HomeMy WebLinkAboutBUBBLING BROOK LT 3
t/''~'~'' O '4,~\\ _ MUNICI PALl TYOF AN CHORAGE _
· 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 IPHONE
MAILING ADDRESS
)
LEGAL DESCRI~/O-~
LOCATION ~' ~ ].~,,/)/ ~ . .~ . /-~'/' . ~= NO. OF BEDROOMS
~:'Vc,':.,-' ~TM . 4:.'
I Well Absorption area Dwelling PERMIT NO.
DISTANC~
TO:
I
~ Z Manufacturer Material No. of compartments
Liq. capacity in gallons IF HOME,DE: Inside length Width Liquid depth
~ DISTANCE TO: Well ~ Dwelling PERMITNO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
~~ = DISTANCE TO: Well
;i~ Top of tile to finis, grade ~ ~i, Material beneath tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
.................. St4EET_ ~ OF ~
501L5
PROJECT Bubblin__q Brook Subd.
CLIENT Buster Newton
W.O. 77886
:TEST HOLE NO. 3
'ELEV. TOP OF HOLE. 719
DATE '~1/15/77
Peat, PT...
Organic, sandy silt, 0L
Damp, brown sandy silt, ML
Damp, brown, sandy silt, SM
Damp, brown, gravelly sandy silt, SM
Damp, brown, sandy gravelly silt, SM
Bottom
NOTE' :
I. No ground water table at time of drilling.
2. Field perculation test results - 30 min/inch.
'i
UNWi J, SCHEBEi KORY NTA
'~ONSUL.TING ENGINE~E_RS AND SURVEYORS
2515 A ST., ANCHORA~--~' ~0-'~(907) 27~'~g
December 5, 1977
Mr. Buster Newton '"
411 East 36th Avenue
Anci~orage, Alaska 99503
Re: Proposed Bubbling Brook Subdivision
Subsurface Soils Investigation
Dear Mr. Newton:
}his report presents the results of our soils investigation for the proposed
subdivision of a 10 acre tract located east of Birch Road and just west of
Ravenwood Subdivision. The investigation was conducted on November 15 and 16,
1977. The results of this investigation are included in thHs
Vicinity Hap
Test Hole Location Sketch
Test Hole Logs (Sheets I through 9)
Standard Explanatory Information
Drilling was accomplished utilizing a mobile drill B-50 mounted on a flex
track Nodwel vehicle, owned and operated by Denali Drilling, Inc. Test holes
were logged and perculation tests conducted by our firm.
The purpose of the investigation was to provide soils data and perculation
tests for establishing the feasibility of on-site disposal of sanitary wastes
usi~lg seepage pits. To accomplish this, we drilled 9 borings distributed
across the site with I test hole on each lot at the probable septic system
'location. The test hole locations are shown on the attached location sketch.
,All borings were drilled to a depth of 16 feet. During the'drilling, our
engineer was present to log the materials encountered and obtain grab samples
of the soil types. All soils were visually classified in the field in accord-
ance with the unified soil classification system as described in the standard
explanatory information attached herewith.
Since the site is fairly small and readily accessible from both sides, per-
culation tests were conducted in all holes at the completion of the drilling
and logging. The perculation tests were conducted from the 6 to 12 foot
levels in each of the holes in accordance with the Manual For Septic Tank
Practice published by the PHS. A ground water table was encountered in test
hole Number 9 at the 12 foot level, lherefore, the perculation test in this
hole was conducted between the 4 to 8 foot level.
LEO SCHEBEN, JR.,P.E.,L.S. EARL D. KORTNTA, RE.
Buster t;ewton
D(~cember 5, 1977
Two
SITE AND SOIL CONDITIONS
The site is a 660 foot square parcel having access from Rockridge Drive on the
east and Ravenwood Subdi'visidn on the south. The site is dissected in a
.sout.~.leasterly/northwesterly direction by a fork of the Little Campbell Creek.
The parcel slopes uniformly from southeast to northwest at an approximate 6%
to 8% average slope. A small knoll is located in the southeasterly corner.
Th,?re are no areas with slopes in excess of 25%. The parcel may be divided
into two very distinct soil map units for purposes of identifying perculation
characteristics. A 300 to 400 foot wide band centered.on the creek channel is
characteristic of old alluvial deposits and consists primarily of well graded
sand~; and gravels with good perculation characteristics. Test holes 2, 8 and
9 are typical of this deposit. Beyond this band, the~materials are much
siltier and tighter as demonstrated by test holes l, 3, 5, 6 and 7.
