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Home My WebLink AboutT12N R3W SEC 9 LT 88 N198' Municipality of Anchorage page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waslewaler Disposal System and/or Well Inspection Report Permit Number: '-SV//'~'D~L~I PIDNumber: ~1 ~- ~/-~J ~NI~ ~A~ ~ ~N~) Wastewater System: D New ~Upgrade Address: ~ ~ o. ~y A~ o ABSORPTION FIELD LEGAL DESCRIPTION so~, ~,~: WELL: Q New D Upgrade Gravel w,dth: ~ FI Number ol~linesI~ D,stance between lines:~ Ft. Yield:GPM I Pump Set al: Fl I Casing Heigh[ Above 6~ound:Fl TANK , SEPARATION DISTANCES ~s***io ~ ,o~i~, ~ s.*.*.*. Well le ~ ~q~ Material: 5~-( Number of Oomp~,,ents: Surface Water ~lo~C ~o~< LIFT STATION Bemarks: BE~GH M~BK ENGINEER SSEAL. Inspections performed by: Dates: 1st Department of Healt~a~ Hgm~n-~ervices approval Reviewed and approved ~;Z~,., ~ ./~¢~ uat~/-~ 72-013 (Rev. 9191) MOA 25 I -1 PS O 05 SO 75 lO0 l?S SCAL£, ]~ = 50 FL I'OB£EM SPUt?KLAND P.E, 205 ~/ 15TN, AVENUE ARCH. AK. 99501 (907) 279 3916 A/198' B£~i LOT 88 SEC. 9 [12N RSW JAMES AND ANN LANIER SEPTIC SYSTEId ASBUILT DATE: JUNE 24, 1994 SHEET: 2/5 GRID: 2555 REMOVE EXISTING TANK EXIStiNG TRENCH [RENCH CLEAN tRENCH ~ON/[OR DOUBLE CLEANOUTS 1250 GAL SEPTIC TANK DOUBLE CLEANOUIS 75 'LONG 12' DEEP 5' ROCK M~:o F'/ .: Ft o£ Sc~,of.,'c ~ N/J SCA/ 91,8 88 TOBBEN SPURKLAND P.E. 205 W15th Ave Anchoraae Ak 99501 279-,39'f~ II N193' BLM LOT 88 SECTION 9 fl2N RSW JA~IES LANIER SEPTIC SYSTE~ ASBUILT DATE: JUNE 24, 1994 SHEEL' 5~/5 GRID: 2555 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 2O DATE PERFORMED: Township, Range, Section: ~LOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth lo Weter Alter Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (mmutes/Jnch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND __ FT COMMENTS PERFORMED BY: ~'~. ,~ I %,~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~:~/¢2'7/'~ ~/ 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGR3~DE) PAGE 1 OF 1 PE~ZT PERMIT NUMBER:SW940141 DESIGN ENGINEER:TOBBEN SPURKLAi~D, P.E. OWNER NAME:LANIER JAMES F & ANNE P OWNER ADDRESS:P.O. BOX 230330 ANCHORAGE, AK 99523-0330 DATE ISSUED: 5/24/94 EXPIRATION DATE: 5/24/95 PARCEL ID:01424101 LEGAL DESCRIPTION: T12N R3W SEC 9 LT 88 N198' LOT SIZE: 58782 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE EXISTING TEST HOLE SHALL BE DEEPENED BY 2 FEET TO VERIFY SEPARATION FROM BEDROCK.~ A SECOND TEST HOLE SHALL BE DUG TO VERIFY SOILS CONDITIONS AT THE NORTH END OF THE TRENCH. RECEIVED BY: ~ ( DATE: DATE: T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN N198' LOT 88 SEC. 9 T12N R3W JAMES LANIER No Ground Water or Impervious Layer to 15.5 ft. Use Standard Trench Soil Rating. From test May 3, 1994 5.7 min/in = 1.2 9al/sq. ft. Use 0.8 gal/sq, ft. Required Area per Bedroom: 150/ 0.8 = 187.5 sq.ft.. Nuntber of Bedrooms 4 Required Absorption Area: 4 x 187.5 = 750 sq. Invert Elevation Tank Outlet. 97+- Elevation Testhole Bottom 88 Locate Bottom of Trench at 92 (Verify no hardpan to 18 feet) Use 5 feet of rock Length of Trench 750 / 10 = 75 ft. CONFIGURATION STANDARD TRENCH TOTAL LENGTH 75 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 10 - 12 FT. ROCK DEPTH 5 FT. COVER 5-7 FT. SEPTIC TAiw-K 1250 GAL. ABANDON EXISTING SYSTEM PUMP AND CRUSH EXISTING TANK ft. The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design N189' Lot 88 Sec.9 Municipality el Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAIN WAS GROUND WATER kid ENCOUNTERED? IF YES, AT WHAT ~' DEPTH? pO E Depth to Waler ~r ¢O/Z r~onitorin07 ~ Date: ~ 2O PERCOLATION RATE (mmutes/~nchJ PERC HOLE DIAMETER lEST RUN BETWEF-N "7 FT AND 'F ,~,~ FT COMMENTS Gross Net Depth to Net Reading Date Time Time Water Drop Fir/ ~{~./,~ ~:,¢-~ P.4¢~-, P-- ___ ~ ~ ~ ~ ......... _ ; ~ /~ ~7'/~ ~ ~ CERTIFY THAT THIS TEST WAS PERFORM~ED IN ACCOROANCEW.THALLeT^TEANOMUN,C.PAL U.OE .NEStN. ECTONTH.S*TE. °ATE: 4¢/A:,. 