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HomeMy WebLinkAboutGLACIER VIEW HEIGHTS BLK C LT 4 REM40 5/ /n Blif Soso- y9/ - 3L Mark Beg. Mayor Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 ww .muni.oro/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: V/ Legal Description Property Owner Name & Address - C/_34 &/» �c.D✓ %/.A G l E /Z V l E VV tt 75 -2 2 yy / G/, C_ I V_r v,-C.u,r DR /2 - G L - 1-1 915/7, qq2, 11 Pump Installation Date: G .— t o — t 11 Pump Intake Depth Below Top of Well Casing:.26V feet I' Pump Manufacturer's Name: I1 Pump Model: 1� Pump Size IL hp ,I Pitless Adapter Burial Depth: � feet Pitless Adapter Manufacturer's Name:.�W C.. V"10l AjM i Pitless Adapter Installer: A)A Well Disinfected Upon Completion'? Yes ❑ No Method of Disinfection: Ch(or011.e ��CFv II Comments: 11 Pump Installer Name:[ �Lr3�, �� ��trv�✓Utcz✓ Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE ® rrt 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-.9 .—� 4w P ONE q —W/ NEW ❑ UPGRADE .� MAILING ADDRESS S � � IC fJCve LEGAL DESCRIPTION 1'�e s �� G/e � &,Ft; LOCATION � t!d J NO. OF BEDROOMS s� DISTANCE TO: Uyel� r ( /V n/ Absor o re�� Dwelling 1 „L 41 PER -, U Y I l­- H Manufacturer Mat, No. of co partments A N Lig. c p i� in gallons IF HOMEMADE: Inside length Width Liquid depth i] Y DISTANCE TO: - Well Dwelling PERMIT NO. J Q Z = z Manufacturer Material - Liquid capacity in gallons DISTANCE TO: Well �OT /tJ Foundation Nearest Sit lis PER IVfJ,�j GJ w = (Ji F'en6I- J LL Z H z w No. of lines Length of e. Total len 1h gff lino �- r%5 Trenc th v inches Distance be - A- Top of the to 'Wish r M�t i bene tie Total effective a sorption area D Z. "!� 7. �1 c� V inches Length Width Depth PERMIT NO. w C7 QH Type of crib Crib diamet Crib depth Total effective absorption area as w U) Lu DISTANCE TO: Well Building foundation Nearest lot line J Class JV,l ✓J Depth ,j r Distance to lot line PERMIT NO. w DISTANCE TO: Building foundati Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ,+ �r ` r SOIL TEST RATING INST ERS+11 ,/�//� hee - c REMARKS 1Ti C� rt'¢ I' F .'\� CH ` - emc i'_' `ccs DEPT. C�- 1 . ENVIRC�!�,��n' lAr; TIO A. Sha i:. 1457 E ` to • � _ r; 1 ry APPROV DATE LEGAL 2-u1,5 mev. s/RA OWNER OF LAND ADDRESS LEGAL DESCR I~ DATE - Started PERMIT NUMBER by DOC Co. clt)a SULLIVAN WATER WELLS P.O. BOX 272, CHUG{AK, ALASKA 99567 · TELEPHONE 688-2759 Ended DEPTH OF WELL ~ DOWN FT. ............ · -/ GALS. PER H--'-7~ R KIND OF CASING KIND OF FORMATION: From From · ~: From ? From 2 ', From.-- Ft. to Ft. Ft. to / :;' ::' Ft. ,-" Ft. to.__ Ft. From_--Ft. to_-- Ft From__Ft. to__ Ft. From _ Ft. to Ft. From _ Ft. to__ Ft. Frond Ft. to Fl_ From ~"~' : - "~ ~' '~ ~ - From____ ~~,~'.~ </From. From.--" ~7 ''"~ Ft. to 7 ~' ~]- ~tt~ ~,:)-~ ~ ,,~/ , -~e~ From__Ft. to Ft. ~' .)/~ff ;- ~ gt':tyt/¢~''=-~ From From_ Ft. to Ft. ~,q/,r~-"'Z~'? From From .... Ft. to i"~C Ft. ~::.,~c~,z_'.'~- ,5,~:. t O From From Ft. to_ Ft._ From From~Ft. to- Ft., From From Ft. to Ft From From Ft. to_ Ft. Fromm_ From Ft. to Ft. From~ From~Ft. to__Ft. From.~ From Ft. to Ft. From Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to _ Ft. Ft. to Ft. Ft. to_____Ft.- Ft. to__- Ft. Ft. to_ Ft. Ft. to __Ft Ft. to___Ft. Ft. to__Ft. Ft. to_ Ft. MUNiCiPALiTY OF~ANC H O R A,,~E~ DEFT. OF HE,\LTII & EN',.,'iRG;,~/viENiAL ,~; GTECT'~©N 3 0 198i RECEIVED MISCL. INFORMATION: DRILLER'S NAME OWNER OF LAND ADDRESS by DOC Co. dba SULLMN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 DEPTH OF WELL STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION "' DRAW DOWN FT. DATE - Started Ended GALS. PER HR f� PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. :,' :` From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Y From Ft. to Ft. f From Ft. to Ft From Ft. to