HomeMy WebLinkAboutVALHALLA BLK 2 LT 5
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE [] NEW
3~J- 7~'2 ~_ ~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
k"f z. L%K b--
LOCATION
I 2~Zl
DISTANCE TO;
Manufacturer
DISTANCE TO;
Manufacturer
No. of lines
Absorpti~on area Dwelling ~.~ (:~ I
Material~ T-~,~
Inside length..~ W dth ~
Well G T I 00~ Dwelling
Well Foundation
Length of each line
Material
Nearest lot line
NO. OF ,~DROOMS
Liquid depth
PERMIT NO.
Liquid apacity in gallons
PERMIT NO. "
Top of tile to finish grade
Trench width
Material beneath tile
inch
Distance between lines
.~ absorption area
Width
Type of crib Crib diameter
Well
DISTANCE TO:
DISTANCE TO:
Building foundation
Depth
foundation
Sewer line
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED
72-013 (Rev. 3/78)
DATE LEGAL
~EPRRT~ENT O~ HERLTH RNP ENVIRON~ENTRL PROTECTION
~25 L STREET~ RNCHORRGE., R~
~4-4720
PERMIT NO:
DFITE ISSUED:
840499 WOI_D ING TRNK
06,.~2J.,.'84
F'IPF'L I CFINT:
FIDE:,RESS:
CONTRCT PHONE:
LOLl S. WILCOX
P.O. 80X
RNCHORRGE, FIK 99511
~4.5-7522
LEGRL DESCRIP:
LOT ~tZE:
SUBDIVISION: VRFIRLLR LOT:
SECTION: 22 TOWNSHIP: ±2N RRNGE:
· 5R (Sf..'L FT. OR RCRES)
BLOCK: 2
I CERTIF'¢ TF'!R[:
i. I Ri'"l FFIMt'LIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS FIS SE]'
FORTF'I B"r' TFIE MUNICIF'FILIT"r' OF RNCHORBGE (MOFI) FIND THE STFITE OF FILRSKFI.
2. I WILL INSTRLL THE S~r'STEM IN RCCORDRNCE WITH RLL HOR CODES FIND REGULRTIOWS,
FIN[;) IN COMF'LIBNCE WITH THE DESIGN CRITERIR OF THIS PERMIT.
3. .I WILL FIDHERE TO FILL. t'IOFI FIN[:, STRTE OF RL.RSKR REOUIREMENTS FOR THE SET BFtE:K
[:,ISTBNCES FROM RI".W EXISTING WELL, WRSTEWBTER DI~POSFIL S'¢S'rEM OR PLIBLIC
SEWERFIGE S'~r'STEI'"I OW THIS OR RW'¢ FI[:'JFICENT OR NERRB'¢ LOT.
IF R LIFT STR]'ION IS INSTRLLED IN RN RRER COVERED B~' MOB BUILDING CODES.,
THEN (.1.) FIN ELECTRICFIL PERMIT RND INSPECTION MIJST BE OBTFIINED.~ (2) FIS-BUILTC;
WILL NOT BE RPPROVED WITHOUT RN ELECTRICRL INSPECTION REF'ORT.~ RND (:~:) TFIE
ELECTRICRL WORK MUST BE DONE B~' R LICENSED ELECTRtCIRN.
[)IEF:'i:::H:¥H'Hi!:N'F (:,, i [!.:ii:::ll ,'i'l I FIND [!!:N"/:[I:~?.I::HqI"IIEI",II'FIL. J' ~ .dFI'EC'I" I
I:::'E:RH ]~ ¥ iqO.
F;II::'I;::'I. :J: C:I::;IN¥: I'"IF:II:R~'r' I..CII~J I'J ]: [J:]:l:::¢,:.:; PI'"ICINE:
I.IEC~iI::!I. !::'E:'.fi;C:t:;:]:F:"T]LEI?',I ;~;LI[?,I):[',/:[rE;]OI',I:'¢FILJ"II::)L.I..I:::I IE~L.OCI':::: ~i LOT:
i.O'T :E; :i: Z'.E~ El :SCL F"T. "i"OHN~;H I I:::': I~:F:INGE: .... ~SEC:T ~ Obi:
i'IFI::':',:I: I"jl..ll"j Iqi..Ij'lE:JEl'~: I:Z)i:::' I~?,I:EI].,I::;:IZ)Oi'I;~; :::: I~l :~;O ] L RI:::IT ][ I",IG :::: IZI IZI I~]l ':;'.~;CL F::'T. ,,"E:Ii:
i...)];E;¥1~D IgtEL. OI,f Fff:?.E THE OF::'"i-]]Edq:5 I'::iVI::t]]LI::I[3L.E 't"O YOU IIq E:'E%IGNII",IC~ "r'OI.Jl:~r %EPT]C
~;"i":~;TEt'"I. I]]:1 tOCI:]E~:E THE] OJr':'¥ ]] ON 'I'HI:::I'F E:IE~5'I F' I '1":5 "r'CjlLI[;~: ~ I'l"~.
