HomeMy WebLinkAboutROLLING HILLS VIEW ESTATES BLK 4 LT 6
Parcel Identification Number: 0 5 0- 3 2 2- 10
Legal Descriptionwner Name & Address:
k 0 IH I i I s V e43 E5 4vu-� 9q1 7" M O
z&1
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: / f I' feet
Pump Manufacturer's Name:AY,M,-, c depo a-' 1�
Pump Model: At(1V ?$-F 311 - 7 v / 5 -
Pump Sizejr hp
Pitless Adapter Burial Depth: /0 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: 016
Well Disinfected Upon Completion? 2-Y-`e`s`r-] No
Method of Disinfection:
Comments:
r , _", ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: All 0 V/Z L'I/ 0 C( 330 EAST 76TH
AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
45AFETY
P.O. Box 196650 <
Mark Begich
Anchorage, AK 99507
Mayor
www.muni.org/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number:
SW Date ofIssue:
Parcel Identification Number: 0 5 0- 3 2 2- 10
Legal Descriptionwner Name & Address:
k 0 IH I i I s V e43 E5 4vu-� 9q1 7" M O
z&1
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: / f I' feet
Pump Manufacturer's Name:AY,M,-, c depo a-' 1�
Pump Model: At(1V ?$-F 311 - 7 v / 5 -
Pump Sizejr hp
Pitless Adapter Burial Depth: /0 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer: 016
Well Disinfected Upon Completion? 2-Y-`e`s`r-] No
Method of Disinfection:
Comments:
r , _", ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: All 0 V/Z L'I/ 0 C( 330 EAST 76TH
AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
GREA(ER ANCHORAGE AREA BORuUGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~/~g~/~ ~;r~ ~'7/~/~-~-~ MAILING ADDRESS P(:~)/~2/ ~)R~'~5~./~ /~'~'/Z~PHONE
LOCATION
SEPTIC TANK:
DISTANCE
..OM WELL
INSIDE LENGTH
MANUFACTURER ~g.U/c/~ ~ 7" MATERIAL
INSIDE WIDTH ...LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY /~0~--) GALLONS.
SEEPAGE PiT:
NUMBER Of PITS / DIAMETER,?~)~'2 OR WIDTH ~"~
LINING MATERIAL {'(/~/ ~ CRIB SIZE: DIAMETER
BUILDING FOUNDATION , NEAREST LOT LINE ~-<:~ ~'
ADDITIONAL ABSORPTION
LENGTH ~--'~' DEPTH C~
DEPTH DISTANCE FROM: WELL //~z)8 ~
TOTAL EFFECTIVE ..~ .~2 ~
ABSORPTION AREA (WALL AREA) ~ SQ. FT.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
DEPTH DISTANCE FROM:
SEPTIC(~) &_~.- SEEPAGE /~.,
TANK ~'~ ('2 , SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
, / . ~ 'Gri~~ Zr ANCHORAGe ARea BO. ;Ugh
~,~ ~ DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO..
LEGAL DESCRIPTION / ~z-'
~ ~ SEEPAGE PIT ~ ~ ., DRA~N ~lEID
INSTALLATION OF: SEPTIC TANK ~ . ~ ~ ~ , OTHER
SO,~ TEST ~ESU~TS ~. / --' ~ =, I MIT IS NOT VALID WITHOUT SOIL
COMPLETION DATE ANTICIPATED
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.
SEPT,C TANK S,ZE /::dX E EPAGE AREA ~>"'
~- ~ ~,'~ ~, /~
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
/...~- /
DRAIN pIELD
, S EEPAG E Pit J~l/~
, ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK ~/~/ ~ SEEPAGE Pit
TO RIVER, LAKE, STREAM.
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
P,TTED w ,T. A,RT, G .T R E/_M OVAS.~ LE.~x.DAPS. '~ .>:':'~X" ...g'd; ;/~" ~
CONFORM TO BOROUGH ~EGULATIONS REGARDING INSTALLATION.
z'.~rll]l,LR~," ~: GREATER ANCtlORAGE AREA t30ROUG,~
~/~fl~l~'~ Department of Environmental Quali~y
3330 "C" Street
Anchorage, Alaska r ~
SOIL SI,O(;- "EROI,ATION TEST
Performed for ~A~/~ D~,]~r--- _ ..:Oate Performed.
