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Home My WebLink AboutNORTON PARK #3 BLK 1 LT 6 d oZ 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. # Of(..,._ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner I~NO DOCTOR Mailing address ~.o. ~o'~ I¢rOI88 Lending agency ~. 6,/~. Mailing address 15-oc* tx/. Agent N~,~ SO~r~-T, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY; Individual well Community well Public water NOTE: Day phone If community well system, provide written confirmation from State ADEC atfest- ins to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. ?2-025(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/orwastewaterdisposal system is safe, functionaland 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 ~',LATTOP TECH Address / ~'53o ECHO Engineer's signature ,].¢~'~ ,~. DHHS SIGNATURE ~.~'"~,..~_ Approved for ~L-"-~F~'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments --,.r:l. ljl i [~] ~ 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 & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _LOT ~, BLk' I ,. NoRToN ~RK~'$ Parcel I.D A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number ~./~. Date completed Io/5/77 Driller P~'NN JER$£Y Cased to 38'0 Casing height_ Iff" Wires properly protected (Y/N) Y' Date of test Static water level 2q Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot bt Public sewer main __ ~ ,.~'O ' f Sewer service line 2. 3 WATER SAMPLE RESULTS: Coliform 0 co( Date of sample: FROM WELL LOG AT INSPECTION g.p.m. '~ ~'¢ ~¢~/¢4'") ; On adjacent lots ~./I. ; On adjacent lots N.8, Public sewer manhole/cleanout ';~ Io0 ' i¢¢.t'n d',o. Petroleum tank NONE Nitrate ,4, ¢, ! m,.,~ ('-¢~ Collected by: TA. DATA ti.^. Date installed Tank size Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Other bacteria Compartments _ Foundation cleanout (Y/N) Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION ~, /~-. Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Weal on lot On adjacent lots D. ABSORPTION FIELD DATA ~.A, ~ ~ ~cz-¢ o(_ Date installed Soil rating Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION Surface water Gravel thickness Cleanouts present (Y/N) Date of adequacy test for If yes, give date System type Total depth bedrooms On adjacent lots Property line To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, F. Signature Engineer's Name Date Waiver Fee: $ Date of Payment Receipt Number Date of Payment Receipt Number A CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAl.. TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Member of the SGS Group (Soci~tb G~n~rale de Surveillance) ~A/, 4~O"V/C/~,,~, ._ ' v W~O,'vx~'~.~v o,~x~v MUNICIPALITY OF ANCHORAGE '~ DEPARTMENT OF HEALTH & HUMAN SERVICES ~/ ~ /"- DIVISION OF ENVIRONMENTAL SERVICES ' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~ OF ON-SITE SEWER AND WATER FACILITY~ ~p/~ Application Date ~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or/irections) (b) Property Owner "~/¢/~'¢-'~ Telephone: Home Mailing Address '~" Business (c~,' 'Lending Institution :.Mai'ling Address Telephone (d) Real Estate Company and Agent /~.'.~'/~'""~' Address (e) Telephone ~>¢~,,-x~- ' '7~-. ~'-~ ..... Mail the HAA to the followina address: or: Check here .~if hold for pick up. List conta~~qd day ~h~e nu~b~ below. TYPE OF RESIDENCE Single-Family~'J~ Number of Bedrooms WATER SUPPLY Individual Well'~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] 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. Page 1 of 2 7¢-o25 IRev 8'~61 Fronl 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 HeaJth 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 /,Z.-o ~ /,,-) DHHS APPROVAL Approved for ~ bedrooms by Approved ~)~ Disapproved Terms of Conditional Approval Conditional Date CAUTION 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. Page 2 of 2 72 02s CRev 8/86~ Bao* MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHOP. AHGE¢LTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION rE8 1 8 1988 WEL,.,:,AT^ RECEIVED 264-4744 Legal Description: z.