I C[~%:¥ ]]1:::'"¢ '1-1i1:¥[':
J... ]] FII"'i I:::'f::ff"IZL.]:I::iF;: i.4]Jl'tl 'THEE F?.E)]~:H...t]]F,~:I]JI'"II~EI",I't"~[J; I:::'C)I:;~: Oi"4'"'E~;]]TE: ~;IEHIEfR~; I:::llq[) HEL. L:5 FIr5
J:::'OJ'¥'J"H J?',: ¥1tI. E J"il. Jt",l ~[ I]: ]] l:::'l:;:tl... ]; ¥¥ CII'::' I:::II'.,fl]]:I.II]]IF~iI::ICE I:'IN[) 'T'HIZ S;"I'Ft"I'E OF: FIL.FI~;~::]I:::I.
]; Iq :[ I_.1. :1: iq:EJ;'l'!::t[.I. TILE: :F?T%'t'E:H :[ I'-,! I::IC:COI::?.DI::IIqC:E: I.,.I ][ TH THEE C:ODErE: I::Ii",ID I'"II::I',/E: [?.E:C:[~: I ',,,'EE:'
(::1 I]]]:1])[:'¥ 01::' THE C:OI]:,IE :~gJI"IHF:IF~:¥ FII",II) I]:,]:FIGI::~:I:::II"I I::IT'I-FICHHI~NTf5 1.4HZC:H :IRE: I::'I::IR¥ OF'
I:::'IE I:Eff"l ]: ¥.
]~f:. ]: I..Ilql)Er:~:[FI'I:::II'.,IE:, 'r'l.ff¥t' ~1'I..][~: ON-..:~i'FIE :E:EI.q[;::R :~:'¢:~'T'EEI','I P'IFI'¢ RIEC!I..I ]: [?.E ENLFI[E:GEHIZN-I- IF' THE
F~:ESJ:ZDIZNC[E :!::~: I:RIEHOIZ)IEL. EI:) I'O ]:I'.,ICI. JJ[)IE HOI:~% 'Tl-ll::llq ~)
PIJEF~ff,1:1; T FIPI:::'I... ]: CFINT I I1:::I~: THE: I::~:[Er~:I::'OhI:E~ I [3 Z L. I T'¢ -I"0 Z I'.,IF'OF?.H F:'EF~:rE:OI'.,INEL. DUIR I NG
'THE ]: I'.,!t~?!'F:If.L.I:::I¥ ]: O1'4 ]: I'.,kE:I::'IEC:'1' :[ Ot'.,[:~: O1:::' F'Ii'.,I'¢ t.q[EL.l_..f5 I::II)..]FIC:E:Iq'f' TO TH Z E~ F:'ROF'E:RT"r' FINE:'
THE NLJHI~J~HEt:,~: Eft::' I:E:I?.~]::[I')E:NCE?.E~: TIIF:IT I'IIE I.qE:l...L ]q]:L.L
]:F:' Irt t..:J:l'::"t' :~:'l¥::lT]:OIq ZI::E; ZN'.E;TR!...L.[EE:,., FIN E:L[EC:IYE::[C:FIL. F'IERH]:T FINE) IN2:PEOTIC~hl I',]I...I:ETT'
E:E CIEq'F:I ]: N[~:E:'. F:I:~:....E',I..I :[ [.."t"f:: CI:::IIqF,I01' E:EE F:ff::'F::'I:~:O',,,'E:I]:' 141 TI.'ICHJT F:II",I ELEOTI(: Z CFIL.. :i: I",IfSF'E)E:T :[ Eq",l
F]:E:F'C~F?.T. "I"IiE []~:I_.IZC¥1:E:ZE.I::'tl. i401::[:1::: I'IL.I:~:'i' E',E [)ONE E',¥ I::i L]:E:IZI",I:E:EE:' IEI_EEC'I'F~ZCIFIN.
]: :5:ii;I.,.IEiE:,
Permit ~ ~)~//'-~"('~
Applicant:
Location:
MUNICIPALITY OF ANCHORAGE
~ Health and Environmental
~ Street, Anchorage, AK.
Department
825
264-4720
* * * HANDWRITTEN PERMIT * * *
~t~t:~AND/OR ~(~'WER PERMIT
Phone Number:
Legal Description: L.~; ~"- ~/(~)~a~{~
Type of Soil Absorption System Is:
Trench: ~ Drainfield: ..... Seepage Bed:
Maximum Number of Bedrooms:
The Required
/ LENGTH
'rotection
~501
DEPTH
Lot Size:
----Holding Tank:
Soil Rating(sq.ft/br)
Size of the Soil Absorption System Is:
/ GRAVEL DEPTH
WIDTF~
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 SE~T-IC(HOLDING) TANK SIZE = ~000 GALLONS * *
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 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 department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * *
I certify that:'
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
I will install the system in accordance with codes.
