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HomeMy WebLinkAboutBRUIN PARK BLK 4 LT 13 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road / �• Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite v 'VC' OGE I -� De aI-tinenr NR P On-Site Wastewater Disposal System Permit Permit Number: OSP221290 Effective Date: 8/24/2022 Work Type: SepticTank Upgrade Expiration Date: 8/24/2023 Tax Code Number: 01611143000 Site Legal Address: BRUIN PARK BLK 4 LT 13 G:2633 Site Mailing Address: 11301 FOREST DR, Anchorage Owner: ROESLER RICHARD W & CAROLE R Lot Size in Sq Ft: 19000 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or - -- b:_-C-overed,_sealed,_and=heatedto-prevenf_freezing Received By: Issued By: Date: Date: 6/�_ LI2 Z Development Services Department =: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 016-111-43 Property owner(s) ROESLER Mailing address 11301 FORST DR, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) BRUIN PARK BLK 4 LT 13 Legal description (Township, Range & Section) Lot Size 19000 Sq. Ft. Number of Bedrooms `l APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ - rlvate 1Nell 0 Water Storage ❑ APPLICATION IS AN Initial ❑ Upgrade FJ Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) El (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 't 3 6 6 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc August 22, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: Bruin Park Blk 4, lot 13 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. After reviewing the MOA records the system was designed for a 4-bedroom leach field. From the MOA records the perc rate was 30 minutes per inch therefore an application rate of 0.45 gpd/sf is required, which would mean the total area required is 600/0.45 = 1,333 square foot. Again from the inspection report the total trench area is 74 feet long x 9 feet effective x 2 sides for a total of 1,332 square feet. Per this calculation we have sufficient area for a 4-bedroom system. The MOA tax records show a 4-bedroom residence. This new tank upgrade will not impact any of the surrounding neighbors. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221290, Deb Wockenfuss, 08/24/22 1"=50' EXISTING SEPTIC WELL EXISTING HOUSE EXISTING WELL 100' RADIUS BRUIN PARK BLOCK 4, LOT 13 SCALE: DJRDRAWN: DATE: BRUIN PARK, BLOCK 4, LOT 13 Anchorage, Alaska RICHARD & CAROLE ROESLER 7/20/2022 SHED SHED SHED BRUIN PARK BLOCK 4, LOT 14 BRUIN PARK BLOCK 4, LOT 12 BRUIN PARK FIRST ADDITION BLOCK 9, TRACT A BRUIN PARK BLOCK 5, LOT 14 DRIVEWAY -F O R E S T D R I V E --READER ROAD--POLAR DRIVE-REMOVE EXISTING TANK AND INSTALL NEW 1500 GALLON STEEL TANK W/ 20" RISER DUE TO DEPTH OF EXISTING TANK DCO CO WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221290, Deb Wockenfuss, 08/24/22 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 d~ / ~J -.///- ~/~ PX C.,y- 1'~4Dl~'~L~--.l~ ~ SEPTIC ABSORPTION Address ,/ /~,/ ~ ,~. ~/ 9 ~ 4. '"" TANK FIELD WELL Phone(s} I Perm,t No. lNG. of Bedrooms WELL ' ~A~ ~ESCR,P.,O. L0m LINE . ~UI~ ~t~ ~o~ ~. FOUNDATION Township. Range. Sechon AS-BUILT DIAGRAM (Show location of well. septm system, property hnes. founeahon. m~veway, water ?roes; etc.)~ TANKS ,Z~. ~:~1~, ~. SEPTIC ~ HOLDING Manu[actu~er Capacuy ~n gallons ' Material : No. of Compa~ments &~ ~ . ~' 1 ' ~ ~ .._" , I~ I~ i TYPE OF SYSTEM ~. ,,,~ - x'~ ~.~~ ~TRENCH ~ BED ~ W. DRAIN ~ OTHER e, ~ O FT ,T~ ~'" · Total absorpbon area Distance between hnes Installer Date~,~ ~ ~ J~,--' H~LI¢ C~ ~'~ %?< k · ~ ~ "' WELLS/ ~j ~ PRIVATE ~ OTHER (Identify) ~~~~-~~ Installe~ Date Installed: .............................. ~ ~ a ~'¢~/~¢¢' REMARKS: ; ~Pf. OF HEALfH & '.t?; ~ C, I~¢U , , , Scale: KbLEiVbu Municipalan, State guidelines in ellecl thisdate: ~Ob~ ¢~l I~ Health Depadmen, Approval: ,,~~' ~~ Date Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O I~,¢.-UIM Pt~1~¢,., ~d[.~Y~',nship, Range, Section: MUNICIPALITY OF DEPT. OF HEAL ENVIRONMENTAL PRO SLOPE RE'CEI¥ & .~CTI( )N 0 WAS GROUND WATER ENCOUNTERED? .