HomeMy WebLinkAboutPARADISE VALLEY BLK 9 LT 3
0 . MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Nam~Vk) ~,.-~t,~ DISTANCES
I I~ .~I'~'::~'J ~ ~ SEPTIC ABSORPTION
~ddress TAN K FIELD WELL
Phone(s) ] Permit No. JNo. of Bedrooms
S~ision
~ot ~ Block ~ ¢~ ~ ~~ FOUNDATION
Township. Range. Section
~ ~ ' ~ ~T~NKS~~ ~ driveway,AS~"~TD~AGRA~(Sh~w~cati~n~fwe~septic~ystem'pr~pe"y~ines~ndati~n~water~bodies,etc.) ~ ~ ~ --. N
Manufacturer Capacity in gallons ,/
,aterial No. of Compadment. ~ /
TYPE OF SYSTEM ~5~ ~ -
~TRENCH ~ED ~ W. DRAiN ~ OTHER ~.~ ~
°rigina~ grade ~,~FT ~,~ F~ ~ ~.
Fill added above original grade Gravel depth beneath pipe ~ .
Gravel length Gravel width
t FT
,otalabsorption area ~S~ F' Distance between lines ~'~ ~' ~ ~
Number of lines ~ Pipe material
~PRIVATE ~ OTHER ~ldentifv) ~ ~ ~
Classification (A,B,C) Total Depth I Cased to
installer Date Installed: ~ ~1
REMARKS: ~ ~ '~' '~ ~? b,I{ ~? ~ "
~ ~l~ t ~ InspectionsPedormedby'
S & S ENGiNEERiNG cedily that this inspe~ionlwas pedormed according to a~
17034 Eagle River Loo~ Road N~ q~ ~ /~/~
Heallh Depadment Approval: Date:
72-013 (3/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744
HAND WRITTEN PERMIT
Permit Number: SW90~f~
Date Issued:
Design Engineer:
Owner Name:
Owner Address:
Permit Type:
Expiration Date:
Day Phone: A77-7~/~t
Parcel ID: ~ A o ~ ~(~- /~
Lot Legal: Subdivision: ~-~ ~-~c~/ Lot: ~ Block: ~
Section: )/ Township: //~3 ~ Ra~ ~/4Y
Lot Size: aq ~.~4~ ~-~q~ or~
Max Bedrooms: This Permit: ~ Total Capacity: ~
SEPTIC TANK: Minimum septi~ tank capacity: /F-v-~ gallons. Each
septic tank must have at least 2 compartments, insulation is
required if depth to top of septic tank(s) is less than 4.0'°
Lift stations require an appropriate electrical inspection.
WELL LOG: A copy of the well log must be sent to DHHS within 30
days of the wells comp~tion.
I CERTIFY THAT:
1. I will install the on-site sewer system and/or well in
accordance with all codes and regulations of the
Municipality of Anchorage (MOA) and State of Alaska , and
in compliance with the design criteria of this permit.
2. I will adhere to all MOA and State of Alaska requirements
for separation distances from any existing well, septic
system, or surface water on this or any adjacent or
nearby lot.
3. I understand that this permit is valid for a single
family dwelling with a maximum of ~ bedrooms. I also
understand that any enlargement will require an
additional permit.
4. I understand this permit is issued for the calendar year
and expires on December 31 of the year issued.
5. I will notify DHHS prior to all inspections by the
engineer or well driller.
SIGNED: (o~e~i~nee)
IssuED BY: ,~~ DATE:
db/ll5
~,~r,~ I~ REC ED
'SCALE
LEGA' DESCR,"T,O.: t--'5 15'~ ~-~2~S~
I
2
3
4
5
6-
7
8
9
10
11
12
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 .--~ ,~.~
A,
SOILS LOG -- PERCOLATION TEST /~;
DATE PERFORM~~
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT !
DEPTH? ~ p
E
13
14
15
16
17
18
19
2O
Depth to Water Afteri ~
MonilorinD? ~ Dale: ~ ~-'~ O
Gross Net Depth to Net
~ '~"" , ,ea...~ Date Time Time Water Drop
PERCOLATION RATE ~,z;~ (minutes/inch) PERC HOLE DIAMETER
OOMMEHTS
$ & S ENGINEERING ~ /~
AOCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ~T ON THIS ~AT,. DATE:
72-008 (Rev. 4/~) ~
PERFORMED IN
~SCALE
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
7
8
9
10
11
12
13
14
15
16-
17-
18~
19
20
Township, Range, Section:
SLOPE
WAS GROUND WATER ~ j~.,~
ENCOUNTERED?
¥'/~,, s
IF YES, AT WHAT I ~)
DEPTH? ~ p
Depth to w~ter Afle~ ]
Monitoring? ~ Date: ~
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
,~t ,-
I A'?"~ ~b ~'-:'~ ~ - 1?r'''
COMMENTS
~ ^ ~ 17~34 ~a~le ~ivor Loop Road No. 204/ / / "1 /~'/" ~ '"
r'ERF~RM:D BY: ~a~iie i~iv~r, ~.=aS~A ~ "- ~'~.~ ~J,~'~-"'~ ~"'/ ~ CERTIFY THAT_~IS~/,~,/'PE~ST WAS
/
72-008 (Rev. 4/85)
PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER
TESTRUNBETWEEN/~AND--~-~ ET
PERFORMED IN
:,,_ , MUNICIPALITY OF ANCHORAGE ,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAI LING AD DRESS~
LEGAL DESCRIPTION~.
