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Home My WebLink AboutT15N R1W SEC 5 LT 121 Municipality of Anchorage DFPARTMEN-I'iOF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES BIVlSION P.O. Box 196650 · Ancb On-Site Wastewater Dis Permit Number: ~ I ~ Page -~-~-- ol ~Z-- . >rage. Alaska 99519-6650 · Telephone: 343-4744 >osal System and/or Well Inspection Fleport PID Number: ~:::;~-~ ~c::~'f~;~"~-"~'"7 Wastewater System: [] New /~Upgrade LEGAL. DESCRIPTION ABSORPTION FIF"LD ooms: Deep Trench O Shallow Trench O Bed ,,~Mound [] Other iting: ~- Total Depth from original grade: ~ bottom trorn original 9rede: Gravel depth beneath pipe I,O FI. WELL: [] New [] UPglrade Depth: ] Cased To: !,. Orilled: i Slat c Wa er Level: Yield: ~ Set at: Casin~ Height Above Ground: GPM F . Ft. SEPARATION DISTANCES TO Seplic Lift From Tank Slal[on Sewer Lines Well Surface Water Line Foundation Curtain Drain Remarks; Fill added above original grade: Gravel length; 3ravel ~d~l~ Number of lines: materiah so. ~. ¢2~ o'~~; Date installed: TANK [] Holding ~.T.E.P. Number of C.~[.~rtments; LIF'r S'rATION Material: 'Pump on".~. (~a~levet · e~,~[ at: High w~m al: ~ump Make & Model BENCH MARK Location and Description: '~ Assumed Elevation: ~ ENGINEER'S SEAL 17034 Eagle Ri~er L°°P Road No, ~a~es (~-t 7-~I Inspections performed by: ER¢~Ei~.r/-~ A~a~ka 73,$77 : 1st Department of Health an¢ Human Services approval Reviewed and 8pproved ,, ........ 72-013 (1/91) MOA 25 Permit No. SW910049 i Page 2 . of _ 2 Municipality of Anchorage DEPARTMEN~T OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SEFIVlCES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well ~nspection Report LegalDescription: LOT 121. SEC ~'. T15N. RIW. S,M. - PIDNo.: ~lfl~? _ MTI C03 ...... ~C01 ~ (~02 SCALE I"=I0' ~ ¢01 C02 ¢03 (~04 LS MTI MT2 A 24..4 26.2 i 30.4 B 21.6 26.8 ~ 33.r7 C 13..3 44.i5 26.5 41.12 D 101.,0 $7.7 25.6 35..4 , P/L P/L DRIVE ~EW 1250 GA, ~PTIC SCALE I"--50' SEPTIC TANK ~'~"~-"~'~ NEW ABSORPTION ~'~'"'""~"~\~'C04 BED 18' X 36' 72-013 A (2/gl) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT 0F HEALTH AND HUMAN SERVICES P.O. BOX 196~50, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW910049 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:OAKLEY LEONARD & JANE OWNER ADDRESS:P.O BOX 670216 i CHUGIAK, AK. 99567 PAGE 1 OF (UPGRADE) PERMIT [O-[q-~ / DATE ISSUED: 4/09/91 ~ ~ EXPIRATION DATE: 4/09/92 PARCEL ID:05108227 LEGAL DESCRIPTION: T15N R1W SEC 5 LT 121 LOT SIZE: 108900 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUC~ION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACNED 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 (18AACS0). 3. THE FOLLOWING SPECIAL PROV.ISIONS. SPECIAL PROVISIONS: Groundwa%er was observed at a depth of 3.5 ft. o~ 4/3/91. Adjusting upwards 1 ft. for thle seasonally high depth to gruondwater, the thickness of ithe sand filter must be not less than 3.0 ft. ~ RECEIVED BY._ - ~i_ DATE: SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGH ROBERT SHAFER, P.E1 ROGER SHAFER Ap~l 5, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L S~re~ I P.O. Box 196650 i Anchorage, Alaska 9¢519-6650 REFERENCE: Lot 121,iSec. 5, TI5N, RIW, S.M. PER~IT REQUEST NARRATIVE In accordance with ith¢ conditional Health Authority Approval issued on March 21, 1991, a! groundwater mo~toring tube w~ installed on the referenced propert~ on March 27, 1991. After motoring the tube on April 3, 1991 it ~as determined ~hal the existing leachfield is within groundwccter. AttaChed is the design for an upgrade consisting of an elevated absorptionibed. The general area cb~sists of large BLM lots with o~ly a mi~bmel slope toward the north, iWe see no negative impa~t thi~ system might have on the neighboring proper.