HomeMy WebLinkAboutMOUNTAIN MANOR BLK 2 LT 10AOnsite File
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue
Parcel Identification Number:
Legal Description Property Owner Name & Address
Mountain Manor Block 2 Lot 10A Jack Stoebner
18640 Jamie Drive Eagle River, AK 99577
Pump Installation Date:
3-26-20
Pump Intake Depth Below Top of Well Casing:
240 feet
Pump manufacturer’s Name:
F&W
Pump Model:
4F07P07305S
Pump Size:
3/4 hp
Pitless Adapter Burial Depth:
10 feet
Pitless Adapter Installer:
Unknown
Disinfected Upon Completion?
yes no
Method of Disinfection:
Chlorine 50 PPM
Comments:
Pitless Manufacturer: Unknown
Pump Installers Name:
Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
He~
UNICIPALITY OF ANCHORAGE
and Environmental Prote n
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
.......................... ~PEcTION REPORT ON-SITE SEWAOE DISPOSAL SYSTEM
.... : ~ :2L~2~--Z . ...............................................
SEPTIC TAN t~:
DISTANCE ~'161"/1~ (-J..... _ .~L j'~l' ' "J NUMBER OF ~
ff~Sl[)E LENG[~ ...... ~[- __ INSI[)E WlD1 H ___'~ ..... LIQUID [~[CPTH ...... LI()UID CAPAC'T¥ I '~$_'~t'~ALLONS.
TILE DRAIN F'ELD:-~-~~e~'~ ;
J TOTAL LENGTH
~ of Lines ........ ' t DIS] ANCE gL]WEEN LINES __.~.__~RCNO4 WIDT~,~.~ IN. TOTAL EFFECTIVE
A[}SC)RPTIO?J AREA . _ ..~ .... SQ. FT. LENGTH OF E. AClt LINE
OE]PII~: -lOP ()F TIL!i lO FI:ilSII GRAI)E ~'~ k DEPTtl OF FILTER
SEEPAGE PIT:
DhAMETER _OR WIDTH ...... EENG[Ft---, DEPTH
Log Crib Rings
BUILDING FOLJNDATION._
Crib Size: DI/\METE!{ ..... DEP¥1~ .... DISTANCE FROM: WELL
] OT4t.. EF'FECTIVE
NEAREST LOT LINE.___ ABSORPTION AREA (WALL AREA)
,SQ. FT,
Class: ~ Depth:
Well Distanc~ To: Lot Line
Bldg: Sewer L~ne:
Pipe Materials:
# of Bedrooms:
Remarks: ~'~ I [
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"F'T'F'E OF SO:Lt. ABE;ORBTION S'¢S'I'EM ]:S: 'f'RENCH
blAX]:MLIM NUMBER OF BEDROOHS = 7~:
SOIL.. RA.]"ING (SQ F"f'/BR)=
'T'HE RIEQIJIRED SIZE OF THE SOIl,.. ABSORPTION SYSTEM IS:
THE I_ENG].'H DIMENSION IS ]''HE LENGTH ,::IN FEET) OF THE TRENCH OR DF.'.RINF:[EL.D.
THE DEPTH OF FI 'T'RENCH OR PI].' IS-.; THE DISTANCE BETHEEN THE SURFACE OF THE:
GROI,JND AN[::, THE: BOT].'OH ElF THE EXCAVATION ,.'.'IN FEET).
THERE IS NO SE']" 14IDTH FOR TRENCHES.
THE GRAVEL DEF"T'H IS ']'HE MINIHUM DEP].'H OF GR. FIVEI,.. BETI.4EEN THE OU].'FFIL. L. PIF'E
FIND THE BO].'TOM OF ]"HE E,'.".;C:AVR].'ION (IN FEET).
F" R C: ~:: F-I I.":~ E P I._. R 1'-I 'l- C) F' "l- :l: ,:::~ 1'-~
A E'ACKAGE PLFINT' MR'¢ BE INSTAl_LED RT THE PERM~TTEE"S OP'T'ION SLIELJ'E:C:T TO "['HE:
FOLLOH I. NG COND I T IONS:
:t.. EI'f'HER R CLASS I OR II NSF APPROVED PLANT MA'T' E',E INS].'AL_I_ED.
2. R I:::ONTINUOLIS MAINTENFINC:E AGREEMENT IS REL:.IUIRED. IF A MAINTENANCE
AGREEMENT IS NOT KEPT CURRENT '¢OU HFI'¢ BE REQUIRE:[) ].'O ENL. RRC:iE 'T'HE SOIl ....