I understand that the on-site sewer system may require enlargement if
(2)
(3)
Signe~:
are
the residence
Applicant /J
is remodeled to
include more th~/C23 bedrooms.
I S S U e d by~/~/( --~Jl ~
Date:
SWP/024(1/81)
Permit
Applicant:
Department
"~UNICIPALITY OF ANCHORAGE
Health and Environmental rotection
Street, Anchorage, AK.
825
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
Phone Number: ~
Location:
Legal Description:
Type of Soil Absorption System Is:
Trench: f~--~Drainfield:
Maximum Number of Bedrooms: C._~
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) ~
The Required Size of the Soil Absorption System Is:
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 TM "~'"/~ GALLONS
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 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 department within 30 days of the well completion.
Other requirements may apply. Specificatibns and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
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 the on-site sewer system may re~uire enlargement if
the residence is remodeled to include more that~Dedrooms.
Applicant
Date: /~/~
SWP/024 (1/81)
GRE ,.
_R ANCHORAGE AREA BOk .
Department of Environmental Qualitv
3330 C Street
Anchorage, Alaska 99503
GH
INSPECTION REPORT ON-51TE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE
EROM WELL/DO
INSIDE LENGTN
MANU FACTU RER,~~ MATE RIAL /'~"~ "~--; NUMBER OF
~_~.,U~.. -¢.-~-%~_/_ _ COMPARTMENTS
INSIDE WIDTH - LIQUID DEPTH LIQUID CAPACITM//f/~']~)GALLONS.
TILE DRAIN FIELD:
( ~ LINE///-~ OF LINES
DISTANCE FROM WELL/~-) FOUNDATION ~¢)/'2L / TOTAL LENGTH
___ _ NEAREST LOT
NUMBER OF LINES [ DISTANCE BETWEEN LINES /)///Z~ TRENCH WIDTH--~:'~'IN. TOTAL EFFECTIVE
ABSORPTION AREA '¢/~'~(~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISII GRADE ~/ / DEPTN OF FILTER
MATERIAL BENEATH TILE _~'~ ABOVE TILE /7/ IN.
WELL:
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE SEWER LINE TANK
CESSPOOL _, OTHER SOURCES
APPROVED ..... DISAPPROVED REMARKS
DEPTH
SEEPAGE
SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY: ~~',~,~,,
, /
SEWER LINE DEPTH: ~'/-,~-
PIPE MATERIAL:
LOT 5LOPE: ~
REMARKS; ~'~
Form LQ-032
DIAGRAM OF SYSTEM
!
Locaaon ...... ,.~ ....... ~ ....... ~..~ ........... (~;~ ........... ~ ..... ~a~:,.~2; ..... ,..~ ....
Date eom e~e ...... ~2~ ...... ~,..,,~,~..~,.~ ..................................................
Size of casing ....... Kx~...../?~.dz.a,~ .....................................
water ...... z~.,2 .... .~a.~ ...................................................................
Distance tO
D~st~ce to water while pumping..... ..... ~..~..../~'.~<.~-, ..................... at rate
of ........ ~.~(J ............................ gallons per hour.
li orma~on ~ Irom } ~o
I::'F.'I;?.H :[ '['
FtF'F'L I CF~NT
LocFr I' I ON
LEGFiI..
· J'IH BENSI.JEI~'.
'.S H[~ N I~ I'.,I E:, f3 FI H RI.)
L!5 E:2 VFILH£:ILLFt ':'i;IJE,'l)
LEFF !SIZE
"I"¢I='E OF [::;()IL. FIBSORBTION ;5'¢STEH IS: TRENCH
I'"IFI'?::IHLIH NUI'"IE:ER OF BEDF4'.OOFI:5 = 2:
SOIl.. Rla"FING <SC.:! FrT,.,'E:F:)= J.E~,L::.I
THE [~:EQLIIF..'ED :5IZE Cfi: "['HIE: SOIL. FID:.:_;ORF"I'ION '.2,'¢STEH IS:
THE LENGI"H [::,:[ MENS I ON I LE; THE LENQTH ,:'. I N FEET > OF THE 'I'F:ENCFI OF~'. I)RI::I I NFI El.D,.
THE DEF:'TFI OF I:~ TRENC:I~I OF..' PIT IL-=; THE E:,tSTFtNCE BETNEEN 'TTiE S::I..IF::[:I=~C[E OF THE
GROUN[> RND '¥HE BOTTOH OF TI*IE E::-:',CFIVF~TION <ZI'.~ FEET>.
'FFIERF~ IS NO ::SE:'[' [4II::,TH FOF..' TF?.ENC:HE:5.