~es. If you have any questions, or require additional information for your review, please contkct us. Sincerely, ROBERT A, SHAFER, ?,E, RJS/gm 17 )34 EAGLE RIVER LOOP, SUITE 204, EAGLE R~VER, ALASKA 99577 SCALE PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage I:}EPARTMENT OF HEALTH & HUMAN SE:RVICES 825 L Street,Anchorage Alaska 99502~0650 SOILS O(=~,-- PERCOLATION TEST DATE PERFORMED! Township, Range, Section:"-'~- SLOPE SITE ~;LAN CAS GROUND WATER !NCOUNTERED? S IF YES, AT WHAT ~ DEPTH? p 0eplh 10 Water After ~ ( Monitoring? /~ Dale: ~'1~, Reading Date Gross Net Depth to Net Time Time Water Drop ~ERCOLATION RATE ~--~ I (m~nutes/inchf PERC HOLE DIAMETER TEST RUNSETWEEN _ '~LFTAND. __FT // PERFORMED BY' ' , ' ' 'I,/_/.~1 ./ ~--~-..-~'~ CERTIFY THAT~,~/41~THI TEST WAS PERFORMED IN ACCORDANCE Wl~'" ALL STATE AND MUNICIPAL GUIDF-LINE'~cf~rl~IECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 / VlAILING AD E~ ~ ~ ' !) ' LOCATION I ' ~ J J We~ ~ ~ I J Absorption a~ea ~ ~ J DISTANCE TO: J ~ ~ J J /~ ¢ Z~ ~:~7--~ _DISTANC~ ~: _]~/~~/ __ ] Dwelling DISTANCE TO: No, of lines Top of tile to finish grade Length Width Type of crib DISTANCE TO: MUNICIPALITY OF ANCHORAGE DEPARTMEN r OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Stree - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISFOSAL SYSTEM AND/OR WELL INSPECTION REPORT Dwelling I Material Foundation Nearest lot line lines Tren~'~idt h NO. OFBEDROOMS No, of compartments Liquid depth PERMIT NO. Liquid capacity in gailons PERMIT NO, Distance between lines Total effective absorption area Depth PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line DISTANCE TO: Building foundatio~ i Sewer line OTHER PIPE MATERIALS SOl L TEST RAT~4~IG w ~w w~// /~ / Z-F REMARKS t ~ Septic tank 72-013 (Rev. 3/78) / DATE LEGAL J.. {3(i:1':I-[' ]i {} H E:OI, IF~F;c V L,.I:£GF:IL. LOT i.2:L 3'f~!~i'.~l ;:?._i:P.I SE',C 'F'.?F'I;( ElF' ::.;L-,IL FIE:SE, I:~?'r'];OI',I S?STEi'fl Z S: I::,RF~ :[ NFl EM:, i'qFIH 3: HUH N Jf'!E;!:::f;: E F' E~EI:,F. tO{)H:ii; I 3 SO :[ t.. RFIT ]: NEi (SF) I THE [;'.E16¢_1 Il RED s, .[ ,¢..~: (:)F THE 'P l' Z L. ~ FIS'~;OF~:F'T I i F! ,r, ,,2.- -.:. - __, T ..., f ~...H THE I EI"t::~Tt.'I [) ]: HENS 3: O1',t .[_, THE LENGTH ,:: :[1',! FEE:T ::, OF THE TF~EI'.,IE:H THE: Eh:l-III ~':F' B 'I'REH::H OR F':[Tl"'""::, THE b.[:.,f**" ': ' "ff.L.~:' ' 8E:THEt:t'.,! THE: 'SURFS:::E: OF THE EiFrE~I...II'..!!:::, FIb,ID THE ::TT'"H OF' THE E .. , ] ]...hi ,:: :I:N FEE:T::,. THE: Ii;~RFI',,,'EL [:,EF'TH ;ES THE l"lli~tZhlUH [::,EF'TH ~X)F' GRFI',,,'Et.. BETH!!EN ThlE FIf_ITFf::! I Z~ ..... I.::. FII'.,ID THE ~:r-TT -t','l OF' THE EHCFI~,,~FIT I ON ,:11[1'.,I I:::'E~;fl'"l ;[ T FIF'F'I_ I E:FINT FIFiS THE: F..E_,F .....:., !. E:, ~ L ]. I · TO :[ I',IF'(}Rhl -I"H :!: S DEEF~FI~;Nri',IENT !::,t..1[~: ;[ N(i 'i'HIE ]: F,!STFIM~.FtT ]: Ot',1 ]; N':q:'E - T ]' i Iv:; -IF FII'.;I'.¢ 14ELI..S FID.~'FICEF, IT 'D "':: I I I [ ._ F*F:OF'ERTY RI',t[:, THE NI..II',IE~E:I;: OF' IA__I[. Ll,!_.f:.:, TFIFIT TtqE HELL HILl ...... E!, H ZF,U'?II...II','} D3:S"t'F'Ih,IE:E: E:E'I"HEEE]',t FI H[{}2L FIND FIN'.? ON--S:["I'E SE3,.II:::IG{i: E:,ISF'OSF3L. S'.?:ENtP'I ills F:EET FOR R F'F::[',,,'FI'I"E HELL OF'. d..D{2) 'TO 2E{Ei F'EET I::'I?OH I::! F'I..IBL. :[ ii: I,JEL.I.. THE T?F'E ElF' F'~ E: ] .... HELL.. hllI",I3:HLII"I D]:STFINCE F!:;:OH FI F'Ftl',,,'FI';E HELL 'If' FI F'f;:;l:'v'f::lTE SEI.,IE:Fi: L.;I:F,{!~: IS 1;"! FEET COHHt..II",t:[ T"t :SEI.,.IEF?. L l t",IE ;[ S '?U FEE'T'. 01'F!E~I;[: F;:E[;¢J ~ t:;:IZHENTS NFI"r' FIF'Fi..?. SPEC I F ~ {21'4"1' ]Z 01'4S F3F',!l.::, COt",ISTr;tUCT :[ ON [::, l: FIGRI::!!"!'E; FIRE: FI'v'F2IL.FIE~L.E TO N",ISIJ[~rE PROPEfq'. 3:I"4f:FFFIL. L..FITION. EEl ~:;;~:: Nil Il '-[- JE~ 2=..=2 F" % IF~: E: ~{:J ~1;1:,, E: ,12 ~:E ~'"'~ E:!~ ~E ~:;:: 2~:: :;:~ ....... ::~._ ::~ =~E~ ::;!! CERT i F'"r' THF:IT FIH FI::IHZI...:[FII;~; H:["R-I THE t:;;%~2LJ:([;rEHENT'S FOR OH-SITE SEI'IE:RS FIN[> HELLS F!S i::'OI:;:i'FI P~'~ 'T't'IE I'"ILIN:[C]:F'FII_:[T'.r~ OF' I.'.IILI.. ]:NSTFIL[. THE S'~":E;I"EI"'I :[? ¢~CCORDFINCE I'.I]:'FH THE CODES. UHDE~:STFII"~I) THF:IT THE ON-S]YFE SEHER S"¢S'[EH HIq"¢ RE(;?UII;i:E Et",!LF~R{~i~N"IEH'T :IF:' THE DENCE i S I:;tEI'"IODELED TO ): I",ICI2LI[:'E: HORE THFIH 3 E',EDF'.E~OHS. 