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Home My WebLink AboutKRAMP BLK 3 LT 6 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion?;;<HV No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. 016 171 15 KRAMP 3 6 STANFORD LAUREN E 11920 NORTHERN RAVEN DR ANCHORAGE, AK 99516 03 29 2023 105 RED JACKET 50C311-8S12 .50 14 MARTINSON PELLETS ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE AK 99518 IrN-W �F41 1 IN" L P T Z L F621 i 'A L A c5 FT 6-1 A MUNICIPALITY OF ANCHORAGE Development Services Department P P - �� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 016-171-15 Legal description KRAMP BLK 3 LT 6 Site address 11920 NORTHERN RAVEN DR Expiration Date: 1/12/23 Current property owner(s) DE LANCEY W RIAN & JANICE M X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: vV Original Certificate Date: 10/12/22 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory X Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Arsenic Advisory Certificate of On-Site Systems Approval # OSC221471 Subdivision: Kramp, Block: 3, Lot: 6 A water sample revealed an arsenic concentration of 18.2 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNUPALITY" OF ANCHORAGE ��✓ � j f. Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 016-171-15 Complete legal description Kramp Block 3 Lot 6 Location (site address) 11920 Northern Raven Dr. Anchorage, AK Current property owner(s) Rian & Janice De Lancey Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: W] Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ® Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NA - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2_26 Waiver Fee $ Date of Payment Date of Payment COSA #, Waiver # COSA Application—June 2022 Legal Description: _ COSA Checklist Kramp Block 3 Lot 6 Parcel ID: 016-171-15 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑✓ Well log is filed with Onsite (or attached) Date drilled 5/1982 Total depth 116 ft Cased to 116 ft ✓❑ Sanitary seal is functioning correctly ❑✓ Wires are properly protected Casing height (above ground) 31 in. Date of flow test for COSA 8/24/22 Static water level at beginning of test 28 ft. Comments B. TANK DATA ured operating fluid level in septic tank Date o ping ❑ Required tanance completed, if AWWTS Comments: Well production at time of test 4.1 qpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes ✓❑ No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 18.2 ug/L ❑ Arsenic less than MRL (ND) Collected by ArcTerra Consulting Date 8/24/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments. D. ABSORPTION FIELD D PUBLIC SEWER Which system tested (date installe ❑ ALL standpipes present per record dr - g Total measured depth from grade ft (m Measured depth to pipe invert from grade ft fmrn. ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 Adequacy test date Results ❑ Pass Fluid depth prior to test _ Water added gal New fluid depth in sed time min Final i depth in in Absorption r gpd FIELD STATUS — T RECOVERY Effective depth (per rec drawings) Effective depth used i Effective depth remaining in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ❑ Yes if No 96* ft Neighboring Tank > 100'✓❑ Yes if No ft Private Sewer/Septic Line > 25' ❑X Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑X Yes if No ft Rv Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No 55* ft ❑X Yes if No ft ❑ N/A – Served by Community Well (not on lot) or Public Water ram Septic/Holding Tank and Absorption Fields) on Lot to: (Please enter distances if less than required) Building Fou > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' If No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Comm IIs > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field is under drivewa ent below F. ENGINEER'S COMMENTS * Waiver previously noted in MOA records G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date 42— Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.4 The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The + �+ OF flow and absorption rates may change due to subsurface conditions that may not be observed from the 4 surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year � *1+ and the water usage of the family being served by the system. The operational life of all well and septic J, I systems are subject to these various and dynamic characteristics and are outside the control of the evaluator 491h !i'^�ii N—A of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will � k 11 function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ■ j encroachments, deficiencies or discrepancies exist % KENNETH