LOCATION
DISTANCE TO: Well
Manufacturer ~~/
[~O(~ If HoME.DE:
Liq capacjt~n~a onsl
DISTANCE TO: IWel~
Manufacturer ~
Well
DISTANCE TO:
NO. of lines Length of each iine
Top of ti e to ~grgde
Length ~dth
'~STANCE T~ ~1
~ISTANCE TO Building foundation
Absorption area ! Dwelling ~
~ Ma te r,~j~
Inside length ~. Width ,.
Dwelling
~_~ '~ ~'~ateri~-~"'~-
/
Foundation ~ I Nearest lot line
Total length of lines t I Trench width
Material beneath ~le
Depth
-t~uilding foundation
Driller
Sewer line
OTHER
PIPE MATERIALS
SOIL TEST RA'~N(~
/
INSTAL~LER
REMARKS
APPROVED
PHONE [] NEW
3 C[ 9 '~o[ ~..~ ~ UPGRADE
NO. OF BEDROOMS
PERMIT N~O. ~
No. of compar~,r~nts
Liquid depth
PERMIT NO.
.L~iq~d capacity in gallons
{¢~ inches
Total ef fective~b~or ptio
N~e~are~ lot Fine
Distance to lot line PERMIT NO,
Septic tank ~ ~3 Absorption area(s)
Distance between lines
Total effecti~Te-~bsorBtion area
PERMIT NO.
DATE
72-013 (Rev.~8)
LEGAL
T H i:: j:i: E:I]:! U 'JJ r., [. [..''"1 {:::' T H E:
........... ,..., j T c:;.
THE LENGTH DIMEN:;:_:;!ON I
THE DE]:::'TH OF' i:':1 TRENCH OF: F'!T' IS TI4E t;:,IS'T'F:iI'.4CE i]?,E:THE;E]h! 'T'HE :~;UF~:I::'RE:E
G¢~:OU~',I[) F~NI], THE BO'f'T'Eff'! OF THE E::.;;C:FiVFiTZEH'.,I (ii'q F'EE:'f').
'THIE GI:;;:F!VEI.. [)EF:'TFI ID 'THE: MiN];HL!H DEF:"!"H OF'
FiND 'THE E',OTmf'Eff'I m3F:' 'THE;
F:'EZ:!"! i '!" F:IF:'F:'L I C:I::[['.,I"i" H.F:i:i~; t Fh::. ,r'~:~"J'2!~;F:'CIK!Ei; I E', T I... T 'T'"i" '['[) '[ .'.,~i::' "' F;']'¢. T ... ":E; ~. F. ,.- t'tg: I ,,,¢- ,.,~, Cd...iF;: I ~',!(~ , ,"..:::
I N'Z'FI:~L. LFI'T t Eli",! T hI':~F'E[C '!" t OH'.~; F F Fti",l"r' !,~[~]....L.~ , [..J .... !....~ ,I, 'T' "'~ 'T'H ); :~; f::'~Ulff:'E~]:;U?'r' I:~N[:' THE;
i'*,iL!P1E',E]:;;: (IF:' F;:EZ; ]; [:'ENE:E:~; "Ff"IF:!T THE HE]....L. H ~ L.L. :E;rzRvF'
H i ?-,i I MLIH [.':, i :STIqNC:E:: [~:E:'THE::EH f:i !.,!E:L.i.
' ::!..eH;-!~ I:::E:r:i!Z' F:OF;: F! I:::'!:;:I',,,'FI'TE~ HE:L..f....~
:L:5¢i.Jt 'f'EI ;;?',:3C~ [':'E~:ET I:::!;i:OH ]::'1 F'UE:L.!C: HELl_
Ei'?'H[':':F;: l:~:l!]:l;:[L.I :_r [;i:l~.:l',ll[~7[,.,tT:~j; I"I?!'T' .F:If:'F'L"r'.
I:::!","!::i ! L..FIIii',L.E "!'C~ I NF.;I..IF:E: F'I:;.%h%EF~ ! F,ISTF!L..I...F!Ti;
i E:I:!~I::~:T]: i:::'"r' THf::t'T
:L: ~ f:li"'l F:Fff'liL.]:F:IR HI:TH 'THE
I:::'OF~:TH D"r' 1"HIE MUI",I I C: I F:'F:IL. I T"r'
2: I HZL. L. :[NSTFIL. L.. THE: S'¢ZTE~:H
Z: I Ui",!E:,E[F~:ZTI:::!hlE:, THFIT THE
GREAi'~R ANCHORAGE AREA BOR~.,GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
¢ PHONE
, I~C TANK:
DISTANCE
FROM WELL /10
MANUFACTURER
MATERIAL
NUMBER OF
COMPARTMENTS /
/'" INSIDE WIDTH / LIQUID DEPTH
INSIDE LENGTH
LIQUID CAPACITY ~-0OOGALLONS.
