samples indicate that the is no bacteria in the water, and nitrate levels are undetectable. Since the existing condition has existed for over 30 years, and the water quality is unelTected, it seems that a waiver is justified. We are requesting that the subject separation distance be waived to 32 feet. If you have any questi, S° ¥ ~ s, please contact me at 337-6179. Thank you for your assistance. E. 24th bJ - HATCHER CIRCLE E. 26th AVENUE ~F 4 / / / AVENUE ALASKA WATER AND WASTEWATF.,R CONSULTANTS, 1NC. III u LL 7;~20 E. CHESI[R HEIGHT~ CIRCLE, ANCHORAGE, AK 99504 PHONE: (907) 537-617g/FAX: (907) 359-~246 LEGAL DESCRIP~ON: NORTH 90' OF WEST 60' OF' NORTH OF 180' LOT 46, SECTION 22, T15N, RSW TYPE OF WORK: SITE PLAN FOR: PHONE NUMBER: BILL PEAKE 3B4-5524 BY: SCALE: PAGE: 9/9/98 J.L.U. 1 = 100' 1 OF 2 '..Jeffrey A. · .. CE-7955 CT&£ Ref,# 95~045001 ~oj~t N~/~ 5219 Matrix Drh~ Ordered B~ PW~ S~mple Remake: Client ~ Primed Dale/Time 09/09/9g 09:23 Collected Date/Time 09/04/98 16:20 Received Date/Time 09/04/9~ 17:10 Techui~l Dir~or: Stephe~ C. Ede PLOT PLAN . ASBUILT ~ SCALE I"-~=: . GRID 14''~'7 : Prolecf No. ,~,-o~, Kenneth G. Lc3nn 1.751 Geo~r_ge Bell Circle, Anchor;age, Alaska 69515 ~ (907~ 345 6476 Phone Registered Land Surveyor .~907:) $45,-4625 F'ox .=.~,~ - ~.~....~,../~-~_~ ,~.~.,... ~..r,,,,~ ~,~o,. ,,,=.k,,, o.,' ",,=* *h. ,.,p~V.,,,... ,,~,,,~ ~:" 49-.~'~' '"~"I flllf'ten ~rl wlfllin Itl. pr~perty lin. mn. do not eno .r~.h. °nto..fl'l. i~'?~l_~__~. enor~m~t on th. mJrv.l,,~a prunes,° aha mm' m?~ ara ~nu ~-.,,~_~-.-_~_-_,. hm'~efl. ~',:.;"~'~"~_ '"~"~:'"'~ ,madwoman., i~,~flanf~ ~' rmffleflon~ wnmn mo no~ appear mi m~ r.~.,--- ~i~i~IT~:_... . . .ubdlvtdo. I~af..,.~' .' ~;:' .' - ..... '--' APPLI(~NT FILLS OUT UPPER HA!~"~ONLY Buyer ¢.~/~/~/,.~ ,~ /</~ Address~¢~ /¢ ~ /O;> ~. ~lr ~.~'~ f~/~ ~ ~ Zip Code ~¢,¢"b ~ / Phone Lending Institution /:~/Z~.% /~/~7../~~ ~ ,~/~/~/~ ~/ /~/~/~/~2~ ' ' / Phone Addres~ Zip Code Street Locati~ ¢Z/9 ~ ~/¢W~U~. ~,~, ~ '~ ~ ,'~/~ / ~ ~2~/~ ~ ~ ~ /4/~]u ~ ¢2~/~/~ ~/~.~//~' Type of Resi~nce ~ '~ ~/~¢~ ~¢¢~ -~--~ t Z~ Y, ~g~¢'~ ~ngle Family D Multiple Family No. of Bedroo~ ,~ ~ Other Water Supply ~// ~//~ ~ndividual / A~ACH WE~L LOG A well Icg is required for all wells drilled since June 1975. ~ Commbnity b ~.C~ ~ ~ ~ For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility ~ X) Sewer Disposal ~ Individual Year Individual Installed: . NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time I Time~.~ LJL~':~ Time ¥ Date Date Date Date \ Insp~t r Inspoctor Inspector Field Notes: / ~ ~ ~U~ICtPALI~ OF ANCHO~GE //~~ ~.. oF ~,',~TU ENVIRONM2NfAL PROTECTION RECEIVE ( ~APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* BATE Soils Rating Date ~wer Installed Well TO Absorption Area Well Log Received Well to Tank Septic T~k Size 72.023 DEPARTM[. ,' OF HEALTH ~ 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: March 10, 1978 ~1: Time ~ ',.~ ~ #2: Time #3: Time Date ~%-lcl-7~ ~,~5. Date Date Insp ~L~. Insp Insp e o REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Coast Mortgage Company Mailing Address: Post Office Box 1200 99510 279-0665 Property Owner: John Nichols Mailing Address: 5219 East 26th Avenue 99504 Phone: Phone: 333-0769/h Legal Description: T13N R3W Section 22 Portion of Lot 46 Single Family Residence: (x) Number of Bedrooms: Two Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual well (~ Community/Public System ( Depth of Well 93' Well Log on File Bacterial Analysis ( ) Sewage Permit ~ Septic Tank Size Absorption Area Disposal System: On-site System ( ) Public Utility Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ~' L , MUNICIPALITY OF ANCHORAGE /='~'~ i "Department of Health and Environmental Protection ~,! 