72-008 (Rev 4/85j ~AC~T I I V~C~NT 50 0 50 100 150 [ I~O0 ,%'ALE, 1"' = 100 F)~I ~A£T A TOBBEH SPU£KLAND P.E. 205 W ISTH. AVENUE AMEN. AK. 99501 (90Z? N190' BLkl LOT 88 SEC. 9 T12N RSW JAMES AND ANN LANIER SEPTIC SYSTEM DESIGN DATE: MAY 2, 1994 SHEET: l j5 G£1D: 2555 TB~ ELEV. lO0. O0 / IOL8 /nsh 107,4 ££Al E~ J' = ,50 [[)BBEN SPURKL^ND P.E. J 203 W ISTH, AVENUE SUITE 203 Ab/EH A~(, 99501 (907) 279-3916 FAX 27'6 6013 A/198' l?Z P/ L D 1' ,98 SEC. 9 ;I£N ~31,/ JAMES AN/) ANN LANI£A? SEPllC SYSTEH DESIGN DATE: HAY P~ 1994 SHEET: ~/~? GRID: 2335 REMOVE EXISTING TANK EXISTING TRENCH TRENCH CLEAN OUT TRENCH ~40NITOR T DOUBLE CLEANOUTS 12,50 GAL SEPTIC DOUBLE CLEANOUTS 75 'LONG 12' DEEP 5' ROCK Cleonouls i'4oo/toF' 4' Topsoil 5' Coven 103,8 4' MiD Corec H,'F o £; ] 4 0 5 F? oF' ,?epL,'c Rock ~ NIl SETIIi 9P I~5~ 9ol. sep{,'c tank EIzWCII MARl(: NW proporlv Corner Assumed Elev. 100.00 TOBBEN SPURKLAND P.E. 205 W15th Ave Anchoroqe Ak 99501 2Y9 59~ N 98' ELM LOT 88 SECTION 9 T12N JAMES LAN/ER SEP~C SYSTEM DESIGN DALE; MAY ~ 1994 SHEEk 5~5 GRID.'2535 I TBI¢ ELEK 100.00 I / ~,~ ~ / z~ zlz ~ / I, , o'o o o~o~6%So~5~o°o o o o°o°ol - 5ASI / I I .~~ ~1 · ~""-" "?" .'~,. ' i ~--,-,-.. --~ .,:.."?~'-"'. ~ ...... i I I ':"' 85 0 25 50 75 I00 125 155 ANCH, AK, 99501 SEC. 9 fl2U ~31¢ I DATE: /fAY ~ 199~ (~07) 279-3916 F&X 276-6013 JAMES ANb ANN LAN/EA?~ SHEET: ~/3 GRID: ~235 (~0 GRE, ,ER ANCHORAGE AREA BOR..dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM '~ ~ ~ ) PHONE SEPTIC TANK: FROM WELL /~]~[ MANUFACTURER ~ __MATERIAL_ COMPARTMENTS INSIDE LENGTH .__INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT¥/.~-~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /'~'~) ~'~ t ,' TOTAL LENGTH FOUNDATION /g') ~ .NEAREST LOT LINE /~'2 OF LINES ~g~-~) , NUMBER OF LINES DISTANCE BETWEEN LINES __ TRENClt WIDTH~-~ IN. TOTAL EFFECTIVE ABSORPTION AREA ///~ SQ. Fl'. LENGTH OF EACH LINE '.7[2 ' DEPTII! TOP OF TILE TO FINISH GRADE ~// I DEPTH OF FILTER MATERIAL BENEATH TILE ~ ' 4~. ABOVE TILE ~ IN, WELL: BUILDING FOUNDATION CESSPOOL APPROVED _ CONST RUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE TANK SYSTEM OTIIER SOURCES DISAPPROVED REMARKS --DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LO TS LOPE: REMARKS: Form EQ-032 DATE ,~/_/,,~L ~t'APPROVED ~/~? 4~.~t¢^~;.~ G.A.A.B. {,~) GREA R ANCHORAGE AREA BOR IGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF ~ ' MAILING ADDR['S$ PHONE INSTALLA'rION LOCATION __ ~ INSTALLATION OF: SEPTIC TANK ................ SEEPAGE pIT , DRAIN FIELD ....... , OTHer , TYPE AND SIZE OF FACILITY TO BE SERVED_.