~0 S L IF YES, AT WHAT O DEPTH? p E Depth to Water Alter Monitoring? ~ v,m, tH'A~Date: SITE PLAN Reading Date Gross Net Depth to Net Time · Time. Water Drop h~ ~ PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND 1.0 FT COMMENTS AOCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES I'N EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: '"7/z~/$7 ! t TO Richard C. Button EE!S Consulting Engineers, Inc. 200 West 34 Avenue 6267 Anchorage 99503 On-sit~ Soriices HHH~, ESD PO Box 196650 Anchorage, Alas]ia 99519-6650 SUBJECT Lot 13 Block 4 Bruin Park Subdivision As--builts DATE 1 /19/90 MEEEA~E All inspections must be filled out on ORIGINAL thr~e part inspections reports. One is enclosed for you. Also, all forms must be stamped and signed by a registered civil engineer. The HeAAh~ Augh~it~ form is incomplete, we do not need the ~hecklist UNLESS ?ou are applying a full Health Authority Approaal and then three is a $170.00 fee to br~ enclosed. The paperwork is ~eu sent iH are copies and we do not accept copies of as-builts, soils t~O~) site plans or health authority ,npproval REPLY ( Laur~ J .%~ merv 'N~'~i~-- Se rvice s 343-4744 ('~-~-~® 45 472 SIGNED · SEND PARTS ] AND 3 INTACT - PART 3 WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP DATE POLY PAK ($0 SETS) 4P472 nicipa i Yof Anchorage P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 ~~4~ Tom Fink, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 8, 1988 Dick Roesler 11301 Forrest Drive Anchorage, Alaska 99516 Subject: Lot 13 BLock 4 Bruin Park Subdivision Permit #870147, On-site Sewer Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re-applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Si. nc~.~e ly, ,/ //-' Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit L. 0 T S J'. Z IE ~: PERFORMED FOR: LEGAL DESCRIPTION: ~T pp_.¢.~ 1 2 3 4 5 6 7 8 9 10 11 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: I~, t~Cf- ~ . '~IZU I~ I~l~,tZ-5o~,Ownship, Range, Section: · ' · SLOPE COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? E Depth to Waler After (.../ Monitoring? ~ '.,O~lf~/. Date: , Gross Net Depth to Net Reading Date Time Time Water Drop ~ IO ~ 6.~ ,~ PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN I'~,, . ET AND I ~) FT CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~TE PLAN ~t Robert P, " #6TE: II Is the owners' eeponslblllty to' determine the of any easements, coven"ate, restrictions which do not apl)esr on the r~orded su~ivlslon plat. under oo circumstances shou?~ a~ data hereon be us~ tot ~nstm~n-or foe ~tabllshing bounda~ of fen~ line& SURVEY CERTIFICATION: t hereby certify that I have surveyed the property shown and u icrlbed hereon and that the Improvements situated thereon are within the property lines and r encroachments exist other than noted. PLEASE NOTE: ~t Is the contract -or'l responsibility to check tOlL!~ of foundation In relation to finish grade end building ~et. backs In relation to lot lines end easements. LEGEND: SET SOUND 518" REBAR O 0 HUB & TACK MONUMENT AL-CAP PK NAIL X IRON PiPE ~ - E LEVS. - DATUM ASSUMED IHVEISTIgATION ANCHOllAGt~. ALA~ ~,0~3 (90~ -NGINEERING EVALUATIC., and INVESTIGATION SERVICES December 19, 1986 Municipality o? Anchorage Department o? Health & Human Services Environmental Health Anchorage, Alaska 99519-6650 Subject: Doc. No.: Attn: Roesler Health Authority Approval 860925.001 Rob Robinson Dear Mr. Robinson: This letter is in response to our phone conversation today. Attached, ?ind the M.O.A. Health Authority Approval ?orms on the well and septic test I per?ormed on September 25, 1986. As you can see, the well is adequate, but the septic system reaches only 250 gallons per day, short o? the 450 gallons per day required ?or a three bedroom house. It should be noted that the system is meeting the needs o? Mr. Roesler's ?amily with no problems. The owner, Mr. Roesler, is presently trying to re?inance the residence with an FHA loan. FHA requires that a home have a Municipality o? Anchorage approval be?ore they will ?inance it. Obviously, Mr. Roesler will need to upgrade his system, however, the cost would be prohibitive at this time due to ?rozen ground. I propose that the Municipality o? Anchorage issue a conditional approval o? the septic system, until July 1987. This will satis?y the FHA requirements. Seattle Mortgage will escrow money ?rom the re?inancing to cover the septic upgrade, and it will be accomplished as soon as the ground is thaued in the spring. Your attention