DISTANCE FROM WELl.
DEPTH:
FOUNDATION / NTE',~REST LOT LINE
DIST-~NCE BE~EN LINES'*~WIDTH--
~ SQ. FT. LENGTH OF EACH LINE
TOP OF TILE TO FINISH GRADE '
DEPTH OF FILTER
TOTAL i]~G:[ Fi ........
OF LINES
IN.
TOTAL EFFECTIVE
MATERIAL BENEATH TILE
IN. ABOVE TILE
IN.
BUILDING ., I NEAREST . ) NEAREST ~ ~ I SEE AG
FOUNDATION ~¢'~) , LOT UNE /7 , SEWER LINE~ , TANK //O , SYSTEM
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:- ~'¢ ~-
LOT SLOPE:
REMARKS:
Form EQ-032
DIAGRAM OF SYSTEM
DATE~._F//~ APPROVED
GREA"-,,:,ZR ANCHORAGE AREA BOR-~dGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
,NSTALLAT,ON LOCA'",ON O / C/"'"" V '
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH TO BE INSTALLED BY /~c'K~''[~'-~ b''~' ~''~ C'/'?L~f?/~'~:') ~ '
SOIL TEST RESULTS NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL
COMPLET'O' DATE ANTICIPATED ~ O ~ ~ ~'~ /~
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
~j~rr~AN~SIZE YPE SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK .iSEEPAGE PIT
TO NEAREST LOT LINe.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAin TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK, ., SEEPAge PIT
TO RIVER, LAKE. STREAM.
DRAIN FIELD
., DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
· SEEPAGE PIT
, DRAIN FIELD
CAST IRON INTO AND OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET into UNDISTURBED SOIL.
4 INCH DIAMETER CAST irON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS,
GRAVEL BACKFILL
CONFORM TO BOROUGH F~EGULATIONS REGARDING INSTALLATION.
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE APPLICANT'S SIGNATURE , ,.. ~
EQ-016(3-75)
PERMIT NO.
RPPL I CRNT
LOCRT I ON
LEGRL
,ROD ENGLE, ~RR BOX 1624
GOLDENVIEN DRIVE
L~ B9 PRRADISE VRLLE¥ SUBD
LOT SIZE
'..44-~--' 6,
-~44~ SQLIF]RE FEET
'- I
TYPE OF _-,~IL RBSORBTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS
SOIL RRTING (SQ FTzBR.,= t27
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
g, EPT| :I~-
THE LENGTH DIMENSION IS THE LENG] N FEET) OF THE TRENCH OR DRF~INFIEL :,.F,~..-
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF
GROUND RND THE BOTTOM OF THE EXC~VRTION (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 EXCFIVRTION (IN FEET).
5 I ZE= ~l_0E'~--21 GI':tLLn]~-~S
REi_.:~ IJ I RE[-" SEF'T I C Ti:If-ti( ------
BRCKFILLIN~ OF RNY SYSTEM WITHOUT FINRL INSPECTION 8ND RPPROVRL BS.' THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND RNM ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE WELL OR 200 FEET FOR R PUBLIC WELL.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF THE NELL COMPLETION.
SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER
INSTRLLRTION.
P E F-' ~ I T %,~RL I D F~DR ONE "r" E R R FROWN I__-=.--'=' ~'~" ~_~=,..--
I CERTIFY THRT
1: I RM FRMILIRR NITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF 8NCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM WRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS.
8PPLI~NT ROD ~NGLE
--- - -
I ~=,UED BY_ ..... DRTE---
[:;E F'~;IRTI',IEf,!T CiF' HERLTH RNI} EN',/I RONHENTFIL F'R(]TEC]~ 101',!
" , '* 2-:~ :! ~:.~ E. TL I":,E F' RE:,, , RNCHORRGE: RE
::2 ..26 - 2:; ;'2' 2 ::L
F'ERH I T NO. ,.'. 76Ed..5)
c~ -., -.
ENGLE
GOLDEN',," I E .4 [:,R I ',,,'E
LEGFIL L~: D9 PRRFIE:,I%E ',,,'FILLE'¢
LOT z-, I ,:.E 244Z:6 ':-;F.*FT
'Pr'PE OF SO); L FID"3ORP]' I ON :':,~ = I E. fl... TRENCH
t ~, ~ , 'qO I L. RRT I NEb 2;QF"T',,"Eff;.:
N JHBEF.. OF E:E'DF.'.OOHzS 2 -
THE REQUIRED .:,IlE OF' THE [4OIL. FtE,'SORF'TIOht .:,~]E~t iS:DEPTH= 4';' LENGTH=
a:,n c~u DEYFIEEN ]'HE OUTF'F:ILL FIFE. RN[:, THE E',qCFtVFtT!ON E:OTTOH
THE.MINIMUM DEF'TH OF
I E; :9. 5 F'F
.... E] WIE:,]"H [J~ TF.':E'NCHES. F:]R [:,RFtlNF'IEL[:,:E;., THE 14I[:,TH IE; ]:F'f'.
