HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 2 LT 9B 'O14 071
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
LOCATION ~ ~. (~'7/~/ ~3~ LEGAL DESCRIPTION ~J~
PHONE
SEPTIC TANK:
DISTANCE FROM WELL /~"~?1 MATERIAl ~-~-
LIQUID CAPACITY / ~ ~'(~ GALLONS. INSIDE LENGTH
NUMBER OF ~
COMPARTMENTS ~
INSIDE WIDTH '~ DEPTHLIQUID ~'-
SEEPAGE SYSTEM: SEEPAGE PiT:
NUMBER OF PITS
LINING MATERIAl
NEAREST LOT LINE
OUTSIDE DIAMETER OR WIDTH
DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPIION AREA (WALL AREAL
., LENGTH , DEPTH
., BUILDING FOUNDATION
.SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
,
lq6 ,FOUNDATION 35" . NEAREST LOT L,NE
/ DISTANCE BETWEEN LINES TRENCH WIDTH
SQ. FI. LENGIH OF EACH LINE
TOTALLENGTH/ ~.
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
WELL: TYPE ~ DEPTH
LOT LINE I~,'~'~ ' ' · SEWER LINE ., TANK
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WATER
SAMPLE
DISTANCE FROM
· BUILDING FOUNDATION
SEEPAGE
SYSTEM CESSPOOl
DIAGRAM OF SYSTEM
, NEAREST
OTHER
., SOURCES
DISTAI~CES:
C-E 3o'
DATE
February 27. lg7~
Kyle J. Cherry
Alaska State Deet. of Env. Conserv.
Rcem G~O ,~)c~ay £utldtng
3~2 Denalt Street
Anchorage. Alaska
Pea, ......~,ell to serve Lnt ~'' Block 2, Cenphell II~i~qts Subd.
Enclosed is a ~l~n for est.~bltsgtng a private ¥?ell on tho sul~Ject lot.
lhis action ~.~s necessary for the se.qt-publlc well serving the lot is
failing ~n~ there ~.,~s no leg.~l agreement stating the miner of s~t~ ucll
.~as responsible to serve the subJedt l~t. ThP previous o,,:nor o? tT:~
subject lot v~cJtu,~ an,'I F.H.A. fo.-assessed it. At tg~t tt~e,
o? thc so~t-pu),ltc ~lell discontinued serving, the subject lot.
As sho;m en the plan, the well will t'e a~prext,?~:t.-ly 93' from a neigh-
bortnn holdtnq tank, g5' fron a dratnfteld, and 75-~' froq~ tv~ septic
tanLs. .'quo to lot size and utility e,~sm~ent, this location uas tte only
one awilahle Car the ~,ell.
I h~ve agproved this site as I believe it ~dll not ~e a health h~Tard
and I See no other ~anner to nrovide v:ntor to the house.
proctate ):rttton correspondence fr~ you concerning tlds matter as soon
as possible.
If you have any ou~sttons, please contact ~o at 274-4EG1. extension 135.
Stnr~rely.
Tim Rumfelt, R.S.,
Sanitarian
TR/ko
Enclosure
cc: Cob Jones - F.H.A.
·
Mr. Tim Rumfeldt
Dept. of Envlronmental Quality
Greater Anchorage Area Borough
3330 C Street
Anchorage, Alaska 99503
SUBJECT: Lot 9B, BIk 2 -Campbell Heights Subdlvislon
Dear Mr. Rumfeldt:
With the modlflcatlons as outlined In our discussion on
February 27, 1974, wlth regard to slightly moving the well to obtaln
as much dlstance as posslble, we have no obJectlon to your proposal.
Regarding the other distances from Septlc tanks and holdlng tanks,
I feel the manner you are handllng this In is In the best Interest
of all concerned and there should be no health hazard from the In-
stallation of thls well In the location we have discussed.
If you have any further questions, please contact.me.
Yours truly,
Engineer
February 25, 1974.
A,VC~O~4~r. .~50~
Mr. Wayne D. Noble
Associate Broker
General Realty
530 West 5th Avenue
Anchorage, Alaska 99501
SUBJECT: Lot 9 B, Block.2, Campbell Heights Subdlvlslon
Dear Mr. Noble:
We have revlewcd the Information presented to thls office
regardlng the waste dlsposal system for the subject property. As
this Involves a problem of a supply being cut-off from, a semi-
public water supply and having to construct hls own water supply,
we have no objection to the well being located 50 fee't frcm the '
septic tank and I00 feet frcm the seepage pit as was the case
under the regulations whlch were In effect befcre the promulgation
of tho Alaska Department of Envlronmcntal Conservation Wastewater
Regulations.
