HomeMy WebLinkAboutT13N R3W SEC 26 LT 3 OF 28 & 29 (3)T! 3N R3W
sEC 26
,Lot
3of 286
29
#007-094- ! 6
MUNICIPALITY OF ANCHORAGE
Rs h3 W= 65'/7/
(~' 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 ! E]NEW
LEGAL DESCRIPTION ¢' ' ~ /'
LOCATION ~ ~ NO. OF BEDROOMS
Well
DISTANCE TO:
n gallons
D,STANCETO:
I Manufacturer
DISTANCE TO: % No. 4264
No of lines
Top of tle to flmsh grade ~ ? beneath tile
Length Width Depth
Type of crib Crib diameter Crib depth
Well Building foundation
DISTANCE TO:
Class . , Depth Driller ~
Building foundation Sewer line
DISTANCE TO:
PERMIT NO,
Dwelling
Material
Width
Material
Nearest lot line
Trench width
inches
inches
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
Total effective absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot lige I PERMIT NO.
Septic tank Absorption area{s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
,n
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
GRF' 'ER ANCHORAGE AREA BCY- ' UGH
Department ~3~n~irs~rne%~ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
MAILING ADDRESS /0/~-~'~/~'/--~//'/~¢'~7~' PHONE
'"~'~' LEGAL DESCRIPTION J~/~/'~
SEPTIC TAN K:
DISTANCE
FROM WELL MANUFACTURER
INSIDE LENGTH INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
.LIQUID CAPACITY
GALLONS,
SEEPAGE Pit:
NUMBER OF PITS / DIAMETER OR WIDTH /~/ LENGTH/~/. /DEPTH .-,~-;~/~'/%
LINING MATERIAL ¢~-~y~c/~z~ CRIB SIZE: DIAMETER ~ DEPTH ~ DISTANCE FROM: WELL
/~/~/'/~' TOTAL EFFECTIVE
BUILDING FOUNDATION~,~) ~ NEAREST LOT LINE-~' /. ABSORPTION AREA (WALL AREA) ~"~-"0° SQ. FT.
ADDITIONAL ABSORPTION ~-'~*~/~C/~"~'~//~/~-Z
WELL:
TYPE ///C/~/~//~z~ CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE TANK SYSTEM
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY: ~-~-~
Form No, EQ-O31
DIAGRAM OF SYSTEM
~ Z-~/~ ~ ~_/_/_/_/_/_/_/_/_/~
DATE
GREATER ANCHORAGE ArEA BorouGh
DEPARTMENT O~ ENVIRONMENTAL QUALITY
3530 "C" STREET ANCHORAGE~ ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
COMPLETION DATE ANTICIPATED
I OTHER'
NOTE= TI-IlS PE;~MIT IS NOT VALID WITHOUT SOIl. TEST
FINAL INSPECTION: Z,~ HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SiZE ~ TYPE
SEEPAGE PIT
ALSO CONS]DER AREA WELLS.
TYPE
I CERT{FY THAT I AM FAMILIAR WiTH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
...... c', ....
' ' ).~ /M ~ ~- , ~.~X~ ~/~.
,_..,~. G~ ~ _, i~ "~--
Uas G~ound i'/ate~2 [~ncour;~:~red? ~y ~o~ ~ J $
~rc~:,co Insta]lat~on: Seepage Pi~ Dpain Field
Deo~h Of lnle~ Depth To :~ottom 0i:~t Or Trench ''
Data Certified By:
GAAS-HO I
GRr,~5~TER ANCHORAGE AREA BOROI}'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASIC~ 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
ADDRESS
LEGAL DESCRIPTION ~
DISTANCE FROM WELL
L,OU,O CAPAC,T ' 7S$
GALLONS.
MATERIAL ~~ NUMBER OF
C~MPARTMENTS , //'
7,,) LR, U,D
INSIDE LENGTH ~' INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
LINING fAT RIAI~k~.~./ ~ ~)ISTANCE FROM WELl
NEAREST LOT LINE
TOTAL EFF ~CTIVE ABSORPTION AREA ,WALL AREA SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES ~ DISTANCE BETWEEN LINES ~ I TRENCH WIDTH
ABSORPTION AREA ~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
OF LINES
TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE' /',.~ N. ABOVE TILE
~'~/,~ ~ DISIANCE FROM .~'! WATER .~
WELL: TYP ~,~r~ DEPTH , BUILDING FOUNDATION, SAMPLE , NEARESI
~ I NEAREST SEPTIC z SEEPAGE ~.. ! OTHER
LOT LINE SEWER LINE .~ TANK ~) -~ . SYSTEM , CESSPOOl '~ . SOURCES
DISTANCES:
=ss-'
(J
DATE ~X~/~
DIAGRAM OF SYSIEM
APPROVED r %~.~' ~AtfH AUTHORITY
GREATEI' ',ANCHORAGE AREA: DROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME 0E APPLICANT ~'~ ~ ~ ~< ' .~'~_ {) '~ ~'
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS
SEEPAGE PIT.
