HomeMy WebLinkAboutSUNSET HILLS BLK E LT 9AMar 22 22 08:26p Anchorage Well & Pump Ser
9072430742 p.1
MUNICIPALITY OF ANCHORAGE
®--�
Development Services Department _ Phone: 907-343-7904
On -Site Water &Wastewater Section � � Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number:
Parcel Identification Number: 018_24137
Date of Issue:
Legal Description Block Lot Property Owner Name & Address:
11 11 REZA, JOSEPH T & MARY R
SUNSET HILLS E 9A 2300 DENNIS WAY
ANCHORAGE, AK 99515
Pump Installation Date: 03 _ 21 _ 2022
Pump Intake Depth Below Top of Well Casing: 115
Pump Manufacturer's Name:
Pump Model:
7Al2
Pump Size: .50
A.Y. MCDONALD
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: MARTINSON
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes ❑ No
Method of Disinfection: PELLETS
Comments:
feet
Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
Company: ANCHORAGE, AK 99518
907-243-0740
Mailing Address: __ __
City: State: Zip:
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage
AUG 50J&
On-Site Water and Wastewater Program • (907) 343-7904 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141167 PID Number: 018-241-37
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade
Name:
ROBIN AND JOE REZA
ABSORPTION FIELD
❑ Deep Trench El Shallow Trench ❑■ Bed El Mound
Address
2300 DENNIS WAY ANCHORAGE AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.2 GPD/SF
9.7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.6 Ft.
Gravel depth beneath pipe
6.6 Ft.
Subdivision Block Lot
SUNSET HILLS E 9A
Fill added above original grade
1-1.5 Ft.
Gravel length
34 Ft.
Township Range Section
Gravel width
2 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
449 Ft2
1
NA Ft.
Well
>100'
>100'
NA
NA
>25'
TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
11000 Gal.
Surface Water
>1001
>100'
NA
NA
Material
Number of compartments
Lot Line
>5'
10'
NA
NA
STEEL
2
NA
Foundation
>5'
>10'
NA
NA
LIFT STATION
Manufacturer
Capacity
Curtain Drain
>50'
>50'
NA
NA
Gal.
Remarks EXISTING SYSTEM DECOMMISSIONED
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
PER UPC REQUIREMENTS.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer
ISAACS EXCAVATING
Drainfield3034 CO/MT 3034
Inspector ANSON MOXNESS
BENCH MARK (Assumed elevation) 100 ft
Inspeection 1117/23/14 7/24/14
Location and description
2nd
ction
3`d 7/24/14 4"'
BOTTOM SIDING SW HOUSE CORNER
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
r'g ®����0
Conditional Approval: Date
Ll0 H
m �-
o
SRURKLAND.•Ux ,s
000
d� c ai�o ..`;•�
ROFE
Approved de f-P rae a Date 10 b I `(
klsX SIy\�_zn
-- (!P J b,
Inspection Report_9-1-12.doc e rted
GRE/-ER ANCflORAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska (,)9503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
LOC^T,ON'~-~'""Z'- ~,h LEGAL DESCRIPT,ON c o~- e A. Zs~--
SI-'PTI C TANK:
DISTANCEFRoM WELL. ~'~'~ '~'~ ~ MANUFACTURER ~.~~ MATERIAL
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
_LIQUID CAPACITY [~O GALLONS.
SEEPAGE PIT:
NUMBER OF PITS ~ . DIAMETER
LINING MATERIAL.&~
BUILDING FOUNDATION__
ADDITIONAL ABSORPTION
OR WIDTH
CRIB SIZE: DIAMETER
NEAREST LOT LINE
LENGTH I! , DEPTH
DEPTH_(~ [ DISTANCE FROM: WELL _.
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~_~ =7~-~ .SQ. FT.
WELL:
TYPE CONSTRUCTION
BUILDING NEAREST
FOUNDATION __ LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~~
PIPE MATE RIAL:~--~(~
LOT SLOPE:
REMARKS:
Form No, EQ-O31
F'EI:.i:I"I I T NEI.