ABSORPT]:C~N S"r'S].'EM RND,.'"OR 'T'OtJ HR'T' BE SUB,]'EC].' TO PI;.':OSECU].'ION
8ACKFIL..L. ING OF AN'T' S"r'S].'EM WI"f'HOIJT FINAL INSPECTION AND APPROVAL B"r' THIS
DtEPARTHEN]" H]:I_I_. BE SUB,IECT TO PROSECUTION
MINIMLIM [::' I STANCE BE'T'HEEN R WEL. L AND AN"r' ON-SI].'E SEHRGE DISPOSAL. S"r'S'T'E:I'"I IS
:t.~i:JO FEE'T' I::'OR R F'RIVATE HELL OR 2~;~O FEET FOR A PUBLIC HELL ....
HELJ_ LOC:iS ARE: RE:QUIF::ED AND MUST BE F..'ETURNEI.::' TO ]"lie DEPARTMENT 1.4]:'T'HII"',I :..:.=:0 Df'I'¢S
OF THE HELL. CC~MPLETION
OTHER REQUIr4.':Ei',IENTS HA'T' RPPL"r'. SPEC':IFIC'.'ATIONS AND CONSTRUC:TION DIRGI:;..'AMS F:IR.E
FIVRIL..ABI...E TO INSURE PROPER INS].'AI,..LATION
:[ CER].'IF"r' ]"HA"['
t: I RI"1 FFIMIL. IF-IR WITH THE REQUIREMENTS FCIR ON-SITE SE:HERS AND HELLS RS SE].'
FORTH B'T' ].HE MUNICIPRL..I.]"¢ OF FINC'HORRGE.
;.::~: ]: H:[LL INSTAL. I,. THE S'¢STEM IN ACCORDANCE HI:TH THE C:ODES.
::'i:: t UNDERSTAND TI-IFI].' ].'HE ON-SITE SEHER S"r'STEH MA'T' F..'EQI'JIRE ENLARGEMEN]" IF" ']"HE:
RES:I:DE:NCE IS REMODEL. ED TO INCLUI:::'E MORE THAN :Z:: BEDROOHS.
S I GI'.,IE[::,: : ..........................
~MENT CO.
08
Russe/I Oyster
694-2774
Soils E~ Foundations
Performed for:
E GEC ,CHNICAL Et DEVEI
Bux 90, Davis St, Eaq ~ (liver, Alaska 99577
694-2774 ol 688-2280
SOIL LOG
Name
:
Mailtng Address:
Legal Description:
O~pthfe~
0
2~
,t,,. -)
S~oit Characteristic%
£a# Ellis
688- ~
Land Development
Tel. No. ~ .....
]3 ....
Ground Water Encountered: Yes ........... No_..~L ........ If yes, what depth~.~
Proposed Installation: Seepage Pit__~Drain Field
Con~ents:
Perfo~ed by: . , ...:. ,.
Date:
MUNICIPALITY OF ANCHORAGE
7
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-671-51
1. GENERAL INFORMATION
Expiration Date: Rib a 3, a o
Complete legal description MOUNTAIN MANOR BLK 2 LT 10A
Location (site address) 18640 Jamie Dr
Current property owner(s) STOEBNER JACK Day phone 907-575-3703
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Day phone
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: W 2 't-0 Se-p%'1�1�C Distance: / 5
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 5 57 0 Waiver Fee $ 1 1
Date of Payment (/ ?A- I Date of Payment X02
Receipt Number 079 ( 02 Receipt Number
COSA # DSC Z 1 1%& 1 Waiver #— O Sv a i 10 a
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) 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 (are) in ron;plia;!G@ With all appliGabIG Munieipal and State eedes, eFdonamees, and Fegulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim. Eng.. Phone 694.-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 9/28/21
Ars *-49TH*. 449 TH* *�fi
6. DSD SIGNATURE
f System #1 Approved for bedroomsc StQ1e_ei9;..
System #2 Approved for bedrooms fly-62ss ��_
Disapproved
Conditional approval for bedrooms, with the following stipulations:
OF
WATER AN D.
WAST`=v'' o
J E3DQrr,"-
S9,I) J
Al�By: OOriginal Certificate Date: Y 2 3 ad
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA cl,eck6 sl blue she•:
COSA Checklist
Legal Description: MOUNTAIN MANOR BLK 2 LT 10A
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 101
19/"
Total depth 282 ft
Cased to 25* ft
❑■ Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA /15/21
Static water level at beginning of test 31.4 ft.