Depgh
Feeg
10-
11 -
12.
'13-
14~
Was ground water encountered? . . .~_._¢~_ ..... If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate
-Proposed installa~h-T- S6~qe Pit Urain Field
DepU~ of Inle~ '.~DepC~-~'-b~'T~-O:Cpit or trench _~
LOG OF
DRILLING
by A Ct L DRILLING COMPANY
ADDRESS ..........................................................................................
WELL S IT ~-~.- --~--.---. -~--~--· .'~. -~-'- .......
DATE--STARTED ................................................................................
DAT~--END~D ........................................................................................
DEPTH OF WELL ...... ~-.--~-- .............................................
STATIC LEVEL OF WATER FT ...............................
DRAW DOWN FT ..............................................................
GALS. PER HR ..... /..-~---?- .......................
KIND OF CASING ..... ~.--~---------~--~. ................................
KIND OF FORMATION:
q FT ~C'' -~7''/~ ~' ~/4~ '~'~''/ c~O/ TO._ .._?--'~-?- ......... FT.--/- .~- -~-'-~-~ - -~- - ....
......................... FROM ........................ FT.
FROM ~ FT TO ........................................................
FROM ........................ FT. TO ........................ FT ...............................
FROM ........................ FT. TO ........................ FT ..............................
FROM ........................ FT. TO ........................ FT ............................
' FROM ........................FT. TO ........................ FT ...............................
FROM ........................ FT. TO ........................ FT ..............................
FROM ........................ FT. TO ........................ FT .............................
FROM ........................ FT. TO ........................ FT ...............................
MISCL. INFORMATION:
AT ~
SUBJECT
DATE SIGNED
Redi~orm ~
SEND PARTS 1 AND S WITH CARBON INTACT -
4S 469 PART :3 WILL BE RETURNED WITH REPLY
MUNICIPALITY OF ANCHORAGE ' ·
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage,'Alaska
99519'665O
343-4744
Parcel I.D. # 050-577-' I0
1. GENERAL INFORMATION
' ~C°mplete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA#
~o~ 6; Block 4; Rolllnq ~ills' ¥ie~
Location (site address or directions) 18840 Upper Skyline Drive, Eagle River, AK
Property owner
Mailing address
Lending agency
Mailing address
Agent nnn M~n~.~
Address
Eric Smith Day phone 276-8451
18840 Upper Skyline Drive, Eagle River, AK 99577
Day phone
Day phone
m
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
Co mmunity well
Public water
xxx
NOTE: If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA~21
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 of this Health Authority Approval application 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 ~ ~ _< EH'Z;:.'===;:.'=
17%3_4 Eagle River Loop Road N,~
Address ~;~ ~rlAia~k~...~77 ~/~
Engineers signature
Phone
Date //,7
Se
DHHS SIGNATURE
Approved for ~_~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
~he Munici,l:~ality of A. nch.6rage Department of Health and Human Services (DHHS) issues Health Authority
Appr~oval ce~tific,at, es-baSed only upon the representations given in paragraph 5 above by an independent
pro~essJonal engi~ieer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and t~eir lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72.025(Rev. 1/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
~_.c=,1- L,,. ~z~_ c~. ~_~.~.~ ~ % Parcel I.D.
Legal
Description:
A. Wall Data
Well ~pe ~q~ If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~ Driller
Log present (~N) ~
Total depth "J.-'Z.-~o ~ Cased to
Sanitary seal (~) "~
FROM WELL LOG
Date of test ~,) ~
Static water level ~/--'
Well flow "J~. c~
Pump level1 t-)~Z'-
SEPARATION DISTANCES FROM WELL TO:
Septic/t'+5,_!d!..,'~ tank on lot
Absorption field on lot \.