'v"::!.. (({ MUNICIPALITY OF ANCHORAGE Department : Health and Environmental 'rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * *!HANDWRITTEN PERMIT * * * W/:~-~R-ON-SITE SEWER PERMIT Location: ~~ ~k~(/L ' --'~ '~ Phone Nu er: Legal Description. ~F ~ I~ ~ '~-~ Lot Size: Type of Soil Absorption Syste~m Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ,~-~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH ~ LENGTH ~) GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation!(in feet). There is no set width for trenches. The gravel depth is the minim.um depth of gravel between the outf~ll pipe and the bottom of the excavationi(ln feet).~7~F~ ~/~/~ ~C/C/ * * REQUIRED SEPTIC(HOLDING) TAN~-~I'ZE TM 3~0 <D GALdONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 2D0 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this dspartment within 30 days of the well completion. Other requirements may apply, i Specifications and construction diagrams are available to insure proper installation. * * * PERMITi EXPIRES DECEMBER 3L 1 9 8 1 * * * I certify that: ~ (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that thc on-site sewer system may require enlargement if the residence is remodeled to include more ~hat/~edrooms. Signe~: Issued by. c, ~ Applicant ~ Date: SWP/024(1/81) Gr. TEaR ANCHORAGE! AREA BORG G~ ARTMENT OF ENVIRONMENTAL. QUAb. ' 3500 TUDOR ~OAD ANCHORAGE-', ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SI=WAGE DISPOSAL SYSTEM L O C A T I O N ~O:=c ,~'-~ f~ ~...~CL!_'~.__L,.~ SEPTIC TANK: DIS1ANCE FROM WELL_ / c'' 6 _ =_MATERIAL '~'/cc'~ ~ ~-"'~'~'/'~' LIQUID CAPACITY__'~',~~' GALLON', INSIDE LENGiH SEEPAGE SYSTEM: SEEPAGE PiT: /"'"%x ot NUMBER OF PITS / JTSIDE DIAMJ LINING MATERIAl / ~x~M --- NEAREST LOT LINE NUMBER OF COMPARTMENTS LIQUID INSIDE WIDTH _DEPTH TER OR _WJD~H~ LENGTH_ __ DEPTH ..... :~ DT~-~- FROM WELl ~ ~ , _BUILDIN~ EOUN )AT ON TOTAL EFFECTIVE ABSORPIION AREA (WALL AREA) SQ. FT. TILE! DRAIN FIELD: DISTANCE FROM WELL / ~'~ ¢'J"' f' I , FOUNDATION_ ABSORPTION AREA ~.~' / 0 SQ. FI. LENGTH GE EACH LINE DEPIH: TOP OF T~LE ID FINISH{ GRADE tOTAL LENGTH NEARES1 LOT LINE "~"~ ~ OF LINES TRENCH WIDTH IN. TOTAL EFFECI'IVE .DEPTH OF F{LTER MATERIAL BENEATH TILE IN. ABOVE TILE~_~ WELl.: TYPE~,~ ;//''c' ~:// , DEPTH : NEAREST SEPTIC LOT LINE , SEWER LINE .... ~, TANK DISTANCE FROM WA1ER , BU{LDING FOUNDATION .... SAMPLE NEAREST SEEPAGE OTHER , SYSTEM ..... CESSPOOL , SOURCES. DIAGRAM OF SYSI'EM DISTANCES: -h~ ~'r~., · !: ,: DATE ADAMS · CORTHEliL · LFE · WINCE & ASSOCIATES ~ CONSULTING ENGINEERS 503 FAST SIXTH AVE. - ANCHORASE~ ALASKA -- 09BO1 TEL. 272-342S April 8, 1969 Associate Builders Post Office Box 11 Eagle River, Alaska 99577 ATTENTION: Mr. Eric Jo%nson PROJECT: Percolation Test- Lot 121, Sec. 5, T15N, R1W, S.M. Dear Mr, lohnson: A percolation test was perfomed on the subject site on April 8, 1969 by Alaska Testlab, The test data are shown on the attached sheet. At the time the test was performed the ground water was at a depth of four (4) feet or less b~low the immediate ground surface elevation and fluctuated somewhat; This was apparently as a result of frost-melt runoff. The percolation rate was determined to be approximately one (1) inch per one (1) minute. This rate did nol consider frost-melt runoff which may or may not have had 'an effect. Very truly yours, ADAMS, CORTHELL, LEE~ WINCE & ASSOCIATES f Frank W. Wince, P.E. FW-W: pc Attachment ALAN N, CORTHEiL, P.E. RICHARD S. ADAMS, P.E, HARRY R. LEE, P.E. FRANK W. W}NCE, R!LA S KA T E S T LA P 1940 Post Road Anchorage, Alaska ' T.H. No. Client /¢,~odl~j/"¢. ' FHA No. , Tech. Location, lot ,Block ] -~,Subdivlston___ PERCOIATION TEST DATA Depth 8oili Class Fac t Visual 5 Unified / 3 Sheet _~_ of /. ' WO No. ?4JO R/q /'/ . ,_Incb_tion ok.tch~ ¢ _ . Rc,'adin~ 5 6 10 11 Percolation Pat, Date Gross Time Net Time _ Minute. II Depth to H20 Net Drop ! I / I I GAAB HO I Go=4TER ANCHORAGE AREA BORO*~H I HEALTH DEPARTMENT 327 EAGLE ~T. ANCHORAGE, ALASKA 99501 279-2511 INSI~CTI-~- REPORT ON-SITE S~-A~E D~OS~ S~TEM NAME LOCATION.