M Du S a �/_ CE 7116 !' '''-C+ COSA Checklist -June 2022 I I 10' UTILITY Lot 5 EASEMENTS 30.0' Lot 17 RETAINING WALL N 89'57'20"E'160.17' WELL Z O WOODEN FENCE -- /� 10.0'x13.7' SHED O Z N ASPHALT _ DRIVEWAY m O ---- o, Lot 6 12.8' 0 N Z o 12,013 S.F. 19.6' w 53.3' o a: O D WOODEN FENCE 2 STORY Z, J N of RESIDENCE M M O` m w m Z 4.0'x6.5' DECK -4 74.D' 12.0' 32.4' 00 Lot 16 —o--_— —c ;0—„ S 89'57'20"W 160.17' MWOODEN FENCE Lot 7 5' UTILITY EASEMENT 15' UTILITY EASEMENT MORTGAGE SURVEY _X_ SCALE _ 1"_= 30'_ GRID __SW_2733_ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, i n c , (907) 522-6476 Phone ooOF Opp (907) 522-4625 Fax oo O A Professional Land Surveyors kenolongsurvey.com o y jonathanOlangsurvey.com O�P� �S4o0 I hereby certify that I have surveyed the following described property: OUj: D LOT 6, BLOCK 3, KRAMP SUBDIVISION (PLAT No. 64-44) 49TH— '• � G Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a �•""""""' C representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any inaccuracies 0 z '; ' KENNETH LANG r that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other improvements. Q s l�( O N 4F ''..LS-5202.•' cp4O Dated this the �— Day of _ b��"��'��`- , �_�_�•_, at Anchorage, Alaska 4Q Oa �Oo �QQ rCSSIONAV �o It is the responsibility of the owner to determine the existence of any easements, �p000o�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELt. lNG 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location 'address or directions) [/? · /3 (b) Property owner ,%, ~1 rll dY) /~ 2~'1;/~.//~ /'~ ~'.'~"/f-,"~F-; 7. (Tr.~Jephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here"!~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'i~ Number of bedrooms 3. WATER SUPPLY Individual Well~[ 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'~ Comrnunity [] 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,[verifythat 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 flies 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 /¢~-~ .5 Telephone Address f¢'/'~'~" ~G~ /~,4/'~/-~,2~.. ,,,¢,~ Date '-~ 6. DHHS APPROVAL Approved for ? ___bedrooms Approved_ ~/'/~-~ Disapproved Conditional Terms of Conditional Approval 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 ordertosatisfycertain 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 ,~"~\~l\s\q~UNICl PALI'TY OF ANCHORAGE (MOA) ~ ,~l~,v~~'~ ~*ra~_,'~,~ Health Authority Approval (HAA) Well Classification ~/~ If A, B, C, D.E.C. Approved (YIN) Well Log Present(~N) Date Completed ~"- Total Depth //~ ' Cased to //& ' Depth of Grouting Static Water Lever ~-~' Pump Set At Yield Casing Height Above Ground / Electrical Wiring in Conduit ON) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~'/..4 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by /~'-~¢- ? Water Sample Test Results /~/4d- 7"-,, C' Comments Sanitary Seal on CasingON) Depression Around Wellhead ; On Adjoining Lots /J/,4, ,' On Adjoining Lots ~///~ To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA -D.~talled Size No. of Compartments Standpi~ Air-tight Caps (Y/N)__ Foundation Cleanout (Y/N) Depression over 'l-"m~~____ Date Last Pumped _ ~d~g~;ntH~Cw~f~tl;~tm~_~ ~rk ~er~ SFPARATION DISTANbbS' FROM:~EPTIC/H~K: To Water-Supply W~II ' '..- '" ____ To Bu"t~oundation To Property Line .... __ To Disposal F-k~._____ To Water Ma!n~Sc~r. vice.-L,,!ne.';;:','",' .;.';.,::; . To Stream P~)nd b'ake"or M'aiorbl;ainage Course 72-026 (Rev 7/88) Fronl Page 1 of 2 '~.-.~..,.~. C. ABSORPTION FIELD DATA Type of System Design Length of Field Depth of Field ~.x..~l~ating in Absorption Strata D a}e48~l e d __ Width of Fi~~..~ Square Feet of Absortion Arb&, Depression over Field (Y/N) ~ Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION Fl'~b~.' To Water-Supply Well _____ T'e~perty Line To Building Foundation _ ~ TO Existing or Abandoned System on Lot ; On dA joirdng Lots "-.,,....% To Water Main/Service Line To Cutback (if pres~ To Stream, Pond, Lake, or Major Drainage Course TOcommentsDriveway, Parking Area, or Vehicle Storage Area '"'~-x~ D. LIFT STATION --D~lled Size in Gallon'}'~ "Pump On" Uevel 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) -~-.~i~..~., ~ during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideli inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back elinCs, in effect on the date of this &~.&.