Public sewer main
,Sewer service line
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: 1 ~-
~/-~' ~.j~--~ - , Casing height
Wires properly protected ~N) 7
AT INSPECTION
.g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
~- ,q~, Other bacteria
Collected by: ~ ~'~
B. SEPTIC/~ TANK DATA
Date installed \~ ~ ~5~
Cleanouts ~1) 7
High water alarm ('~_~__.~'~
Date of pumping
Tank size ~ o~ ¢:~ Compartments
Foundation cleanout([~N) '-/ Depression (Y/~
~ Alarm tested (Y/N)
~ ~ Pumper ~'~_~ ,* ~'f'~
SEPARATION DISTANCES FROM SEPTIC/H~)EDtN~ TANK TO:
Well(s) on lot
To property line
Surface wateddrainage
72-026 (3/93)* Front
On adjacent lots
Absorption field
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pu~l at
High water alarm level ~ ~
Meets MOA electrical codes (Y/N)
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed \\
Length ~
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y~
Soil rating (GPD/Ft2) "7..-~c~ ~ I ~'/..-- System type S~.~P~='.,-%.~ ~' ,-~
Width '~---~'~ ~ Gravel thickness '~' ~ Total depth Ltt
~oo~ cleandut present.N) ¢ Depression overfield (Y(~ ~
Results~[~fail) 43A'-~'~ for ~
'7' }'~-~ After test ~:) ~/~L ~'
,--~.c, ~ ~ ~--~O~ If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ ~ ~-~
To building foundation
On adjacent lots '~
Surface water ~
Curtain drain
On adjacent lots '~ c-~c:~~ Property line
'~5, ~ To fxisting or abandoned system on lot
Cutbank ~ ~- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA
of this inspection.
Engineer's Name
Date /
HAA Fee $ ~¢43 ¢ cJ~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRON MENTAL SERVICES
343-4744
Parcel I,D, #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
(,(~ ~-h- ~ -~]~ HAA # ~ (~- '(~-~ 'L~O
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lOt, block, subdivision, section, township, range)
Lot 6; Block 4; Rolling Hills View Estates Subdivision
Location (address or directions)
18840 Upper Skyline Drive
(b) Proped:y owner Robert Blahut "- Telephone: (home}
Mailing AddreSS. 18840 .Ui~per Skyline Drive, Eagle River, Alaska
(c) Lending Institution Telephone
Mailing Address
Business
99577
(d) RealEstate Company and Agent RED CARPET/GREATLANDREALTY- Lola Pederson
Address P.O. Box 663, Eaqle River, Alaska 99577
Telephone 694-9125
(e) Mail the HAA to the following address: (or check here O0, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING/694-2979
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Number of bedrooms 3
Single-Family []
3. WATER SUPPLY
Individual Well:{~[
ordered by Lola Pederson
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72.o2s (Re,. 7/S8) Page 1 of 2
ENOINEERIN G 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 Munici pal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm Telephone ~;;;~7~''''~-'~-~'~ ~
_~ & $ ;NGINEERING
17034 Eagle Ri~er Loop Road No. 204
Add ress =_,;I. Rlver~ A!'-~" 99577
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 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
Tom Fink,
Mayor
unicipality of Anchorage
Department of Health and Human Services
825 "L" Street
P,O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
October 11, 1988
Robert A. Shafer, P.E.
S & S Engineer
17034 Eagle River Loop Road
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 6 Block 4 Rolling Hills
View Estates Subdivision
Waiver Request #WR88-062, #H88-0407
Dear Mr. Shafer:
Your request for waiver of the required 100 foot separation of
a septic system to a private well has been approved. The
approved separation distance is 93 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
A1 ~undquist,~Manager
On-site Services/Water Quality Program
DJR/ljw #6
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
2 3 1988
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, Alaska 99501
REFERENCE: Lot 6; Block 4; Rolling Hills View Estates Subdivision
Request you issue the attached Health Authority Approval (HAA)
and grant a horizontal separation distance waiver between the
private well and septic tank located on the referenced proprety
at a distance of 93 feet.
The septic system was installed in November, 1975 and inspected
by the Municipality of Anchorage (MOA). The inspection report
claims and approves a separation distance of 88 feet. However,
a surveyed measurement determined the distance to be closer to
93 feet. Health Certificates were issued on April 28, 1977 and
January 10, 1978.
Attached for your review are the following documents:
1. Site plan showing distance between well and septic tank.
2. Waiver request worksheet.
3. Satisfactory bacterialogical and nitrate water sample results.
4. A well log for the referenced well.
It is our opinion that the horizontal separation distance prescribed
by 18AAC72.021 is not required in this case.