__ SEPTIC TANK:' D STANCE EROM WELL_ LIQUID CAPACITY "7,..~ ! MAI-ERIAL GALLONS ADDRESS ___ PHONE__ NUMSE~ OF INSIDE LENGTH .~INSIDE WIDTH. _DEPTH· SEEPAGE SYSTEM: SEEPAGE PI[: NUMBER OF PITS __OUTSIDE DIAMETER__ OR WIDTH LINING MATERIAL DISTANCE FROM WEI.L NEAREST LOT LINE TO~AL EFFECTIVE ABSORPTION AREA (WALL AREAI ·LENGTH__ ~ DEPTH BUILDING FOUNDATION__ SQ. FT. TILE DRAIN FIELD: D'STANCEPROM WELL ZC')O NUMBER OE L'NES__ ABSORPTION AREA_ DEPTH: TOP OF TILE TO FINISH GRADE FOU~4DATION_ '~/ / ' i ,NEAREST LOT LINE ,-~' '-~ ,~ "~SQ. FT. iLENGTH OF EACH LINE DEPTH OF FILTER MAIERIAL BENEATH TILE TOTAL LENGTH' / OF LINES //~'~2 - __IN. TOTAL EFFECTIVE IN. ABOVE TILE -~ / ~' WELL: LOT LINE SEWER LINE__ DISTANCE FROM ~ / _, BUILDING FOUNDATION. I WATER · SAMPLE_ ~/~.~ _. NEAREST ~'~" / SEEPAGE /.,'q ~.q / OTHER , SYSTEM__/C~"~'~,~ . CESSPOOl ~ , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED. GREATEL 327 Eagle St. ANCHORAGE AREA . )ROUGH I HEALTH DEPARTMENT Anchorage~ Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPklCANT /~S,qtrx?.t6kq/~ "q~u, Jt~,o/?,_~.MAIklNGAODRESS '~o'.x // PN(1NENO.~"¢~-'~7~'9( RESIDENCEADDRESS_'B,'¢c ku, oo ~ ~-oo ~___LOCATION OFINSTALLATION___~_tr¢~u,o~A ~h¢,~ LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED TI-IROUGH~"'/~/.,~ PERCOLATION TEST RESULTS__ ,/ , LoT SEEPAGE PIT_ .,DRAIN FIELD /~'"' ,OTHER TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO lie FILLED OUT BY ttEALTH DEPARTMENT DISTANCES: , PERMIT TO INSTALL A _AS DESCRIBED BELOW, SIZE OF UNIT TO BE SERVE[) SEPTIC TANK SIZE 73-~'9 _TYPE --q [ ¢¢ [ ,SEEPAGE AE DIAGRAM lealth Authority I certify that I am familiar with the requireinents of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATI: ¢ APPLICANTS S I G N A T U R~~'r"~=:~.~.~.~ Vlun c. pa . Anchor P.O. E ' 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-,~1Ax 4 ? 4 4 TONY KNOWLES. MA YOR January 9, 1987 DE 3ARTMENT OF HEALTH & HUMAN SERVICES / Leonard L./Jane E. Oakley PO Box 216 Chugiak, Alaska 9956? Subject: T15N R1W Section 5 Lot 121 On-site Well Permit ~860223 A permit issued by th~s Department for an individual well and/or on-site sewer ~ystem has expired as of December 31, 1986. Permits are issued onla 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 engineeriznspected 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. If there are any further questions, at 264-4744. Since~r~ ly, R.W. 'Robinson Program Manager On-site Services please call this office RWR/ljw enc: copy of permit :[ SSLIE::O ~'~. £ / . AS-BUILT hereby certify that I hav~ surveyed the following described ~cho~e R~ng Prednc~, ~aska~ a~ t~t th~ improve. m~t~ situated thereon.~e with~, the p~y ~nes and do no~ ~erlsp or en~oa~h on. the proper~y ~in~ ~d~acent there- to~ tha~ no ~p~vement~ on proper~y 1~ adjacent ~her~to en~oach ou the premises madwey~. ~n~ssion l~m~ or other ~sible e~s~ent~ on s~d pro~ except ~s indlc~ ~CAI~: F' = ~,~ ~ Box 458, Eagle Riv~, Al~ka Phone (907) 694-2543 ( erlifie Drili ng DOC Co, dba SUILLIVAN WATER WELLS P.O. BOX67q272, CHUGIAK ALASKA99567 · TELEPHONE688.2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER Ended I)EI'IIt 0F ~aELL ST\H( LEVELOFWAH~R FI l)R.\~,s I)OWN F'I. G..\LS. PER HI>, ; KIND OF CASIN(; KIND OF FORMATION: From Ft,[o Ft From Ft. to Ft From__ Ft. to __Ft. _ From__ Ft. to Fl From__ Ft. to Ft From Ft, to_ __Ft, From Ft. to Ft, Frmn Ft, to Ft From. __ Ft. It) __Ft. From Fl. o MUb0~IPALITY OF ANCHORAGE ........ DEPTT~ Frum ..... Ft. to__ ENVIRONMENTAL PRO~ECrlON From_ _ Ft.lo_ _ F,.o,, Froln I' . From Fl, h)__ _ Fl From Ft. to Ft, _ From___ Ft. to Ft. From Ft. to Ft. From Ft. Io . _Ft From ' Ft. to-- Ft. _ From Ft. to _Ft From__ Ft. to Ft. From _ Ft. to_ _Ft From .... Ft, to Ft. From Fl, to Ft From Ft. to __ .Ft Frmn Ft, to Fl, . From. Ft. to Ft. From Ft. to Ft. From Ft. to Ft, From ...... Ft. to _ _ Ft. From__ Ft, to ._ Fl MISCL. INFORMATION: From_ Ft. to __ _ Ft DRILLER'S NAME E!; 6:! L,I FIl-;ir E I::'E:E T ~( C::E:[;~:'T:[F:'"r' -f'HFIT ::l..: Z I:::11'"1 F':f:IH:[L:[FI~;: PI:[-I"H 'THE r,;rE~]!LI):REHEhFr:5 F'Eff~: Ohl--.:E;:[TE rSEI,.II~i:Fi::E; FiND HIEL.L.:i; FI:E; FEIR'T'H E:','¢ THE I','ll._ll'.,l :[ (:: :[ [::'F:ll.. :[ "l"',:' OF FINCI'..IE,,~;:FIGE. 2: :[ H:[L.I... ):hI?r'F:IL.L. 'THE %'.r":'~;TE:r,'l :[f',l F:ICCO,'~::E:,FINCE: I,.I:[TH THE C()DE'.:~;. MUNICIPALITY OF ANCHORAGE Department Health and Environmenta~ rotection 825 L ~treet, Anchorage, AK. 99501 264-4720 * * *iHANDWRITTEN PERMIT * * * WELL~~~ PERMI~ Location: ~tx)~ ~n~ Phone Nun~er: Legal Description: LOw ~Z/ ,~C ~- r/~/~ot Size: /D~ TOO__ Type of Soil Absorption System Is: Trench :'~--~--~D~lnfle].d: Seepage Bed: Holding Tank: Maximum Number of Bedr~o~0~m .-~-~_ Soil Rating(sq,ft/br) The Required Si_e System Is: DEPTH ~----- ~2NGTH i ~ , GRAVEL DEPTH .... WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation{in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel, between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE : Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well. will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution; Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum dist&nce from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. ~Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 1 * * * I certify that: (1)I am f~niliar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2)I will instal], the system in accordance with codes, (3) I understand that the on-site sewer system may require enlargement if the ~esidence i~~to include more that 3 bedroo~~~i i Signe~ _ : ~ Issued by: ~ A~icant Date: . ~ ~[(~ ~ / SWP/024 (1/81) Parcel I.D. # 1. ~ 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 HAA # ~ ¢;~c:~ \ ~)('~(~ / Lot. 121, S¢.C. 5, TI5N, RIW, S.M. I..ocation (site address or directions) 21515 Blair Av~nu~ Property owner L~.o rmCd Mailing address p. Lending agency I Mailing address Day phone_ cb~9,~J~, A~. ~g~67 Day phone 688-~356 Agent ~Vir.qinia Kohfi¢6d RE/MAX OF EAGLE RIVER Day phone ~q4-4900 Address 16600 ~r~6rficld Driv6, Ea~l~ River, Ak. 99577 Unless otherwise requestedj HAA will be held for pickup. NUMBEFI OF BEDROOMS: TYPE OF WATER SUPPLY:~ Community Well Public water NOTE: If community welllsystem, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on,site XX Holding tank~ Community on-s~te Pub c sewer NOTE: 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 S~UeLULUO0 leUO!l!pp¥ :suoijelnd!~s I~U!MOIIOj eql qJ[M 'sLuoo~peq Jot le^oJdde leUO!~!puoo 'uol~oedsu! s!ql lo e~ep eqj uo Joel,L@ u! suo!~elneeJ pue 'seoueu!pJo 'sepoo ele~S pue led!o!un~ lie LII!M eoue!lduJoo u! s! uJe~S/~S lesods!p JeleMm, SeM Jo/pue ~lddns JeJeM e~ls-uo eLl~ 'uo!~oedsu! pue uo!~ee!~seAu! XuJ Luo4 pue Sel!t ee~Joqouv to Xl!led!o!unlAJ eLll LUOJt peu!elqo uo!~eLuJotu! eLlJ UO peseq 1eLI1/~tpeA JeLIpnt I 'u!eJeq pejeo!pu! eJnlon4s ~o ed/9, pue suJooJpeq to JeqLunu eLp, JOt e~enbepe pue leUOflount 'eles s! uJelsXs lesods!p JeleMe~SeM Jo/pue ,qddns JeleM e:l!s-uo eql leq~ SMOLIS uo!leo!ldde leAoJddv/qpoqlnv q~leeH s!q~ lo uo!~ee!lse^u! ~uJ jeq~ Xt!Je^ I 'MOleq UMOqS e~ep uo!~ep!le^ eql Jo se pue m, eJeq pex!tte legs/~Lu ,~q Pe!ti~JeO sv tJ3:~NIDN:~ All NOI/O=IdSNI JO /N:~IN=I.LV.LS '9 MUNICIPALITY OF ANCHORAGE Dep~rtment of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES ] 343-4744 · CERTIFICATE OF INsPEcTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.#~.