~~. :~¢r ~ngineer's Seal Receipt ~o. - -- Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I,D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~)/ ~ / '~ /? '~'"' HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here'S', if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family~[~ Number of bedrooms 3. WATER SUPPLY Individual Wel I'~ 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-o25 (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 flies 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 ~_5 Telephone Address /~/r/~ ~ ¢ ~ ~ Date / ~ -~ ~ 6. DHHS APPROVAL 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. TheMunicipalityofAnch°rageisn°t responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present~(~N) Total Depth //~' Cased to Static Water Level '~ ~ MUNtCIPALt'TY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: Date Completed //~ Depth of Grouting If A, B, C, D.E,C. Approved (Y/N) ~._~/~ Yield Pump Set At Casing Height Above Ground Electrical Wiring in Conduit(~N) ! Sanitary Seal on Casing(~N) Depression Around Wellhead (Y(~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ."~--~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments (~ /.,.,/~-L-~- ,,~/-~/¢0 ,"¢//~ ; On Adjoining Lots .x..///~ / 4//~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole.~ /~Az:-,A// ;Date //%.¢0 B... SEPTIC/HOLDING TANK DATA ~"~O('~LI¢-.-~ _~-%E~-*='7'-'~ '/ led Size No. of Compartments Standpipes"'(-V..L% Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tan'~-~Y~_ __ Date Last Pumped _ Pumping/Maintenance Conta"c-t.~le (Y/N) __; for Holding Tank High-Water,Alarm (Y/I'~p.._ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM .SEPT C/~'6~NG TANK: To Water-Supply'Well . ,. ~lding Foundation _ To Property Line __ To D~l~o~ield __ To Water Main/Service Line ' : ~ To Stream, Pond, Lake or Major Drainage Course ~ Comments ~%. 72-026 {Rev. 7~88) Front Page 1 of 2 C. ABSORPTION FIELD DATA '~~ating in Absorption Strata Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Square Feet of Absortion Depression over Field (Y/N) ~"%_ Date of Last Adequacy Test Results of ~ast Adequacy Test "'%%,_ SEPARATION DISTANCE FROM ABSORPTIO~LD: To Water-Supply Well '~,~o Property Line To Building Foundation ~ To Existing or Abandoned System on Lot ; On Adjoining Lot~..%. To Water Main/Service Line To Cutback (if'l~t) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area '"'""% Comments D. LIFT STATION "Pump On" Levelat -'~. High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Comments 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 effect on the date of this inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back / ,~-6¢ g i nee r's Seal Waiver Fee: $ Date of Payment Page 2 of 2 fiFt-" < <l ; BILL SHEFFIELD, GOVERNOR a DEPT. OF ENVIRONMENTAL CONSERVATION a Telephone: (9o7)274-2533 y address: 437 E. Street Suite 200 Anchorage, AK 99501 January 19, 1984 Mr. Alfred E. Sunquist, P.E. Anchorage, Water & Wastewater Utility 3000 Arctic Boulevard Anchorage, Alaska 99503 Dear Mr. Sunquist: Subject: Kramp LID X6146 Waiver Request RECEIVED .SAN 2 3 1984 Anch. Water & Wastewater Enaineerina Div. The following waivers are granted for the horizontal separation distances between private wells and public sewer lines and manholes. The waivers are conditional on the fact that the sewer line and manholes be constructed as dictated in your waiver request letter, same subject, dated December 8, 1983. Lot 6, Block 3: Waive horizontal well to sewer line separation from 75 ft 50 ft. Waive the horizontal well to manhole separation from 100 ft to 95 ft. Lot 5, Block 3: Waive horizontal well sewer separation from 75 ft to 60 ft. Waive the horizontal well to manhole separation from 100 ft to 75 ft. Lot 4, Block 3: Waive the horizontal well to manhole separation from 100 ft to 95 ft. Lot 5, Block 2: Waive the horizontal well to sewer. -line separation from 75 ft to 70 ft. Lot 9, Block 2: Waive horizontal separation between well and sewer line from 75 ft to 34 ft. Waive horizontal separation between well and manhole from 100 ft to 75 ft. Sincerely, C:� Bruce E. Erickson Environmental Engineer BEE/msm Time Time me • rel (, � �:r�� C�-��1 �o�-E � Date Date \ Date ka-s- �1 Inspector Inspector Inspector IC OF ANCHORAGE Comments �\ h -r a'o Conditional Approval R E C. E I V \I m�� c►�u - �0 Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank _ APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Phone Mailing Address _ Buyer Address Lending Institution m t Phone Address Realty Co. & Agent Phone Address Legal Description Street Location�,�� Typq ! Residence �- ,�jSingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Wate Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewage Disposal Individual Year Individual Installed: Public Utility When Connected to Public Utility: ft ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.