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Home My WebLink AboutHENKINS BLK 1 LT 3 -~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ~ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES g~g?r~.cq~:~ ~CJ~t'KJ ~ SEPTIC ABSORPTION WELL Add~ess TANK FIELD Phone(s) Permit .o. ' Bed-room, WELL t O~1'~ AS-BUILT DIAGRAM (8how location of well, septic syslem, prope~ lines, foundalion, TYPE OF SYSTEM Z% ~ Depth to pipe bottom from Total depth from original grade [ - Fill added above original grade Gravel deplh beneath pipe I i I ~ J ~ 2. ~ Total absorption area Distance between lines ~ ~2 so FT B FT / Number of lines Soil rating Pipe material ~ WELL8 Classification (A,B,C) Total De?h Cased to t REMARKS: / I 170~4 Eeqle River Loop goad No~ 204 cedily thais inspmion was ped0rmed according to all Heallh Depadmen, Approval: ate: t ;()lEV :[ F.~'!' :I: C~N F?'.'.C.d"i Ei;Ni:i:; ]: hlJEE:F:,' ' ~ii; )::)lES :l: (glq i::;:EDL.i :I: i::qES [:)l'"il"'l.~ (q:::'F'RQL,"P¢._ I:::'1::;: ][ E)R TC) CC)NSTF;tL~CT :[ i::~hi,, lq[)"i' :i: F'Y ~:)1 !HS :(':dEi:::'C)F;:I~'.~: F:fi...L. ;i: NSF:I:~i;C;T :[ C)NS ,, ~:~ I... F':iEDU :[ I:(IE'.:~:~ TIqlE Fq:::'I:'F¢.:)F:'F~ ]: ('~Fi'E I:}~:I..E:C'[ I::( :[ ChqL.. :[ NSI;:'IEC'i'' :[ C)N ,, 'T'Fti:L lEX ]] S'F ;[ NG 'I H I ~ I::'IEF~M J: F i. S I:::'C)F~ (:~' :3 }3E~:DFdDC)H ~ Z NE)I...E: I:::'(::~M ]: t...Y RES ]: DEiqC::IE i~: X F:' :[ F,:IE'.:~ (:]i'q :i. ::;~/:5 :)./?O ,, " ~ i ...... ' .... ... ,, !'~(.h-~ ,, .... I .... .... ~::) '.,' .. . . i-ii iL., iC~i' .::~;~.!~r:' ~::u (4 .:.[1~.: ~:;)t'..:T:V~'..(:.:'~ ~..I J .::x:~:-J.,.~:~. ,, ' ' ' :i. ~ ~ '~ .... "':' ..... 6.! ' .. , ! ~ ~ '" :,", j')LIh ~¢ 'J ..,..... .......:.... ::, ~. ,, ,.,,~ .f C;H"~ .... :L ~ C~i' E~fIV a:~(:L'.J .~:';~C:C.~i'YL C.." ,, ....... I J,, ~ ]. 4.. 'r · ................. ... _ " ' ""~ ~ :i. '~..], i,)~' '" ~:~."' ' ") ¢-:'~ ~' ¢~ J 'f :[ ~::~ ~ ~ .~.(-:.:¢~.~ y~:,.3' '" ~~ /~¢~~ ~:.~ ..'~'F E: ~ ........... : %/)/, 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 STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER ce Y ROBERTSHAFER, P.E. ROGERSHAFER January 3 I, MUNICIPALITY OF ANCHOEA~ 1990 DEPT. OF HEALTN & ENVIRONMENTAL PRO~;ECTIoN. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Mr. Bob Mart~n COLDWELL BANKER AREA, INC. 4105 Tudor ¢~ntr~ Drive Anchorage, Alaska 99508 RECEIVED REFERENCE: Lot 3~ Block I~ H~nkins S~5division~ 16207 Old Glenn Highway PM # 222338 Mr. Mart~n, Pl~as~ b~ advised that th~ s~ptic tank on thc r~f~r~nc~d property has b~n converted to a holding tank. as r~qu~st~d. Tweed Excavatlng ~ Construction converted th~ ~xist~ng s~ptic tank to a holding tank b~ installing a bl~nd flang~ on th~ out~t. Pumping of th~ s~ptic tank was completed at this tim~. Attached pl~as~ find an invoic~ from Tweed Excavating for th~ amount for compl~on of th~ job.. of further s~rvic~, pl~as~ contact ~.. ~ SHAFER, P.E. ~/gm ~ OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER rfll ng by DOC Co, dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 DEPTH OFWELL ~/ i? STATIC LEVEL OF WATER Fr. Ended DRAW DOWN FT. GALS. PER HR (, '?.i:: ~9 ./) KIND OF CASING ~':' ,. . KIND OF FORMATION: From (~; Ft. to ~ From ,~'~! Ft. to ,3 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. 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. From Ft. to Ft From From..__ From__ From From ~ Frnm From From From ~ From__ From From From__ From__ From From From .Ft. to Ft Ft. to Ft.' Ft. to__Ft. Ft. to Ft~ Ft. to__Ft Ft. to Ft. __Ft:to__Ft.~ Ft. to Ft. Ft. to__Ft. Ft DEPT. c~ HEALTH & .Ft. to t ":".~ 'i~gU Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME ~': , ~' .-: ~ ' ' :Oay F:'hor~e ~ I...ot Leg a ].: Sub d :i. v :i. s :i. (::~r~ ~ t".IENK ! NS I.,,o'L: ;'.~; B ]. oc: k ~ 1 LcxI'.. S:i.z{~ 2047;5 (sq,, {t,, of' aizPes) P!ax E.',(:.~:,d i' oo~'riE~ ;~ Th i s Per m i 'L: 3 Tota i Cap a[: i t y ~ 3 SIEi;::'TIC "l"Ahll.::;J', M:i.r~imLmt 't:..,'.:)tal se.i::rt'.:i.c 't:.ard< c:apac::it¥= :1.,000 ga].].c~ns, Each septic: · i'..anl.:: taus!'., have at least ;7 COml:~ar'tmer'~t Depth to top of' sept:Lc tank(s) < t' ~.:,e t r' e qu :i. r (.:,:.~s i n s u 1 a t :i. on ~::)v e r' t. an I< (s) WELL..;; Log mL e suL:~m:i.'Lt:.ed 'I:.o ~].:i. ty o~:' Aric::hcCr'ag~~tmerrL of I-leaLLh :I: NSPiEC'T ! C)Ix!,,~ ~ t~ S R ~ F:'I~¢~i .IT :i; S OUT S I DE ~.... ~¢SIEi'~i~TS AND ,,,.::G,...iT...C),::'-t¢,,Ay?~ :'~ I~ SF~TI:C ]"A,'~..< AND E_K.:.E.::'(~t:'F~ARE 'f'[) PP"~I"4'OC)I' 'D 'l-I'l F' ~].<: -.c~:: :::'D F'CR " :::'"'[,::: ....... ,' 7; B:])::~ "¢ S 1[ f,IGL..E FAM I ~'f C: OI'xlLY AND EXF' I ~ZE~:I.~-Z/3 :i./89 ,, { cir'1'..h J:iy 'l'..he JfiLtr'l :i.c :i. pa! :i. ty c:)f' Arichcir'~?~ge (ivJCJA) &tl"!l::J '(..hE~, ~;'(. ,?¢.'(. (.::¢ of' ;::.:,, ): wil:l :Lr~s'La;l. 1 the s'y~iFt'..(.s~ffl :J.r'I acccmdance w:i. th a:!.l MC)A c:c)cJ(.:~.H~i al'Id /¢d'!(:J :J. ri c;c)inj::i]~¢':tric::(E, v~J.'J'.h th(.:~) des:i, gn c:r:J, ter':La o.F th:J.~ per'rnit. 5. :[ wi!I. adhel",:::.~ I'.o a].i MOA em]el S~t-~:'~'(:.e (::~' Alaska I"~:.>~qLI~.r'er¢Jer'F~..s {[:ir' the set d:i.s'LarJces f'r'om f:~l"iy (~x:i. st:f. ng well, wastewat, er' disposal system oi" public: sewe)l'a(L:;8 sySt.~):.)m c~n tl"i:J.s or' alf"Jy ad...jac:er'lt c:)i" i"i~:.:.)ai"J::)y ].c)t,, z:j.,, :[ L(I"iC!E'f'~BtCM"/Q that ::~:z,r'm;i.'L :J.~ va].:i.l::J f'op ~i~ m~ximum c:)t' 3 bec:lr'ooms,, S :i, g n ed: DA'T'E:// ( 0 w n (.:,~ J" ) ]: sst.~ec:l ~.)'>., :: I. A I ~::. ,, SCALE Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST LEGAL DESCRIPTIO.: I~ ~ ~ ~~ Township, Range, Section:~ SLOPE ' SITE 1 / \' _~/AS GROUND WATER ~/ ~- ~---~ ENCOUNTERED? ~'~1~ S 11 L IF YES, AT WHAT O DEPTH? p 12 E' Depth lo Water Alter ' 13 Monitoring? 1 ¢--"q Date: ; b Gross Net Depth to Net Reading Date Time Time Water Drop 14 o¢ 15 16 17 18 19 20 PERCOLATION RATE TEST RUN BETWEEN ~FT AND '~ FT - / COMMENTS 17034 ~ag~a ~n.v~ -~r .......... ~ __.//-/~ j" e~ka 995~ / PERFORMED B~-~ e~ver. Al /b / ~ CERTIFY~HAT THI~TEST W~S PERFORMED IN July 17, 1989 ADDENDUM TO PURCHASE AGREEMENT BETWEEN EDWARD H. SPARKS (PURCHASER AND BROKER OF RECORD WILDERNESS REALTY) AND THE VETERANS ADMINISTRATION (SELLER). Edward H. Sparks 5572 Kennyhill Dr. Anchorage, Alaska 99504 Purchaser acknowledges that the ~ septic system and leach field do not meet the me*edistance requirements from other existing wells on adjoining properties as set forth by the Alaska Department of Environmental Conservation. Further that the existin~ septic system is not adequa'~ in its' ability to l~ach and drain. The seller will remove the existing septic S~ystem oP leach field as required and excavate soils, install new sewer ~mavel and pipin~ as necessary to bring the system up %o working conditions. The new system will be located in the same loc~tion as the existin~ system. Upon completion of the installation of the new system seller will perform an adequacy test to de%ermine the pate of absorption and provide results '~.o puncl.aser. The results of this test must provide a minimally acceptable rate for a woPkin~ system. purchaser waives any remedy concernin~ the location of the newly excavated and installed system. Edward H. Sp~' ? " .08- EGEOTECHNICAL E~ DEVELOPMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils ~ Foundations CO. Earl Ellis 688-2280 Land Development SOIL LOG Performed for: Legal Description: Z¢7' :~, J~ ~ Depth (feet) 0 1 Name: /V'/~, ~..~O/-Y~'/-(-.~. Tel. No. ~-o°~-,277'c- Mailing Address: ~..O,~o,~ 2~"'~t ~IH~, ~, ~-~ Soil CharaCteri~t~c~ ' 3 5 6 7 8 10 11~ Ground Water Encountered: Yes v' No__ If yes. whet depth Proposed Installation: Seepage Pit / Drain Field Co~ents: ~Y~- p/T Vv'~£ ~lu~ .20'r- ~,~ .Y~o~ 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 # -L.[ ~'~ c:i i.~:.(~", ~ ,f~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 3; B~ock I; Henkins Subdivision Location (address or directions) 16207 01d Glenn Hiqhway (b) Property owner V.A.#222338 Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) RealEstate Company and Agent AREA COLDWELL BANKER,REALTORS ATTN: Address 4105 Tudor Centre D~ve Anchorage, Ak. 99508 Telephone 561-2488 Bob Martin (e) Mail the HAA to the following address: (or check here r~YJf hold for pick up.) List contact person and day phone number below: 5 & S ENGiNE-"':Ri!NG 17034 Ea.'-lte River Loop Roa~ ~]o. 204. Eagle River~ Alaska 9.95~ 2. TYPE OF RESIDENCE Single-Family [~3x. Number of bedrooms $ 3. WATER SUPPLY Individual Well ¢NX 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. 72-025 (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 theval[dationdateshown below. I verify that my i.nvestigatJon 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. , Name of Firm Address Date River, Alaska 99577 Telephone (~¢/"t/"'¢---~ '~ ~' ' ¢ .'?.~ ,,, , '<. Approved for~ bedrooms te / Approved __ Disapproved Conditional Terms of Conditiona! .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 order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DO~ Well Classification Je. I Well Log Present (Y/N) ¥ Date Completed Total Depth -~-~ Cased to ~ · ~'/ Depth of Grouting Static Water Level ~"~ ' Casing Height Above Ground ! ~- Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 / oo %/- 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 Legal Description: If A, B, C, D.E.C. Approved Yield Pump Set At u ~' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ./~)t'~ '? ; On Adjoining Lots l CO "~ To Nearest Public Sewer Cleanout/Manhole ~5 ~/~;~ ;Date ~-- Comments B. SEPTiC/HOLDING TANK DATA Date Installed '~'-lT-'~O Size Standpipes (Y/N) ~'~ Depression over Tank (Y/N) I ~..~--g)~, ~l No. of Compartments Air-tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N) · Holding Tank High-Water Alarm (Y/N) A,J/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: TO Water-SuPply Well ~/ CO /'f" To Property Line ( 0 '~- To Water Main/Service-Line I c~ ~ To Stream, Pond, Lake or Major Drainage Course Foundation Cleanout (Y/N) Date Last Pumped ~/~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ! ~0 + LO Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~2/-- I ~ Width of Field ~_.oc, ¢//~ ~"~ Type of System Design - ~0 Length of Field ' Depth of Field Gravel Bed Thickness ~ ~' 0~c/¢¢ ~r Square Feet of AbsortionArea ~ Oo ~ StatndpipesPresent(Y/N) Depression over Field (Y/N) /',.) Date of Last Adequacy Test Results of Last Adequacy Test t,J/~ /k2d'LO SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well [ ~O -('- To Property Line /,D ,-/_ To Building Foundation ! O To Existing or Abandoned System on Lot "'%0 '1"' ; On Adjoining Lots _~_~_~_~_~_~_~_~_'~o ~ To Water Main/Service Line ( O I'l'- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~O '2: Comments D. LIFT STATION Date Installed ~ Dimensions Size in Gallons ~~ Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at % Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection. Signed Company Date MOA No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE £or Work Order ~ 27350 Date Report Printed: SEP 24 90 @ 19:07 Client Sample ID:L3 B1 HENKINS PWSID :UA Collected SEP 17 90 @ 15:50 his, ReceiYed SEP 18 90 @ 17:20 his. Preserved with :AS REQUIRED Client Name : S & S ENGINEERING Client Acct: SNSENGP P.O.~ NONE RECEIVED Req ~ Ordered By : R. SNAFER Analysis Completed :SE? 19 90 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGINEERING Released By : ~~. ~ 2) Special Instruct: Chemlab Ref ~: 903728 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Teated Result Units Method Limits NITRATE-N 4.7 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ. 1 Tests Perfoxmed ' See Special Instructions Above UA=Unavailable ND~ None Detected '* See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL j~ ~ - ~"7~_ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date //~/~ ::~ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) /_°7 g / .% Location (address or directions). (b) Applicant Name /~-,.~/~ o,-'/"-,~/-~ ~'/~"~! Telephone: Home Business Applicant Address ./~ (c) Applicant is (check one): Lending Institution []; Owner/builder [~"Buyer []; Other [] (explain); (d) Lending Institution ~.~o~4"i~L/...d~ Address (e) Real Estate Company and Agent Address ~i'~ Telephone (f) Mail the HAA to the folJowing address: .~ ~, .~ ENGiNEERiNG 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [~'/Mutti-Family [] Number of Bedrooms --~ Other WATER SUPPLY Individual Well E~ 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~J,,.SPOSAL Onsite L_ff Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/8~4) ENGINEERING FIRM PROVIDINL~ ,NSPECTIONS, TESTS, FILE SEARCH, DA'I ~ AND INFORMATION As certifi,ed 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 Jn compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection ....... S & S ENGINEERIN~ Name of Firm 37034 E-_~!e P~'~" IL~p I~oad NO. 204 Telephone ~ ~-'-Z-~¢~;~ ~ .~ Address Eagle River~ Alaska 99577 DHEP APPROVAL. Approved for ¢/'"'~-~- ('E')bodrooms by ~ ~ ~~ Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 homes and their lending institutions in order to satisfy certain federal and state requirements. Employees 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 the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MO,-./ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHOP, AGE 264-4720 ENVIRONMENTAL SEI~VlCES DIVI$10N Legal Description: ~,,~7' RE¢ F[-VED WELL DATA Well Classification Well Log Present (Y/i~. Total Depth f~5'/ Cased to Static Water Level $"G, f Casing Height Above Ground Electrical Wiring in Conduit~__(~q) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed /qr)~?-o~. /$7--o Yield Depth of Grouting - Pump Set At O~/~- Sanitary Seal on Casing ¢~/N) Depression Around Wellhead (Y/I~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line r,./[/~ To Nearest Public Sewer Cleanout/Manhole ~'//'~f To Nearest Sewer Service Line on Lot ;Date Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~;/N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size ~ o0¢ No. of Compartments ( Air-tight Caps ~'~/N) Foundation Cleanout (Y/~ Date Last Pumped ~--/~?~A~ ,:~ To Water-Supply Well To Property Line To Water Main/Service Line Course /"'//,~1 Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test ///'~,,~___ Type of System Design Length of Field Depth of Field / Gravel Bed Thickness Standpipes Present ¢~'N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //o To Building Foundation ~/ Lot To Water Main/Service Line /o~'~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments .--~-_ L]P~-~-~-' .~Y~7~¢,,.4 'T'~ .~tc To Property Line /o/ 4- To Existing or Abandoned System on ; On Adjoining Lots ~o/nc To Cutbank (if present) /"//4 D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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 S & S ENGINEERING Date 17034 Eagle RlYer L~op Road No. 204 Comparw.~,- ,~ .... A~_o~.~ oo,:.~-~ MOA No. Receipt No. z/O O ,," Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Mailing Address: 2. Property Owner: Mailing Address: ~t.~ ~.. ~~.~ 3. Legal Description: ~ //~ v . ~ 4. Location: ~ ~ ¢9;!,~ ~ ~. ~~'~'~ 5. Type of facility to be inspected >~:~~,,'~ NO] Zbedroo~~ ) 6. Well Data:~/~Z/~~ ~ ~/" A. Type ~/~~ B. Depth C. Construct~ ~. Bacterial ~nalys~s Sewage Disposal System: A. Installed ~ B. Installer , '/]-', ~ C. Septic Tank: 1. Size~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area _ 2. Material E. Disposal Field: Total length of lines Distances: A, Well to: septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line GREATER ANCHORAGE AREA BOROUGH ~/~ Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES i. Type of InsPection: CMRO VA × 2. ProPerty Owner: Robert H. & M~rilyn ~. O,,m~ll~ Mailing Address: FHA CONV 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: Dwight M. and Shirley White 102 Marcus, Eagle River, AK DaS Phone 688-2974 Day Phone 694-2348 Alaska National Bank Pouch 7-010, Anch. Phone N/A 277-5511 Phone 6. Legal Description: Lot 3, Block 1. Henkins Suhdlvlmi~n Location: Mile 4, Old Glenn Highway, Chugiak; Ala.~ka 7. Type of Facility to be inspected: Water & Septic 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 65 ft. 9. Sewage Disposal System Type of sYstem: Public Utility If Individual, date of installation 1970 No. Bdrms. 2 . Individual (on-site) x EQ-037 (1/74) Page 2 of two pages - Re:~,st fOr Approval of Individual · 'er & Water Facilities Comments A p p r o v~,~/~.~__.~.~t~L/~~D i s a p p r o v ed Date 4~://,~J~ Approval .,,Valid for one year from date signed Greater Anchorage Ar~a 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. ;:/ "' Date ~'-~/