MAILING ADDRESS c~-~ ~X'/~/~PHONE N0,~;~'~g~5~)
LOCATION OF INSTALLATION '~ ~Y.-I-¢ i~ ~&,
, DRAIN FIELD , OTHER
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION ~- ~ T'
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~¢! '%\3~. ,PERMIT TO INSTALLA
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE '~'"J'-~ TYPE (~'~ ~"~)~SEEPAGE AREA
TYPE
DISTANCES:
/ : HEALTH ~UTHOFtIT¥
DIAGRAM OF SYSTEM
'7 0~
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
BATE 4,//~')/'70 APPLIOANTS S'6NATURE ~~%
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION / 825 L Street - Anchorage, Alaska 99501 :CT .~,~
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER I PHONE
SNYDER, James M. & Mary C. I ~
IAI LING ADDRESS
38~5 Baxter Road Anchorage, Ak 99504
PROPERTY RESIDENT (If different from above) PHONE
same
2. BUYER PHONE
MAILING ADDRESS
1518 ~lverine Anchorage, Ak 99504
3. LENDING INSTITUTION PHONE
Amfac Mortgage Corporation 277-8588
MAILING ADDRESS
705 West 6th
Suite 201
Anchorage, Alaska 99501
4. REALTOR/AGENT
Daniel Holm or Jan McGregor/ Are~ Realtors
PHONE
278-2525
MAILING ADDRESS
3300 C Street Anchorage, Ak 99503
5. LEGAL DESCRIPTION
Lot 3 of the .su~ivisic~ of Blks 28 & 29 of the detendent resurveyand subdof
~_~t__zen 26, T!3Ni R3W~ ~
STREET LOCATION
3835 Baxter Road Anchorage, Ak 99504
6. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] Two [] Five
..... [] Three _ .F I Six
[] Other
WATER SUPPLY
INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells dri[led
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
FI PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM *** ~ INDIVIDUAL/ON-SITE*~
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE IVIUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
***Please be advised that the captioned property is in the process of being changed
to a lateral sewer syst~
MUNICiPALiTY OF ANCHORAG5
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
t978
RECEIVED
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
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
[~]INDIVlDUAL/ON -SITE DATE INSTALLED
E~]PU BLIC UTILITY
Connection Verified INSTALLER
E~]Septic Tank or E~] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area 8ewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Tit[e)
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
1. PROPERTY OWNER
MAILING ADDRESS
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
CERTIFICATE OF INSPECTION
SEWER AND WATER FACILITIES
/
2, LEGAL DESCRIPTION
Z,,r- '~ ~.,~.~, ~- ,-~,--' ,,r< Z;,-''' .~.~.~'-~ ~ 't ~./~ r/,~ ~/~-.:,;.,.~.~,,'7~,'~.~
3. TYPE DWELLING
SINGLE FAMILY RESIDENCE
MULTIPLE FAMILY RESIDENCE
OTHER {Describe)
WATER SUPPLY
'[53
INDIVIDUAL
COMMUNITY/PUBLIC
SEWAGE DISPOSAL
\~, INDIVIDUAL/ON-SITE
[] PUBLIC UTILITY
~ HOLDING TANK (Maintenance Required)
APPROVED FOR -~,~ BEDROOMS
CONDITIONAL APPROVAL (See Attached)
DISAPPROVED
SEAL
DATE
72-014 (3/78)
l. Approval requested by:
~t~ GREATER ANCHORAGE AREA BOROUGH . _ '
' Department~f Environmental Quality
3330 "C" Street, An~age, Alaska 99503 274-4561
~ Date R~ived A~q~st ~3, 1976
.V"
Mailing Address:
2. Property Owner: wayne R. Glea$on
Phone:
Phone: 333-0672
Mailing Address: 3825 Baxter' Road
3. Legal Description: T13N R3W Section~t Lot 28,
4. Location: 3825 Baxter~~ house
5. Type of facility to be inspecte~il[y No. of bedrooms
6. Well Data: indiYt ! ~,a~l~
A. . Depth
Type
C. Construction D. Bacterial Analysis
7. Sewage Disnosal system
29
3
Installed
C. Septic Tank:
D. Seepage Pit:
1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines __,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page I of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner: ,~'~'~/~ ~'A,J~-~ ~