FIF'F'L I CFINT I}FIt..E: MURPFI~
L.OCFt'F I ON I)ENN I S 1.4F?'r',.'"OI_D SEI.,.tFIF.'.I}
LE~GFIL L.S~FI BE ':':Ut",ISET HILL. E; SUE:E)
."~20i C STREE:T
T"r'F'IE OF:' SOIL R[':ISORB"I'tON S¥S'T'EM :IS: F'IT
i"IRF,',IHUH NUMBER OF 13EDI:;::OOi"IS = ]:
SOIL RFrr'ING ,::SQ FT/E:R)= 85
THE REQUIRE[:, SIZE OF 'FHIE SOIl... FIBSIDRPTII]d'q S'-r'S]"IEM IS:
IEE'] II::=' 1- IF-II == ?:.E. EEII IL... EE ~"~.1t C'ii If" I~-II == :'if .. :::IL EL51 ~;L" IF:II %-" IE: It ..... [::" lEE IF::" ""if'" IH-II :==
THE L. ENCCrH [..,IflEfl_.[_t,I "- THE LENGTH (iN FEET) OF EFICH ':SI[:,E F'OR I:::1 ..L. EJ ...I.. PIT.
THE DEPTH OF la TREI'.4CH OR PIT :[!...E; THE D:[STFINCEE BE]"WE:Etq 'THE SIJRF:'F4C:E OI::' THE:
GF'.OtJN[) FIN[) THE B(]TTOi'4 OF THEE IE',:.::CFtVf:ITION (IN FE:E]').
"['I-..IE.~ [~iF.'.FIVE[.. [)EPTI'.{ IS THE i'qIi'.,llf,'lUM [:,EI::'TH OF GRFIVEI.... BETHL::EN THE OIJ'I'I::-FIL.I.. F:'IF'E
FIND THE IB(]'F]"OM OF THE E',:..','C:F:IVFITION (IN FEET).
IF~?.' EE] uS! LII ][ ~:E' EE: IE:, "-=~.'; E: F' 'T' I~ C: "IF' F# tF..~ F=::] E!i:;; 2C ~EE] EEC ..... ::if .. ~) EiE~ e.L.:.E~ EZEii Ffl L... II..... E:D U"..41 :fEE;
.... If" IL.J~ ¢.:]n .C ;~E." ]:. ][: I!'-,,~ LEg IF:' EE E]: "'If"' ][ ~:]} ~r"~ E~"; F~ E;?.' E: IFE'.: E:: ri.L:,:!! ICJt :If.: FE~: EE:: I1Z::.
BI:ICI<F ILL. I NG O1::' RN"¢ S~'r~ST[E:M !.4 ]] THOUT F I NFIL If NSF'ECT I OI",I FINE:' RI~:>F'RO"?Ia[.. E',"r' ]'H :1:
E:'EPRRTMENT 14ILL BE SLIF.%'rECT TO PROSECUTt[)i'..I.
M I N I MUM [) I STRNCE BE:THEE'I"4 Ft I.,.IEI._L. RND RN'¢ (IN-:5 1 TIE E]EI4FIGE: I} I SPOSRI... S"r'STE]'"I If S
:LOO F'E]-:..'T F'OI:;.: f:l F'RI',,,'R'I"E !.,.IEI...L [)1;':: ;.T.~'E~E~ FEET FO[;;: FI PU[L.'~t.r. IC: 1.4EL.I .....
1.4ELL LOG':E; FIRE I:E'.ELT.!IJII;:tED FINI) HIJST BE RE:]'URi'.,ffL'D TO THE C,E:PFIRTMEF,!'f' I.,]I'TI-IZi'.,I ]!:9 [:,F'I"?S
OF' "['HE L4ELI... COi"IPLET]:OIq.
SF'ECIFICFFrION::T, FfllqD COI'.,ISTRUCTION DIFIGFE'.FqMS FIRE FI',,,'FIILF]BL.E TO I'NE;IJI-~:E
I NSTIBI._LFIT I ON.
F" E] I1~." IPll ][ T' "..." FII IL .~ E:. IF:- C~ If:E.: (:]:l ~'-.11 E] "-~" EE] IF:~ ~-~." If'":' E;,?.: C:) II"-] ][ ZE~; EE; Lif EEE
I C:ERTII::"¢ THFIT
1: I Ri"l FFIMILIRR WITH 'I'IaE RIE(;!UIF..'EPIEi'.,!TS FI]lIT:'. OIq-S:I:TE SIEHERS
FOI:~:"I]"i B"r' THE HUNICIF'RLI'I""r' OF RNCHORFIGE.
2: I 1.4IL.I_ :[NST¢~LL THE Sh"STEM :IN RCCORI)FIi",tC:E I.'.IITH 'I'HE E:OE:,ES.
Z.': t LINDERSTRi",I[:' THRT THE ON'-SITE SEI.4ER S~r'STEH I"lF:?'r' REg!UiRE:
RESI[:,Ei",ICE I.'E; F.'.EHODEL. ED '1"O INCLLI[:,L:: I"'IO[;'.E THFIN ;.~: E:EDROOI'"IS.