~%=~L~D-J~~ i HAA# ~-"~W~/°~ 1. GENERAL INFORMATION (Must be c~mpleted prior to sabmittal) (a) Legal Description (inelude 10t, bloo~, subdivision, section, township, range) Lot 121; Section 5~ T15N; R1W Location(address ordirectioes) 21515 Blair Avenue ~, (b) Property owner Leonard Oakl~y Telephone: (home) 688-2356 Business Mailing Address P.O. Box 67~216t Chug±akt Alaska' 9956? (c) Lending Institution Mailing Address 274-5150 NORTHLAND~MORTGAGE Telephone 2605 Denali~ Anchoraqe, Alaska 99503 (d) RealEstate Company and Agent IRE/MAX OF EAGLE RIVER - Virqinia Kohfield Address 16600 Centerfield Drive¢ suite 201, Eaqle River, Alaska 99577 Telephone 694-4200 (e) Mailthe HAAtothefollowing address:(orcheck here;/;~ifholdforpick up.) Listcontactperson and day phone!numberbelow: S & S ENGINEERING/694-2979 17034 Eaqle River Loop Road, Suite 204 Eaqle Riverf Alaska 99577 2. TYPE OF RESIDENCE Single-Family,'~ Number of bedrooms 3 "4 3. WATER SUPPLY ~ Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Departmen.t of Environmental Conservatidn attesting to th legality add status. 4. SEWAGE DISPOSAL ~ On-site [] Public E] Community [] Holding Tank [] Note: If community well system, mus~ have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 {Rev. ?/88) Page 1 of 2 '~tJo~ s,Jeeu!6ue IBUO!SSejoJd eq~ u! S~O!SS!U. JO JO SJOJJe JO; elq!suodseJ ~ou s! e§eJoqou¥ jo XHled!o!un!Ai @q/'panss! s! eI8olJ!~Jeo ~ eJo,t@q 8~ep ezXlsue Jo suo!~oedsu! lonpuoo~,ou op SHHO ;o saeXOldLU3 's~uecuejlnbeJ e~eis pue I~Jepe; u!e~JeO X;s!~es o~ Jep~o u! suo!~nH~su! 8u!puel J!eqI pue seuJoq ~o sJes~qoJnd o~ Xse~,Jnoo e se s!ql seop SHHO eqj. 'e~SZl'¢ ;o e~e~S eq) u! peJ@ls!6eJ JeeU!§Ue leUO!SSe~oJd ~uepuedepu! u~ Xq eAoqB ~ qdeJ§e~ed u! UeA!I~ suo!lB~uese~deJ eq~ uodn ,{lUO peseq p@leo!,tHeo 18^oJddv XqJoq~nv qlleeH senss! (SHHQ) seo!^Je$ ueLunH pue q~,leeH jo lUeW~Jedeo a6eJoqouv jo Xl!l~d!o!unlAI eqi leUO!~!puoo pe^oJddes!O .~ . ~suJooJpeq pe^oJddv ~ ]o~ pe^oJdd¥ 'lYAOl:lddV SHHC] '9 e~eQ sseJpp¥ pu~ led!o!unp1118 q3,!M eoue!ldWoo u! s! we3sXs lesods!p Je~,eMe~se,v, Jo/pue Xlddns JelBM eHs-uo eql 'uo!loedsu! pu~ uo!leS!isenu! ~ ~oJ~ pu~ sew eSeJoqouv jo X~!led!o!un~ eqi ~o~j pau!e~qo uo!~e~oju! aq~ uo pes~q ~q~ ~¢!Jen Jeq~Jn¢ I 'ulaJeq Pe~go!pu! eJn~on~s jo ad~ pu~ s~oo~peq jo ~aq~nu eq~ Joj e3~nbepe pue leUO!~ounj 'e~es si we~sXs lesods!p Je~e~e3se~ Jo/puB Xlddns Je~ e3!s-uo eq3 ~q~ s~oqs leAoJddv X~HOHmV qlleeH s! q~ jo uo!3~8!~seAui Xw ~eq] ~JHeA I '~oleq u~oqs alep uof3ep![BA eq~ Jo s~ pub oleJeq pexgje lees ~ Xq peWHeo sV NOI&Y~BO~NI aN~ VZ~a 'HOUV~S ~31J 'SIS~ 'SNOI~O~dSNI DNIQIAOad ~alJ ONlag~NIDN~ 'S 'uo!)oedsu! s!q3 Jo e3ep eq~ uo ~,oeCj@ u! suoRelnSe~ puc 'seoueu!pJo 'sepoo ele~S ~ MUNICIPALITY OF ANCHORAGE (MOA) (~,~..~/ Health Authority Approval (HAA) ~.// CHECKLIST- FEBRUARY 1984 ~ ~ 343-4744 A. WELL DA~¢CC~~ ' Well Log Present (Y/N)_ ~ _Dat~ Completed ~/~ _ Yield Total Depth Static Water Level Cased to ~'0~ Depth of Grouting 2. ~- Pump Set At ¢ f Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELl..: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field']on Lot To Nearest Public Sewer Line 'To Nearest Sewer Service Lineion Lot _ Water Sample Collected by ~ ? ~ 4~--- ~,Jq/~J E'.~¢~u~ .; Date _ Comments ; On Adjoining Lots __ [ O0 I cO ~' _; On Adjoining Lots _ To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date nstalled / !-?'-~l Size ~O0~_?~l ~o. of Compartments Standpipes (Y/N) __ ~ Air,tight Caps (Y/N)_ ~ Depression over Tank (Y/N) _ ~ Pumping/Maintenance Contact on File (Y/N) Holding Tank ~igh-Water Alarm (Y/N) _ t,2/~ Foundation Cleanout (Y/N) Date Last Pumped / Temporary Holding Tank Permit (Y/N) /,J/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well / To Property Line To Water Main/Service Line _ To Stream, Pond, Lake or Major Drainage Course Comments ~'b d'~ -/L-f' ¢ To Building Foundation To Disposal Field [0o -t- 72-026 (Rev 7/88) Fron~ Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed P¢'~0¢' /~' (~[ Width of Field ~ t/CD Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~¢, .~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /,,.)//gl To Water Main/Service Line ~/~ Type of System Design Length of Field Depth of Field ~.