Comments *Casing into bedrock
B. TANK DATA
Age of tank(s) 44 years
Tank type/material fbgls
Measured operating fluid level in septic tank 50
❑■ Standpipes/foundation cleanout per record drawing
Date of pumping 11/1/21
D. ABSORPTION FIELD DATA 9/12/77
Which system tested (date installed) same
❑■ ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 2.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 5.5
Parcel ID: 050-671-51
Structure served by this system
Well production at time of test 1.1 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑■ No
❑R Coliform bacteria is Negative
Nitrate mg/L ❑■ Nitrate less than MRL (ND)
Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 9/21/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date /15/21
Results Q✓ Pass For 3
Fluid depth prior to test 30
Water added 450 gal
New depth 36 in
Elapsed time 30 min
bedrooms
in
❑E Code -required soil cover over field Final fluid depth 30 in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: Absorption Field MT @ End of Trench- Photo taken
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot a 100'
El
9�+
Community Sewer ManholelCleanout a 100'
Yes
if No
ft
[ 7., Yes
if No ft
Neighboring Tank > 100' ElYes
if No
ft
Private Sewer/Septic Line > 25' E-,] Yes
if No ft
Absorption Field on Lot > 100' E Yes
if No
ft
Holding Tank > 100' :0 Yes
if No ft
Neighboririg Absorption Fields > 100'
Q Yes if No.
Water Main > 10'
Animal Containment? 50' Q Yes
if No ft
Q Yes
if No
ft
Yes if No.
Water Service Line? 10'
Q
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main ? 75' Yes
if No
ft
E Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations? 10'
El
Yes
if No
ft
Surface Water? 100'
E]Yes if No,
Property Line ? 5'
0
Yes
if No
ft
Wells on Adjacent Lots.
Yes
Absorption Field a 5'
Q
Yes
if No
ft
Private Wells a 100'
Q Yes if No.
Water Main > 10'
Community Wells ? 200' El Yes if No ft
Yes
if No
ft
Community Wells? 200'
Yes if No.
Water Service Line? 10'
Q
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter dista noes if less than required)
Building Foundation a 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line ? 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main ? 10'
Yes
if No
ft
Private Wells ? 100' Yes if No ft
Water Service Line � 10'
[]
Yes
if No
ft
Community Wells ? 200' El Yes if No ft
Surface Water ? 100'
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and review +++�� OF . .1
of Municipal records that the above systems are in conformance with J�Q'• • "2.�-�#
MOA CCSA guidelines in effect on this date. i co49
........................
Steve Eng �<v J0
C -625 AV
11/23/
COSA Checklist yellow sheet
,���i
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.ora/Onsite
Development Services Depadment
On -Site Water and Wastewater Section
n� n r
\,� S
Ucpartment
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV211092
PID#: 050-671-51
COSA#:OSC211661 Permit#:
Legal Description: Mountain Manor Block 2 Lot 10A
Engineer: North Rim Engineering
Applicant: Jack Stoebner
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 95.0 feet. See engineer's
waiver request for justifications.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
Waiver is Granted: X Waiver is not Granted:
Date: 110,3 1202 1 Approved by: aW6�
Name of Reviewer
.............................. a R a U K E ........... ■ .......... \ ............. t .... ■ 1
**** VARIANCE/WAIVER REVIEW ****
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 11/23/21 Number of Pages: 1
To: MOA On-Site Services
Subject: Mountain Manor B2 L10A
Well to Septic Tank Waiver Request
In 1977 the original septic system was installed for the subject property. A 1977 MOA
Inspection Report approval includes the well phrase “Not in yet”.
The 1977 well log indicates the water well was drilled the following month after septic system
construction. Evidently the placement of the well was measured from the septic tank standpipe.
Measuring from the standpipe does not include that underground portion of tank within the 100-
foot well radius.
A recent as-built survey indicates the septic tank standpipe to be 100-foot separation from the
water well. Attempting to move the fiberglass Sunset septic tank will likely break it. The best
option is to apply for a separation distance waiver.
Arguments in favor of the well waiver include favorable slope away from the well, water table
disconnected from surface water, favorable soils, favorable water table gradient, and favorable
water sample results. The well log indicates the water table @ 33-foot depth with favorable
“Hard Pan” layers between potential surface water migration. The water well is about 30-feet
higher in elevation than the septic tank, making contaminant transfer highly unlikely.