If you have any question regarding the above please do not
hesltate to contact me.
Yours truly,
Kyle 'J? Cherry, P.E. ~
Regional Envlronmental Engineer
cc: Reit Strlckland, GAAB/'
MUNICIPALITY OF ANCHORAGE
Development Services Department r' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 014-071-30
Certificate of On -Site Systems Approval
Expiration Date: 11/30/23
Legal description CAMPBELL HEIGHTS BLK 2 LT 9B
Site address 3436 E 67TH AVE
Current property owner(s) LYNCH KATHLEEN R
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: Original Certificate Date: 8/31/2023
/Z —
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovWjune 2022
no
U,%�U�1�JHMP UTY OF HCHORQG
It
`.,t Okla
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax- 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 014-071-30
Complete legal description CAMPBELL HEIGHTS BLK 2, LOT 9B
Location (site address) 3436 EAST 67TH AVE. ANCH AK
Current property owner(s) LYNCH
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank WO Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑®
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ `-1 q S
Date of Payment 'z3j %,Z-
COSA# OSC2� 1301
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: CAMPBELL HEIGHTS BLK 2, LOT 9B
Parcel ID: 014-071-30
If more than 1 well andlor septic system on lot, provide separate checklist Structure served by this system
f_A§9=14457-11 _1
❑ Well log is filed with Onsite (or attached)
Date drilled UN Total depth '40 ft
Cased to 40+ ft
® Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 8/1/23
Static water level at beginning of test 12 ft.
Comments 'WELL DISINFECTD BY HEFTY DRILLING
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
❑ Required maintenance completed, if AWWTS
Comments: AWWU SEWER SERVICE
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑ ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
Well production at time of test 4.5+ gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? X Yes ❑ No
® Coliform bacteria is Negative
Nitrate 0.618 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 0 Arsenic less than MRL (ND)
Collected by MNA
Date 8/2/23
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date
Results ❑ Pass
Fluid depth prior to test _ in
Water added _ gal
New fluid depth _ in
Elapsed time _ min
Final fluid depth _ in
Absorption rate _ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) _ in
Effective depth used _ in
Effective depth remaining _ in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑i Yes if No _ ft F�] Yes if No _ ft
Neighboring Tank > 100' R Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft
Absorption Field on Lot > 100' 0 Yes if No _ ft Holding Tank > 100' Yes if No _ ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ ft
0 Yes if No ¢ it
*12 Manure/Animal Excreta Storage> 100'
Community Sewer Main > 75' ❑Yes if No _ ft QYes if No _ ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No _ ft Surface Water > 100' ❑ Yes if No ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
❑ Yes if No _ it
❑ Yes if No _ ft
❑ Yes if No _ it
[I Yes ifNo_ft
F. ENGINEER'S COMMENTS
LOT SERVICED BY AWWU SEWER LINE
Welts on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
El Yes ifNo_it
❑ Yes if No _ ft
If tank or field is under driveway comment below
* WAIVER SUBMITTED FOR WELL TO SEWER MAIN
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Finn f''t I It C/ lf/ A Pf �. • Phone 727-8864
Engineer's Printed Name Giunw L . Date
..'�. c
�.....
...;
° VO •• MICHAEL N. ANDERSCIN f
l� f . CE - 9469 j
COSA Checklist—June 2022
4, t�ti�rtt S.
Municipality of Anchorage � ��-
rrt L>
_ Ue.partmne.nt
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV231045 COSA#:OSC231304 Permit#:
PID#: 014-071-30
Legal Description: CAMPBELL HEIGHTS BILK 2 LT 9B
Engineer: Mike N. Anderson
Your request for a waiver of the required 75 feet horizontal separation from the public sewer trunk
to the private well has been approved. The approved separation distance is 6.0 feet. See the
engineers letter.
This waiver may be revoked in the future if nitrates in the well increase or if there are other
indications that the separation between the well and public sewer line could cause a health issue.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: g 2 Approved by:
Name of Reviewer
............................................................ ■ .............. ■ 1
**** VARIANCE/WAIVER REVIEW ****
AUG. 31, 2023
Municipalities of Anchorage
On-Site Water and Waste Water Section
4700 Elmore Rd
Anchorage, Alaska
Phone 343-7904
Re: 6’ Well waiver
Legal: CAMPBELL HEIGHTS BLK 2, LOT 9B
To whom it may concern:
This is a request for a 6 foot waiver between the AWWU sewer main (8 inch ductile iron pipe DIP) located on the south side of the property and the existing well, see the attached asbuilt survey. From the 1976 AWWU asbuilts drawings the well was clearly shown and existed prior to the sewer main installation. Justification for this waiver was the well was installed first around the 1970’s and has functioned well for the past 40 years with no reported issues. The first water test failed due to contamination from an open well cap and it appears the house has been abandoned or run-down for a few years so usage of the well. The well was chlorinated by Hefty Drilling and a new test was done which passed, see attached. No well log was found on the MOA web site but Hefty Drilling found the well is over 150 feet deep and is cased below 40 feet. The flow rate was greater than 4 GPM.