~. Gravel Bed Thickness ,2. Statndpipes Present (Y/J:~ Date of Last Adequacy Test ( Oo q¢ To Property Line To Existing or Abandoned System on ; On Adjoining Lots , {0 p To.Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course __. To Driveway, Parking Area, or Vehicle Storage Area J D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested ~or Meets MOA Electrical Codes Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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-tf inspection. Signed Company Date MOA No. Eagle Idvo;¢, Alaska ~"YbY/ ¢/¢ / - Receipt No. Date of Payment Amount: Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE[ ALASKA 99518 TELEPHONE (907) 532-2343 Date Nep~rt Printed: MAN 4 91 0 06:47 FAX:(907)561-5301 Client Sample ID:LL21, SS, T15N, PWSID Collected ~BB 28 91 @ 10:30 hss. Necelved FEB 28 91 ~ 13:30 hrs. Preserved gith tag ~BQUINED Analysis Completed :MAN I 91 Laboratory Supe~vt%ox ~_8~HE}{ C. EDE Client Name Client Acct BPO { Ordered By :S & S EN(ilNEENING :SNSENUP PO # NONE NECEIVED :N. SUAEEN 1)$ ~ S ENUINEENING 2) Chemlab Ref S: 910707 Lab Smpl ID: 3 Matrix: WATER Allowable Parameter Tested Nesult Units Method Limits NITNATE-N ND(O.IO) mE/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: N.D.J Rerm:ks: I Tests Per£otmed ' See; Special Instructions Above UA-Unavailable ND= None Detected "See Sample Nemrks Above NA= Not Analyzed LT-Le~ Than, GT=Grontor Then I~UNICIPALtTY OF ANCHORAGE DEPARTMENT oF HEALTH AND ENVIRONMENTAl, PROTECTION DIVISION OF ENVIRONMENTAl. HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORFrY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Legal Description (include lot, bloSk, subdivision, section, township, range) Location (address or directions) Application Date (b) Applicant Name.I.~¢;P_~I,,,~C-t> ~,Z~'-L~_%__ Telephone: Home (¢~ ~ ~."~¢/0 Business Applicant Address ~J'~, _';~2J;~_~ ¢_~_LL~_~C~'_t,)~7-qJ/'~/.~__I ,L'xIL--.._ °)¢t,~¢~'*7 (c) Applicant is (check one):.Lending =Institution []; Owner/builder,~ Buyer []; Other [] (explain); Address (e) Real Estate Company and Agent Address Telephone (f) Mail the 14AA Jo th9 following address: TYPE OF RESIDENCE Single-Family ~L Multi-Family[] Number of Bedrooms ___..~ Other · WATER SUPPLY Individual Well¢ Community E.'] Pbblic [] Note: IF community well system, must havre wntten conhrmabon from the ,State Department el Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~ Public [] Community F"] Note: I1 community well system, must he~ attesting to the legality and status. Page 1 of 2 Holding Tank [] e written confirmation from the State Department of Environmental Conservation ENGINEERING F:IRM PROVIDING INS ~ECTIONS, TESTS, FILE SEARCH, DA'I ~ 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 tbe on-sit~ water supply and/or wastewater disposal system is sefe, 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 end 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 tbe date of this inspection. Name of Firm ~e~~[~(~ _ Telephone Address Date F. A6LE RIVER~ AK 99577 Approved_ ,/%( Disappro~dd . Condition~'F'~'-') Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depadrpent 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 fedleral and state requirements. Employees ol 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) WELl. DATA MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ~THORITY APPROVAL (HAA) DEPT OF HEAL~'fH & ' -'L P"^'f~.;I~'~R~KLIST ' FEBRUARY '1984 ENVIRON~EN~A ~ · 264-4720 RECEI VED Well Classification Well Log Present. N) Total Depth __~, i;'l Cased to: Static Water Level 5, Casing Height Above Ground Elech'ical Wiring in Conduit O~/N) Se'paration Distances from Well: To Septi~/.Net~:r~ Tank on Lot To Nearest Edge of Absorption I:ield.o To Nearest ~ubli~ Sewer Line _ Cleanout/Manhole_ If A, B, C, D.E.C. Approved (Y/N) ~te Completed ~/~;/z:, Yield ~1¢;' Depth of Grouting Pump Set At O ,.c~ Sanitary Seal on Casing (~N) Depression Around Wellhead (Y~ [~:~,'--.,-' ~ ; On Adjoirfing Lots Lot ~1~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Water Sample Collected by ~ ~ ~ ! '~:;"~..