Mailing Address: ~-~'~ ~'~ "~/F~?-~'/c'
VA FHA
Day Phone:
CONV
3. Name of Buyer:
Mailing Address:
Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description: ~'~°')N
Location:
Day Phone: ,
Phone:
Phone:__
Type of Facility to be Inspected:
No. Bdrms..'~'---~
Water Supply
Type of Supply: ~¢//~ Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well /-e ~-2A%'"; ~ ~t~')
,Individual
Sewage Disposal System
Type of System: ~ Public Utility
If Individual, date of installation ~- ~ ~ ~-) /~
Individual (on-site)
72 003(3/76)
Page ~ of two pages - Re~--~t for Approval of Individual ~-'%r & Water Facilities
.Legal Descrlpti0n T13N R3W Section 26 Lot 3 of Govt Lot 28, 29
Comments
Approved
Disapproved~_ ~-~ Date
Approval Valid for one year from date si§ned(.J~
Greater Anchorage Area Borough, Department of Environmental Qua~lity
DIAGRAM OF SYSTE~/2~~'
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIG~ED
Date
EQ-034 (1/74)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 ,¢,, Street, Anchorage, Alaska 99503 274-4561
Date Received
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Time of Inspection
Bate of Inspection
/~--
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
2 ~. /~Tz( /~O~ Phone:
5. Type of facility to be inspected No, of bedrooms
6. Well Data:
A. Type B. Depth
C. Construction ~0¢ ~oo~ ~ D. Bacterial Analysis
7. Sewage Disposal System: ~
A. Installed ~/~0 B. Installer,
C. Septic, Ta~: , 1. Size ~L 2. Manufacturer
D .... : 1. Absorption Area ~a~.~ 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank ~ , Absorption area
Nearest lot line ~/) /?/o//¢/, Other contamination
!
B.
Foundation to septic tank ,2'~ , Absorption area
C. Absorption area to nearest lot line
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
HAR
'GREATER A!ICHORAGE' ARt::, BOROUGH
Department of Environm,mtal Ogalityl~rnO~fNYm~l~l~t~L~UAU~¥
3330 "C" St., Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
IltDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO VA . FHA x
2. Property Owner: Danny O. Birchfield and Gwynn M. Birchfield
''' Day Phone
Mailing Address: 3825 Baxter Roo. d~ Anchora_~Fze_
3. Name nf Buyer: . Way_n__~e R. Gleason and Susan K. Gleason
Mailing Address: 21 A~S PSCI Box 1264, BlmendorDa.y_ Phone
4. Name of Lending institution: Coas~ Mortgage Company
Mailing Address: P.o. Box 1200, A~chorage, AK Phone 279-0665
CONV
333-037q
752-2201
5. Name of Realtor or
Mailing Address:
Agent: Selective Realty - Patricia Bleyle or Dick Nehls
100 B. ~ireweeed Lane
Phone 272-0524
Legal Description: Lot 3 of the resubdlvision of BL~I Lot 29, S~,S26,T13N,
RSW, Alaska Sewg~d Meridian
Location: 3825 Baxter Road~ An. chora_~e~ Alaska
Type of Facility to
Nater Supply
Type of Supply:
If Individual,
If Individual,
be ins eot°d:
p ~
Public Utility
number of dwellings
depth of well __
Sewage Disposal-System
~ys~ra. Public Utility
Type of
If Individual, date of installation
Home No. Ber,.,s 3
Individual x
presently served _ 1
Individual (on-site) x
Page~2 of two pages - Request for Approval of Individual
L~§al Description
S~ewer & Water Facilities
Approved
Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Aria Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
1
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
March 21, 1974
Coast Mortgage Co.
P. O. Box 1200
Anchorage, Alaska
99510
SUBJECT: Sewer and water facilities serving Lot 3 of resub of BLM Lot 29,
S~lf/4 of Section 26, TI3N, R2W - 2825 Baxter Road
Gentlemen:
On March 19, 1974 this Depar~nent inspected the subject facilities and noted
the following:
The water is via a private well located 20' west of the dwelling
end 10' south of the north lot line. The well construction is
satisfactory.