__ COMPLETION DATE ANTICIPATED TO NEAREST LOT LINE. WELL TO SEPTIC TAN K ~- / y~/~rep~C-~4~oYob ~P~-g CAST IRON INTO AND OUT OF' SEPTIC TANK AND INTO CRIB CROSSING GAp OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL I CERTIFY TI4AT I AM FAMILIAR WlTII THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO 28-68 AND THAT THE ABOI October ].5, 1975 R & M No. 5621~. Char Les Cox 32011 Cottonwood Anchorc~go ~ Alaska RE: Test Hole and Soil Log Report for Sanitary System North [L98 feet o'~ Government Lot 8S! ~R 1/~ Section 9, T 12 N, R 3 W, S. M. ]Dear Mr. COX: We are submitting herewith the test boring resu[Lts and our conm]enns regarding soil conditions encountered at the s~ject site. This inves- tigation ~{as performed 'in accordance will your request of October ]3, 1975, and those.procedures outlined inca letter dated July 2.5, 1975, by Mr. Roll Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single,test hole was put dovm within the Section 9 area for the purpose of defJ.n~ng genera], subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rzg and the test hole was extended to a total depth of 17.0 feet below ground s~rface. The final log prepared for the test hole has been included in Drawing A~O1. Ground wa~er was not encountered iH the test hole. We appreciate being given this opportunity to be of service to you. ~hould you have any'c~]ostions with regard re> tim above, p]aase do not Very '~×'~ly yours, R & M CONSULT~2qTS, INC. Jmaes W.1 Rooney Vice President JWR/WED/Ja Encl. xe: GAAB Central TEt_aX O90-aS4~O ; ~, GRE/ ~R ANCHORAGE AREA' BOF JGH / ~ , /7' ~,/' TELEPHONE 274-4561 ,~~~% ~PPLICATION AND PERMIT PERMIT NO. PHONE LEGAL DESCRIPTION 7~)'~ //~'/' /""/ SEEPAGE PIT -, DRAIN FIELD , OTHER SEPTIC TANK SlZ TYpe CONFORM TO So~ ~N~ RE~A~DIN~ '~;7 SEEPAGE AREA SIZE TYPE I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGH ORDINANCE NO 28-68 AND THAT THE ABOVE ~ .,~ ;~ ~ , 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) ~(o/~, /~J~¢7~/ Property owner Mailing address Lending agency Mailing address Agent .~,ob Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 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 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. NameofFirm i ~,~ ~,¢~_.[,~_~:2 '-'~.~__ Phone ~7c~--~?/~ Address ¢~¢~ ~' / ~f ~ ~ Engineers signature f~~~~ Date DHHS SIGNATURE ',~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 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. 72~25(Rev, 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. O I t'/ -,2 q l- A, Well Data Well type ~ Log present (Y/N) Total depth Casing height Cased to ~ '7 Sanitary seal (Y/N) / If A, B, or C, attach ADEC letter. ADEC water system number ['"~/~ Date completed ~J~ /7~'- Driller L~./J-2~cn..~'~ Wires properly protected (Y/N) AT INSPECTION ; On adjacent lots ; On adjacent lots Date of test Static water level Well flow Pump level1 ,~ ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I co %. Absorption field on lot ILI O FROM WELL LOG 7- o Public sewer main Sewer service line WATER SAMPLE RESULTS: Public sewer manhole/cleanout Petroleum tank Coliform Nitrate Date of sample: q/I,51~ G/~-'i/¢"I Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~/'~:~/R) ' '( Cleanouts (Y/N) / High water alarm (Y/N) Date of pumping Tank size 1~ ~.-~0 Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) ~"/~t- Alarm tested (Y/N) ~"///,,~,- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot %4L~''/¢~ TO property line Z~ ~ Surface water/drainage P~ On adjacent lots Absorption field Foundation ¢;~' Water main/service line ~ .~ O CONTINUED ON BACK PAGE 72-026 (3/93)' Front C, LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level et High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot D. ABSORPTION FIELD DATA Date installed ~/~'-~/~/~ Length '~ ,~ Width Total absorption area 'TSO Date of adequacy test f"¢//~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) On adjacent lots Surface water Soil rating (GPD/Ft2) o (~ System type ¢~- Gravel thickness '~ .