~>'~C-', /Tz ~4/Z / /o,~.'?;:~.a Well Classification Well Log PresentON!. Total Depth ~',."-y'..9 Cased to Static Water Level (~ ~ /' ~2 " Casing Height Above Ground /, Electrical Wiring in ConduitCN) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line 7~ '"¢' Cleanout/Manhole Water Sample Collected by Water Sample Test Results ~"¢,,'fd "/- '-¢' C.~mments (~.3 '://¢'~ '~/CIv//¢~/-~/ If A, B, C, D.E.C. Approved (Y/N) /'-///~ Date Completed ~/.~ ..5~ ~7¢ Yield Depth of Grouting Pump Set At '~'"')/'~ Sanitary Seal on Casing .(~)N) Depression Around Wellhead (Y~_.,¢ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer ~j , To Nearest Sewer Service Line on Lot /~' ~:"/i~-'~/ ; Date f SEPTIC/HOLDING TANK DATA.~/)~ "~led Size Standpipes'~(~ _ Air-tight Caps (Y/N) Depression over Tank~(-Y.Z..~. ____ Pumping/Maintenance C o n t ~ac"~'~N) Holding Tank High-Water Alarm (Y/N) -"'--. No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: ~ To Water-Supply Well To B'~0ttu d'~u~h ounFoundation .ro.e,t..,.eTo . '~ To Water Main/Service Line. To Strea~'l?P...o. nd, Lake, or Major Drainage Course '""'~ ........~..~ Comments Page 1 of 2 72 026 IRev 886~ Fropt ABSORPTION FIELD DATA /.,~,,~//~ ting in Absorption Strata Square Feet of Ab~_ Depression over Field (Y/N) ~ Results of Last Adequacy Test ~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Meier Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) ' Date of Last Adequacy Test ~Y LineTo Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present)~'-........~ LIFT STATION Size in Gallons-'"'"----~_ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at '~'~--~ Vent (Y/N) -~C~.ycles during Adequacy Test. Meets MOA Company Receipt NO, ~' Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha~.~c//becp/ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. SignedL/'~'~/~-~ //~/"~-'- Date Page 2 of 2 72 026 fray 8'861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. · 5633 BSTREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 Client Sample ID:L6 Bi NORTON PK PWSID :UA Collected FEB 9 88 8 07:00 hrs. Received FEB 9 88 ~ 16:00 hrs. Preserved with :NONE AHALYSIS REPORT BY SAMPLE for Work Order ~ 5117 Date Report Printed: FEB 12 88 9 07:59 Client N~me: AECS Client A(:ct : AKECSRP P.O,~ NONE REC'D Req ~ Ordered By : A, WIIIN Analysl9 C~pleted :FEB lO 88 Send Reports to: Laboratory Supe,r.vt~or :STEI?H~ C, EDE I)AECS Released By :~i~;/~/,~C. ~' 2) Special Instruct: Chemlab Ref ~: 9060 Lab ~pl ID: t Matrix: Water Allowable Paraneter Tested Result/Units ~ethod Limits NITRATE-N ND(0.10) mg/I EPA 353,2 10 S~ple ROUTINE SAMPLE Remarks: COL[,ECTED BY A, WIEN 1 Tests Performed * See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample Remarks Above NA: Not Analyzed LT=Lees Than, GT=Greater Than bCONICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application DateUpv~mber 6, 1984 (a) Legal Description (include lot, block, subdivision, section, township, range) ~_~.~lock 1. Norton Park Subdivision,__SE__l/~of Section 19 T. 12N. R. 3 W Location (address or directions) _~O~_est 123, Anchoraqe, Alaska (b) Applicants Name Peter Jarratt Telephone - Home Applicants Address 207 East Northern Lights, Anchorage, Alaska (c) Applicant is (check one) Lending Institution ~ ; Owner/builder~ ; Buyer ~ ; Other ~ (explain>; Real Estate A~ent (d) Lending Institution _3~/A Telephone Address _ N/A Business276-1333 (e) Real Estate Co. & Agent Heritage Hon~s Address 207 East Northern Lights (f) Telephone 276-1333 Mail the HAA to the following address: Hold for pickup . 2. T~pe of Residence Single-Family ~--~] Number of Bedrooms 3. Water Supp1L Multi-Family~ 2 Other (describe) Individual Well ~----] Community ~-~ Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewa e Dis osal Onsite ~ 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. [Page 1 of 2] 5. E__n~ineerin~ Firm Providing Inspections~ Test~s. 