I::IPI::'I..IIE:F~ [:'FtI...E; I"II_IiE4F'H¥ ~¢~
s:--
FIND 141ELI_S FIE 'ECET
E:NI...FII:4tGL:]','IIENT Il:::' 'TI. lIE
March 23, 1977 B'. & bi MO. 751126
Mr. Dale Murphey
Jack ~lite Real Estate
3201 C Street
Anchorage, Alaska 99503
RE: Test Hole and Soil Log Report for Sanitary System
Lot 9A, Block E, Sunset Hills Subdivision, NE¼, Section 23,
T12N, R3W, S.M., Anchorage, Alaska
Dear ~. Murphey:
We are submitting herewith the test boring results and our comments
regarding soll conditions encountered at the subject site. This in-
vestigation was performed in accordance with your request of March 18,
1977, and those procedures outlined in a letter dated July 15, 1975,
by Mr. Rolf Strickland of the Municipality of Anchorage, Departmlent
of Environmental Quality.
A single test hole was put down within the subject site area for the
purpose of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type drilling
rig and the test hole was extended to a total depth of 19 feet below
ground surface. The final log prepared for the test hole has been
included in Drawing A-01.
Groundwater was not encountered in the test hole while drilling.
A percolation test was performed from a depth indicated and reflects
average infiltration from that depth to the bottom of the hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTANTS, INC.
James W. Rooney
Vice President
JWR/pe
xc: Municipality of Anchorage
-77
GRAVEL W/SOME SAND
AND SOME SILT,
Occasional Cobbles
20' DENNIS WAY
TH-1
LOT 9A
Test hole locations are approximate
and have not been located by survey
methods.
SANDY GRAVEL
W/TRACE SILT,
Occasional Cobbles
SAND W/SOME GRAVEL
A~ SOME SILT
7.0~
-- 11.0'
19.0' TD
Water Table Not Encountered
This log represents subsurface soll
conditions within Lot 9A, Block E,
Sunset Hills subdivision, NE¼,
Section 22, T12N, R3W, S.M., Anchorag~
Alaska
SANITARY SEWER TEST HOLE
JACK ~{ITE REAL ESTATE
ANCHORAGE, ALASKA
iD_ ~033
PERCOI~ATION TEST
JACK WHITE REAL ESTATE
R & M NOB 751126
TH-1
March 22, 1977
ELAPSED DROP IN
TIME TIME INC~ES INCHES
1:05 0 5.00 .0.0
1:06 1 7.00 2.0
1:07 2 10.00 3.0
1:08 3 12.00 2.0
1:09 4 14.00 2.0
1:10 5 15.50 1.5
1:11 6 16.50 1,0
1:12 7 18.00 1.5
1:13 8 19.00 1.0
1:14 9 20.00 1.0
1:15 10 21.00 1.0
1:20 15 25.50 4.5
1:25 20 30.50 5.0
1:30 25 32.50 2.0
1:35 30 34.50 2.0
1:45 40 37.00 2,5
1:55 50 40.00 3,0
2:05 60 42.00 2.0
37 INCI~ES TOTAL DROP
1.62 MINUTES PER INCH
u: VT, 1 D. AIF.ASIKA "0501
qa-14-7' 2 14-
SIX TH E ID E rT 1-1 OF —UQ feei- INCH WATER WELL DRILLED AND CASED OUT TO
DRILLED AT THE RATE OF PER FOOT.
PROPEPTY OWNER _Mrs Joirl, Narquardt 3006 7J 34th ava.
LOCATION OF VVELL SITE 140A Blit, 6-- Sub: -J-F
OR,LLER of ?.,Fmpaz', DrA.11-Unt, gork
WELL LOG
0+...._42• Hardpan with 40� gravel aa,d czAltl bcu',-d0rS.
42.67, Gravel and cobblese
67-1020 Sandy o . IV with 20% gravel.
102..1081 Wet sand*
108-119, silty gravel.
1.19-1211 Water bearing gravel produr.mg 37q,,, 7rith a 25 foot heads
A2,
C05t 0.7 S2,160.00
COST INCLUDES LA'EkOR AND V',/',- - Z CCNIF-ETION OF SAID
z 11,
WRITE CHECK PAY;,'- -E TO RAM -PA 7 DRILLING, FOR THE SUM OF
THU7 4K YOU V"*RY NILICH,
OF' �7PsMIPART DRUI.ING WORKS
�AT'E
SERVICE CHAR'S C F I'/j% AS'=E$`:ED ON PAST DUE ACCOUNTS.