1'HERE IS NO ,zz"
........... FIN[:,
F.'.E.N...H OR I:'~T I.S THE DISTFtNCE E,'ETFIEEN THE GROUNC' :,UF.I"H..E THE
THE [:,EPTH OF ...... ' ~"
BOTTOH OF:' THE E',.',¢CFIVFIT I ON.
THE LENGTH E:,IMENSICd',I .IS THE LENGTH OF EFICH SIDE FX)R Ft %EEPRGE F'!T OR THE
L. ENGTH OF THE TRENCH., OF.'. [:,RF~ I NF' t EL.E:'.
THE F:'.E[.:.!UIRED SEF'TIC 'f'FINK SIZE IE; '?5E~ GFILLON%
DFICKFIL. LII"~G OF FIN'T' S'~-~;I'Eft klITHOI. JT F'iNFIL !N'~;F'EZ'I'ICIN EFt' ]'Hi:E; E:,Ef:'FJR]'HENT NIL. L,
DIE SLIDJECT TO pR::'::ECJTIOI"] ,.... FiF:,qr.F,F:,Ti.~N
M!NIMLIM DIS]'FfNCE FROM 14ELL. TO FIN'¢ SEPTI'C TF~NK,.-'F'F~CKF!GE PLFINT OR
, ~"F ' 2E~E~ F'T FOR FI PU[.:.I[ tC klELL.
~"c* '~ ]:S ±00 F'T F"F." FI PF*::]~, HI ..d.,.IE. LI_ RN[:,
..,-r _,t' EH ,. .... - -
NELl_ L']GS, i'lJ:,~ DE RETLIRNEE:, TC) THE [,EPFIRTMENT WITHIN :i:E~ [:,R'./S OF THE NELL
COMPLETI ON.
SPEC I F'Z CFIT IONS RND CONSTRUCT I ON E:, ~ FIGRFIHS RRE R',,"FIT LFIBLE TO I NSLIF.:E F'ROF'ER
I N:5'FFILLRT I ON.
.... EklLF .... RN[:, !.,.!ELL:5
I _.E. RTIF-r THFIT ~ F¢"i F'FIHiLIFIF.: NtTH ']"PIE REC¢.JIREHENT'-:~; FOR ON-E;ZTE
R.'-:] F_;ETF(]F.'.]"H D"r' THE HLIH I E '[ F'::tL I T'¢ OF FINE:HORF~GE RI'.,IE:, !-41 EL. I NSTFILL. I N FICCORDFINCE
W I TH THE COI}.!E. ?
RECEIPT FOR CERTIFIED MAIL--30~ (plus postage)
SENT TO POSTMARK
OR DATE
STREET AND NO.
P.O., STATE A~O ZIP CODE
OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURR j~. L Shaws to whom and date delivered ........... 15~f
With delivery to addressee ¢pnly ............ 65¢
RECEIPT p 2. Shows to whom, date and where doliYered ..
SERVICES With delivery to addressee only ............ 85¢
DELIVER TO ADDRESSEE ONLY ...................................................... 50~
SPECIAL DELIVERY (extro ~ee requirecl) ....................................
PS Form NO INSURANCE COVERAGE PROVIDEO-- (See other side)
Apr. 1971 3800 NOT FOR INTERNATIONAL MAIL ~GPo:lg?2
· SENDER: Complete |terns 1, 2, ant[ 5.
Add your addr~s in the "RETURN' TO" space on
1. The following service is requested (check one).
[] Show to whom and date delivered ............ 154
[] Show to whom, date, & address of delivery.. 354
[] RESTKIGTED DELIVERY.
Show to whom and date delivered .............
[] RESTRIGTED DELIVERY.
Show to whom~ date, and address of delivery 85¢
2. ARTICLE ADDRESSED TO:
Rod Engle T,NB/lfi h
Star Route A Box 1624
Anchorage, Alaska 99507
S, ARTICLE DESCRIPTION:
REGISTERED NO. CERTIFIED NO, I INSURED NO.
I
744872
(AIwaye obtain eignature of addressee or agent)
I have received the article described above.
GNATU.E [] Addressee [] Authorized agent
FDATE OF DELIVERY ~ POSTMARK
5. ADDRESS (Complete only It requeefod]
6. UNABLE TO DELIVER BECAUSE: CLERK'S
INITIALS
T.H.1
T.H.1
SAND, SOME GRAVEL
TRACE SILT (SP)
Q.0I
SANDY GRAVEL
TRACE SILT
Occasional Cobble (GW)
GRAVELLY SAND
TRACE SILT (SP)
6.0~
SANDY GRAVEL
TRACE TO SOME SILT
Occasional Cobble (GW-GM)
(155 Sq. Feet/Bedroom)
12.0'
SANDY GRAVEL
W/ SOME SILT
and Cobbles (GM)
%7.0'T1
No Wa~er Table
No Scale
Log represents Location
of test hole Lot 3, Block
9, paradise Valley
subdivision
R Consultonfs inc,
~uc.oRA~ ~A,~a^,~s ALASKA
2._1]- 76.~~= 1"=3' I
Ron Eng] e
Log of Test Hole
Anchorage, Alaska
~ lo NO.