The fiberglass septic tank has been in place since 1977 at the current location. The tank will not
corrode & tank levels were measured demonstrating that it is not leaking. We request that a
waiver distance of 95-feet should be granted. If there is need for additional information or
clarification please give me a call.
LA
A o / L=25.82'
R=20.00'
.. Tbp1'13"E /nn .
N / Px l% \ 'I"9T
°s°�• /Did
I100 PR0 CTIV
.� GRAVEL �.
- WELL 6.
WOOD RETAINING WALL
/4PN i
3.8' WOODEN WALKWAY\L / \
Lot 9
NOTE: THE WELL IS 0.3' FROM THE
PROPERTY LINE PER THE PLAT.
2.2' x 7.9'
81 -LEVEL
RESIDENCE
11.3' x 13.9' CANT)
2.0' x 28.3' CANT
SEPTIC PIPES
Lot 10A
65,503 s.f.
ROADS END CIRCLE N
O1P
Lot 11
MORTGAGE SURVEY X SCALE 1" -=40' GRID NW 254 Project No. 21-715/AM1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates inc. (907) 522-6476 Phone 000Op O
(907) 522-4625 Fax o�p0�
Professional Land Surveyors kenOiangsurvey.com
O F q
Y jonothanOlangsurvey.com O�P� kY" 10
I hereby certify that I have surveyed the following described property: G7'0
LOT 10A, BLOCK 2, MOUNTAIN MANOR SUBDIVISION (Plat No. 88-26) 0 49TH '•�*0�
Anchorage Recording District, Alaska, and that this Mortgage Location Survey Is a 0' • •' • • • • • • • • •' • • • • • • • •�
representation of the conditions that were found on the date the survey, was performed. Q
This survey does not constitute a boundary survey and Is subject to any Inaccuracies Q • • • • • • • • • • • • • • •�
that a subsequent boundary survey may disclose. The Information contained hereon shall ••, KENNET o G
not be used to establish any fence, structure, or other Improvements. Q0 s�'•• j �IQ,RIQ,( ,•�'Q�
�Fo ��yy 02.•''
Dated this the �� Day of ��-tv�"��-�� `W2 at Anchorage, Alaska Q aR �'p
400 afFSSI0NA1. Via
It Is the responsibility of the owner to determine the existence of any easements, DOpppooa
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
APPLIC HT FILLS OUT UPPER HAL ONLY
Property Owner Phone
David A. & Celina M. BERLIN 694-9818
Mailing Address Box 1024, Eagle River, Ak. mp Code99577
Suyer Jack L. & Ronda P. STOEBNER
Address RR ~1, Lennox, South Bakota mp Code 57039
Phone
Lending lnstitution National Bank of Alaska
Address Pouch 7-025~ Anchorage, Ak. ZipCode99510 276--1132
Realty Co. & Agent Phone
C-21 Heritage Homes (Bob Caswell) Z76-1333
Address 207 E. Northern Lights Blvd., Anchorage, Ak. mpC°de99503
~,~ ~o~
LegaI Description Mountain Man&~ Subdivision Block 2, Lht 10
Street Locatlec NHN Jamie Drive, Eagle River, Ak.
Type of Residence
~ Single Family
[] Multiple Family No. of Bedrooms ~
[] Other
Water Supply
~ Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
~J Community For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility
Sewer Disposal
~:1 Individual Year Individual Installed: 1 q78
[] Public Utility When Connected to Public Utility:
~J Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date
Ins~.tor Inspector Inspector Inspector
(_~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~-~ Well to Tank Septic T~k Size
72-023 (31P2)
August 13, 1982
David A. and Celina ~4. Berlin
~ox 1024
Eagle River, AK 99577
Subject: Lot 10 Block 2 Mountain Manor Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
The water analysis report needs to be submitted to this
l_ office from the Chem Lab, 5633 B Street, for our review.
" ExDose the well for our inspection to determine proper ~/~ ~.
45~. ~cohstruction, also to insure minimum distance re~.uirements
~-~,~ ~~Li'~"~°~Ware met between the well and sewer system.
~~ePtic tank pumped with a receiDt submitted to this
" An adequacy test needs to be performed on the existinq
leaching area. This test will determine if the system is
~.~ a¢~equate according to National Standards. A listing of
private firms performing the test is enclosed. This re~Dort
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Enclosure
Cory Willis, R.S.