No existing waiver could be found in the AWWU or the ADEC files. The well stickup is 24 inches which provides good protection with a good sealed cap. No manholes or possible points of above ground contamination are within 100 feet of this well. From the AWWU asbuilt drawings the sewer pipe is DIP which is a tough and tight system, which will not leak.
A neighboring well log from Campbell Heights Blk 2 Lot 10A was found in the MOA file and clearly shows good confining clay layers (elev. 75-85’) in the area which would prevent contamination between the well and the AWWU sewer line. This clearly shows the well water is a confined aquifer. Again, the strongest justification is the well is over 40 years old with no history of contaminated service.
The granting of this waiver will not impact any of the surrounding neighbors.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
r
•
E. 67TH AVE
LO1 " -- 30' o � »
N 89 59 09 W 63-28
(N90'00)00"E 63.10' R)
0�
co^
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00
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0
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SIN �v uv UU r O'D. f U K)
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
CAMPBELL HEIGHTS SUBD
LOT 9B BLOCK 2 PLAT 69-115
NOTE: BASIS OF BEARING IS
CENTERLINE OF SPRUCE STREET
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a .�•"�" O 4,� L ,�
physical survey of this property as shown on this drawing and that the,is �.. • • . 0 -S, l
improvements situated hereon O • �
im ' 1
p e eon are within the property lines and no
en
chroachments existt K'
o her than noted. Under no circumstance should / 4 9TH
a�
ny information on this drawing be used for construction of fences, . • , .:. N ,�.,
structures, improvements, or for establishing boundary lines.
FA
... ...(. .......A04
YA a
EXCLUSION NOTES: It is the owners responsibility to determine i ' ' ' ' '
'.JOHN L. SCHULLER.• 0
the existence of any easements, covenants, or restrictions which �,
do not appear on the recorded subdivision plat. �0 .,,.,�...,•
1831 Talkeetna Street
WORK ORDER NUMBER: DATE: SCALE:E-MAIL: . • ' ! � ®
AUG 17, 2023 1 =30 � Anchorage, schuilerOok.net � �`A •�" �-� t d � , Alaska 99508
23090 DRAWN BY. CHECKED BY GRD NUMBER: B001K PAGE: �� rOfeS Si41'1 a> Le•�
-- (907) 227-1455 office
.�.
,ILS SW2035 230260 (907) (907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE —SEWER UTILITY Form No,, S229(4-76)
I� SEWER CONNECTION:On Property, Location Record Permit No. L3yIZ
Name.
L�' �r�s��- Address 3`{3� £• ��� �S - Acct. No.
Subdivision Lot Cie Block G
Location,, Alley El IStreet El 35-E'rcrn� SE Po�2 D-�' se 7nnti 'W Cotte. o� hLusu.
0-1' (Sketch on Back)
Size Connect.
Al Type ��C Depth at Stub �' Depth at Structure
Size Main Type Approved ❑ Riser Locate.
New Connection ❑ Replacement Connection El % Grade ---,Couplings O Type-------
Backwater
Valve El Type Bedding El Type Compaction
Insulation El Type Cleanouts Type Location
01
WATER: Municipal El C.A.U. El Private El
Residential aType 'No. of Units
Commercial D Type
Industria I ❑ Type
Control Manhole Location
Type...Elevation App roved
Comments:_
Connection Mode By: (01�Q-
Temporar
Construction Rate
ASSESSMENTS
Imp. Dist No.
Lateral Assmt.
Trunk Assmt.
Trunk Imp. Dist.
Grid. Assessments
Comments .*
A c+1 Lr s -
Sub. Agreement
El
Ext. Agreement
0
Paid ❑
I
Inspection By.* �d`ty�c���^-fid. gate:
^ A r ` * • 'rf .{% -
OEM
f
A (9LIV) L00 -[E
!4
~ Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561 j jJ
Date Received
Time of Inspection
Date of Inspection
e
4.
5.