MUNIDIPALITY 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
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
SUNSET HILLS BE L9A [018-241-37) North ½ of Northeast ¼ of Section 32
LTOWnsh,ip .12 North, Range 3 West of Seward ~Gridiem.
ocation [aUeress or directions)
2300 Dennis Way (South on Old Seward l~ast DeAnnoun to second left)
(b) Applicant Name Gene & Lisa Short .... Telephone: Home Business
Applicant Address 2300 Dennis Way
March 8, 1985
562-7868 (Lisal
(c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d)
FIRST FEDERAL BANK 274-6565
Lending Institution Telephone
813 West Northern Lights Blvd., Anchorage, Ak 99503
Address
(Attn: Bambi)
(e) Real Estate Company and Agent U S REAI,%¢ Gordon E. Williams 562-4513 562-S259msg
Address 1200 Southampton, Anchorage, Ak 99503
562-451:5 562- 5259ms~
Telephone
(f) MCNthe HAA to the following address: FIRST FEDERAl. BANK
813 West Northern Lights Blvd., Anchorage, Ak 99503
2. TYPE OF RESIDENCE
Single-Family [] Multi-Family []
three
Number of Bedrooms ....
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If commuaity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4, SEWAGE DISPOSAL
Onsile ~:] Public [] Community [~ Holding Tank [] 1000 gal. septic
Note: It community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the locality and slatus.
Page 1 of 2 72-o25(iD84)
ENGINEFRING 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 verity 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.
NameofFirm CRW ENGINEERING GROUP Telephone 562-3252
Address 3900 Arctic Blvd, SuJ. te 203, Anchorage, Al( 99503
Date 16 March, 1985
Engineer's Seal
Approved for-~'~k~.L-%--~ bedrooms by _
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 lo purchasers of homes and their lending
institutions in order to salisf¥ certain federal and stale requirements. Employees of DMEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Aachorage is not responsible for errors or omissions in the
professional engineer's work,
Pane 2 ol 2
A. WFLL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHI"CKLIST - FEBRUARY 1984
264-4720
Lot' 9A,
Legal Description
Sunset
MUNICIPALIIY OF ANCHOP, AGE
DEPT. OF HEALTH &
ENVIRONMENTAL pROTECTION
RECEIVED
Block R)
Hills Subdivision, Anchorage, 6k
Wel Classification Private
Wel Log Present (Y/N) Yes
Tota Depth 120 ' Cased to
Static Water Level 9 4 '
I 8"
Casing Height Above Ground
Yes
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Seotic/Holding Tank on Lot
To Nearest Edge of Absorpbon Field on Lot _
To Nearest Public Sewer Line ] ) 000~+
Cleanout/Manhole 1 ,~00 ' +
Water Sample Collected by
If A B. C. D.E.C, Approved (Y/N)
Date Completed 197 ? Yield
120' Deoth of Grouting Unknoun
Pump Set At 115 '
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead fY/N)
115'
. On Adjoining Lots
115 ' On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date J5 March
N/A
'10 GPM
Yes
150'
180
'L9Jg_5
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 1977 Size" ,000 gal No. of Compartments 2
Standpipes (Y/N) _ Yes _ Air-tight Caps (Y/N) Yes Foundation Cleanout (Y/N)
Depression over Tank(Y/N) No Date Last Pumped 16 March,
Pumping/Maintenance Contract on File fY/N) N/A for
Holding Tank High-Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N)
Separation Distances from Seotic/Holding Tank:
To Water-Supply Wel
To Property Line 3 5 '
To Water Main/Service Line _ 1 ) 000 '
Course 60' to minor drainage ditch at
Comments _ Pumper commented that the tank
Yes
' 985
To Building Foundation 35 '
To Disposal Field 25 '
To Stream Pond, Lake, or Major Drainage
road.
needs cleaned out to remove
material t.at can't be just pumped out.
Page 1 of 2
72-026111/84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 1 9 ? 7
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 115 ~
To Building Foundation 35 ~
N/A
Lot . ; On Adjoining Lots
To Water Main/Service LIn~" f~c'") .... ~ . ~Cutbank
To Stream/PondlLake/or Major Drainage Course N /
To Driveway, Parking Area, or Vehicle Storage Area 6
85 S.F./bedroom Type of System Design Crib
Length of Field 11 '
1 5 ' Depth of Field 1 0 '
Gravel Bed Thickness 6 ~
372 Standpipes Present (Y/N) Yes
No Date of Last Adequacy Test 16 Harch, 1985
Accepbable
To Property Line 35 ~
To Existing or Abandoned System on
170+
(if present) N / A
Comments Test on 3-15-85 fa~?~ed due to heavy household water usage,
Test on 3-16-85 passed after 12 hours of little or no
water usage.