The sewage is disposed of via an on-site sewage disposal system
consisting of a 750 gallon septic tank and 50' of adjoining
drMnline. The existing systm~t is adequate for a two bedroom
home but not for a three bedroll; home. In order to comply with
State and Borough standards, the drainfield must be enlarged,
the amount of which can't he determined Until a soils test is
done on the lot.
This moper'anent mistakenly approved the existing sewage system on Becanb~r 2,
1973 and sent said approval to First National Bank and V.A, This approval ~as
in error and should be considered invalid as of this date.
This 8epar~nent will give temporary approval on the existing sewage system
pending escrow of funds needed for the above improvements, The above tmprove~
ments must be made on or before July 15, 1974.
If you have any further questtons~ please contact this Department at 274-456l,
extension 135.
Sincerely,
Tim Rumfelt, R.S.,
Sanitarian
TR/ko
cc: D. Btrchfield
FI~
VA
GREATER ANCHOP~AGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279~8686
Date Received__~
Time of Inspection
~ FoRWA~R FACILITIES
Approval Requested ay:
Type of H~cilit~ to be Inspected:
Number of Bedrooms:
A. Type
Construction~.l~-
7. Sewage Dis6osal System:
B. Depth
Disposal Field:
Installer
Manufacturer
Total Length of Lines
Distances:
A. Well To:
Septic Tank_~>'~-0 , Absorption Area -~ ,,, Sewer Lines
· Nearest Lot Line /~__, Other Con'taminatton
Foundation to Septic Tank ,z~~t "}AbSorption Area ~--
Absorption Area to Nearest Lot Line
RegJest for Approval of iHdividual Sewer & Water Facilities'
l)a~% Tw~
.A~rqved ~,~~ Disapproved Date /~~'~ '
~ )~ Approval Valid for One Year From Da~e S~gned
Gr~r Anchorage Area Borough, De~r~meu~ of Environmental Quelthy
DIAGRAD~ OF SYSTEM
I certify that the information contained in this request for approval to be e true
end accurate re?resentation of the subject sewer and water facilities located
Signed Date
GREATER ANCHORA'G~ AREA BOROUGH
DEPARTMENT
APPROVAL
ADDRESS:
PHONE:
OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD.
ANCHORAGE, ALASKA 99~507
279-8686
DATE RECEIVED: //-~7/
INSPECT: /,~ - 7- ~/
REQUEST FOR APPROVAL OF --S
-
PROPERTY OWNER: .,~_,~'.~_)
LEGAL DESCRIPTION:
TYPE FACILITY TO BE
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE
B. DEPTH
C. SIZE
'
D. CONSTRUCTION ~'
E. BACTERIAL ANALYSIS
BACK)'
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON
1. SIZE "7 ~ ~ ~fi ~ O ~,'~O
3. MANUFACTURER (]~-'/?~A~rc--
4. INSTALLER
o
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
B. SEEPAG~IT
1. SIZE X
2. LINING"~
DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH .~"-0'
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. ~L-t: , 9---S"E'E'F~AGE P~-T
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
COMMENTS:
APPROVED:
DATE:
APPROVAL VALID
GREATER ANCHORAGE AREA
DISAPPROVED:
DATE:
FOR ONE YEAR FROM DATE SIGNED.
BOROUGH DEPARTMENT OF
ENVIRONMENTAL
QUALITY
~ec~mber ~8, lg71
~ex~er ~oad.
tlonin~ properly, Our files sho~ that the sewer
~ell.
St~c~ely,
Ly~n S. Ce~d
Form Approved
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PAR~ $.--70 BE COMPLKTED BY FH.~
Anchorage, Alaska
MOITGAGOR OR SPONSOR
Betty Kester
SUBDIVISION NAME
TOTAl. NUM~IRi
WATIR SUPPLY BY:
~Public system
MORTGAGEE SERIAL NO.
First National Bank of Anchorage
[PROPErty ^nDRESS
3825 Baxter Road, Anchorage, Alaska
.... ~L 0~'0. LOT NO.
L t 3 of ~ubdivision of Lot S 28 and 29~
t~e and S/P oE Sec. 2~ ~ ~S N I
dependent survey New installation ~l~e..I
~ C~mmuni~ system ~ Individual
SIWAGE DISPOSAL BY~
'--]Public system
PART II.~TO I~ COMPLETED BY 14EALI'Id D~iPART,I~ENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [-] State [] County [] Local Department of Health that this individual water-supply system
[] is [] is not ~,tisfactory as a domestic water supply for the subject property.