1~-~o.3. NO. 656202I 'w~,
A~OI
249 EAST S1ST AVENUE
CONSULTANTS, INC.
ANCHORAGE
FAIRBANKS
JUNEAU
P.O. BOX 6089' ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 · TELEX 090-:35419
February 11, 1976
R & M No. 656202
Mr. Ron Engle
Box 1624 SRA
Anchorage, Alaska
99507
RE: Test Hole and Soil Log Report for Sanitary System
Lot 3, Black 9, Paradise Valley
Dear Mr. Engle:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
investigation was performed in accordance with your request of
February 10, 1976 and those procedures outlined in a letter dated
July 15, 1975, by Mr. Rolf Strickland of the Municipality of Anchorage.
A single test hole was put down within the Lot 3 area for the purpose
of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type
drilling rig and the test hole was extended to a total depth of 17.0
feet below ground surface. The final log prepared for the test hole
has been included in Drawing A-01.
Ground water was not encountered in the test hole.
We appriciate being given this opportunity to be of service to you.
Should you have any questions with regard to .the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James ~.-~o~n~y ~
Vice President
JWR/pe
xc: Municipality of Anchorage
siX INCH WATER WELL DRILLED AND CASED OUT TO THE. D,F?TH OF 2_~)~¢_~e~,,~ , .
DRILLED AT'THE RATE OF ~8.,00 ' PER FOOT.
' ' ' 99~o7 ';:, '
PROPERTY OWNE~ , ~s~ Do~&~ ~le. Box &6~ ¢.~,A'~ . ,' -
. . .',. · ,. ,,.. ·
LOCATION OF WELL SITE ~, g B~ ': ,~Ub,
,,~. ..... :,.,.:,,,... ..;,:,..,, : ~.,, ,:. ,, _,,,x,: , _} ,.d%:.' , , '.,' :.,i .~, -
WELL LOG:
0 .... X8~ Small bo~ez, s ~d g~avol~ ,,..
18'~;.32~ Saudy gravel and clay. ¢¢¢¢¢~%~ '~onglemerate from 25 to 31 feet.
31---194e Sedimentary
19~-£02~ G~-auular rock producing
201~-215' S.~d~entaz~¢ ?ock;
£1~228~ A porous rock producing at least ~ ~dditio~l tw~ GPM.
228--230 ~ Sedi~entary rock~
~'fell has a fast recovery ~rlth a stand of'water within 22 feet of sUrfacee
, · :.,-', . ' "-: - :' : ~ ' ,~: . , .-.':: ,2.:~ .' '~: );; '; ::.:~ ~- .... :? ~;;~,.;- ':"
' ' ' ' ' . , ~f.."~, . .,]~:- L'.';? '. ; : ;"',51,- ..;]~.'z,., .-u ¢,;.:'.' - ~-"4., ,,> .'. '¢.~':/ ,' .'~ ,' ,. 4.4 ,' '~'-:.-'~ -:, ' '.
' ....... ' :'"::_"'
COST INCLUDES ALL LABOR'AND 'MATERIAL FOR COMPLETION oF SAID'. DRILLING,
-, ' .,' , ' ?.L:. ;.. .. . . ' '. ", .,.~ ' , . .-"i&,,'~:'~,.; .
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF , ~ ..........
.. , .' 7, , .. , BERNIE CLAUS .~J~--I~MPAR~ DRILLING WORKS ..
. BERVICE CHARGEOF IFz~ PER MONTH WILL BE ASSESSED ON PAST DUEACC~$,~
gomp ere ega oescnp;;on .... , ..................~ ~ ....- ....... -
Location (site ad~res~ or alrecuons~: ,,-.,¢'. ........ ,, ............ 1';" -'7::":-; ,' :~ ,.: :'": ',.
~" '~ ' c' ':'~ r ' ".' · ': ......... A~ ~ nO *:,~ ~¢:",~;~ ' ;''';7~
¢:"_ . ..¢_oroneev,,nwner Joh~ P~E , ~:.;: ,: "";~ ':'; '.- '~,[%',,uay pnone .. :...
. ~, ;,,:,'~ .
Mailing ~ddCe~ *, ....... "" "
~ ,' Mailing addceaa .... '; ..... ' '"'"'"'¢ .......... ' ""'" ' .......... *' '~'*¢~''''*'¢'~' .........
Agent' :. or~q H~on/. HERITAGE REAL,ESTATE .. , .... ,:.Day~php~e..:;::?. - . .
'l ~ . · - ', · ~",;.'~':',-7~,~Y.'~:: ;'~/ ~, .,..~'~,,': ; ,,?','!~'t-t'( '.. ,
' Address ';:~ 3230"C" S~6~":' ~6':~O~t:~;, An~o~a~6~'~AK,-'.99505:'.,; .... '
], · ,; ..;.. : ;.,: , . .