to this matter uould be greatly appreciated. Once approval is granted, please contact Keith Nading at Seattle Mortgage Co. His phone number is (907) 562-5626. He is handling the loan ?or Mr. Roesler, and uill send a runner to pick up the approved paperuork so the loan can be ?inalized. I hope this meets with your approval. questions, please do not hesitate to call. you have any RCB/jw Richard C. Button, PE/ / 200 West 34th, #267 · Anchorage, Alaska 99503 · (907) 274-7611 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH - , CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 - Application Date G£N£RAm INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (add res8 ~ r__di re_ctio, o,~) .., (b) Applicant Name ~)10¢-. '~.,O~l.~lff... Telephone: Home~'~"~l~.'~ Applicant Address '~"1~ I ~ ' ~ ~ ~ ~ ' (c) Applicant is (check one): Lending Institution [] · Owner/builder~; Buyer []; Other [] (explain); '- '~, · Address ': ............. "'- ' ........ Real Estate Company and ~gent ~ ....... . Address' "'h. · · ',~ ',, '-.' Community [] Holding Tank [] ,? :i ! ::i ! . .i. Note: If community well system, must have written confirmation from the State Department of Environmental ConserVation · attesting to the legality and status. , ., , ,. : ~ .... :: i:, i: ii~, Page 1 of 2 , :,: :; '.i:"; 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto andas 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 insDectio_D_. Name of Firm' ~~ Telephone L~ %7~' Address ~O ~ ~ ~Zb3 ~~ ~t~ Date --- I , I ' 6. DHEP APPROVAL Disapproved Conditional CAUTION :: The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approva 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 n 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) Application Date MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name p~C ~~ Telephone: Home ~fi Applicant Address ~~ ~ ~~ (c) Applicant is (check one): Lending Institution"~ ' Owner/builder; Buyer ~; C'her D (explain); (d) Lending Institution ~ H,~.e.~ Telephone Address 4-4-'~'-/ 1~OSf. tJ~¢~.~ ¢'/~_ ~2¢..U~ F~L~(., ~ Real Estate Company and Agent (e) (f) Address Telephone Mail the HAA to the following address: NoT TYPE OF RESIDENCE Single-Family ~ M~'lti-Family Number of BedroOms Other WATER SUPPLY Individual Well'l~ 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~. 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 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D T~.' 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this i~spection. Nameof Firm IIdW'~'~TIb~A'I'IO~) Telephone DHEP APPROVAL Approved for,~'-- bedrooms by. _ Disapproved Engineer's Seal Approved Conditional Terms of Conditional Approval ~",~'~ -s'~','~ d'Y.v.s',-~/~ ~,$ ~~ 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) I~.' ,pALI'~' OF ANO-tORAGE PT. Oi: HEALTH & MUNICIPALITY OF ANCHORAGE (~I~i~TN. PROTECTION HEALTH AUTHORITY APPROVAL (TIAA) ' CHECKLIST- FEBRUARY 1984 ~ ~ 1. 9 'jj 264-4720 WELL DATA Well Classification Well Log Present (Y/N) I Total Depth ~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot '1' ~ If A. B, C, D.E.C. Approved (Y/N) .J~ Date Completed (~, ~'~ ,~C~ Yield Case,d to c~c~! Depth of Grouting ~,~, I- ~¢u Pump Set At ~-~ ~" Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot ~,~.,~t .4: To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results i~), t(.. I:'t~I -O" · On Adjoining Lots [ lDO t ..{. · On Adjoining Lots [bot "'r To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~0 ~t~--'~ · Date Comments SEPTIC/HOLDING TANK DATA Date installed ~ Size Standpipes (Y/N) 'Y Air-tight Caps (Y/N) Depresmon over Tank (Y/N) /'~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) J'Jl Se paration Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments No. of Compartments ~1/ Foundation Cleanout (Y/N) Date Last Pumped '- ' -- · ' ":- ; for Temporary Holding Tank Permit (Y/N) j ~(.~!.....~ ,~ To Building Foundation -.,~r ;..~__. To Disposal Field -,~ ~;~d~I '~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026t11/84) C. ABSORPTION FIELDDATA Soils Rating in Absorption Strata ~/'~ Date Installed ~¢'1~1~.0'% Ic~'~ ~ Width of Field ~ ~ ~l~Ov~ ~ Square Feet of Absorption Area L)l~(.