If you~/eequir additional information, please contact us.
Si ' erely,
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
MUNICIPALITY OJ' ,~1'~-~ * .......
£N//~p, Of*tMSNTAL SEP. VtCE$ DIVISION
SEP 2 .988
RECEIVED
Legal Description: ~ ~ ~ ~
A. WELL DATA
Well Classification ~
Well Log Present (~N) y Date Completed
Total Depth "~,'7,4~ I to~YCjz¥ I
Cased Depth of Grouting
Static Water Level ~'-"~
Casing Height Above Ground
/If A, B, C, D.E.C. Approved (Y/N)
Electrical Wiring in Conduit~5~'N) y
Pump Set At ~,
Sanitary Seal on Casin¢)
De pression Around Wellhead (Y(:~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot '"~"-~'~--
I
; On Adjoining Lots
To Nearest Edge of Absorption Fiel~o~ Lot
To Nearest Public Sewer Line
~. ~ I-V ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot '~ ' ~
Water Sam pie Collected by ."~ ,~ ~ '_~'~ [ ¢,-~=~1 ~
Water Sam ple Test Results ~'~l~'~"~ _f~,,~r[ ~'~/.~
Comments -~ ~;~¢7 I ~"~-'O ~~
B. SEPTIC/HOLDING TANK DATA
Date Installed !!-~'""~' Size ~No. of Compartments
Standpipes ~/N) V Air-tight Caps~;)/N)
Depression over Tank (Y/~ 1~
Pumping/Maintenance Co ntact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Foundation Cleanou'i~N)
. pate Last Pumped ~=[ ~ I t~ -
for '"'-
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOL-B-tN-G~TANK:
/
To Water-Supply Well
To Property Line
To Building Foundation
To Disposal Field
To Water Main/Service Line
To Stream Pond, Lake or Major Drainage Course
Comments
72-026 (Rev, 7/881 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/~)
Results of Last Adequacy Test
'~-~;t~Iz¢z--~ Type of System Design ~c:~::~?,/'~.~
Length of Field
Depth of Field
Gravel Bed Thickness ~
~:~:~' ':~ Statndpipes Present t~N) '~
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation~
Lot r-~
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots "P-pc>
~, c:~ ~Jr To Cutback (if present)
Comments
Date Installed
Size in Ga'"~
"Pump On" Level at "---~-. ~
High Water Alarm Level at ~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ Pumping Cycles during Adequacy Test
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe¢
inspection.
Signed $ & $ .....~,~=~,~
Company 17034 Ea~lle River Loop Road No. 204
Eagle River, Alaska. 99577/
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
~/~ o~f this
.... (
Page 2 of 2
SCALE
/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY MUNICIPALITY OF ANCHORAGE