It is the opinion of the
tern with proper fnaintenance:
]Can be expected to function satisfactorily, and
is not likely to create an insanitary condition
[] State [] County [] Local Department of Health that this individual sewage.disposal sys-
]Cannot' be expected to function satisfactorily
~--~ J mONATU"R ] nTte
I I
NOTE: The hoolth authority should complete the appropriate opinion statement above ~nd affix date, signature and tltll In the
PART III.~FOR USE OF FHA OFFICE
ro THE CHIEF UNDERWRITER**
I have reviewed the foregoing and the pertinent FHA Cornplim~ce Inspection ReporL and recommend that the
Individual writer-supply system be considered [] Acceptable [] Not Acceptable
Sewage dispOsal be considered [] Acceptable [] Not Acceptable.
DATE
SIGNATURE
HI~ALTI4 AUTHOI~ITY APPROVAL
INDIVIDUAL WATEE~ SUPPLY AND SEWAGE ~ISPOS&L SYSTEM
] CHIEF ARCHITECT
] DEPUTY FO~ CHIEF ARCHITECT
FHA lro~m
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 007-094-16
GENERAL INFORMATION
Complete legal description
Location (site address)
COSA# L'~,~ ¢---
Expiration Date:
T13N, R3W, Section26, Lot3 oqC c~ ~
3826 Baxter Road Anchorage, AK
Current Property owner(s) Dennis J. Kelly Family Investments, LLC
Mailing address 9531 Albatross Anchorage, AK 99502
Day phone
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
2;~ NUMBERiO. F BEDROOMS:
3, TYPE OF.. WATER,SUPPLY:
Individual Well []
Individual, Wate:r Storage []
Community Class Well []
Public Water System []
Three (3)
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
Supply system. DSb also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work..
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
DSD SIGNATURE
~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Original Certificate Date:
(Rev 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
T13N, R3W, Section 26, Lot 3
IfA, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to >40 ft.
FROM WELL LOG
g.p.m.
Legal Description:
A. WELL DATA
Well type Private
Date completed 7/21/04
Total depth 63 ft.
Date of test
Static water level
Well production
Nitrate N/D mg/L
Date of sample: 11/15/2011
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: 6.07 ug/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material AVVVVU Sewer System
Tank size __ gal.
Foundation cleanout (Y/N) ~
Date of pumping
C. ABSORPTION FIELD DATA
Number of Compartments
Depression over tank (Y/N)
Pumper
Parcel ID: 007-094-16
Date installed
Length ft.
Total depth ft.
Date of adequacy test
Fluid depth in absorption field before test
Elapsed Time: __ min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
11/29/11
40 ft.
3.2 g.p.m.
Collected by: A. Harala
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Y
>18 in.
Soil rating (g.p.d./ft2 or ft2/bdrm) __ System type
Width ff. Gravel below pipe ft.
Eft. absorption area · Monitoring tube __ Depression over field ~
Results (Pass/Fail) __ For ~ bedrooms'
in. Water added gal. New depth in.
in. Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
E.
in.
SEPARATION DISTANCES
Size in gallons
"Pump off" level at ~
Cycles tested
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main >75'
Sewer/septic service line >25'
Animal containment areas >5o'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >100'
On adjacent lots >10o'
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
>100'
>100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line ~
Water main Water service line
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field
Surface water
Property line
Water Service line
Curtain drain
Building foundation
Surface water
Wells on adjacent lots
F. COMMENTS: Lot is Served by AWWU Sewer System.
Water main
Driveway, parking/vehicle storage
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in.
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 12/2/2011
COSA Fee $.