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 regula- tions in effect on the date of this inspection. Name of Firm A. W. Murfitt Con~mly Address 8010 Kin%o~treet, Anchor~qe, All Date November 6~ 1984 (ENGINEER SEAL) Telephone 349-7531 ~' ,~.: / .~ , :, · ~'~q' :' ' l" ~. ' ' ' DHEP Approval Approved for /o~'c~ bedrooms By Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRO~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF H~[ES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ~PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TIlE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 ~W~LL yT~T,D TEST RESULTS TJ_m~ I4eter Readi rigs Total Ellispe Gals/ Date Start Finish Start Finish Gallons Time (miq) l~in_ 10/30/84 10:45a 2:45p 3374 3964 590 240 2.46 Murfitt Company ~,~]~ Yieqd Test Results Lot 6, Block 1, Norton 5ubd Arctic Civil and G~technical En~ineerins Consultants Jobno 84-117.01 _~n~KK~Dote30-31-84 Anchorage A]aske A® MUNICIPALI'fY OF ANCHORAGE DIEPT, OF HEALTH & MUNICIPALITY OF ANCEDRAGE (MOA[NvIRONM[:NTAL. PROTECTION HEALTH AUTHORITY APPROW~L (HAA) NOV 'l 0 '~'(~': CHECKLIST - FEBRUARY 1984 WELL DATA Legal Descriptj. on.[~ ~.~C ~--~ [ ~/~ ~ Norton Pork SUk_~d~vi.qion.. ,gE 1/a n~ .q~n~innl9, T. 12N, R 3W__ Well Classification __Single Fan~ly_ If A, B, or C, D.E.C. Approved.(Y/N) N/A Well Log P~esent (Y/N) Yes Date Cor~)leted 10/5/77 Yield_~]~Igin TotaI Depth 380 f~ Ca.,S~.>d_~ to~ 114 feet Depth of p~outing N/A Static Water Leve ~ ~5 f t '" ~-~~P Set At · ~ ~ ). : . .~ - 8 f~e~ ~- _ Casing Height Ab°~Gl~Cur~d~!~'~.5{~[~} ~ ....Sa~ita~y Seal on Casing (.Y/N)Yes Electrical Wiring in Conduit (Y/N) Yes Separation Distano~s from Well: To Septic/~olding Tank on Lot N/A To Nearest Edge of Absorption Field on Lot ~N/A To Nearest Public Sewer Line Depression Around Wellhead (Y/N)No ; On Adjoining Lots N/A ; (~ Adjoining Lots N/A To Nearest PublicS ewer Cleanout/Manhole 220 feet To Nearest Sewer Service Line on Lot 26 feet Wate= Sar~le Collected By Cherie MgCraken ; Date 10-30-84 Water Sample Test Results Satisfactory Comments sewer servic~ line assumed to be at riqht anqle with main sewer line to clean-out next to house. 36 feet from well to edqe of driveway, 8 feet from SE corner of the house to well. ~- · Date Installed N/A Size N/~j-~ No.~of C~19art~nts N/A Standpipes {.Y/N) ~.~ '~ Air-tight Cap~ (Y/N) ~n Foundation Cleanout ( ) Yes / Depression over Tank.(¥/N) ~/~ Date Last Pumped ~/~. / Pumping/Maintenance Co~tract on File (Y/N) N/A ; for_N/n / Holding Tank High-Water Alarm (Y/N) N/A Temporary Holding Tank Rer~,t/!Y/N) N/A Separation Distances f~om Septic/Holding Tank: To Water-Supply Well N/A To Building Foundation Q<5 feet To Property Line apProximately 32 feet To Disposal. Field ~/A / / To Water Main/Service Line N/A To Stream, Pond, Lake?/or Major Drainage Co~men~No cap on clean-o~. Structure is on public sewer [Page 1 of 2] u 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed N/A Width of Field N/A Square Feet of Absorption A~ea N/A Depression over Field (Y/N) N/A Results of Last Adequacy Test N/A Separation Distance frc~l Absorption Field: To Water-Supply Well N/A To P~operty Line N/A Type of System Design .N/A Length of Field N/A Depth of Field N/A Gravel Bed Thickness N/A Standpipes Present !.Y/N) N/A Date of Last Adequacy Test N/A To Building Foundation N/A TO Existing or Abandoned System cn Lot N/A ; On Adjoining Lots N/A To Water Main/Service Line N/A To Cutbank(i.f present) N/A To Stream/Pond/Lake/o~ Major D~ainage Course N/A To Driveway, Parking Area, or Vehicle Storage A~ea N/A Conments Structure is on public sewer D. LIFT STATION Date Installed N/A Size in Gallons ~/A "Pump On" Level at N/A High Water Alarm Level at Tested for N/A Electrical Codes(Y/N) N/A Conments Dimensions N/A Manhole/Access (Y/N) "Pump Off" Level at N/A N/A Vent J.Y/N) N/A Pumping Cycles during