THE GRFt'v'F~L [::,EF'TH I'.5 THE I',IINIf,'IUI',I DEF'I"H OF GF:.FI',,,'EL BETb~EF.:N TFtE OLI'I'FI::tl..L. I::'IF'E
AND 'I'FIE BOTTOH OF ]'lie E',~',CFI',,,'AT:[ON ,::IN FEE']'::,.
E:FICKF' I L.L ]E NG OF Flhl"r' :::~'¢s'rEr,'l [41 TFtOU'F F' I NFIL I N%F'£ECT I OI'.,I F:II'.,I[::, laF'F'I;~:O',,,'FIL. E:'¢ ']'H I '.-5
E:,E:F'FIF..'THEN'I" b~II..L F3E SUB..'fE:CT TO PF.'.OSECUTIOf.,I.
f"IINIHIJH DI2;TFINE:E BETI.4EEN FI NELl_ RND I:iN'¢ ON-':SITE SEI4F:IGE I)I:51='OSFtL S"r':E"f'lEl'"l
:t.E~O FEET FOR R PF..'IVFITE klELL. O['. 20~) FEET FOR R F'LIBLIC b~E:LL.
!.4E:LL LOGS RF':!E F.:E£.:!IjIREL:, FINE:' HIJST BE[ F:IETURNED TO '¥HE [:'EF:'FIF::THE:I",IT 1.4ITHII",I
OF' '/HE 14ELL COHPLETION.
:SPECIFICRTIOI",IS RI",ID CON'E,'I'RIJCTIO[',,I [:'tRC~RRHS lIRE R',,,'FItLRBLE 'FO II",I:E;URE PROPEI:~'.
]: [",1 f:;'l'F:lL L.R T I ON.
I CEI;U¥]:F'¢ ]'HFFf'
:i.: ]: FIH FrRI'"IIL. IFIt? PJITH THE RE6!U]:REHEN"FL:.: FOR OF,I-2;IT[(
I::OF(I"H B'.? I'HE I','IUNZCIF'F~LI"F'T' OF RNC:HOi~:FII3E.
2: i klZLL INS'TF~LL THE S'¢STEH IN RCCO~'Z:,RNCE F~ZTH THE C:O[:,E~;.
3:: :[ UNDEI:;~:[~;TRND 'FFIRT THE ON--SITE [51ENER S'T'S'FEI'fl I"lFCr' F'.E6¢JIRE E:NL.F~f~:r]EI'flENT :IF:' THE
F?.ESIDIEI'4C[E IS REHO[::,ELED 'FO INCLUDE HORE THRN 3 BEDROOHS.
:,] ~t4EI..: ...............................
I-IF Pt. t _.H ~ [ .. l 11 BI
I _,..,LIE,[ E, 'r _
September 17, 1976
R & M No. 656302
Jim Bensler
Star Route A Box 1566B
Anchorage, Alaska 99507
RE: Test Hole and Soil Log Report for Sanitary System
Valhalla Subdivision, Block 2, Lot 5 Anchorage, Alaska
Dear Mr. Bensler:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This in-
vestigation was performed in accordance with your request of September
13, 1976 and those procedures outlined in a letter dated July 15, 1975,
by Mr. Rolf Strickland of the Nuncipality of Anchorage Department 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 19.5 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 ho~.
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.
/ ,.' i ~'"'
'James W. Rooney
Vice President
JWR/ddp
xc: Municipality of Anchorage
TIME
PERCOLATION TES~
JIM BENSLER
R & M Ng. 656302
ELAPSED
TIME INCHES
4:08 0 5.25
4:09 1 5.75
4:10 2 6.25
4:11 3 7.00
4:12 4 7.50
4:13 5 8.00
4:14 6 8.50
4:15 7 9.0
4:16 8 9.25
4:17 9 9.5
4:18 10 10.0
4:23 15 12.0
4:28 20 13.5
4:33 25 15.5
4:38 30 17.0
4:48 40 22.5
4:58 50 26.75
5:08 60 32.0
DROP IN
INCHES
0
.5
.5
.75
.5
.5
.5
.5
.25
.25
.5
2.0
1.5
2.0
1.5
5.5
4.25
5.25
26.75 inches drop
2.24 min/inch
T.H. 1
9-14-76
PEAT
0I
SANDY SILT W/TRACE
GRAVE'L
Tan
· SILTY SAND W/SOME
GRAVEL Tan 6'
40'
T.H. 1
Lot 5
SAND W/SOME GRAVEL, SOME
SILT
Tan ~.5'
SANDY SILT W/SOME GRAVEL
Moist, Tan '' ~
11.0'
SILT W/SOME SAND,
TRACE GRAVEL
Moist, Tan
19.5 TP
This log represents subsurface
soil conditions within
Valhalla Subdivision, Block 2,
Lot 5, Section 22 12N-3W
Anchorage, Alaska
C'KD:
DATE:
SCALE: 1"=3'
Jim Bensler
Soil Log Report
Anchorage, Alaska
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
/bi Propertyowne Telephone: (bome) '? usiness
(c~ution Telephone
Mai~ing Addr~
Telephone "
(e) Mail the HAA to the following address: (or check here~[ if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Familyx Number of bedrooms
WATER SUPPLY
Individual Well ])~
Community [] Public []
Note: If commugity well system, must have written c0~firmatio.n' f[9..m the State Department of Environmental
Conservat!on. att'esting to th legality add ~tatus.' '~ · '' ' .... ' ·
4. sEWAGE DISPOSAL ' ' r ' r
· )4
On-site[] ' Public[] _ Community[] . Holding Tank i~. ,
Note: If community well system,' must ha~,e written ~onfi~mation from the State Department of Environmental
Conservation attesting to the legality and status.' ' ' '
?2*02§ (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION.