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS
Clie.1 ~ame Anderson l(ng~mcrhlg Printed: DaleM~me I 1/23/20[ ) I6:37
Projeel Xame/ff 'il 3N Section 26 R3W 1,or 3 Collected Date,'line t 1/15/20 [ 1 15:45
Client Sample ID Privale Wel! Waler Drawn BR Received Dale/lime I 1/15/20t 1 16:00
~la~fix Drinking ~¥ater Technical Director Stephen C. Efle
Sample Remarks:
Metals by ICP/M$
&~7 5&0 ug'L EP200,8 C i<lO)
t/23/l~ NRB
Waters Depar~ent
[mai Nilrale/Ni[rile-N ND 0~t00 mg,l, SM204500NO34: 13 (<10)
AY<7
~iicrobiotoc3~- ~aborato~
('olo~1> Cmml 0 co[/t0(tmh SM20 9222B A i<200}
Fecal (7otifom~ 0 col/100m[. SM2O 9222[3 A {<l}
[omi Co}i~brm 0 col/lO0mL SM20 9222B A {< 1 }
1/15/lt DI,C
1/15ill DLC
lov 30 11 03:50p
Aarow Pump & Well Service,
P.O. Box 110496
Anchorage, AK 99511
office: (907) 346-9355 · Fax (907) 333-8976
Eagle River: (907) 622-9335
3388078
LLC
CUSTOMER
tINVOICE DATE
~UAN'ClTY
IWELL DEPTH j SWL [ CHLORINATED
DESCRIPTION
JOB SiTE __
IPUMP DEPTH I SALESPERSON
PRICE I AMOUNT
LABOR
)RK ORDERED BY
HOURS RATE AMOUNT
DATE COMP,
TOTAL
LABOR
TOTAL MATERIAL
TOTAL LABOR
PAY THIS AMOUNT
Thank You
SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion of the Above Described Wod( and agree that if above work is not paid lor in 90 days I agree to allow Aarov
Pump & Well Service. L.L.C. the right to remove unpaid for equipment and charge lor labor already performed & labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
C1¥0~1 - ~I::I.LXV~-
O~'~L M ,I, 0 O0 N
A ~O.Z~ -~A/O
::lSfl 1~1~13N39,01.
0~'1;/. M ,!,0 O0 N
~m<~
Oozo
I
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-79O4
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 007-094-16 HA6. #~
Expiration Date:
1. GENERAL INFORMATION
Complete legal description T13N R3W Sec 26 Lot 3 of 28 and 29
Location (site address or directions) 3825 Baxter Rd
Current Property owner(s) Julie Richards
Mailing address
Day phone
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Roger Briley Day phone 240-0369
c/o Coldwell Banker Realty, 2525 C Street, Suite 100, Anchorage 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-sita []
Individual Holding tank []
Community On-site I-1
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer ragisterad In the State of Alaska. Certificates of Health Authority Approval ara required for the transfer of
title (except between spouses) for properUes served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for Properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) 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(are) In compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Watkins Engineering, Inc. Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis Date /J -~Z -O'~
5. DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stip
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
~: WAIEHANU : m
'~ [ WARTFWA~R ~
Maintenan~ Agreemen~
Supplemen~l Engineer's Repo~
Other
Original Certificate Date: I'/,'"~l(~,,
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(9071 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: T13N R3W Sec 26, Lot 3 of 28 & 29
WELL DATA
Well type P~
Date completed 1960
Total depth 40+ f.
Date of test
IfA. B, or C provide PWSID # -
Sanitary seal (Y/N) Y
Cased to 40+ ft.
FROM WELL LOG
NA
Parcel ID: 007-094-16
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 12+
AT INSPECTION
11-14-04
Static water level NA ft, 37 ft.
Well production NA g.p.m. 3.8 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 .colonies/100 mi,
Arsenic: NA mg./l.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material NA - Public Sewer
Tank size __ gal.
Foundation cleanout (Y/N)
Date of pumping ....
C. ABSORPTION FIELD DATA
Date installed NA
Length
Total depth ft,
Date of adequacy test
Nitrate <0.1 mgJI.
Date of sample:
Number of Compartments
Depression over tank (Y/N)
Pumper
Other bacteria 0 colonies/100 mi.
Collected by: ~Cindy Ellis
Soil rating (g.p.d./ft= orff2/bdrm)
ft, Width ft,
Eft, absorption area ft2 Monitoring tube
Results (Pass/Fail)
Date installed
Cleanouts (Y/N)
High water alarm [Y/N)
Fluid depth in absorption field before test In. Water added
Elapsed Time: min, Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
System type
Gravel below pipe ft,
Depression over field
For bedrooms
gal. New depth in.
Absorption rate >=
If yes, give date
g.p,d.
Date installed NA
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump oH level at __
Cycles tested
Property line NA
Water Service line
Curtain drain
F. COMMENTS
in,
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots NA
On adjacent lots NA
Public sewer manhole/cleanout 40+*
Holding tank NA
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NA
Absorption field on lot NA
Public sewer main 10+*
Sewer/septic service line 25+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation NA Property line __
Water main Water service line
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Wells on adjacent lots
Absorption field
Surface water
Water main
Driveway, parking/vehicle storage.