-I'J01~ 1~ Depression over Field (Y/N) Results of Last Adequacy Test '----"---- Separation Distance from Absorption Field: To Water-Supply Well I ~ "~ I _ O H To Building Foundation ~(~1'"~ q Lot .1~ / A To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~__ ~ ~,~._.~ ~ ,4 H,0.^. ~- PPP-cu~ Type of System Design ~.r~~ Length of Field Depth of Field [JN~0 Gravel Bed Thickness LJ Standpipes Present (Y/N) ~"~----~ Date of Last Adequacy Test LJ To Property Line 'Z.O ! ~ H To Existing or Abandoned System on ; On Adjoining Lots ~;~) f'~O'~ '~- To Cutbank (if present) ~ ~u ~¢~---~ /t15soc~T~J 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 th~/0hec~.¢z~, v~[ied,~r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~~ ,~ Date Date of Payment Amount: $ 6 5 ~o~._ _~_,~,:...o ~ -....~ineer's Seal Page 2 of 2 '~ .i~.,~ c. ~,,o~ ~,~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. '~~."'~, ' ' 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ,¢..-~..~, FEDERAL *AX ~D # 92-0040440 AN~Li ~[S kEPOF,.'T ~' %!iPL~ G~ient PO~ : VERBAL ~eq #: Ordered By : Send Neport~ To: OE$IGN CONSULTANTS OF ALASKA Work Order No, ;JSiO Date Report Printed: JUL 24 87 ~ 09:2;) Released By : 2 ,,';'~--,,;~ Reports Abdresa ~2 ZOO W 34TH, ~267 ANCHORAGe. AK. 99503 Spe¢ia) ROUTINE S~MPLE COLLECTED ?-21-87. !300 HRS BY BUTTON. instruct: ChemtaD Ref ~: 69% [,ab ~pi iD: [ Matrix: Water ~l~OW~b~e Parameter ?e~ted Re~ult/Unit~ i~e~ho~ N1TRATE-N ND(O.iO) m~l Sample ROUTINE ~emarks: &NAL~$IS COMPLETED: ?-23-8? LABORATORY' SUPERVISOR: STEPHE~ I Tests Performed ~ See Specia~ Instructions Above NO= None De~ected ~ See Sample ~emarks Above NA= No( Analyzed LT=Less Than. UT=Greater Than APPLIC IT FILLS OUT UPPER HAL ONLY PropertyOwne,' T-~C~/~l[~,~ -RO~_/,~,~-~. ~ Phone Buyer Address * Zip Code Lending Institution Phone Address ' Zip Code Realty Co. & A~'~ Phone Address Zip Code LegalDescription ~1~ P~ ~U~, ~LOC~{ Ct Lo+ ~ Street Locatim e~ E S~ D~ ~ ~ k~ ~ Type of Residence  Single Family Mulfipl~ ~amlly ~o. o[ 8odrooms ~ Othor Water Supply ~ O / ~3 G- g © A ~L '& ~. ~ (~ ~ Individual~j A~ACH WELL LOG. A wall log is required for all wells drilled sin~,June 1975. ~ Community ~?~ ~' G o ~., For wells drill~d prior to that date, give well depth (attmch log if available). ~ Public Utility Sewer Disposal ~ Individual Year Indiv~ual Installed: ~ Publle ~tility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATER. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY 0--'~ ANCH(DRA~ .4./.~.~ 0 DEPT. OF HEALTH ; ENVIRONMENTAL PROTECTIOI SEP 8. RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL (.,~.?) DISAPPROVED ( ) CONDITIONAL APPROVAL* 8oils Rating Date ~wer Installed Well To Absorption Area / ~ ~ ~ Well Log Received Well to Tank Septic T~k Size 72-023 (3/82) September 13, Richard Roesler SRA [~ox 1778 Anchorage, AK 99507 Subject: [)ruin Park Subdivision, l~tock 4, Lot 13 Approval for the individual sewer and water Lacilities cannot be granted until the ~ollowing items have been completed: The top of the well casing should be sealed so that it is water tight. Exl?osed electrical wires to the well heaG are in violation of the Municipality of Anchorage co~es and must be encased in conduit. The septic tank pumped with a receipt submitted to this department. The total number of gallons pumped needs to be on the receipt and verified by a registered engineer as to the actual number of gallons pumped. ?his is to verify the size of the septic tank. Expose the septic tank manhole to verify its existence. Locate and expose the cleanout to the seepage pit and/or leaching area for our inspection. This is to insure the minimum distance requirements are met between the well and sewer system. four (4) inch cleanout needs to be installed to the sep- ic tank. An adequacy test needs to be performed on the existing leaching area. This test wi].], determine if the system is adequate according to National Standards. A listing private firl~ls performing the test is enclosed. This report needs to be sub~itted to this of[ice £or our review. Richard Roesler September 13, 1983 Page 2 The standpipe to the sewer system need caps on them. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further {.Iuestions, please call this office at 264-4720. Sincerely, .,'/ Jim Roberts ~/Associate Environmental JR22/e]/,~2 Specialist