As certified by my seal affixed hereto an d as of the validation date shown below, I verify that my investigation of this
Health,Authority Appro~/al shows that the on-s~te water supply and/or wastewater disposal system is safe,.
fbnctiohal.end adequate'for the number of bedrooms and type of structure indicated h~reim I further ve¢ify that '
. . based on the information obtained from the Municipality of Anchorage files and from my investigation and
"insl~eCii0n~ the on-site water supp[yand/or wastewater disposal system is ih compliar~ce with all MUnicipal and
State codes, ord nancesl and regu at ons in effect on the date of this nspect on, ' ' ' ' -
Date
Approved for ~;~ bedrooms b;
Appro{,ed ,.~ /~'Disapproved
Terms of ,Conditional Approval
,~ate
Conditional
'fA JI II Iff i
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 (R~v. 7/es) e.o* Page 2 of 2
A, W E L~2C, TA
Well Classification
Well Log Present (Y/N) '~ i-?,.,.. Date Completed
Total Depth ¢!~"~' Cased
Static Water Level
Casing Height Above Ground
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: !
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
Depth of Grouting D\ ~ ) t~
Pump Set At .... ~ ¢ ~' *
' ' Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
If A, B, C, D.E.C. Approved (Y/N)
To Septic/Holding Tank on Lot ~ ~ r ~ ;
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line _
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments __
; On Adjoining Lots ~r
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA / h,~' "· ~ I ~¢,t,'!~!~(~ .~H~'~[~:'
Date Installed ~,,,~ ~ Size %, F'.~%"~' No. of Compartments ~.., ~.~ ~'~, ~;" :-~ ~
Standpipes (Y/N) "~ - ~ _Air-tight Caps (Y/N) -~ ~;-7, Foundation Cleanout (Y/N) : : ,,
Depression over Tank (Y/N) '; -~ 4 Date Last Pumped ~ ' ' t L', ' ~
Pumping/Maintenance Contact on File (Y/N) ¢" '- ' ; for
Holding Tank High-Water Alarm (Y/N) ¢ . Temporary Holding Tank Permit (Y/N) ¢';i' ,-'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well I i'::!.~:".
To Property Line '~'
To Water Main/Service Line
To Building Foundation
To Disposal Field __
TO Stream, Pond, Lake or Major Drainage Course ~%~//~
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
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
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
D. LIFT STATION ¢ :, '-
Date Installed ~,
Size in Gallons ,.
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
~-¢,~,, 'f'~;~. ?;,¢,
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
*toheck 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
inspectio~n
Signed
Company
; ; Engineer's Seal
MOA No, ::~,
72 026 (Rev. 7188) B~ck
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277.8378 · FAX 274.9645
3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 907-456.3116 · FAX 456.3125
Kniefel Engineering
8441 Miles Court
Anchorage Al( 99504
Attn: Robert Kniefel
Report Date:
06/27/90
Date Arrived: 06/22/90
Date Sampled: 06/22/90
Time Sampled: 0910
Collected By: RK
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
A101757
12221 Shenadoah
Water
Flag Definitions
U = Below Detection Limit
DL Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Method Parameter Units Result Flag
EPA 300.0 Nitrate-N mg/1 0.3
Anchorage Operations Manager
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 May 13, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
I,mt q Rlmc~ 9 V~lh~llm ,~tlhdJvisiort Township 12N, Range 3W Seward Meridian
Location (address or directions)
~71 ~h~n~n~h Anr-hmr~g¢~; Alaska 99516
(b) Applicant Name Mary Lou Wilcox Telephoee; Home 345-7522 Business 786-8415
Applicant Address _l~l~J~Jl~tandoah ~chorage: Alaska 99516
(c) Applicant is (check one): Lending Institution []; Owner/builder ICl; Buyer []; Other [] (explain);
(d) Lending lnstitution City Martgage Co.