Septic tank abandoned in place on 11-22-04. *Distances approved by ADEC on 1/4/78.
in.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Cindy W. Ellis
Date //'~ ~'~" ~'~
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
0~-'1~/- /V~ ~[0 O0 N
m
Z
0~'~- 7~A ~LO O0 N
$
MHB-I
I/~
W ,, '~ ~. W
j BAXTER ..
...................... · ...... G .......................... --G ..................... 6 G ....................
· Anchorage
Development Services Department
Building Safety Division
On-Si{e Wster and Wastewater Program
4700 South Bragaw St,
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL SUBMITTAL COMMENT SHEET
To: Watkins E~i~eeHna
Legal deecription: T13N R3W S~ction 26 Lot 3 of 28 and 29
The attached paperwork has been reviewed and ts being returned for the following reasons:
[] Original signature or stamp missing on
[] Calculation error in design,
[] Additional soils information needed.
[] Water monitoring results inadequate.
[] Discrepancy in information submitted.
[] Topographic information misstng or inadequate.
[] Incomplete; missing
[] ln~:m~ptete; missing
[] Additional adequacy test information needed,
[] Water sample unacceptable.
[] Measured/proposed distances/dimensions missing.
[] Locations of all soils, percolation and water monitoring tests not shown.
[] Proposed system too deep for soils information submitted.
[] Well log required.
[] Omission m narrative.
[] insufficient fill over tank or f~d.
[] Other. Electrical Plate cove~ missirm o~ well electrical conduit,
Name of reviewer: 3'ulie Makela. P.E.
Date:
Please supply the necessary information and re-submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
· Municipality of Anchorage
Developmen{ Servlce~; De~aiHment
Su~dlng Safety Division
On-Site Waler and Wastewaler Program
,~700 Sou{h Bragaw St.
P.O. Box t96650 ,"~nchorage. Al( 99519-6650
wWW.ct.anchorage.ak.us
(907) 3,{3-7904
CERTIFICATE Of HEALTH'AUTHORiTY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1.' GENERAL'INFORMATION
Completelegaldescripti0n':.Lot 3 of Lots 28-29: Sec 26; '1213 ~;
Loc~lioh'(slte"~ddresS6?dire'ctions) 3825 Baxter Rd.
CtJr.re~l.P(dl~e'-rt~; ~ .w'ner(s) 3' Ky'l e A 1 len Day phone
M~i!ingadd.ress.;',,~ 2541 Sebrin8 C~r. Anchorage, AK 99516
Lending agency Day phone
HAA # ._ffA~O,o20/6-~'
Expiration Date: ~ "/~, -o ~.
R3W
Mailing address
Real Estate AgeM
Mark'Soquet
Day phone 561-1616
Mailing Address
Unless olherwlse requested, HAA will be held by DSD for plckup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Indi~/idual Well
Individual Water Storage
Communily Class--. Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Indiv!dual On-site
~[~ CommunRy On-site []
Indiwdual. Holding lank ~
[] Public Sewer ~
The Municipalily of Anchorage Development Semlces Departmenl (DSD) Issues Certificales of Health Authority
Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
lille (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply syslem. DSD also Issues HAAs upon request to homeowners. Cedificales of Health Authority Approval are
valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued wilh
new water sample results less than 30 days old. (Cedificales may be reissued for a period of up lo one year with
valid waler snmples.) Cedillc~lcs are valid roi' one year for properties served by Class A or B wells or a public
water system. The Munictpalily of Anchorage ts not responsible for errors or omissions In the professional
engineer's work.
4. STATEMENT OF INSPECTION BY E~Gi~JEER
As cedil]ed by my seal affixed hereto and as et Ih~ validation date shown below, I verify that my Inves{Iga~ion,
based on procedures outlined In Itle Health Authority Approval Guidelines for Ihis application, shows that the
on-site wa~er supply and/or wastewater disposal sy~tern Is(are) safe, functional and adequate for the number of
bedrooms and type of s[ruclure Indicated herein. I fudher Verify Iha~ based on the Informalion obtatned from the
Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or
wastewater disposal system Is(are) In compliance With all applicable Municipal and Stale codes, ordinances,
and regulations In effect at the time of Installation.