6.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Mailing Address:
Property Owner: Phone:
Mailing Address: ~4~
Legal Description:
Location: ~_~C
Type of facility to be inspected
No. of bedrooms
Well Data:
A. Type~~,~,~ B. Depth
Y
C. Construction ~F~'~ D. Bacterial Analysis
Sewage Disposal System: ~~
A. Installed B. Installer
C. Septic Tank: l. Size
2. Manufacturer
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 1 of two pages
· GREATER ANCHORAGE ARk:', BOROUGH AU06 ~74 ~
Department of Environmental [}ualtty '~t^~,~^uc~°~^°~^~,°~" ,,
3330 "C" St., Anchorage, Alaska 99503 - 274~6~g~~N ~' ~t.,^ .
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
CMRO __ VA FHA
334 West 5th Avenue
Larry N. Brossard
CONV
Day Phone 265-4875
· 4.
Mailing Address: 3436 East 67th Avenue
Name of Lending Institution: KASSLER& CO.
Mailing Address: 319 West 5th Avenue
5. Name of or Agent: Byrnes Realty
Mailing Address: 604 West 2nd Avenue
Da~, Phone 277-6652 (wife work)
Phone 272-9501
Esther Byrnes
Phone 279-7404'
Legal Description: Lot 9B, Block 2,
Location: Campbell Hts. S/O
3436 East 67th Avenue
.Type of Facility to be inspected: well No.
Water S~p~l~
Type.of Supply:. Public Utility Individual
If Individual, number of dwellings presently served . 1
If Individual, depth.of.well
Sewage Disposal'System
Type.of S~stem: Public Utility Individual
If Individual, date of installation
Bdrms. 5
X
(on-site)
' ***PLEASE SEND REPORTS TO KASSLER & CO.,
Sincerely yours,
KASSLER & CO.
319 5TII AVENUE
AN~ORA~ AI~ASF~ Dc~Ol
· Page 2 of two pages - Re~.es~ for Approval of Individual ~.~e, .& Water Facilities
L~eg~'(' Description
Comments
val Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGP~AM OF SYSTEM
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)
August 6, 1~74
rJssler &
319 Uest 5th Avenue
Anchorage, Alaska
99501
SUI~£CT: t{ealth approval on Lot 9[~, [;lock 2, Ca~:pbell I{eights Subdivision
Dear Sir:
The residence on the subject lot has an on-site sewer system inspected
by this Depar~:ent end designed for three bedro~:s.
The request received by thts De~r~ent if for five bedrooms. The existing
systen~ cannot be expected to function under the additional load, therefore,
! cannot approve the request.
Sincerely,
Les Buchholz,
Sanitarian
LO/ko
~==ttb=~ry ~rossard
3436 East 67th Avenue
Anchorage, Alaska
93507
/'~GREATER .~b'~OtOl~&GB ~ BOROUC
327 ~ ~
~0~, ~ 99501
279-2511
TIM~:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAG~ AND WATER FACILITIES
FOR
S. Nell Data:
B. Dep 'Ch
C. Size
D. Const~c~
B. Bacterial Analysis
6. Sewage I~sposal System:
A. Septic Tank (If homemade, show diagram on back)
4. Installer
Approval Request £ez &. De ~ Water Fac~lir~es
s. Se~ege Pit
1. SXze
2. Lining
C. Disposal Field
I. N,,~her of l,Xnes
2. ToVal ~
A. Well to S~c
We~l to Se~aEe
C. weZ~ co S~er ~ne
o. Well to ~e~y ~ne
F.
G.
Well tower Possible
Fo~md~on co septXc ,?en~ ~ ~ /
FOU~dst~o~ to Seepage Pit ~,,,~,,~
seepage eit to 'Property Line
DISAPPROVED:
DAT~:
APPI~VAL VALII~ FOR. ONE YEA~ I~;l~i DATB $IG~D.
G'R~TI~R A~OIORAG?, ARP. A 801~0UQJ J~ALTB DEPARTMENT
EDII?O
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART L--TO BE COMPLETED BY FHA
INSURING OFFICE MORTGAGEE SERiAl, NO.
Anchorage, Alaska First National Bank of Anch. [111.009246 203
MO~fOAGOI OR SPONSOR F'tO~[ITY ADDRESS
Herman F. Freeman 3436 E. 67th; Anchorage, Alaska
CAHPBELL tlEICHTS S/D
[] Public system
[] Public system
......
D ~mmunlty system ~ Individual
PART II.~TO
REPORT OF INSPECTION--INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
PIIMAIY TISATMINT consists d ~ Septic tank. I-1 Cesspool.
Total liquid cap,Sty.
Inside length.. .ftx't. Inside width.
Inside dbmetcr, feel
galloes. Cara&y inlet compartment.
feet. Liquid delXh.