-':,: ,:~ Unless otherwise requested~ HAA will be
~. ~UMBER.OF BEDROOMS:
3, ':;' TYPE OF-WATER SUP
NOTE: ~-
to
TYPE OF'WASTEWATER
,.
.,,., : .: ,;,¢~ Holdin tan.
:,. ...... ~ ~ ,,~::~ comm'~Jhitv
Public sewer
NOTE: If community
attesting to thb legality ar
· , i.:;F!
72-025 (Rev. 1/gl) Front MOA#21
' ' 'c ' 'i-U'~ '..' :,' .: ~,~' ~'~ ', ~ /.~:. ~ 'I~ ~..* ~,. 'r · '
s cert~hed by my seal affixed hereto .nd as of t~ vaildat?i d?te shown below verify that my
": investigation of this Health*A~th'6ri~ A~P~6~i*~Pl!~tl~'*Sh~vs th~t'the'0n-site water supply
and/or wastewater disposal syste~ is sa~e, 'f~.i~'~l; ~d,~d~'ate, for 'the number of bedrooms
and type of structure indicated h~eln,' I f~d.h.e'~ ~.i.~t"~e~ ~'~e information obtained from
the Municipali~ of Anchorage files and from my in~es~atlon'and inspection, the on-site water
supply and/or wastewater disposal system is in corn plianbeWith all Municipal and State codes,
ordinances, and regulations in effect onth e ~ate of.~ th~'s inspection.~ .....
'~" ' ~'Phone" ~
Name of Firm ~ & S ~N~C
Address 17034 Eagle River L~ Reed NO. ~ '., =:.~ ~,., ~. ,.
Engin~fs signature · ~' 1:''~ [~Date
DHHS~,~SIGNATURE
ApprOved for ._~ ' bedroomS., ?!
Disapproved, '~'
Conditional approval for the :fOllOwing :stipulations:
Additional comments
St. ate and Htt~-icipa'l Code~;".~
cont
It ~s
/1. EPA
The Ml~ni~ipality of'A"~chorage Department 'of Uealth,'ah~' R[Jman: se~t~ ~(D'~HS)"'~s~es Health Author
Approval ~odificate~'b~sed only upon the representatlofis given in/~'a~ag~aph'.5 above by an independe?t
professional engineer registered in the State of Alaska, Th° DHHS ~ee'tht~ ~s'~ c~ desy to purchasem of hom~
and their lending inet tut eno in order to satls~ ce~aln federal and. .statb"~~'q'ol~t~. , , Em"ploy~s of DHHS do not
conduct inspections or analyze data before .arcedlflcatel~[]s8~ed;;~Th~"~:~l~ipall~"of Anchoraoe is not
responsible for erro~ ~r'omlsslo'ns In'th~'~6~'~n~l '~'~l~ee~'~6~?~?'?~??~?~',~ ?.;'~ ~:~?:~;::'-,, Y
, . ' ~ ~Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ 7- ~/. ~J~ ~. ~/]~L_g~ L//A:~.E? Parcel I.D.
A. Well Data
Well type
Log present ~N)
Total depth
Sanitary seal (~/N)
If A, B, or C, attach ADEC letter. ADEC water system number
~:~' Date completed e~/~ Driller ,~/~?
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
C~,"~~ Cased to
FROM WELL LOG
Septic/~/old~tank on lot /OO 'Z-
Absorption field on lot / Oc~ ~
Public sewer main hJ/'A-
Sewer service line (0 ~
[~,F__j2F_c~c~¢ Casing height / ,)..~
Wires properly protected (~N)
AT INSPECTION
.g.p.m. ~ g.p.m.
; On adjacent lots /4)0 ~.~
; On adjacent lots /
Public sewer manhole/cleanout /'.J/'~
Petroleum tank
WATER SAMPLE RESULTS:
Coliform O Nitrate
Date of sample: ,~- I- c~ ~ / 5--;)-5--~ 3'- Collected by:
B. SEPTIC/H~:~N~G TANK DATA
Date installed ' [01 :~'~
Cleanouts ~t~/U)
High water alarm (Y/~
Date of pumping
Other bacteria
Tank size
Foundation cleanout (~N)
/~f//'~ Alarm tested (Y/I~
~ I~/~.~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HO~G TANK TO:
On adjacent lots
Absorption field
Well(s) on lot /
To property line
Surface water/drainage
Compartments ~
Depression (Y/I~ /LL~
Foundation /~)
Water main/service line c3 ~
72-026 (3/9~)° From CONTINUED ON BACK PAGE
Date install~'~~
Size in gallons
Manufacturer
Manhole/Access-(Y/Ni
Vent (Y/N)
High water alarm level
"Pump on" le~ebat. ...... Pump off" Level at
Meets MOA electrical codes (Y/N) .........