CONCLUSIONS
The n~inimum perculation rates observed in'the field for the.following holes
Test Hole Number 1 - 30 minutes per
Test Hole Number 2 - 13 minutes per
Test Hole Number 3 - 30 minutes per
Test Hole ~;umber 5 - 35 minutes per
Test Hole Number 6 - 45 minutes per
Test Hole Number 7 - 60 minutes per
Test Hole Number 8 - 5 minutes per
Test Hole Number 9 - 5 minutes per
nch
inch
~nch
~nch
~nch
inch
~nch
nch
?n-site waste disposal systems appear feasible on all lots. An aerated package
;lant or other treatment process is advisable for the lots with high percula-
:ion rates.
hope this is sufficient for your present needs If we can offer further
la,¥'if~_a~ion please do not hesitate.to contact us.
!-achn~ents
K/c 1 r
Very truly yours,
c>__----
Earl D
I
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i
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7
RG
,~.TH
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'D43 RvEYOR'S
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CER'I' i FIC A'[ E_~.-
M-W DRILLING, INC.
DRILLING LOG
Well O~vner Gunnars on Cons truc t ion __Use of WelL_Dom.
Location (address of: Township, Range, Section, if known; or distance main road ....
Lot 3 Block 1 Bubbling. Brook Subdivision, Anchorage
Size of casing._ .6"~__Depth of ttole
Static water level __ft.
Screen ( ); Perforated (
Describe screen or perforation___ N/A
Well pumping test at_]~J .... gallons per
of drawdown from static level.
Date of completim~___ 1 / 11 / 79
209 .feet Cased to 208.8 feet
(below) land surface. Finish of well (check one)
).
open end ( XX );
(minute) for__! hours with 100%
WELL LOG
Depth itl feet from
ground surface Give details of formations penetrated, size of material, color and hardness
__~[8 ......TO 21
.... ~_TO.125
125 TO_ 138
_!}~_TO 145
!4~_ _TO 163
_.XP_[_TO 203
203 TO_ 209
.... __~Rg~ffXRR Cas in_g _S t__i_ckup
0rg~nics~
.... Sm~ 1 L_cabhlea
....... _W_e~tt_ grave_%
S andy_grave 1
Sa_n~d _
_Sandy_ g r~a~l_
Cobbly hard pan
Clay
Silty gravel
tt~rd pan
_.SiltY c_lay
..... _Wa~?_r_ 5F~.V_?_i: ex_t_.r__e_.m.e!.y silty
Sand water ravel
1 --CUSTOMER
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 3 ~
BuSbti-nq Brook Subdivision
Location (site address or directions)
6301 Bunnyshoe Circle
Anchorage, AK
Prope~y owner Steven and Marianne Ritchie
Mailing address C/0 PHH/HOMEQUITY P.O. Box 4039
Attn: Janine Va~£ey
Lending agency ~
Day phone
¢oncord~ . CA
Day phone
346-1647
344-3080
94524
(w) Marianne
Mailing address
Agent
Day phone
Address
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firms & s E~Gi[~EERING . __/~__ Phone
! 7034 Eagle River Loop Ro~
Address Eagle !~iver, Alaska 995~
Engineer's signature ~ Date
DHHS SIGNATURE
Approved' for '~'-/-/¢-~"--'~ ~/~) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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 engine, er 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.
72-025 (Rev. 1,/91) Back MOA If"21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type /~-'~
Log present(~N)
Total depth
Sanitary seal(~l)
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number /('"//~
Date completed //(//7 ~ Driller ~""
Cased to ~_~c.3~, ~' Casing height //~-
Wires properly protecte(;~)
; On adjacent lots
AT INSPECTION
-~ ~ g.p.m. I'r'l
g.p.m.