Adequacy Test. M~ets MOA Structure is on public sewer Check Permitted BedrocmRating Against HAA Request I certify that I have checked, verified, or conformed to all MOA on the date of this inspection. Signed Company A.W. Mnrf4 f~ Company KB1/d5/s Date 11-5-84 MOA No. _~ [Page 2 of 2] lnes in effect 2-15-84 -- D, .: RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE MUNIOIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT, OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION AU~ ~ 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~~I~S~ DI~ECTION~: Complete all parts on page 1. Inuomplete requests will not be processed, Please allow ten (10) days for processing, ~iLl~g A~RESS /[ , / PROPERTY RESID~T (If different from ab~) 2. BUYER %~ ~ PHONE ._ MAILING ADDRESS 4, REA~/AGENT ¢ ('/ ~ - J PHONE 6, TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBER OF BEDROOMS [] One BI Four /~ Two E} Five Three ~] Six Other 7. WATE B~ S/IJPPLY /J~ INDIVIDUAL* /~ COMMUNITY PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is recruited for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/C N-SITE** ,./~ PUBLIC UTI,LITY YEAR ON-SITE SYSTEM WAS NSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ',~010(Rev. 6/79) ¢ 1~ ~¢~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~ gL Connection VerifieOe"'~}-~)~ ~ ~j~ '~:~_ ¢-~1/y' . INSTALLER []Septic Tankor [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS fi~;~-- APPROVED FOR '"~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED .,/~ DATE ,,'x~ c~ ORr, GE, AI_/!SKA '264 ,'1 '111 August 10, 1981 Chris L./Mary J. Gilbert Post Office Box 10-1458 Anchorage, Alaska 99511 Subject: Lot 6 Block 1 Norton Park Subdiw[sion ~3 Approval. for the individual sewer and water facJ. li'ties cannot be granted until the following item have been completed: (1) The water ana].ysJs report needs to ]De submitted to this office from the Chem Lab, 5633 B Street, fOL- our rew[ew. If there are any fucther questions~ please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 720 99510 % Annyce Hensen Brian Kent Company Post Office Box 791 99510 MUNICIPALITY OF ANCHORAGF DEPARTMEnt, JF HEAI. TH AND ENVIRONMEN'I~,= PROTECTION 825 L Street, Anchoraoe. Alaska 99501 264-4720 #2: Date Received: April 20, 19'78 Time _~l~O~ ~3: Time Date _~i~.-7~_~.~ Date Insp ?_~{__ Insp REQUEST FOR APPROVAl, OF INDIVIDUAL SEWER AND WATER FACILITIES 10 Lending Institution Request: Alaska Statebank Mailing Address: 2. Property Owner: Mailing Address: 310 East Northern Lights Blvd. Hicks/Jones Phone:_ 279-7.637 Phone: 3. Legal Description: Lot 6 Block 1 Norb~o Park Subdivision 4:. Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Two Number of Bedrooms: Well System: Permit tl Construction Individual Well (~ Conununity/Public System ( ) Depth of Well Well Log on File Bacterial Analysis Sewage Disposal. System: Permit tl Septic Tank Size Absorption Area On-site System ( ) Public Utility (x) Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest ]Lot Line to Absorption Area Absorption Area Page Two Department of Health'and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 6 Block 1 Norton Park Subdivision Comments: Affadavit Attached: ) Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: RECEIPT c R [.Et, lit, lED iVlAIt--~30c (plus postage) SFN~ TO POSTMAI~K OR DATE STREEF AND NO. P.O., STATE AND ~i~66D~ PS Form Apr, 197 ] 3800 NO INSIIRANC[ COVEIIAG[ PROVIDEO-- llOT FOR N/ERNATION^L MAlt, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROT£CTION 2510 East Tudor Road, Anchorage, Alaska 99§04 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner:_ ,~.~2---) CONV Y' VA_ FHA Mailing Address: Day Phone: Mailing Address: Da Phon~: 4. Name of Lending Institution: ~~~~ ,~ Mailing Address: Phone: 5. Name of Realtor or Agent: ~ Mailing Address: Phone:_ 8. Water Supply Public Utility Type of Supply: No. Bdrms. ~ Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76)