~ I~r,7(~ ; Date Water Sample Test Results Comments ~ ~ B. SEPTIC/~J;C.~-~I'NEi TANK DATA Date Installed Standpipesd~N) Air..tight Caps(~.N) Depression over Tank (Y/~-~ ; Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N)i ~/~ Separation Distances from Septic/H~, Tank: To Water-Supply Well I ~'c~' / To Property Line To Water Main/Service Line Course I/~'~-~'~ Size _~ No. of Compartments Foundation Cleanout ~/ Date Last Pumped (~'1~7 ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ -ro Disposal Field [ ~ ~ ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026{11/§4) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/(~. Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ _6;~¢:> ~ To Building Foundation Lot ~//~ Type of System Design ~"-~;::f--'-'-'-'-'-%~M Length of Field ~ ~ ,~-~IC- '-'~m"A,~ Depth of Field Gravel Bed Thickness Standpipes Present ~ Date of Last Adequacy Test To Property Line ; On Adjoining Lots To Existing or Abandoned System on To Water Main/Service Line ~. c:, f-Jr'" To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To C~tbank (if present) D. LIF.T 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. JUL I 8 1986 Date MOA No. Signed $ & S ENGINEERING Company~R J~ 196X EAGLE RIVER, AK 99~,,577 Receipt No. ~¢e~ Date of Payment r~ Amount: $ Page 2 of 2 72-026 (11/84) __ __ I RECEIVED DATE DA~E DATE NSPECTOR IN~PEC-FOR INSPECTOR ' MUNICIPALITY O~ ANCHORAGE ~UNIOIPAblTY OF ANOHO~AGE DEPT, OF ~EAL~IJ & DEPARTME~T OF HEAt TH & ENVIRONMENTAL PROTECTION A - ENVIRONMENT L [ ENVIRONMENTAL SANITATION DIVISION ], Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER I DIRECTIONS: Comolete all Darts oil page 1. Inc01~plete reque~ds wi not be proce~ed. ~lease allow ten {10) days for processmg, ~R~PECTY RESIDENT (H different f~m above) ~ MAtLINE ADDRESS ./ ~ 3.---- I. E~N/~71N G INSTITUTION MAq LING ADDRESS 4. REAL'FOR/AGENT '~' i. '~'-. LEGAL DESCRIPTION ' ;~ EET ~OCA'~ON 6, TYPE OF RI"SIDENCE SINGLE FAMILY MULTIPLE FAMILY ~. WATEH sUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY 3//0 -:FIONE ~ JPHONE JPtfONE PHONE NUMBER OF BEDROOMS X E] One ~] Four E3 Omer _ '1~]; Two E] Five . Three E] Six ' ATTACH WELL LOG. Awelim~ s requ~'ed for all we sdrilled since June lg75, For wells drilled ~rior [o that date, give well de~th (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED, 8, SEWAGE DISPOSAL SY!~TEM ,,~ NDIVI DUAL/(]N-SITE** [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ~CCOMPAN Y 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 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions; 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 [] APPROVED FOR ~ BEDROOMS [~"~-CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED 72-010 (Rev, 6/79) Jane and Leonard Oskley Box 216 Chugiak, Alaska 99567 Dear Mr. and Hrs. Oskley~ EXCAVATION ROBERT A. SHAFER WORK CIVIl. ENGINEER 694-2979 September 17, 1981 MUNICIPALITY OF ANCHORAGE ENVIRONM£N1 ,-,L ;OfECTION RECEIVED Reference: Lot 121; Section 5: T15Ni RiW A sewer system adequacy test was performed on the system located on the referenced property as yQu requested. The septic tank was pumped and verified to have a capacity of approximately 750 gallons. The leach field was tested ]Dy a continuous flow of 567 gallons of water over a period of 24 hours without any adverse effect on the system. It can be concluded from this test that the waste water disposal system serving the two bedroom ~esidence located on this property is currently functioning adequately, iHowever, -the system cannot be guaranteed against subsequent failures. If we may be of ~urther &ssistance, please do not hesitate to call. SJ. nc~e] y, /r.! cc: Dall Rea].~y ATTENT IO~[: John Russell Municipality of Anchorage Department of I~ealth and Environmental Protection SRB 196X EAGLE RIVER, ALASKA