FROM WELL LOG
Date of test ///( /
Static water level
Well flow
Pump level1 ~'~-'~-~
; On adjacent lots
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot /~--~/'-~
Public sewer main /CJ~
Sewer service line
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Oo,, orm
Date of sample: ~::~//~-~1 ~ ~
Nitrate
~/,~ Other bacteria
Collected"/by: _~--~'=~-~/,~L-/~/,/~(~
B. SEPTIC/HOLDING TANK DATA
Date installed /()]/0/
Cleanouts ~1) -/~?~:~ Foundation cleanout (~N)
High water alarm (¥~_j~
Date of pumping ~-----~/~/? ~--
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~O ( On adjacent lots ff~ r.~
To property line ~d.~ r7/'- Absorption field
Surface water/drainage /~_~
72-026 (3/93)* Front
Compartments (_2/~/~jL/b>--)/L_J
~-~,~' ~ Depression (Y/N)
Alarm tested (Y/N)
Pumper A '{'- ~ ~
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N) ~
Vent (Y/N) "Pump on" level at _~vel at
High water alarm level ~ ~sted
Meets MOA electrical codes (Y/N)
SEPARATION DIST~t~'E~ROM LIFT STATION TO:
~ On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed /~//~-~/'~ 0
Length Fr~ r
Total absorption area
Date of adequacy test
Width
Water level in absorption field before test
Peroxide treatment (past 12 months) (y/N)
Soil rating (GPD/FF)
Gravel thickness
Cleanout present~lN)
Results(~fail)
47 "
System type '~"-;/~"'/U ~/~
0C) ¢ ' Total depth / / ~'
Depression over field ~ ~
/~ for ~ Bedrooms
After test ~ ~
~~ If yes, give date ~/~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water ~.)0
Curtain drain
On adjacent lots //0 ~ r¢.~ Property line /0
To existing or abandoned system on lot
Cutbank //'J~,,'c/~ J/~C'~ater main/service line
Driveway, parking/vehicle storage area /~' ~
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature ~.~
Engineer's Nam ~7~~34~Eagle River Loop Read No. 2134
Date ;~le ~;v~. Al~b~ oog~
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
06/17/95 15:10 C?&E ENUIRONHENTAL LAB
NO. 22.8 D02
& ENGINEERING CO.
.......... Rk'1mORT of ANALYSIS
Chemlab Ref.$ :93.2785-3
Client Sample ID :L3 ~]BBLING BI~)OK S/D
Matrix :WATER
5533 B STREET
At,.IC~.~ORAGE. AK 9951.9
TEL' ~907) 562,234,~
FAX' 1907.~ 561-5301
Client Nam, e :S & S ~NGINEE~ING WORK Order :67191 .
Ordered By : Report Completed :06/17/93
Pro~ect N&m~ ~ Collected :06/14/93 @ 18:23 hr[
ProJect~ : Received :06/15/93 8 16:15 hr~
PWSZD :UA Technical Oirectoz~STF. P~H~N/¢. EDE
Sample Remarks: ROUTINE SAMPCE CO[~CTED BY: $.S.
QC Allowable Ext. Anal
Parameter Results Qual Units ~ethod Limits Date Date Inl~
N[trate-N 0.i0 U mg/L ~PA 353.2/300.0 l0 06/[6 L~
* See St>ecial Instructions ~bove UA ~ Unavailable
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. LT = Less Than
D = Secondary dilution, GT = Greater Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Lot 3; Bubbling Brook Subdivision
Location (site address or directions) 630] R,~nny .qhc~P P_~,~r't- ~ An~'h~-~g~ ~ A1R.~]CR
Property owner
Mailing address
Dugan and Christine Petty
Juneau, Alaska
Day phone
Lending agency
Day phone
Mailing address
Agent Kris Kurtz/JACK WHITE COMPANY
Address 3201C Street, Anchoraqe, Alaska 99503
Day phone
563-5500
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3 ~"
NOTE:
Individual well ×××
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site ×××
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
~ & S ENGINEERING
' ~"~' .............. L--- R--.
~.~te :~iver, Alaska 99577
Phone
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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.
72-025 (Rev. 1/91) Back MOA ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~:>T ~ ~ff,~,,.~l,~ ~.~-' ~1~ Parcel I.D. 0/6-- ~7/~-/'.~-
A. WELL DATA
Well type
Log present ~N)
Total depth ~/--~:> ~ ~
Sanitary seal (~1)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~- ~\-~ Driller
"J-O ~=,. '~:,~ Casing height
Wires properly protected (~UN)
Cased to
FROM WELL LOG AT INSPECTION
'7.-~'. ~ g.p.m.
Date of test
Static water level
Well flow
Pump level
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL ,SERVICES DIVISION
i991
g.p.mRECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot [oC>
Absorption field on lot ~. ~ '¥'
Public sewer main ~J/~
Sewer service line
;'On adjaCent lots
;On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate fJD
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~0-' ~, o -'1 ~ Tank size
Cleanouts (~N) ~/ Foundation cleanout~/N)
High water alarm (Y/~) /4r
Date of pumping ~-~ \'1 -~1
Other bacteria ,~Jo~l.~
S & S ENGINEERING
17034 Eagle ~,;,~" t.~,~ .,:: ......
Eagle River, Alaska 99577
(.~L. Compartments
~ ..~ Depression (Y~]~
Alarm tested (Y/N) '"~//~
Pumper /~,?' ~o~'L~.