Auqust 5, ].982
David A. and Celina M. Berlin
Box 1024.
Eagle P, ivor, Al( 99577
Subject: Lot 10 Block 2 Mountain ~4anor Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been colnpleted:
¢~he %~;ater facilities were not turned on at the time of the
scheduled inspection. Please call this office :for another
Expose the well for our inspection to determine proper
construction, also to insure minimum distance requirements
~re met between the well and sewer system. ~.~,,~m'~ ~O{~,t~ ~
~e septic 'tank Dumped w~th a receipt submitted to this
departn]ent.
An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system is
adequate according to National Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies hnve been corrected. If there are any
further ¢Iuestions, please call this office at 264-4720.
Sincerely,
Robert C. Pratt
Associate Environmental Specialist
RP177/p/EH
Enclosure
EXCAVATION
ROBERT A. SHAFER
WORK
August 19, ].982
CIVIL ENGINEER
694-2979
Century 21, Heritage Homes
ATTENTION: Bob Caswell
207 East Northern Lights,Boulevard
Anchorage, Alaska 99507
Dear Mr. Caswell,
MUNICIPALITY OF ANCHORAGE
F'?T C~ JE':T'~ ".
ENVIk.,It I ,A. ',O E ,~'. 4
I982
RECEIVI D
Reference: Lot 10; Block 2; Mountain Manor Subdivision
A sewer system adequacy test was performed on the system
located on the referenced property, as you requested.
The septic tank was pumped and verified to have a capacity
in excess of 1000 gallons. The absorption trench was
tested by a continuous flow of water over a period of
24 hours without any adverse effect on the system.
It can be concluded from this test that the waste water
disposal system serving the three bedroom residence located
on this property is currently functioning adequately.
However, the system cannot be guaranteed against subsequent
failures.
If we may be of further service, please do not hesitate
to call.
Singly, // /
~7~£ ~ERT n. SI:~FER, P.E.
Ye /ss
CC
Safeco Mortgage
Municipality of Anchorage
Department of Health and Environmental Protection
RRR 1RRX EAGLE RIVER. ALASKA
/vlUIql~w~LiiY OF ANCHORAGE
: r ' MUNICIPALITY OF ANCHORAGE DEPT. Oi:; ~.[.~H &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECl~I~RONM~j~TAL ';~O~ ECTION
825 L Street-Ancho,age, A,aska 99501
' AUG 2. 9 'i979
CEIVi:D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. .
1. PRQ~.~RTY OWNER I PHONE
MAI LIING A D D'R [=$8 ·
PROPERTY RESIDENT (If di'fferen-t from above) PHONE
MA~L~NG ADDRESS
3. LENDING INSTITUTION I PHONE
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
MA LING ADDRESS ........ ,
5 LEGAL DESCRIPTION-
I STR E ET LO~'ATI ON
6, TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
~ INDIVIDUAL*
[] COMMUNITY
I'-- PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
.~ INDIVIDUAL/ON'SITE'*
[] PUBLIC UTILITY
NUMBER OF BEDROOMS'
[] One [] Four --I Other
[] Two [] Five
Three [] Six
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL',
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMB'ER
2. WATER SUPPLY
· [] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY L~
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank ~l~v\ ¢~ ~
Size: ~ ~)O~-~ If Tank is homemade i SOILS RATING
give dimensions: I ~) E~
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL ..._(
4. DISTANCESwELL TO: Septic/Holding Tank [Absorption Area ISewer Line [ Nearest Lot Line
Absorption Area to nearest Lot Line
5. COi~IMENTS
~;~.'"~PPR'OVED FOR ..~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany c~e~tificate)
[]DISAPPROVED //~
DATEj~ ~._~..~ (~ B~ (titl~ ~_ ~
LEGAL DESCRIPTION _ ~ .,
72-010 (Rev, 3/78)
AUgUSt 30, 1979
Duncan '~lc Leod
Post Office Box 795
Eagle River.~ Alaska 99577
SubJoct: Lot 10 Block 2 Mountain Manor Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
complete~
(1) ~e water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
(2) ~e depression or pit around the well casing needs to
be filled with im~ervious type soils so that it slopes
away from the well casing.
Please notify this department for a re-inspection when the
above descrepancy has been corrected. If there are any
further questions, please contact this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Asso~&ate Specialist
RCP/!Jw