-~ Total depth [ Cleanout present (Y/N) ~/ Depression over field (Y/N) Results (pass/fail) ~ for ~ ~ After test ~ ~ If yes, give date On adjacent lots ~ /o 0 Property line To existing or abandoned system on lot Cutbank [%.~ o ~. -~ Water main/service line DrJveway, parking/vehicle storage area ~d;L~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I L~ O TO building foundation On adjacent lots ~ o Surface water ~ ~, Curtain drain ~ Bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name HAA Fee $ .~--~, Date of Payment Receipt Number 72~026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number CT&ERef.# Client Sample 13) Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services al~,'~j,~r~-~-~-jj,~-~-j~e-~r~rf~'jf~jjffjjj~jj~ LABORATORY ANALYSIS REPORT 94.3179-5 POTABLE N198 LOT88 WATER Client Name TOBBEN spLrpdALAND, P.E. WORK Order 79800 Ordered By TOBBEN SPUI/2G~AND Printed Date 06/28/94 ~ 11:21 hrs. Project Nmne Collected Date 06/24/94 ~12:00 hrs. Project// R.eceived Dar e 06/24/94 ~ 16:00 hrs. PWSB-) UA TecheicalD/rector STEPI:LEN C. EDE Released Smnple Remarks: ROUTTNE SAMPLE COLLECTED BY: T.S. QC AlLowable Ext. Anal Parmneter Results Qaal Units Method Limits Date Date Init * See Special Instrtmtions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed · U= Undetected, Repor~edvalue is the practical quantification limit. LT= Imss Ihan ~ D- Secondary dilution. GT= Greater Tn~ 6633 B Street, A~ehorage, AK 995`18-'1600 --Tel: (9071 562-2343 Vax: (907} 56] ~530~ ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA ENVIRONMENI'AL PaOi'EC~ION ~UNI~IPALIT? O~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825LStreet'Anclmraoo, Alaska 99501 /~ ~ REQUEST FOR APPROVAL OF INDIVIDUAL WAT'[R AND SEWER ~~ 1. PROPERTY OWN EP~-~) t'( ~ F' ,~"L ('~ ~-~ '~) ~(~'~:~ ('(~' 2--PRONE -- PROPERTY RESIDENT (If different from above) 2. BUYER MAILING ADDRESS PHONE PHONE 3, LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT MAILING ADDRESS PHONE 5. L E G_G.~,~O ESC R IPTI O D-3 STREETLOCATIQN O.~0 iG 6, TYPE OF RESIDENCE ~.._ SING LE FAMILY [] MULTIPLF FAMILY 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTi LITY 8. SEWAGE DISPOSAL SYSTEM NUMBER OF BEDROOMS [] One [] Four [] Other [] Two [] Five (~..~1~[. 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.) ~;~- I N DI VI DUAL/ON-SITE** [] PUBLIC UTILITY **if individual/on-site, give installation date/~_[ '[~ S- If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FlEE MUST ACCOMPANY EACH REQuEsT BEFORE PROCESSING CAN BE INITIATED, 72~10(3/78) ;-.." ': , , j ~.zt.t ) THIS SIDE FOR OFFICIAL USE ONLt, DATE RECEIVED INSPECTION APPOINTMENTS TIME IME 'IME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM E31NDIVIDUAL/ON -SITE []PUBLIC UTILITY Connectidn Verified [~]Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TOTAL ABSORPTION AREA 4. DISTANCES WELLTO: MATERIAL~ ~¢ ~'~-~'~* ¢~.~ Septic/Holding Tank Absorption Area Sewer Line [] OTHER Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter mus~com[ [] DISAPPROVE~D ~ . DATE ~ I \ ~' I BY (Title) /~ ~ LEGAL DESCRIPTION ficate) 72-010 (Rev. 3/78) August 16, 1979 John P. Selden [~616 A'i]]3ott Loo~) Roatl Anchorage, Alaska 99507 Subject~' 'i'12N R3W Section 9 N19~ of Lot 88 SI!:~ Approval for your individual sewer and water facilities (~an not be granted until the following items have been oot.