Number ol' compartments
gallo~s.
feet; neares~ I{~ llne It I-] (font. [-1 side. r-I tear. feet.
Liquid'capadty, gallons. Lining material
Distance from: Well.
Total Icn~h of tile lines.
Trench width,
Lrngth of each llne.
fees', foundati~m, feet; neart~ Im llne at f-I front, f-I side, f-I rear,
feet. Number of lines,. Distance between lines,
inches. Total effective absorptk)n area in bottom of trenches.
· feet. Depth, top of tile to i~nlsh grade.
Type of filter mntetlzl: f-I Gra,,el. f-I Broken stone. Other
Depth ~' filter matt'rlal beneath tile., inches.
Number of p.its , . Outside diameter feet. D~pth.
Distance from: Well, fe~; building foundati~m,
;n~ectkm mode by~ fq State. [-I County.
square feet.
inches.
Date (d' insp~th~n
Depth of filter materlll over tile.
.feet. Lining material
feet; near~t Io~ line at I-I front, I-1 side, f'] rear,.--
I-I Local Health Autbo~iry.
Inspected by
19
fees°
REPORT OF INSPECTIONmlNDIVIDUAL WATER-SUPPLY SYSTEM
Distame to nearest public water main, feet. Size of main. inches.
Indlv/dual wells [] ate I'-1 are ixx cust*l(naty in neighborBu4]d.
Give most r~ent re'crud of failure of wells in immediate vKinity to furnish adequate supply of water
Properties in neighborhood f-] are f-I are no( being developed with both individual water-supply and sewage-dispos31 systems.
Lot size: feet wide. fctt deep. Dwelling set back from front property line feet.
Individual water supply from: [] Drdled well. f"'l [)riven well. f"l Dug well. I"l l~ored well.
Building fimfldatlon, feet; fleares~ I~ line at I=~ front, f'q side. [-[ re~t.
cast iron sewer, feet; tile sewer, feet; septic tank. feet; disposal field,
seepage pit,. feet; cesspool feet; other sources of' possible pollution, .i'eet.
Diameter, inches. Total depth, fees. Type e:4r casing,
Approximate depth to pumping level of water in well. feet. Approximate field.
Sealed watertight to depth ~f feet.
p. xteriot sp~e around casing sealed with: [-1 Cement grout. [] Puddled clay. [] Ordinary backfill.
Well cover: f-I Concede. [] Wood. f-I Metal. Openings in well cover watertight: I'1 Yes. f-I No.
I~m~s [] Shallow well. [] Deep well. Lengxh of drop pipe, feet. Pump capacity,
L~xated in; [] Baser~ent. f-I Pumproorn off bas, meat. {-I Pumpbouse above ground. [] Pump pit.
Pumproom properly drained: I-1 Yes. [] No. Pump mounting watertight: [] Yes. [] No.
Type cA' storage: ["1 Pressure. [] Gravity. Capacity. galloas.
Itas bactetiologkal eaamination of water been made.> [] Yes. [] No. If answer is ','yes." give
Quality o$ water [] is [] is not satisfacxory for human consumption.
Installltlon I-I does I-I does not comply with approved eahilAta, if an)'.
Inspectio~ made by: [] State. [] County [] Lu~a] It"-'"'lea th~Autho~it _..y_-~'. ,'~''''-,
Inspected by
Date of inspeetioo , 19
Delxh of casing,
.gallons per minute.
.gallons per minute.
(Tm J)
,19
feet,
Nov, 11~
~, Joseph tlilllar~s
6808 Spruce Strcot
Anchorage, Alaska
S~JECT: Sc~t-Ptblic Cl~s
I~'ater Supply ~tng Lots IOA~
10~ iOC~ IOD and ~A
~lc~ 2, ~pbell Heights
S~dtvisien
Dear )h-. William. s:
~ Creater And~orage Area Borou~ l~alth Do;x~rtment irmpccted
and took four {4) w~tcr smuplcs of thc subject water supply.
This ~ell and distribution systc~ wa~ recently installed and
all required cn~inecrin; reports ~d p~tcctivc radii have
been submitted to ~is office. ~c f~r
taken were also sctisfact~y.
Your na~e will bo put on our m.~iltnj list and you will receive
a smnplc bottle ever)' three ~nt. hs.
Presently the water supply serves on Let 9~ but is cxpcctcd to
serve the re~aining lots in 1~?0.
Sincerely,
DAVID R. L. DUNCA~t, lq.D.
Hcdical Director
BY:
Roll R. Strickland, R. S.
Em'lrcr~ental Health Supervisor