Address 405 W. 36th Ave. Anchorage~ Ak.
(e) Real Estate Company and Agent N/A
Telephone 563-0700
99503 Attn: Da~e Ribachi
Address
Telephone
(f)
Mail the HAA to the following address:
CJty~ortgmga Cm. APCm'- ~w¢ Riba~hi
405 W. 36~h Ave.
Anchorage: Alaska 99503
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms _ 3
Other
WATER SUPPLY
Individual Well,,~ Community [] Public []
Note: If comm unity well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status.
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 72-025 111/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of lhe 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 tile 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 _~±11±a[, R. HarvRy~_~r. P.~. Telephone 786-8]~3
Address 13720 Davis Rd. Aneh~ragp, A]~ak~ qq507
Date May 13, 1986
Engineer's Seal
DHEP APPROVAL
Approved for '/L/q""'~'r'~ bedrooms by-"~-~:'~''''''' '~' '"~'~ Date
Approved ~ Disapprovedv Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
HOME SERVICES
15900 Francesca Drive
Anchorage, Alaska 99516
907-345~1890
April 24, 1986
William and Nary Leu Wilcox
12221 Shenandoah Road
Anchorage, Alaska 99516
I, William, Mary Leu Wilcox
agree to have A-'~ Home Services
Dump my holding tank(s) on an as needed basis or on a
date sDecified by me for a period of one year.
Total volume of tank(s)_
Price per t;)u. mping
A+ Home Services reserves the right to increase their rates
in accordance with any rate increase i~urred from the
Municipality or any other agency.
Price reflects pumping during normal business hours.
Your Septic, Cesspool a~ld Drainlield Professional '
scs~ x ~cc Compan'y
MUNICIPALITY OF ANCHORAGE (MO~;
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: Lot 5 Block 2 Valhalla
Subdivision
WELL DATA
Well Classification Individual
Well Log Present (Y/N) Y
Total Depth 74 ft Cased to 74 ft
Static Water Level ~ ~ 11 ~
Casing Height Above Ground ~ 5 ft.
Electrical Wiring in Conduit (Y/N) Y
Separation Distances from WelJ:
To Septic/Holding Tank on Lot ~
To Nearest Edge of Absorption Field on Lot ~N/A
If A, B, C, D.E,C. Approved (Y/N) N/A
_ Date Completed April 14, 1977 Yield
Depth of Grouting 0
Pump Set At Unknown
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Nearest Public Sewer Line ? 1 To Nearest Public Sewer
Cleanout/Manhole CT 1000 £t. To Nearest Sewer Service Line on Lot
Water Sample Collected by Mar;/ Lou Wilco× ; Date 4/28/86
Water Sample Test Results sat±efactory (see attached)
360 GPH
N
; On Adjoining Lots 150 ft.
; On Adjoining Lots 100 Ft.
GT 1000 ft.
Comments
B. SEI~6:/HOLDING TANK DATA
Date Installed --6/27/84
Standpipes (Y/N) Y .
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) Y
Separation Distances from Septic/Holding Tank:
~o Water-Supply Well !1,5 ft
To Property Line 42 ft.
To Water Main/Service Line ~~-
Course GT 1000 ft.
_Size 3500 gal No. of Compartments _2
Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Date Last Pumped -May 9, 1986
Y ; for Tn~mfinmtm
Temporary Holding Tank Permit (Y/N) '
To Building Foundation ~t.
To Disposal Field N/A
To Stream, Pond, Lake, or Major Drainage
Comments The JnteEr~/y nf thC hnldiog t~n~.~sJ~ed and f-cund to
Page 1 of 2
72-026( I ~/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
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
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Graver Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
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 that,,,, // Il,.... - , 'v~l ~have cj~ecked, verified,~r conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed /,(.'LI¢('I~-//"I',(c%/I-,LLt):\,~)JDate _f~-q.,, 1~% lg86
Company~7~l 1 i~m ~. ~*~'~Te~(?~F~.MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
MUNICIPALITV OF ANCHORAGE
DEPART~EN'I OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CEflTIFICATI£ OF INSPECTION FOR HEAl/TH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILI1 Y
264-4720
Applk:ation Date _.~q~]~Q,
QENERAL INFORMATION
Legal Doscr, otioe (inclnde lot, block, subdivision, sechon, township,
Location [address or direct one)
=- ,' · 786-84]5
Appl~canI Address -P,.~. -~ox -]..lJ.(~nche~g~k~
(c) AppHcam ~s tcnecK one): Lending Ins,luuon ~: Owner/builder E]; Buyer El; Other ~ (explain);
Address 405 W. 36th Ane, Almhoragat Ak. 99503 Al:tn; Dave Rihaahi
,e)Real E:aate Company alld Agent ~/A
Address'~ ..... ..........................