SEPARATION DIS~ANCE FROM LIFT STATION TO:
..~11 o~oot// On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Len~h GO'
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/~)
5-~(:,-<~0 Soil rating (GPD/Ft2) ~'/'~/Z Systemtype ~
Width ~' Gravelthickness ~, ~ ' Total depth ~ ~
~ S ~ Cleanout present ~N) ~' Depress~n over field (Y/~ ~
~'" ~ ~fi F Resu,s (~fail) ~ for ~ Bedr~ms
D~-? After test ~g?
~ ~ If yes, g~e date ~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation l~ '4-
On adjacent lots ~ ~+
Surface water /06 'I
Curtain drain /~ ~-~,.-'
[0(3 ~4 On adjacent lots /00 ~ Property line
To existing or abandoned system on lot
Cutbank /u/~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I cerO'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effec~.~o~f this inspection,
Signature ' '"' ...... '/' '" "'/'"'~"'~' "'"~'~"'"'= ..... ~'~'
~,,~~.
Engineer's Name
Date
H~ Fee $ ~ ~¢3 , (/d.) Waiver Fee $
Date of Paymem ¢/)-o </~ % Date of Paymem
Receipt Numar ? / Receipt Numb.r
/
72-026 (3/93)" Back
Matrix
Client ~ample ID
CT&E Environmental Services Inc.
Laboratory Division
ss. 1ss3-1 Laboratory Analysis Report
WATER
L3 BLK9 PARADI$~ VALLEY
Client Name S & S ENGINEERING WORK Order 14304
Ordered ~y R. COWAN Printed Date 0s/04/95 ~ 11:25 hrs.
Proj~ Name Collected D&~e Q~/01/95 ® 13:~0 hrs.
Projeot~ Received Dabs 05/01/95
PWSID uA
Teohni~al Dir~Gtor STEP~E~ C.
Remarks? SAI~PGE COLLEcTeD BY: J.W-
GC Allowable Ext. Anal
parameter ~esulte Qual Units Me~hod Limits Date Date ~nit
......................~Nitrate-N i-?'-?--r ......... 6,~='2 ............................................................................ P m~/L E~A 353,2 ~0. 05/03/95 CMR
* See Special I~t=~ctions Above UA - Unavailable
** $~e Sample Remarks Above NA = Not Analyzed
~,.. = Undetected, Reported. value is bh~ prac~ical q~ntffication limit. LT = ~m Th~
~.= ~co~dary dilution. GT - Gr~ator Tha~
2~ W. Po~sr DHve, A.~ho~age. AK 99518-~05 -- T~l: (907) 552-2343 ~8x: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA. CALIFOR,NIA, FLORIDA. ILLINOI6, MARYLAND. MICHIGAN. MISSOURi, NEW JEReEY, OHIO. WE~T VIRGINIA
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 3; B~ock 9; Paradise Valley Subdivision;
Location (address or directions)
5850 Romania Drive
(b) Win Fowler Business
Property owner
Mailing Address
5100 Woodridge Drive,
Telephope:(home)
Anchorage, Ak. 99516
27,7-7912
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the following address: (or check here (;~(if hold for pick
List contact person and day phone number below:
$ & S ENGINEERING
~,7034 ~gIe Ri,vet Loop Road No. 203l~
Eagle River~ Alaska 99577,
2. TYPE OF RESIDENCE
Single-Family r~× Number of bedrooms ,~
3. WATER SUPPLY
Individual WellY~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
conservation attesting to th legality add status.
4. SEWAGE DISPOSAL '
On-site E~X Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION~
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm Telephone
Address
Date
S & S ENGiNF. Lq:t;NG
17034 E., ;';: ~ ,,~'~. ~oop R~ad No. 204
Eagle Riw~, ~ ....... .~957']~/~
6. DHHS APPROVAL
Approved for .~ bedrooms by
Approved ,//'~,~. Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
JUN 1990
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~ ~ '~--~--- q
WellClassi~l~c~iCEJVED ~/'~J~ ~'~..)/>'~L.- IfA, B,O,D.E.C. Approvod(Y/N) I'~/~
Well Log Present ~N)~ D~ompleted ~ ~ ?~ ~//7~ Yield
Tota Depth ~ Cased to ~pth of Grouting
Static Water Level I ~
Casing Height Above Ground \'~lJ¢'
Electrical Wiring in Conduit (~/N) y
SEPARATION DISTANCES FROM WELL:
To Septic/He~L[~ Tank on Lot ~
Pump Set At
Sanitary Seal on Casing ~/N)
Depression Around Wellhead
;On Adjoining Lots ~ ~;~:~t .~.
, ; On Adjoining Lots
To Nearest Edge of Absorption Field c]n Lot ~ ~tJr~ I
To Nearest Public Sewer Line i~/~:~ To Nearest Public Sewer Cleanout/Manhole ~/~
To Nearest Sewer Service Line on Lot ~.~. I .iF.