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO ~' VA
2. Property Owner: Cbarle.~ T,. M±z]~.r
Mailing Address: Box 554, Eagle Rivert AK 99577
3. Name of Buyer: Stephanie S. Aquinas
Mailing Address: 7960 Resurrection Dr., Anchorage, AK
4. Name of Lending Institution: Coast Mortgage Co.
Mailing Address: P. O. Box 1200, A~choraqe, AK
RECEIVED
FHA CONY
Day Phone 694 2616
Day Phone 335 1216
Phone 279 0665
Name of Realtor or Agent: Harvey Prickett, Alaska Associated Realty
Mailing Address: 4446 Business Park Blvd, Anchorage Phone 274 3556
6. Legal Description:
Location:
Lot 6, Block 4, Rollina Hillview Estates
Mile 1 1/2, Skylin~ Drive. Eaale River
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
Single Family
No Bdrms. ,,~ ~'
Public Utility Individual
If Individual, number of dwellings presently served
If Individua, depth of well 220'
Sewage Disposal System
Type of System: Public Utility
Individual (on-site) x
f Individual, date of installation
1976
EQ-037 (1/74)
,~)~ ~ MUNICIPALITY OF ANCHORAG,F-~ EAGLE RIVER
AREA
l~.~]~X~ ~ DEPARTM: ' OF HEALTH AND ENVIRONME~ L PROTECTION
~~Jt t 8225_ L Street, Anchorao~. Alaska 99501
!'" ~/ ~ 7~--~gC ~e Received: December 16, 1977
~1: Time ~ / ,~5~p r~a ~2: Time ~3: Time
,/ Date ;_ (%. ] ~ C~% Date Date
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES(J
i. Lending Institution Request: Coast Mortgage Compan,/
Mailing Address: 3201 C Street, Suite 101
Phone:
2. Property Owner: Sharon/John Ryan
Mailing Address: Star Route 2 Box 7327 99577
Phone:
3. Legal Description:
4: Single Family Residence: (x)
Multiple Family Residence: ( )
5. Well System: Individual well (x)
Permit # Depth of Well
Construction ~_
Lot 6 Block 4 Rolling Hills View Estates
Number of Bedrooms.~Fo~~~~'~
Number of Bedrooms:
~,-r~
community/Public System ( )
220' Well Log on File (,~/
Bacterial Analysis ~
6. Sewage Disposal System: On-site System (x) ~ f~u~lic~ti~ity ( ) ~.~
Permit ~ Installed C/7 Installer ~ ~-~+/~r--e~4
Septic Tank Size ('00~ Manufacturer .~~
Absorption Area ~ Soils Rate ~O Materialp~.
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
~' " ~MUNICIPALITY OF ANCHORAG[/~
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 9950~.~.~, ~
264-4720
uest for Approval of Individual Sewer and Water Facilities
1. Property Owner: ~ ~&- , -,_ 6L~/~ ·
Mailing Address: ~I~Q~I.F~ ~ ~_7~7 Phone:
2. Name of Buyer: ~(~[ ~, [}~t.~OC~kL~k~~ __
Mailing Address: /~ ~/~ ~ Ph°ne:d'~--0~/ ?
3. Lending Institution: (~~ ~
Mailing Address: ~'0 .-~C~l O ~V~~ --
4. Realtor/Agent: %~ qO~~- C~[~
Mailing Address: ~~ ~ ~ ~
Street Location:
Single Family Residence:
Multiple Family Residence: (
Number of Bedrooms: 4 Number of Bedrooms:
Water Supply: *Individual Well ~ Public/Community System ( )
If Individual Well, well depth ~
If Connnunity System, name of system
Sewage Disposal System: *~n-site System
If On-site System, date of installation:
*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 adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 6 Block 4 Rollinq Hills View Estates Subdivision
Comments:
Affadavit Attached: ( )
Letter Attached: (
Approved~~. Date:
Disapproved: Date:
Department Worksheet:
1st ~_~ns
i~)~ ~'MUNICIPALITY OF ANCHORAGF~'~'
k,?~[~:,,-'-!:I?~,;FME:NT' ,~,~ HEALTH AND ENVIRONMENTAL ,"ROTEC.Tt~ON'~
~ ~-~ 82~L Street, ~,chorage~ Alaska 995~01 '
~' ~,~ % ~7~511, ex-h. 224~ 225 · Eagle River Area
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
I. Lending Institution ~equest: Coast Mortgage Company
Mailing Address: Post Office Box 1200 Phone: 279-0665
2. Property Owner: Charles L. Miller Phone: 694-2616
Mailing Address; Box 554 Eagle River, Alaska 99577
3. Legal Description:
Single Family Residence: (x)
Multiple Family Residence: ( )
Lot 6 Block 4 Rolling Hills View Estates
Number of Bedrooms:
NL~nber of Bedrooms:
Wel'! Data: Type Individual Depth 220'
Construction ~Z{,~_~_f~L~-'~/ Bacterial Analysis
Sewage Disposal System: On-site system (xi Public Utility
/ao V,
Permih ~ ~_ InstaIled
Septic Tank Size ~
Absorption Area ~ Soils
Well Log Filed
,A-
Installer
Manufactnrer ~_~[[~- -
1
~~ to Absorption Area
to Sewer Lines ~. /~_ , Nearest Lot Line
Absorption Area to Nearest Lot Line ~ O
7. Distances: Well to Septic Tank
{ )
Page .Two.
"~ ~Depa'rt~ment~ of?~ea~tth ,and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 6 Block 4 Rolling Hills View Estates
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved:
Disapproved: ~te
Department Worksheet:
