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HomeMy WebLinkAboutBUBBLING BROOK LT 1\%«m1 ^ ��� ��� � \\ � ^� r \� � ~\\ ~ � � � «/.: \ . / \ » ,.: \ � .� Development Services Department Building Safety Division On-Site WaterWastewater Program , k4d 47000 BrogowStreet P.O. Box 196650 Mark Begieh Anchorage, AK 99519-6650 Mayor www mun. nm/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: _/ �r Parcel Identification Number: -y0a- 13 DescriptionProperty Legal LL%�I��1�-� 13j -00L, - �i LOT -1 Owner Name & Address: OeoGA�D 7WeM/as 42,1 �a74'AN: Pump Installation Date: 7/14 Pump Intake Depth Below Top of Well Casing:/ 78 feet Pump Manufacturer's Name: ;eZ4 _%c,tL T PumpModel: CJ✓S /9, 6S Pump Size �� hp Pitless Adapter Burial Depth: /2 feet Pitless Adapter Manufacturer's Name: ON Pitless Adapter Installer: �p Well Disinfected Upon Completion? (Yes ❑ No Method of Disinfection: Comments: Pump Installer Nami ANCHORAGE WELL & PUMP SERVICE, INC ?30 EAST 76TH AVE. ANCHORAGE, ALASKA 99518 (907)243-0740- FAX:(907)243-0742 E-MAIL: pumpmanjim@att.net Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 1? -01? IR,- 3/7R1 MUNICIPALITY OF ANCHORAGE - �� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑ NEW �Ahi ICL HoL-A& 2 z .UPGRADE MAILING ADDRESS GO Z81 1 CLE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS -QD J Well Absorption area Dwelling PERMIT NO. DISTANCE TO: loo + 100+ UY F Z Manufacturer Material No. of compartments aQ wF GRE1=R I Liq. rapacity in gallons IF HOMEMADE: Inside length Width Liquid depth 0.S J z L-1Well IS NCEO: Dwelling PERMIT NO. _ Manufacturer/ �C f -t `A Material Liquid capacity in gallons SO 0 p Wel11J Foundation Nearest lot line PERMIT NO. w = DISTANCE TO: ID } 2-S J LL Z No. of lines Length of ea h line Total length of lines Trench width 3fD�KQ'8i Distance between lines Z w BEDinches ~ �Top of file to finish grade Material beneath file Total effective absorption area 0 3 inches1-7 18 Length Width PERMIT NO. Lu Type of crib ;Depth Crib diameter Total effective absorption area as LU LU Building foundation crest lot line ti DIST Class Q Depth Driller Distance to lot line PERMIT NO. J 1 , a I �r Lu Building fou ine Septic tank Absorption area(s) DISTANCE TO: QF 111- 1 �tr}~� •a' A�q OTHER .� s. PIPE MATERIALS 4'R .�'� • r • �N 000i1e0...H•s� r.•ir • O SOIL TEST RATING �� ` ■•• .rrr•• �•OT _;• INSTALLER 1 �i� CE 5130 LOUE ( ASC- �X ac.AVA M.,, �C, .. <y Ext r REMARKS OFESSI`�►''r' I -TAMr-4 `y '�i� S oCIL zT KI+ -IC Swe-11 3 Yp x E ► C, 1sZ rr ed e cu't o t S LE ve e V AP VED DATE LEGAL 12 1? -01? IR,- 3/7R1 • • • • • • • • • • POST IN A CONSPICUOUS PLACE • • • • • • • • ' ' ' 24 HOUR NOTICE IS REQUIRED FOR INSPECTION SERVICE ELECTRICAL 'APPLICATION AND PERMIT BUILDING SAFETY DIVISION X E C Xis MUNICIPALITY OF ANCHORAGE No. t 1 3500 EAST TUDOR ROAD PHONE 7868211 INSPECTION 563-3464 DATE BUILDING ADDRESS/0C PERMITTEE OWNER k t ELECTRICAL PERMIT FEES N0. @ FEE LOT BLOCK ,n� ` /J _ v tv . PERMIT FILING FEE iK L e CONTA$TOR / (f (Jp/IJCE a TEMPORARY SERVICE RESIDFNGE SINGLE FAMILY NEW ADD ESS DUPLEX NEW AUDI IONA1. DESCRIPTION OF WORK y REMODE-IN NEW D ADDITION ftl,� EPAIRS ❑ SIGNS ❑ ) " IF OTHERS. SPECIFY �:� �, `. 1�4 r � �•�"� REMARKS ----------------------------------- e_ A �F TOTAL FEE "�yr have reatl the above application and know the contents thereof. the �� IVED same Is true and correct. I runner agree the above work will be done in' FEE accordance with all state and municipal laws and ordinances. BY DATE (� PERMIT EXPIRES IN 360 DAYS IF WORK PERMIT APPROVED & ISSUED IS NOT COMMENCED BY AUTHORIZED OFFICIAL X> It J 0 ' SIGNATURE 0F RM TEE OR AGENT 84-009 (Rev. 10i83) CUSTOMER COPY r-1 wil I REEXAMINE AT NEXT INSPECTION [I DO NOT CONCEAL UNTIL REINSPECTED COMMENTS < Lr ATF INSPECTOR WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE 84002 (Rev. 2/83) INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION DOR 3500 EAST ROAD ADMINISTRATION (907) 786-8211 INSPECTIONS (907) 563-3464 PERMIT NO. NAME PHONE STREET ADDRESS JK /DATE LOT/ BLOCK SUBDIV. El ELEC. TEMP. PLBG- UNDGR. - El FOOTING -❑ BG. ROUGH - ❑ ELEC. SERVICE PLAS ❑ FOUNDATION T El EMP. ELEC. ROUGH (� ❑ BOND BEAM E] ELEC. FINAL El,e-tAS 0 FRAMING - 1:1 OTHER [0' MECHANICAL INSULATION MECH. FINAL SHEETROCK El FIRE FINAL❑ PLBG. FINAL El STRUCT. FINAL - ❑ ZONING _--- OTHER OTHER El CORRECT IONS ESSENTIAL AS NO NONCOMPLIANCE OBSERVED EXPLAINED BELOW r-1 wil I REEXAMINE AT NEXT INSPECTION [I DO NOT CONCEAL UNTIL REINSPECTED COMMENTS < Lr ATF INSPECTOR WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE 84002 (Rev. 2/83) ff:��� ~ D�PARTMEM[ OF HEALTH AN� ENVlRONMENTAL PROTECTION . 825 L STREET, ANCHORAGE, AK 99501 '-' ^ 264-4720 P�R�l7 NO: 86O376 � DAlE lSSUED: 10/05/�� �`- � A|`|`�-lCANT: DANIEL E. HOLM AUD�ESS: 62O1 BUNNYSHOE CIRCLE ANCHORAGE, AK 99516 LEGAL DESCRIP: SUBDIVISION: BUBBLING BROOK LOT: 1 BLOCK: NA SECTION: 23 TOWNSHIP� 12N RANGE: 3W L2lS1IE: 1.25A (SQ.FT. OR ACRES/ M�� BEDROOMS: 4 ** DEP[H TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULA[ION ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK MUST HHVE AT LE�ST TWO COMPARTMEN[S I certify that� 1. l am <amiliar with the requirements �or on-szte sewers and wells as set �orth by the Municipality o nchorage (MOA> and the State o{ Alaska. 2. I wi1I V., at the system in accordance with all MOA codes and regulations, and in compliance wzth the design criteria o[ this permit. �l wzl1 adhere to all MOA and State of Alaska requirements �or the set back distances �rom any existing well, wastewater disposal system or public sewerage s�stem on this or anv adjacent or nearby lot. 4. I understand that this permit is valid [or a maximum o[ 4 bedrooms and any en1argement wil1 require an additional permit. 1F� Ll| [ 3TATION lS INS�ALLED IN AN AREA CDVERED BY MOA BUILDING CODES, AN EL�CTRIC�L PERMIT AND IN�PECTI�N MUST BE �87AINED; (2) AS-BUILTS :I|) NU[ �E APPRO�EU WITHOU\ AN ELLCTRICAL 1NSPEC[ION REPORT; AND (3> THE E SED ELECTRICIAN. 4P�'LICA�T: DANl HuL� ��S�ED B� DATE: /�/-�-----�----7-------------- - ----�--r------- �` } . ^ `^,7-/� ^ '--/� ./\/_ /- c�+� ��c^'- t�u-/ |4- / ". / r . _- �' ' /—'' ' ^-' '^- =;r �et -1 Z11�� , ,S d•-owI q �a.s geen< mcd;-g'ed Gy hte gineeR a-nd sko, 06e used rok i l/vsi4a de Por-PaseS on%y. 7'Ap- off' added gees awe app►oxema- on/y aM4 406Je41 A C . ;5,& $1A.