Water Sample Collected by ~ '~'¥'~t~-~--~l~;Date ~-~'Z-~'~'"~'=~
Water Sample Test Results ~~-~/~-----~"~¢~, '" ~ ~. ~ ~
Comments
B. SEPTIC/HOLDING TANK DATA
/'lq
Date Installed ~ ! Size
Standpipes ~'N) 7 Air~.~ht 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
To Water Main/Service Line
No. of Compartments
~ Foundation Cleanout (:-~N)
/..t/Date Last Pumped
; for
Temporary Holding Tank Permit (y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
,Comments A
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field /
Square Feet of Absortion Area
Depression over Field (Y/t~)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot ~
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
~::~f'~(? '4¢r Statndpipes Present ~N)
/'J j Date of Last Adequacy Test
/,,
; On Adjoining Lots
/¢ ¢ '~ To Cutback (if present)
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Y
To Property Line
To Existing or Abandoned System on
Comments
D. LIFT STATION
"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)
~ ~cles 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
inspection.
S & S ENGINEERIN
Signed 17034
Company
, .
Date of Payment ¢ - ¢~¢ O Waiver Fee: $
Amount: $ /¢~ ¢ ¢ F~) Date of Payment
72-026 (Rev. 7/88) Back 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
ANM,~S!$ gEPOI{~ ~l~ SM~L~ £o~: Work O~der. ~ 2201'½
Client Sample
?W$iD
Client Acct: SNSENGP
P.O.~ NONE RECEIVED
aeq ~
Chem]ab Roi ~,: 901556 Lab 3mpl ID: I Matzix: WATEP..
Para!2¢t~x Te~ted P,e~ult Unit~ M~thod
...................................................................... ?~ ........................ 7 ..................... : ............
Tests Pezfo~med ' See Special inatzuct:on~ lbeve UA=UnaYailable
MUNICIPALITY OF ANCHORAGE
t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
~'~, ~ ~ 825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
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. PROPERTY OWNER PHONE
Stephen/Roderick Engle 344-6267
MAILING ADDRESS
Star Route A Box 1624 99507
PROPERTY RESIDENT (If different from above} PHONE
2. BUYER PHONE
H. Winthrop Fowler/Karen D. Burke
MAILING ADDRESS
Star Route A Box 476N 99507
3. =LENDING INSTITUTION I PHONE
Alaska StatebankJ 279-7637
MAILING ADDRESS
310 East Northern Lights Boulevard 99503
4. REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
Lot 3 Block 9 Paradise Valley Subdivision
STREET LOC^T~ON
See attached map
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One 7~[] Four
-t:~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is requ'ired for all well~ drilled
since June 1975. For wells drilled prior to that date, give,;well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
:~ INDIVIDUAL/oN-sITE**
[] PUBLIC UTILITY
**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 ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
~IR ECTI~S:%
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ SINGLE FAMILY ~ ONE ~ THREE ~ FIVE ~ OTHER
~ MULTIPLE FAMILY ~ TWO ~ FOUR ~ SIX
PE~MtT NUMBER
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
Connection Verified INSTALLER
~ptic Tank or ~cling Tanl<
Size: ~,)00 If Tank is homemade SOILS RATING
give dimensions:
TYPE OP, TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
'~ - Septic/Holdin, Tank ~Absorption Area ..r [Sewe~ Line I Nearest Lot Line
4
DISTANCES
Absorption Area to nearest L~ine ~,~
5. COMMENTS ·
~¢- APPROVED FOR ¢_ BEDROOMSvD_ , atek~-f&~ f~:~ ~'~
~ CONDITIONAL APPROVAL (letter must ~cc~npany certif'c )
72-010 (Rev. 3/78)
/~.iUNICIPALIT¥ OF ANCHORAGE ~__~ ,6.$~
~- , Department O~ Healt'~ a=~ Environmental P=otection \
~' 825 L Street, Anchorage, Alaska 99501
264-4720
~quest for Approval of Individual Sewer and Water Facilities
Property Owner: Stephen & Roderick Engle
Mailing Address: SRA Box 1624
Phone: 344-6267
Name of Buyer: H. Winthrop Fowler, Jr. & Karen D. Burke
Mailing Address: SRA Box 476N 99507
Phone: 349-3635
e
Lending Institution: Alaska Statebank
Mailing Address: 310 E. Northern Lights
Phone: 279-7637
Realtor/Agent: Anchor Realty
Stan Engle
Mailing Address:
Phone: 272-8481
o
Legal Description: Lot 3, Blk 9, Paradise Valley S/D
Street Location: NHN Romania Drive
Single Family Residence: (X)
Multiple Family Residence: ( )
Number of Bedrooms:
Number of Bedrooms:
o
Water Supply: * Individual Well ~) Public/Community System ( )
If Individual Well, well depth
If Community System, name of system
Sewage Disposal System: *~n-site System ~) Public System ( )
If On-site System, date of installation:
~UN~cIP~Lf'ry OF ~NCHO%~G2
*~O~g: A well lo9 is required on A~ wells drille~'lA~e
** I~ on-site se~er system is over t~o(2) yeAm3 old, an adeguacy
.test is required by this departmenL'requ~'~
A fee of $25.00 must accompany each ocessing
can be initiated.
3/77