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 t h at I~v~_~ed, v/~'ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection·
Signed
Company CRW ENGINEERING GRCUP
Reoeipt No. otO ¢1
Date of Payment ~ - \ r.~ .. 6<¢%~
Amount: $ L~c.L~ . 6)O ,
Date
MOA No. SI? 85-253
Page 2 of 2
72-026 (I 1/84)
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTO% f~
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~-,[~NMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION SEP 5 1980
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~&%~(~I LVI'~I~"~
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing,
1, PROPERTY OWNER ~' PHONE
Alan D. & Robin L. SharpnackJ344-6453
MAILING ADDRESS
SRA 4035
PROPERTY RESIDENT (if different from above) PHONE
Corner of Dennis Way & Old Seward Hwy.
2, BUYER PHONE
Homequity Inc. (415) 572-53
MAILING ADDRESS
2600 Campus Dr. San Mateo, California 94403
3. "LENDING INSTITUTION PHONE
none
~-AI LING ADDRESS
~-, REALTOR/AGENT PRONE
Clair Ramsey Jack White Co. 277-1553
MAILING ADDRESS
-- 3201 C St.. Anchorage, 99503
12
~D~S C-'"~'~Ti O N
Lot gA, Blk E, Sunset Hills
SIREEI LOCATION
Corner of Dennis Way & Old Seward Hwy.
5, TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
~] SINGLE FAMILY
[] Two [] Five
[] MULTIPLE FAMILY ~] Three [] Six
[] Other
7. WATER SUPPLY
~] INDIVI DUAL* * 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 UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SFI'E** //~7~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY -~ATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[]Septic Ta,nk or [] Holding Tank
Size: /~./2 If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TAN K MAN U FACTU R ER
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
~"/'APPROVED FOR ~-~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 {Rev. 6/79)
~1: Time 3:3
Date 8-5,
In sp
oEWER AND WAILI{ FA('ILITIES
REQUEST FOR APPROVAL OF [NI)IVIDUAL
Lend 'i_ng
Mail:Lng
Institution Requesn:
Address: 3 3~0 _1 _._._q__~ t ~r_e.._e_t._,. _g._a..!.9_i_ _s !_.'~[ .......... Phc)ne: 278-4581
2. Property Owner: ___A--__J_~o_h!_.M_a_rq_E_as_dt~/~Cj_ D~_!_e~_.._M_u_~p_h_Y' Phone:
Mailing Address: 3900 Caravelle Drive
3. Legal Description: Lot 9A Block E Sunset Hills Subdivision
4.- Sing]_e [~aml. ty" Residence: (x) Numoer of Bedrooms: Throe
Mu].tipl0 Family Residence: ( ) Number of Bedrooms: ..................
' ' ] oy.,~em ( )
5. Well System: Individual Well (x) Comnunzty/Pub.~.t,c e o..
Permit ~ Depth of Well 120' Wel]. Log on Flle ( )
Construction
Sewage Disposal System: On-site System Sx) Public UtiliLy ( )
Permit ~
Size
Septic Tank ''~
Absorption Area
Installed 1977 Installer
Soils Rate Material
7. Distancos: Well to Septic Tank
to Absorption Area
to Nearest Lot r, ine
tO Sewer Line Nearest Lot line Absorption Area
Page Two
Departmen % of
Request fo3.- Approval
Legal Description:
Health and EnvJ. ronlnenhal ]?ro%oction
of Individual Sewer and Water' Facilities
Departmant Wo;?ksh-~eu ~ ~-
COR~ReI'1t S:
Affadavit Attached: ( ) Letter Attached: ( )
Disapproved:
MLJNICIPALII'Y OF ANCHORAG~ MUI~C!PA~tFY
//~_-~ Department of Health and Environmental ProU~3~6~i~ALF;~ &
~ 825 L Street, Anchorage, Alaska
----request for Approval of Individual Sewer and Water Fac, ilities
Mailing Address: _~O Caih~.~¢,
Mailing Address: ~_~ ~_~_?_~_~ ............. Phone:
Mailing Address: _-~L~_% ~---' ~'3~__.~2~I~-B- Phone,:
4 o
o
Single Family Residence: ~ Number of Bedrooms: __~ ...........
Multiple Fam!.ly ResJ.dence: ( ) Number of Bedrooms: .......................
Water Supply: * Individual Wel]. I:ublic/Cormnm lty System ( )
Z:ndividual we_ii, weii depth __L_~.~Z.
if Coneaunity System, name of system .......
Sewage Disposal System: On-site System ~ Public System ( )
*NOTE: A well log is required on ALI, wel].s dri].led since 6/'15.
3/'77