Ft. ' ' ` From Ft. to Ft From Ft. to :.' r' Ft From Ft. to Ft. From Ft. to Ft. f ...:. s :, From Ft. to Ft. From Ft. to Ft From Ft. to Ft. DEPT. OF HEALTH & From Ft. to Ft From Ft. to Ft. s� 3 1981 From Ft. to ' `- Ft. ii. } From Ft. to -Ft. From Ft. to Ft. From Ft. to Ft. R E C E I ,I ` D From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME TYPE OF SOIL ABSORPTION SYSTEM IS:IRE4CH MHXIMUM NUMBER OF BEDROOr,'IS � ] SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: EA EE IS:9 �����rIFA �����E-E'L ��F_'n —H�� � THE LENGTH DIMENSION I� THE LENGTH (IN FEET) OF THE OR 0RlflINFIEL[| THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE (".111— THE GROUND HND THE BOTTOM OF THE E>�CHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE QRHYEL DEPTH IS THE MINIMUM DEPTH OF SRHVEL BETWEEN TH� OUTFHLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN �EET>. ����I fe'REE.T.-I-A R:: ---q— 1 C.- �F:::� P-4 K 1 Z YD �'El �fl-1 L_ L_ RD opoq� PERMIT APPLIC'AN'T HAS THE RESPO@SIBILITY TO INFORM THIS DEPHRTMENT DURIN� THE INSTALLHTION INSPECTIONS OF ANY WELLS ADJHCENT 7`0 THIS PROPERT9 HND THE NUMBER OF RESIDENCES THAT' THE WELL WILL 5ER'VE 1-1 -.9. 101 �--IT 1 r-Iff !H� 1� RME", C_ _T- IF L.) r -A �EE BACKFILLING OF ANY SY5TEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSHL SYSTEM IS 1GG FEET FOR H PRIVHTE WELL OR 150 T8 20C-) FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO 8 P�I;HTE SEWER LINE I� 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET- NELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY HPPLf. SPEC! FICHTIQNS HND CONSTRUCTION DIHGRHMS HRE HYHIL8BLE TO INSURE PROPER INSTHLLHTION ���M 1 —0— �F --� I I E:-- E:'," E f I CERTIFY THAT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~S�TE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES ]� I UNDERSTAND THHT THE ON~SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I.S. REMODELED TO IWCLUDE MORE THHN ] BEDRQOMS. SIGNED-~~—�~_��~~~ ~~~^~ HPPLI �DWFRD C� EVHNS ISSUED BY_�_������.��DHTE~_���� Y40 x ' . DEPHRTMENT OF HEHLTH HND PROTECTION STREET, HNCHORHLE, HK 264�4720 ���� CD������ PERMIT NO ( 810990 ) HPPLICHNT EDWHRD EVHNS SR 177 694��6]7 LOCHTIDN CECILIH WHY LEGAL LOT 4 BLK C GLACIER VIEW OT ZE ]2670 SQUHRE FEET TYPE OF SOIL ABSORPTION SYSTEM IS:IRE4CH MHXIMUM NUMBER OF BEDROOr,'IS � ] SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: EA EE IS:9 �����rIFA �����E-E'L ��F_'n —H�� � THE LENGTH DIMENSION I� THE LENGTH (IN FEET) OF THE OR 0RlflINFIEL[| THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE (".111— THE GROUND HND THE BOTTOM OF THE E>�CHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE QRHYEL DEPTH IS THE MINIMUM DEPTH OF SRHVEL BETWEEN TH� OUTFHLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN �EET>. ����I fe'REE.T.-I-A R:: ---q— 1 C.- �F:::� P-4 K 1 Z YD �'El �fl-1 L_ L_ RD opoq� PERMIT APPLIC'AN'T HAS THE RESPO@SIBILITY TO INFORM THIS DEPHRTMENT DURIN� THE INSTALLHTION INSPECTIONS OF ANY WELLS ADJHCENT 7`0 THIS PROPERT9 HND THE NUMBER OF RESIDENCES THAT' THE WELL WILL 5ER'VE 1-1 -.9. 101 �--IT 1 r-Iff !H� 1� RME", C_ _T- IF L.) r -A �EE BACKFILLING OF ANY SY5TEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSHL SYSTEM IS 1GG FEET FOR H PRIVHTE WELL OR 150 T8 20C-) FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO 8 P�I;HTE SEWER LINE I� 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET- NELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY HPPLf. SPEC! FICHTIQNS HND CONSTRUCTION DIHGRHMS HRE HYHIL8BLE TO INSURE PROPER INSTHLLHTION ���M 1 —0— �F --� I I E:-- E:'," E f I CERTIFY THAT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~S�TE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES ]� I UNDERSTAND THHT THE ON~SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I.S. REMODELED TO IWCLUDE MORE THHN ] BEDRQOMS. SIGNED-~~—�~_��~~~ ~~~^~ HPPLI �DWFRD C� EVHNS ISSUED BY_�_������.