~plet ed: (1) 9,~b.~', water analysl.~t report be dellvezed tc ~.his office from Chem Lab, 5633 B ~]treet, for o~r rev~;~w. (2) 'i~he septic tank pumped with a receipt submitted to thi{3 office ~ If %~h~e are any fu~:ther ques'tions, please toni:act t:his office at 264--4720. Sincerely, Rob()rt Co Pratt~ i(oS. Associate Speciai/ist RCP/lw S¢~eurity Pacific Bank ~4ortqage Loan D~partment 2525 C Street '-' Suite2S02 99503 Richard F, Buchanan, M.D. Liver & Dl§estive Diseases John F. SeMen. M.D. Nephrology Patd L. Steer, M,D. Internal Medicine & Infectous Disease George L. Stewart. M.D. James B. Watson, M.D. Thomas C. Wood, M.D. lnternal Medicine Associates, Inc. A Professional Corporation 3500 LaTouche Street Suite 310 Anchorag% Alaska 99504 Phone: (907) 274-5550 August 21,1979 Robert C. Pratt,R.S. Associate Specialist Departmen~ of Health and Environmental Protection Municipality of Anchorage 825 L Street Anchorage,Alaska 99501 Subject: T12N R3W Section 9 N198 of Lot 88 S.E;.t/4 Dear Mr. Pratt: I have enclosed copies of the water analysis and the receipt from the septic tank pumping service 'indicating that I have complied with your request so that my individual sewer and water facilities can be approved. A copy of this has also been sent to Dr. James Lanier at Providence Hospital who is the buyer of my house. Sincerely, John F. Selden,M.D. JFS/pw cc: Dr. James Lanier GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C~' Street, Anchorage, Alaska 99503 274-4561 Date Received ~ - ×~- 7~J Time of Inspection t~$~0 .~ Date of Inspection Approval requested by: Mailing Address: 2. Property Owner: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR (~~ ~-~ Phone: Mailing Address: 3. Legal Description: /J /¢~' y, · Z~ 5. Type of facility to be inspected, ~f~z~.2~i~ ~/. No. of bedrooms 6. Well Data: C. Construction ~ D. Bacterial Analysis A. Installed B. Installer C. Septic Tank: 1. Size ]~/F~ 2. Manufacturer 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 3330 GREATER ANCHORAGE ARL/, BOROUGH Department of Environmental Quality "C" St,, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV Mailing Address: ~_0(~'___4~/~' ~%-j7~- _]ay Phone ~.)~- 3. Nam .; Buyer: %~.~ ~ Mailing Address: ,]~.-~. (~;~ Da,y 4. Name of Lending Institution: /~-X~]~~~ Mailing Address: Phone Name of Realtor or Agent: _ __~/_ __ '~ 2~::'(%)EZP ~ '5~/- Phone Mailin9 Address: :_~ _~ o Locati ?~ Type of Facility Water Supply Type of Supply: If Individual, If Individual, 'bO be inspected: Public number of Utility ........ Individual _/V~__.. dwellings presently served depth of well Sewage Disposal System v Type .of S~stem: Public Utility If Individual, date of installation Individual (on-site) ~___ Page 2 of two pages - Ret st for Approval of Individual ~ ir & Water Facilities L~gal Description Kpp r o v ~ :~/~{~.-~ Oi ~/approved Date Appr~_~r, Valid for one year from date signed Greater Anchorage Area 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) ~e_~et,V ~ pue- ~'o,~iqnd. X~e.~o~2~ '$Z6I 'tlo~eI~ to X~p t[~OI Sttlt atu eao/aq pa~osqns pu~ u~oz~S First }~tional Po O. And~o~e~, Alaska 99510 A'i~IT~I0~L' ~9aret F~it 8616 ~b~)tt ~op P~ad fi~s. A n~{ ~r sys~m ~mis~3 of a n~; 1750 galt~ ~eptiC ~m~ ~d a ~nf:[~ld (size (~n(~ ~ ~1 ~t) will P&~ r~fmm~ by J~y 1~ 1975. denc{~. A t~-{~r~ af~proval will be grin%ted r~%ding the~ esc~c~ of ~;un~ m d a o0mp].et~{%4% dat~ of ~].y 1, 1975, sn~c~r~ly~