NameofFirm S & S EnRineerinE
Address 17034 N. Ea~le River Loop Rd.
Engineer's Prinled Name Robert C. Cowan
5. DSD SIGNATURE
~ Approved for ,~
Disapproved.
Conditional approval for ~
bedrooms.
Phone 694-2979
Eagle River, AK 99577
Date
.~'~" ..."- I~
bedrooms, with Ihe following stipulations:
Additional Comments
Altachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
SUpplemenlal Engineer's Report
Other
..Original Ced ficale Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak, us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: ,L.,~T 3 es t-,ro~.it-~.~ ~,¢. ~1. G
A. WELL DATA
Well type/~'~' ~at ~
Date completed ~*
Totel dep~' H¥4. ff.
If A, B, or C provide PWSID # ~
Sanitary seal (~/N) Y~.r
Cesed tu ¥0,
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform Q .colonies/100 mi.
Arsenic: __ ~
SEPTIC/HOLDING TANK DATA
Tank Type/Material
/~-~' ParcellD: 00'7
we, Log
Wires properly pmtectedi~/N) ye' J'
Casing height (above ground) t a, 4- in.
AT INSPECTION
g.p.m.
Other bacteria O colonies/100 mL
Collected by: .,, & $ ENGINE~.RING
! 7034 F. agle Rt'mr M)ofl K0ed No. 2~
Date installed /
Tank size gat. Number of Comperlmente Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) High water/r.]~) ~
Date of pumping · ' Pumper
C. ABsoRPTIoN FIELD DATA*
Date inste!.lec!. __ Soil rating (g.~fodrm) __ System type
Length ~ ft. ~ .~ ft. Gravel below pipe
Total depth ff. E.,,...~rpfien ama ~ Monitoring tube Depression over fielri
Date of adequ~..~-"'~ Resulta (Pass/Fail) ~ For bedrooms
Flu*gl...~kl"abeorpfion field before test in. Water added gal. New depth in.
,/.~sed TIme.' min. Final fluid depth in. Absorption rate >- g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. UFT STATION
Date i~stalled Size in gallons Manhole/A~;cess (Y/N)
'Pump on' level at in. 'Pump off' leve~l at
Datu~m__ ~s tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Publtc sewer main /o
Sewer Iseptic sendce line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding lank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line ~
Water main Water sen, ice line ..,--'~Surface water
Wells on adjacent lots /
;E:Z::N DISTANCE F~;:ti:Z ON LOT ,Ov~ater main
Water Se~ li~e/~ Surface water ~ Driveway. paCing/vehicle .torege
..~at~draln Wells on adjacent lots
F. COMMENTS
G. ENGINEER S CERTIFICATION .. . ~
conformance ~ M~ H~ gu~ellnee in eff~ on ~is da~. ~~ ~ d
HAA Fee $
Date of Payment
Receipt Number
(Rev, 12/01)
Waiver Fee $
Date of Payment
R~i~ Number
~aousry 4, 1978
M~. ~ohn ~. Rlinger
Administrative Officer
~nchoraqe Sower Utility
3000 Arctic Boulevard
Anchorage, Alaska 99503
Bear Mr. Xlingerl
Anchora~e-Saxter Road LIB 189
RECEIVED
Plans (3) for the subject project were ~orwarded to this
Department by your latter of December 28, 1977o There ~ere
no specifications but~ots 2 of sheet 2/3 stated that con-
struction would bo in accordance ~lth the Municipality of
Anchorage 1976 Construction Specifications.
This proposal ~lll provide about 321 feet of g~ U! sower
running northerly ~rom MI! B-l, This manhole ~s a part of
the pro,oct and As 13~ feet northwesterly along Campbell
Field Road from 1ts intersection with Eastwood Loop.
~c have no objections or conwonts to this pro~ect which
le approved by this Department for those items of our
Sincerely,
Richard ~0 Drltt
Facility Construction
& Operakion
C'." : I0
· -: \ \
w t ~ w BAXTER tZ"D.,.
...................... J ...... O ............................ G ..................... 6"0 ....................
FROI'I : UHY USR SC~UET RERI..TY FP.X HO. : cJO? 563 6202 Apr. 03 2002 04:30PM Pi
. I~. 89 59' 45' ~. 13164
45' I~. 12164
33'
NO CQc?~R~ SET THIS O~ rE
~o ~T~
LOT 3 ~ ~ ~ LOTS ~*~ ~a~
Tl~4 R~. S~