��DHTE~_���� Y40 x ' 1 IJ JUILJ LUV MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION y� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 /SOIL�S� LOG - PERCOLATION TEST PERFORMED FOR: / G/ (,_-� (� �L �---J m DATE PERFORMED: �7 //Jy�L� � lic LEGAL DESCRIPTION: DEPTH 2 1 / r S/L y ,S,q'Nl /G SLOPE WAS GROUND WATER ENCOUNTERED? 12 \U J IF YES, AT WHAT /P DEPTH? 14 15 16 COMMENTS SITE PLAN s O P E Reading Date Gross Time Net Time Depth to Water Net Drop 3 �4 ' '/' a� II j / / a RCOLATION RATE pi � (minutes/inch) TEST RUN BETWEEN �-FT AND FT PERFORMED BY: S. SE£1g1iec-T'•f.g _CERTIFIED 72-008 (6/79) z r AGE a DEPARTMENT OF HEALITHLAND NV RO MRENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL'- �(�Q OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date April 22, 1988 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4, Block C, Glacier View Heights Section 16, T14N, R1W Location (address or directions) Cecila Way Eagle River ' (b) Applicant Name Ervin & Kathleen Telephone: Home 694-2999 Business n/a Rentel Applicant Address HC1558-M Eagle River, AK 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder$U; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Centrust Telephone 561-4930 Address 4000 Old Seward Suite 103 Anchorage. AK 99503 (e) Real Estate Company and Agent Fortune Propoerties Agent: Sue Dvorak Address 3000 A Suite 101 Anchorage, AK 99503 - e ep one 562-7653 (f) Mail the HAA to the following address: Pick up by Engineer 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well 29 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIW ASPECTIONS, TESTS, FILE SEARCH, DA AND INFORMATION As certified by my seal'affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Wigle River Engineering Svcs. Telephone 694-5195 Address p O Box 773294 Eagle River AK 99577 _t _`' }�Cr�l�f o�svoo reo. s_aa <.1 J(� J Ly145TIS_� t-dui3 A. °uiera C::-6726 M 6. DHEP APPROVAL P Approved forZ42 bedrooms by Date 7 Approved ex:__ — Disapproved Terms of Conditional Approval Conditional dhep 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) A. WELL DATA f , MUNICIPALITY OF ANCHORAGE (MO)q� MUNICIPALITY OF ARE"M6UTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES 10HEICHLIST - FEBRUARY 1984 264-4720 2 51588 RECEIVED ©W �Igl52 Legal Description: /mew tiP/dl/T/ If A, B, C, D.E.C. A N/ Well Classification Approved (Y/N) Well Log Present (Y/N) X Date Completed /l,�'z �! �r Yield /•S Groh T�srr®l z!/ /sb Total Depth a yD Cased to /So 7 ", Depth of Grouting Static Water Level /7l /m'a -.* Pump Set At ,a y Casing Height Above Ground /S Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 5�°° / 0/d ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot f/vim V47 % On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Al Cleanout/Manhole Neu To Nearest Sewer Service Line on Lot Y -2-s-" Water Sample Collected by Date Water Sample Test Results e2 7 Comments B. SEPTIC/HOLDING TANK DATA Date Installed /;F*/ Size 1"62 5o/ No. of Compartments a Standpipes (Y/N) % Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 04 for Holding Tank High -Water Alarm (Y/N) /✓,% Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 3'/Oy " (/l, ) To Building Foundation L To Property Line t/o To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata l�� �� Type of System Design Date Installed Length of Field sr / Width of Field 3,1 Depth of Field Gravel Bed Thickness s / Square Feet of Absorption Area SSD 06 Standpipes Present (Y/N) Depression over Field (Y/N) Al Date of Last Adequacy Test Z6_1�� Results of Last Adequacy Test .74 ;if A4 y_�fGrvr6i iP4f� �— 3 �S'c �isea Separation Distance from Absorption Field: To Water -Supply Well t/oo/�e',� To Property Line * /D� (a3 To Building Foundation 6O To Existing or Abandoned System on Lot ; On Adjoining Lots -,�- 3d ' To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area _/o Comments D. LIFT STATION 4 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed - Date Company le��eFT MOA No. Receipt No. �� anC 3 1% �f cr > Date of Payment ° Amount: $ Eagle River Engineering Services e R 0. sox nava DSO eeoeG e'°°oc ac i _� Bole River, AK 00577 •• eve uceov•.