825 L Street, Anchorage, Alaska 9950~ ~ ' . Y nest = proval of =ndividnal Sewer =a er Property Owner: John Nichols . Mailing Address: 5219 E. 26th, Anchorage, ~ Phone: 333 0769 (home) Name of Buyer: Mailing Address: Michael Kasterin Phone: Lending Institution: Coast Mortgage Co. Mailing Address: P.O. Box 1200, Anchorage, AK Phone: 279 0665 Real%or/Agent: . none Mailing Address: Phone: Legal Description: Portion of Lot 46, S~gt±oD 22~ m~wn~hi? 13 North, 3 Wcst, S.M. Street Location: 52~9 E. 26th Avenue, Anchorage, AK Single Family Residence: Multiple Family Residence: ( ~ Number of Bedrooms: ( ) Number of Bedrooms: Water Supply: *Individual Well (x) If Individual Well, well depth 93' If Community System, name of system Sewage Disposal System: *~n-site System If On-site System, date of installation: 2 Public/Co~nunity System ( ) ) Public System x) *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old an adequac M~NICIPAUTY 0~: ANCH~RAG~ .test is'required by this department. DEPT. OF HEALTH& A fee of 125.00 must accompany each request bef~%~RO~s~lON can be initiated. MAR 8- 1978 3/77 RECEIVED P~ge Two Department of Health and Environmental ProteCtion Request for Approval of Individual Sewer and Water Facilities Legal Description: T13N R3W Section 22 Lot 46 Comments: Affadavit Attached: Approved: _~ Date: Disapproved: Date: Letter Attached: ( ) Department Worksheet: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Approval requested by: Mailing Address: Proper~ Owner: Mailing Address: Legal Description: Location: Date Received December 16, 1975 Time of Inspection i,'~ - ~ Date of Inspection ~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. Alaska Bank of Commerce Pouch 7012, 99510 Phone: 279Z'~641 x 121 James M. & Carolyn R Crouch Phone: 333-7918 Type of facility to be inspected Well Data: Individual ~.~i:~fj A. Type · ~2 B. Depth C. Construction .~---~) D. Bacterial Analysis Sewage Disposal Sys~: On-site system A. Installed 7-_.1~2~68 B. Installer C. Septic Tank: %1. Size 2. Manufacturer 5219 East 26th Avenue Portion of Lot 46 Section 22 T13N R3W S.M. 5219 East 26th Avenue, Anchorage Single Family No. of bedrooms D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines __ Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages 333O MUNICIPALITY OF ANCHORAGE O~P^~TMFNT OF HE^LT~ ~ GREATER ANCHORAGE AREA BOR~,.MENTA · . ~. L PROTECTIO~ Department of Environmental Qual~y "C" St., Anchorage, Alaska 99503nFm~-&~l REQUES'r FOR APPR0VA . 0F RECEIVED INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA 2. Property Owner: J~me~ ~. C~ouch ~nd C~ol~n R. 5219 ~. 26~h Avenue 3, John R. 8426 Duben #2 4. Name of Lending Institution: Mailing Address: Name of Buyer: Mailing Address: FHA CONV .xx×x DaJ; Phone .,3~,3 7918 · DaF Phone 279 7594 ALASKA BAN~ OF CQHMERC~ Mailing Address: Pouch 7012 AD~h 99~10 Phone 9,79 5641 x 12] Name of Realtor or Agent: Esther By~rnes Mailing Address: 60q %1. grid Ave Phone 279 740.4 Legal Description: Location: portion of Lot 46, Sec 22~ T~3N~ R3W~ SM 5219 E. 26th Avenue Anch Type of Facility to be inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings If Individual, depth of well Sewage Disposal'System Type ,of S~stem: Public Utility If Indiv'idual, date of installation s~n~lP f~nlily NO. Bdrms. Individual ~ presently served Individual ?-12-68 (on-site) Page.2 of two pages - Req/~t for Approval of Individual SAr & Water Facilities L~al Description Portion of Lot 46 Section 22 T13N R3W S.M. - .: ~. / ..... 7~ - _, ? - _- .~--- ~ppproved .~'~/XL~ ~isapproved Date./~,,~--~ :4 , ,~~A '~oval ,Valid for one year from date signed '/~' V Greater Anch~age Ar6a 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)