—C..;I," 0 r I /&-a L17-1 7Y i oe Ez S0.00 e /,V 0� 27 ZS S�1 v� s Flo E Gv u �T- ,S d•-owI q �a.s geen< mcd;-g'ed Gy hte gineeR a-nd sko, 06e used rok i l/vsi4a de Por-PaseS on%y. 7'Ap- off' added gees awe app►oxema- on/y aM4 406Je41 A C . ;5,& $1A.—C..;I," ', SOILS LOG - MUNICIPALITY OF ANCHORAGE ® PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 'll 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:—DA N AOLMES DATE PERFORMED: 9 IID`E6 LEGAL DESCRIPTION: �-.�T 1 RuIr1Q R2.00iC ci nvF SITE PLAN Y ( T OB 1 2 ..o 3 r. s 4 0 •` o 5 C M-17povP GREY r- AKy 6- 7 8 9- 10 10 `•4 WAS GROUND WATER S 11 '6' _4'� 1° , ENCOUNTERED? yes O 120I`P„• ~i�.p�a W YES, AT WHAT10 G2 C 0 13 • • .tEPTH? 4?49 1 4 14- 15 4 15 16 17 s192018- 19- 20 COMMENTS ­J& PERFORMED BY 72-008 (6/79) .•<• •a•.eeu N• N• •• .•.� N.� N t C. BarMr s' •.� CE 3930 ,.� asst► a� ©FESS�o?�':4' 4 Alt Reading Date Gross Time Net Time Depth to Water Net Drop 1 6 /b 3 -/ /0:3 rA/ PERCOLATION RATE 'S 0 (minutes/inch) 184 $F�Boa+y ,.7,r &Vq t9 6s4ed' TEST RUN BETWEEN FT AND 3-- FT `� • e az 4A CERTIFIED BY: DATE: �" d3 - X SOILS LOG MUNICIPALITY OF ANCHORAGE V PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DAQ 14OL.MES DATE PERFORMED: "1- Iy'66 LEGAL DESCRIPTION: O S - o. it i eopw 1 Date Gross Time Net Time Depth to Water Net Drop 9•'6° 3- ''� b /5/6 4 4- :�� 5 5- 6 6 b• 1: Zl la M a 9:21 8 z ley G 9 r q: 3 2 t � •' ■■■ ■UNN Blom INN SOWN NORM ■■NE ■■1,■ ■■1,■ MEN 10 T .r`►GG o� Ac M,, � �';'•. � ♦L+� � � WAS GROUNDWATER 11 �y����• ENCOUNTERED? 12 G "'' �t r'• *�I, e� �: ,***eMe YES, AT WHAT s PTH? 13 • �N� �P t 0. =arfer 14 tii0 CE 51�Q : a' so 15 <�``�'i�'°�� qua► 16 17 18 19 � �LC v9'E' SITE PLAN S jes L O P E ►o° Reading Date Gross Time Net Time Depth to Water Net Drop 9•'6° ''� b /5/6 :�� 1: Zl la M .5 9:21 z q: 3 2 t � /o 3 9 � 5�2 / /'►ti � S~ Ia 946 !� 9c S3 O M 20 _rrj y PERCOLATION RATE 4P�j(minutes/inch) Ms%sf,8DANt TESTRUN BETWEEN � FT AND �' _ — FT COMMENTS U.1w- tp_ I,3eGAt, AA o+ 4se- 8� I e.ae-� . j PERFORMED BY: 72-008 (6/79) CERTIFIED BY: DATE: lR-,,"8L ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: �A T To l %/lt5 DATE PERFORMED: I I-3 - A L LEGAL DESCRIPTION: L04 l ICU O � � I VIQ dJ1�00� r-rTn7rLT SLOPE SITE PLAN ( ) 6& 1 �q� •�9 1 R 149YN Net Time r Net Drop 2 /1-3 •5: io 3 �- t •�� 1 i S 13t � 4 c 5 6 7 s f 9 10 11 � 12 . 13- 3141516 14- 15- 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) ex Of A �q� •�9 1 R 149YN Net Time Depth to Water Net Drop 0. Barw CE 5130 4-k, o CCAS GROUND WATER S ENCOUNTERED? L O P IF YES, AT WHAT E O DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop /1-3 •5: io 6 sib -7 A �- 1l-3 •�� 1 i S 13t � PERCOLATION RATE -S7 (minutes/inch) v7q - SP/9"w-TEST RUN. BETWEEN FT AND _.-- FT �tffl�,, CERTIFIED BY: DATE: 11-3- —klf 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGI I �S{ 825 L Street - Anchorage, Alaska I pil-,{'�l� cP ri ON-SITE SEWAGE DISPOSAL SYSTEM ANWWU DELL INSVM340N REPORT NAME •� ` 1G80 PHONE J j NEW UPGRDE C% MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDROOMS LOCATION C'-/V<.,w SrJc` Ger✓n7 Well Absorption area Dwelling PERMIT NO. DISTANCE TO: (' f 't 966,9,51 UY H Z Manufacturer Material No. of compartments 2 CL Q N F %L Liq. capacity in gallons Inside length Width Liquid depth be)5IF HOMEMADE: Well Dwelling PER�� NO. S O DISTANCE TO: -1 aZ O Z Q Manufacturer Material Liquid capacity in gallons S H p Well Foundation Nearest lot line PERMIT NO. DISTANCE TO: j t� S 7 5 To JLL Z No. of lines Length of each line Total length of lines Trench width / inches Distance between lines IC iyi i Z w ~ Q 'C) Top of tile to finish grade ;' Material beneath the Total effective absorption area F inches Length Width Depth PERMIT NO. W Q H Type of crib Crib diameter Crib depth Total effective absorption area as w W Well Building foundation Nearest lot line cn DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PI PE MAT ER IA LS y 1 P/-4.51/ ,- 00 .2 1 y TA .c ru E—cm—t /,v/.l, t: i SOIL TEST RATING G 2 ✓0 INSTALLER it n 7"7 - REMARKS REMARKS ja i5 t �� t f T/ C� /l d .L r.. / S �Q t:I C. : A t SC r ,r, ti, .-7 - 2 _ - - ..'��QF A�*�' r 7 'T ZA.`. .. * ♦ s lip .ti Ro1Ph & Jokil <u at T APPROVED DATE LEGAL 72-013 (Rev. 3/78) Tyoe of soil absorptinn systs- in? TRVWC;� Ilayinown n(Men of hydroomy T4e rwavi-ed size at the CA no C" 17 0, The lenith dimonsin- in thy Taonth li" Foot) ... trench or drainfield.. Tka depth of o tranch ._ vP i. •::. toe dintance 6etween the surface of the qrnq�n Y"A Tha kn��,w 0; �o (in fayt�;, Tkn-y in ra vef "WAK Kn- t�G-c�±o; Tkj UpnVej depth ho thE dapO wi yow,vi wetween the outfall pipe e -A M hakfow of tnn SY00-00iw- �Lr resc-2 �on i �4,0 ��n '5q Q000�� loll hi; W L",unm inio department during the �r any "Olin SajoLunt to Win Ppoperly and we n"Wkn, gz rovidnoco� thpi the oyj� �jj� gypag:1 .......... 1 1214 % v 10 to, IN 1E lot !±.. "LLu"i L -i 1. iL:-. E)i ........ ....... x (3 1 is! 0 :1 RarkTIMPq of Y -Y nyq?oy wllk� vt�o! ond approval by dywartment will kq wuhjm�t to - a aa , _ ... �- gan c sandy silt, OL C , brown, sandy Silt, ML ;rrr, .roti!n. gfave?y sandy silt, SM W A tea«;p, bravm, sandysilt `M ' Y c Ci -c:, sm, ? gray -el - o'. torn ground water table at time of drilling t Derculation test - 30 min/inch - _ v ,? 23 0 ,';r. Buster '!o SITE AND SOIL CONDITIONS tW. S te �s �1 660 ­­�t and Pavenw foot squa re parcel having access from Rockridge, Dr i ve on tlh,3 "ui" ood -outheasterl iM visibn n -1ihe south. The s -*4-(, o. is dissecte,(i -in j, directi n by T 'he wqrr-�` slovel-� a ors; of tine Little Gane _�l'' CrotaE:> )r)�`ormlL: Y fror-,] southec'st +0 northwest per Est an s located in -) into two very d,s,� c ner . th s n r) e s r, excess 0 f 25`x. The par�' cel May b- divided charact ori.c;tics. map sln; or purposes Of i de n t I fy i n g pt,; -c tj 1 a f, on to �00 �-aCter ej- f ."100 00t' Wide band centered or) the C-ec' ri,.annel is illi -vial deposits and consists a ;cis and ri.,ve s pp4 imari ly of i.:-� I 1 9 L I tj good perculation Test lhojr, 2, tP�g"' r-" 'h , -;s dePOsit. Reyond this band, the materiats er, and t is depionstrated by test holes 1, 3, 5, 6 - 30 an.J, CoNcUis MIS 711 mir i1num percu',i "_--7 gn rates observed i n - the field for the. fol 1 ci,.-ii nq holes Test Hole Nuri!T,,,r - 30 minutes per inch Yes t tjo'ie Numher 2 - 1,13— m's nutes per inch Test Hol e rJ i t) e r 3 - 30 minutes per inch Test Hole N't r� " 5 c r 1) - 35 m 1 n u t e s per inch Test Hole Nlurn):,r 5 - 45 minutes per inch lest Hole N u r, i be� r 7 - 60 mi nil Ites per inch Hoie Numbr,r R - 5 rtri nu tes 'per inch p Hole NUr. !)e Y, o - ;minutes p e r inch v.,,aste d;sos,'�! pSystems appear feasible on all lots. On I tF An aerated package �ant or other trca-;-JTient process 3-5 advisable for the lots L i(jh percula- ;,-,!on Yates. Wi,1-h 1)4 'ye �)'OPc' this is sUffic-70,T14- for your present needs. If we can offer further Aaci fication, pleaie do not hesitate.to contact us. Very truly yours, art D. Korynta, P.E. At tachments K/ c �,.� ro �' �� GG /r i �I f i � .. C�+ " �< 11 �n y ��„ , .iC" �.,. . . i • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH_ VIA 1� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 1c3 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) lit 1 _R�j 66� R Re -,o K Location (address or directions) (b) Applicant NameH-oU,e's• Telephone.,Home 3416 2,623 Business Applicant Address Gab1 :~ Qv►►nv (c) Applicant is (check one): LendiIg Institution ❑ ; Owner/builder 0; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution FIR4 .-LwAM 4AL Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms �=-o u P, 3. WATER SUPPLY Individual Well o 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. SEWAGE DISPOSAL Onsite X 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 72-025 (11184) 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 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 Address Date Telephone 34c,, 1(78 1� )F 4,( ash 1 1 I� >fr go �s •w• .• • •••••••r = �� Y D. sorter ,• ��,5 Engineer's Seal `� `��.•'• CE 3130 v~�� dew s at 6. DHEP APPROVAL _� Approved for IM �4 tZe, bedrooms by at f �/ Approved Ilk 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 72-025 (11;84) NCN9}h*IPALITY OF ANCHORAGE (MOA) OMU�,yICIFAIt �HEALT DEQT ,)Ui AUTHORITY APPROVAL (HAA) ENYIROtiME CHECKLIST - FEBRUARY 1984 264-4720 t Legal Descript' n: �+ ( W1 Ka 82.k, CE�� �� 6.01 r►n�,.s� �a2cle.. A. WELL DATA Well Classification ?ru4c If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) l( Date Completed (o - S -an Yield 3 Total Depth 1535' Cased to 185 Depth of Grouting Static Water Level 30 Pump Set At Casing Height Above Ground ta} Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 16a �- , On Adjoining Lots To Nearest Edge of Absorption Field on Lot t n+ ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole — To Nearest Sewer Service Line on Lot Water Sample Collected by �+� ; Date la`Qj-8L Water Sample Test Results ZA+J6F c_4a Comments B. SEPTIC/HOLDING TANK DATA Date Installed '7-67-80—Size IQU5-b No. of Compartments Two Standpipes (Y/N) y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) I�o Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well I x-1- To Building Foundation '5o To Property Line 35 To Disposal Field -70 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a8+ Type of System Design BED Date Installed ) - -8(o Length of Field !16 Width 16Width of Field C� Depth of Field 4 ` Gravel Bed Thickness )� Square Feet of Absorption Area l i `L� Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well t 6-6'} To Property Line .y To Building Foundation k 6h To Existing or Abandoned System on Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments — —T On Adjoining Lots To Cutbank (if present) .n 4<> t 5 Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have c ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company E < p MOA No. 2ZBT7 OF 11�4, Receipt No. •'' ��•• Date of Payment 4QTH I (oSa I+,•• •................ ..:. d Engineer's Seal Amount: $ Page 2 of 2 72-026 (11,,84) 5. LEGAL DESCRIPTION DATE RECEIVED ��/ INSPECTION APPOINTMENTS TIME NUMBER OF,BEDROOMS TIME TIME DATE ❑ Two ❑ Five DATE DATE 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR �}- since June 1975. For wells drilled prior to that date, give well INSPECTOR INSPECTOR] ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 1 INDIVIDUAL/ON-SITE** MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTl(�NIDEPT. OF I_,'•.LTH & 825 L Street - Anchorage, Alaska 99501 tt'"`��Yv RONMENTAi rL;�TECTION NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ENVIRONMENTAL SANITATION DIVISION JUL 2 8 1980 Telephone 264-4720 RR FF RF ((""� [[ n REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVQLkVIE>D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER_ PHONE MAILING A/DDDRESS X-464belrry a._X�(dl. 9� 461 PROPERTY RESIDENT (If different fro above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION � ` { 141 PHONE MAILING ADDRE 1 tq- 4a_ t 5 a 4— 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ��/ STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY �}- since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ( ^. l ,-X -c',-. � .-�u/c , �G - .•_ E_ 441 - THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE El SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO EJ FOUR ❑ SIX 2. WATER SUPPLY fl INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM OINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER r. DATE INSTALLED INSTALLER -E]Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING 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 - -- _1 `.:,- VAS\ _� a`���<' [APPROVED FOR Z1' BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED i DATE C-` BY 72-010 (Rev. 6/79) Municipality of Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION July 30, 1980 Joey/Lori Willis 611 Raspberry Road Anchorage, Alaska 99502 Subject: Lot 1 Bubbling Brook Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: --\�l) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. '-(2) A well log submitted to this department for our review. J ,,,-(3) We have not received the as-builts of the installation T of the sewer system in this office. If a private engineer inspected the system, prease send us the report for our files and review. y;\(4) The be final grading around the sewer system needs completed so that it slopes away. This will to need to be reinspected when completed. If there are any further questions, please call this department at 264-4720. Sincerely,� Robert \C. Pratt,llR.S. Associate Specialist RCP/ljw cc: Alaska Mutual Savings Bank 1503 West 31 Avenue 99503