•.ca..•®oa:o °� Pa Page 2 of 2i� g 6948185�J Loui, Butes � e CE -6736 c, j�(�J'�L��+°° icy✓ 72-026 (11/84) V�tj�ROFES5`�" ql� a�� 5. LEGAL DESCRIPTION DAIERECEIVED INSPECTION APPOINTMENTS c� 1 G� u o'U TIME TIME TIME 6. TYPE OF RESIDENCE Ili /y DATE DATE DATE O Two E:1 Five O MULTIPLE FAMILY Three EJ Six INSPECTOR INSPECTOR INSPECTOR * ATTACH WELL LOG. A well log is required for all wells drilled O COMMUNITY 0Ye1'ZAA MUNICIPALITY OF ANCHORAGE �����lpp��PALITY OF ANCHORAGE OF HEALTH & ENVIRONMENTAL PROT'ECTt6 DEPARTMENT 825 LStreet- Anchorage, Alaska 99501 DL'.'f. OF HAIL -h-1 & ENVIRONI,MENTAL i'i.aTK1ri0N ENVIRONMENTAL SANITATION DIVISION ,, ;. [01`11 2 '0,; Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S_Q,,VkFefttV 1gi DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ouumt� PHONE a MAILING ADDRESS 5' 2a - PROPERTY RESIDE (If di ferent rom above PHONE ©n)E 2. BUYER PHONE i 0? y U MAILING ADD SS - 3. LENDINGINSTI/T��UTION PHONE � t/ Ar_antc N 6 MAILING AD HESS pp d F. V G R LI 4. REALTOR/AGENT - L i_ PHONE MAILING ADDRESS D 1,W , l/ / ° !i EU c_'H6 M C 5. LEGAL DESCRIPTION o L c� 1 G� u o'U STREET LOCATION U `1 !c_ piluer go z 6. TYPE OF RESIDENCE Ili NUMBER OF,BEDROOMS 0 One O Four EJ Other SINGLE FAMILY O Two E:1 Five O MULTIPLE FAMILY Three EJ Six 7. WATER SUPPLY T;<. INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well ED PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM .1 INDIVIDUAL/ON-SITE*YEAR ON-SITE SYSTEM WAS INSTALLED. ((( ED PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS kt APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE i BY r 72-010 (Rev. 6/79) PENINSULA ENGINEERINGDEPT. OF November 24, 1981 Ed Evans Adept Construction Star Rt. 177 Eagle River, Alaska Re: Lot 4, Block C, Glacier View Heights Water Sample and Well & Septic Inspection Dear Mr. Evans: MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL p�-OTECTION NOV 3 o im RECEIVED As per your request, I have inspected the well and septic system installation on the above lot. The lab test results indicate that the well water is acceptable and the well is installed and capped in accordance with Municipal Standards. The septic tank and absorption system appear to be installed per Municipal specs with all required standpipes above grade and sealed. The well is located over 100 feet from the septic tank and system with the absorption system significantly lower in elevation due to the natural terrain. Sincerely, Wayne Henn, P.E. WH:sa Attachments: Water Test Results v> % va�t4®q QAv "®r�°eeoeooaoo���� o 49!—Hl* 0 0 e � e000000�000000 o.DAei eDYo ePio B.Yf3= Reelmn[v�fsoN a 9�e CE-"iL�tiO e0 � �t 00p0ee000°e Pb�® 2820 "C" Street, Suite #3, Anchorage, Alaska 99503 276-4855 I DATE: TO: FROM: SUBJECT 91-010 (5/78) Municipality o c or e MEMORANDUM October 22, 1981 Laura Crow Senior Office Assistant Sewer and Water Program Request for Refund - Account #2460 Please make arrangements for a refund on the following. A private engineer has completed the inspections for the installation of the on-site sewer system rather than this office. Receipt #159122 Permit # 810990 Amount $30.00 Lot 4 Block C Glacier View Heights (Lot 4 Glacier View Heights) Adept Construction Star Route A 177 Preuss Lane Eagle River, Alaska 99577 _ JCS Laura J. Ward Senior Office Assistant LNW