Well(s) on lot ~ o C> t On adjacent lots
To property line ~,0 t '~ Absorption field
Surface water/drainage ~ c>c::, ~ ¥
72-026 (Rev. 7/91) Front
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
\ O~
Foundation lbt~'
Water main/service line ~ ~ ['~
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at ','
High water alarm level
Meets MOA electrical cgdeS~/Nf)
S~NCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Manufacturer
"Pump off" level at
Cycles tested
Surface water
D. ABSORPTION FIELD'DATA
\0-\0-'38
Soil rating '?--~'° ~'/~ System type
Gravel thickness ~,~' ' Total depth
Cleanouts present (~:)/N) y
Date of adequacy test J 7-- -/~
for '7'"r/~8~ L/'?--) bedrooms
i~',,~/o ~,,,/,4' If yes, give date /,.1/~.
Date installed
Length ~,-~O~ Width
Total absorption area
Depression over field (Y/~
Result~ail)
Peroxide treatment (past 12 months) (Y~J~ /~/~/~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot tC~ ~'~
To building foundation
On adjacent lots
Surface water \c>
Curtain drain
On adjacent lots 't~ t ~ Property line
To existing or abandoned system on lot
Cutbank ~{/~ Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER's CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect_o~te of this inspection.
Signature 17034 Eagle River L~p Road NO. 2~
Eagle River, Alaska 995~
Engineer's Name
Date ~ - ~ ~ ~ ~
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev, 3/91) Back MOA 21
::ii..'.:te.'. :,i=%: 1: =! ,? i?:,>)
~.r,.~,'.:~s_~J :DEC 20 ~1
L.~.ooratory Suz. erv;sor :STEF'HEJ'~ C, EDE
Client Sa,~ple ID: L3 BUBBLING BROOK S/D
MATRIX: WATER
Samole ROUTINE SAMPLE COLLECTED BY: RAY.
Extraction Analy:-is Anal yst
CBem[~ab
Samo! e# Test-F'arameter Method Units Result Date Date Signature
End of Semple# 3 Lab Instructions on WORKorder# 41231 1 Tests for this Sample.
E:O,-I 900 O000000000000000CO00 00000000000000000000 80:I.I. E:~-EI, T.-16GT.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~T{I~,.~D~'~//~';
825 L Street- Anchorage, Alaska 99501 '~r-~N,VJlR(~x~I~:'/ '~'~"'1'--1
E.V, RO.MENTAL E.G, EER,. D.V,S,O
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER
Ol RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1, PROPERTY OWNER PHONE
MA~LING A D[34{ E~S
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAI LING AD~R ESS
3. LENDING INSTITUTION I PHONE
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAILING ADDRESS
STREET LOCATION
J~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL~
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ I~DIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date
,_, ,.~,; v',J ..... ,~:,L~I
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED ,
TIME
INSPECTION APPOINTMENTS
TIME
TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
NUMBER OF BEDROOMS
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTI LITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
F-I PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: I ~ ~) If Tank is homemade
give dimensions:
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
MATERIAL
Septic/Holding Tank IAbsorption Area
I
Sewer Line
Nearest Lot Line
5. COMMENTS
~__.~APPROVED FOR ~" BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
Nlu cipality
t~:,:::,, ANCHORAGE, ALASKA 99502
f ~ (907) 279-2511
0 ~,,I~.~[X~,-I'.~ ,d,',~
Anchor e
DEPARTMENT OF HEALTH AND ENVIRONMEN1-ALPROTECTION
(825 "[." Street)
March 28, 1979
Gregg Gunnarson
Box 10432
Anchorage, Alaska 99511
Subject: Lot 3 Block 1 Bubbling Brook Subdivision
Approval for your individual sewer and water facilities
will not be granted until the following items have been
completed:
(1) A well log is submitted to this department
(2) Expose the well for our inspection to determine proper
construction, also, to insure the minimum distance
requirements are met between your well and sewer system.
(3) The water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
Notify this department for a re-inspection when descrepancies
have been corrected. If there are any further questions,
please contact this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
CC:
Alaska Mutual Savings Bank
Post Office Box 1120 99510