-{elepllono ............................
fl Mad tim HAA to the fo{lowing address:
_ 405 ~= 36/:.~ ~XgL_.~nf. horage, ~k- 9~50_ ~ ...........
'tYPE OF RESIDENCE'."
Sin(Jle-Family~-~ Mdlti-Fami y ~ Othe*
Ndmber of Bedrooms
WATER SUPPLY
Indw~dual Well ~1( Comrnudity L] Public []
Note: If commemty well system, rnusl nave written confirmation freer tim State Department or Environmental Conservailon
attesting to tt]e legality aed status.
4, SEWAGE [IISPOGAL
Onsite L,~l Public
Holding 'rani(
Note: If community well system, must have written confirmation from the State Depm tmont of F~nviron mental Conservation
a[iestln§ lO ire leOallly al]rd SlaltlS
Page ] of 2
ENGINEERING FIRM PROVIDh...~ INSPECTIONS, TESTS, FILE SEARCH, D.. A AND INFORMA'rlON
As certified by my sea affixed hereto and as of tho validation date shown below, I verify that my investigation of this Health
Authority Approval scows mat [ne en-s te water SLJpply and/or wastewator msposal system is safe, functional and adequate
for mo number of I)Odrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Aachorago files and fro~ my investigation and inspection, the on-site water supply and/or
waslewator disposal system Is m comphance with all Municipal and State codes, ordinances, and regelafions in effect on
life date of this inspechon
Name of Firm I~L~ ]__ .I f.a]s [,, ~i ] cox PI,; ..... Telephone
Address ?~ O~_J~).,'~l_~ ¢.~7/~_
Date A l.". 3::L ]. 3Q,-_.L986
Cii5795
Engineer's Sea
DHEP APPROVAl.
Approved for ........ ooerooms ey
· q 3provee Disapp~ove~
~erms of Conditional Approval
..... Conditiona
Date
CAUTION
I-he Muncipality of Anchorage Deparm[en[ of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely npoa the represemauons given in paragraph 5 above by an independent professional
engineer reg~s~eron in tho State of Alaska. The DHEP does this as a courtesy to purchasers of homos and their lending
nstitt~tions in Order to satisfy certain fedora and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Munic~ oality of Anchorage is not responsible for errors or omissions in the
nrofessional engineer s worK.
Page 2 of 2
WELL DATA
EPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) ,5,~)R ~ 0 1~}~
CHECKLIST- FEBRUARY 1984,
Legal Descriptio. n:, Lot 5 Blo Subdivzszon
Individual
If A, B, C, D.E.C. Approved (Y/N)
Y Date Completed April 14, 1977 Yield
0
Depth of Grouting
Pump Set At Unknown
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Well Classification
Well Log Present (Y/N)
Total Depth 74 Cased to 74
Static Water Level ll ft.
Casing Height Above Ground 2.5 £t.
Electrical Wiring in Conduit (Y/N) ¥
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
115 ft ; On Adjoining Lots
N/A ; On Adjoining Lots 100 ~t
To Nearest Public Sewer Line GT 1000 ft To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
X/A
360 GPM
150 ft
GT 1000 ft To Nearest Sewer Service Line on Lot GT 1000 ft
Hary Lou Wilcox ;Date
B, y_$~p~k~(/:t:IOLDING TANK DATA
Date lnstalled 6/27/g4 Size ':l~flf~ g~l
Standpipes (Y/N) Y
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line 42 ft
To Water Main/Service Line ~rp 1 dnfl~
Course GT 1000 ft
Air-tight Caps (Y/N)
¥
No. of Compartments ?
y Foundation Cleanout (Y/N)
Date Last Pumped April, 1986
;for Indefinate
Temporary Holding Tank Permit (Y/N)
To Building Foundation 30 ft
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
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
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Non Appl±cable
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
Non Applicable
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 st
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed
Company
Receipt No.
Date of Payment
Amount: $
Date
MOA No.
_. ¢/. Engineer's Seal
Page 2 of 2
72-026 (11/84)
~' INSPECTION APPOINTMENTS (..~ t. ~.~L¢ J,.)
, ,
MUNICIPALITY OF ANCHORAGE MUNICIPAL~IY 0~'
( ENVI RONMENTA L SANITATION DIVISION
Telephone 264-4720
R~OUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~
~ LENDING INSTITUTION ..... ' / / , I PHONE
MAILING'AddRESS /
· LEGAL DESCRIPTION
_/o/ X'---
STREET LOCATION
6. TYPE OF R~DENCE ~ SI~GLEFAMILY
~ MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[~ One [] Four
[~ Two [] Five
~' Three [] Six
[] Other
7. WATER S PPLV
W INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach Io§ if available.)
S. SEWAGE DISPOSAL SYSTEM
,~' INDIVIDUAL/ON-SITE** _~.'~:(C~ YEAR ON-SITE SYSTEM WAS INSTALLED·
[] PUBLIC UTI L[TY
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
DATE DRILLED
[] PUBLIC UTILITY ~
Connection Verified LOG RECEIVED ~.~. ~ ,
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
II~NDIVIDUAL/ON -SITE DATE INSTALLED .
[]PUBLIC UTILITY 7 -/
Connection Verified INSTALLER
[]Septic Tank or [~ Holding Tank ~-.'~/,¢//-~ lZ'-'~,/~
Size:~O Z,-)~C' IfTank ishomemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER ~
TOTAL ABSORPTION AREA MATERIAL
'~. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
9-27-82: Conditional approval if monies are escrowed to
have an adequacy test on the existing sewer system~; the wires on
the well casing placed in conduit. A re-inspection is needed
when completed .~~''~
/,o-./~
APPROVED FOR ,g BEDROOMS o
~"~ONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
825 "i"
ANCHOh'AGE, ALASKA 99501
(9071) 264 41 I 1
June 18, 1981
Donald Mark Williams
Star Route A Box 1570D
Anchorage, Alaska 99507
Subject: Lot 5 Block 2 Valhalla Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1) The water analysis report needs to be submitted
to this office from the Chem Lab, 5633 B Street,
for our review.
(2) The septic tank pumped with a receipt submitted
to this office.
If 'there are any further questions, please call this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska USA Federal Credit Un]on
777 Juneau Street 99501
JAI EE ES. ROBERTE$, PE, RL5
ENGINEER & SURVEYOR
(907) '349-2526
SEPTIC SYSTEM ADEQUACY TEST
DATE 9/29/82 S- 82140
CLIENT:
Name Mark Williams
c/o Larry Eaton
Address Polar Realty
1101E. 76th Ave.
Anchorage, AK 99502
Telephone
LEGAL DESCRIPTION: Lot 5 Block 2 Valhalla Subdivision
Shenandoah off Huffman Road
SEPTIC TANK:
Material Type Fiberglass
Size 1,000 Gal.
LEACH PIT:
DRAIN FIELD:
TRENCH
400 SF
Number Bedrooms 3
Surcharge Test 380
Rate of percolation
Sludge condition in tank:
1,670
l0II
Required Tank Size 1,000 Gal.
gal. water; 0.80 (150 x No. bedrooms) min.
gal./day
OK
Remarks: Tank size and material, and trench data supplied from
Municipality files. Soils rating from files - iOOSF/BR
1207 East 74 th Avenue Anchorage,
Alaska
9950E~
DEPARTME
825
MUNICIPALITY OF ANCHORAG~
OF HEALTH AND ENVIRONMEN,
L Street, Anchorage, AlasKa
264-4720
Date Received:
PROTECT I ON
September 1, 1977
IIi: Time 2:30 p.m. ~2: Time #3: Time
Date Date
Date 9-2-77 Friday
Insp Kennedy Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: National Bank of Alaska
Mailing Address: Post Office Box 3-3859 Phone:
279-2506
344-0146
2. Property Owner: James/Connie Bensler Phone:
Mailing Address: Star Route A Box 1566B 99507
3. Legal Description: Lot 5 Block
4: Sing].e Family Residence: ( ~
Multiple Family Residence: ( )
2 Valhalla Subdivision
Number of Bedrooms: Three
Number of Bedrooms:
Well System:
Permit i~
Construction
Individual well (x) Community/Public System ( )
Depth of Well 64' Well Log on File
Bacterial Analysis
( )
Sewage Disposal System: On-site System ~ Public Utility ( )
Permit It Installed ~'~'~ '~"~Installer
Septic Tan]< Size
Manufacturer
Absorption Area
Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection 82~ L Street, Anchorage, Alaska 995Q1~
.~quest for Approval of Indzv~dual Sewer and Water Facilities
1. Property Owner: -~.j ~ ~.~ <,
2 o
Mailing Address:
Name of Buyer:
Malling Address:
Lending Institution: /~)(~.~ , /r~_ ,L k~ o / /~f'/~L ~/c~'~'~-
Mailing Address: ~/~. [~). ~/'~ /2~,~. Phone: ->p,~- ~,~/~
Realtor/Agent:
Mailing Address:
Phone:
5o
Legal Description:
Street Location:
Single Family Residence: (~)
Number of
Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well (~) Public/Connnunity System
If ]individual Well, well depth 6~-~'t.
If Community System, name of system
( )
Sewage Disposal System: On-si_re System ('~) Public System
If On-site System, date of installation:
( )
*NOTE: A well log is required on ALL wells drilled since 6/75.
3/77
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Block 2 Valhalla Subdivision
Comment s:
AffadavikAtta~ed: { ) Letter Attached: ( )
Disappr~d: / Date:
Departmenh Worksheet: