HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 3 LT 19C
Well Log
........ : '-. .
completed. / .4. .t / ~/ .?. ./. .........................................
Date
Depth of well ....... .?...~...../. .............................. ' ...................... ~ ....................................
Size of casm~ ............................................................... , .......... , .................................
Distance to water.........~..~4.~..~.,.....~.~.~..~_..~. ....... ..~...~,...~ ...................................
Distance to water while pumping .......... .~...~..~. ....... i .......... : ............... at rate
Formation
from
to
/3
Driller
DELTA DRILL*lNG COMPANY
SRA BOX~3O4 B
ANCHORAGE. ALASKA 99507
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ~ ~ L~ -- ~'"1 ;::k- Q._~ HAA# ~"~ ~~lc~ '~-~ ~O~
1. GENERAL INFORMATION
Complete legal description
Lot 19B; Block"3'; Campbell Heights Subdivision
Location (site address or directions) 4139 East 67th. Anchorage~ Alaska 99507
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
David Mader
Day phone 349-3399
4139 East 67~h. I Anchoraqe, Alaska 99307
Day phone.
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 2
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
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 of this Health Authority Approval application 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 inves.ti_gation 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.
Phone
/
Name of Firm s & - ..... .q :.'c
...... NEE
~agte K,ver.
Engineers signature ~~ -
D~S SIGNATURE
Approved for
Disapproved.
'~' (~) bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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 satis~ 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.
Municipality of Ancho.?ge
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: (-~'T iq /~. I,'~UIC~. OAC,~/~E'(_[
A. Well Da~
Well ~pe ~tU~
Log present ~)
Total depth
Sanitary seal (~N)
Parcel I.D. O / ~Z_ o 7'~- - ~'~'"
If A, B, or C, attach ADEC letter. ADEC water system number.
Date completed (0 (;;).~ I~{ Driller
Cased to ';2~ ~ ' Casing height
Wires properly protected ~/N)
FROM WI~LL LOG
Date of test ID I~-~ I~ t
Static water level
Well flow
Pump level1
· '-----SEP. ARATION DISTANCES FROM WELL TO:
g.p.m.
AT INSPECTION
~, q~ g.p.m, rtl o
Septic/holding tank on lot ~
acent lots
Absorption field ;~n lot
Public sewer main
.;C
~ "/- Petroleum tank
WATER SAMPLE RESULTS:
Coliform (~
Date of sample: II/~"~
e. ~NK DATA
Date installed ~
Nitrate (~), "~
Collect~d by:
~ E c.~, ~. o ..r'
Other bacteria
Tank size Compartments
C,eanouts (Y/N) ~anout (Y/N)
High water alarm (Y/N) . ~ ~ (Y/N~...~
Date of pumping ~ -- .
SEPARATION DISTANCES~I~TANK TO':- ~ ~
Well(s) on lot ~ On adjacent lots Foundation
To prope. L1y line'"'""'- Absorption field .Water main/service line
ud"~ace water/drainage
72.02e (3/93). i=m~t CONTINUED ON BACK PAGE
Size in
Vent (Y/N)
High water alarm level
Meets MOA electrical codes
level at
Manufacturer
.Manhole/Access (Y/N)
'Pump off' Level at
.Cycles tested
r STATION TO:
Well on lot,
Surface water
D. ABSORPTION FIELD DATA
Date installed
,System type
Length Width
Total absorption area
Date of adequacy test
Water level in absorption field
Peroxide treatment
Well on lot,__
To building
On
I thickness Total depth
Depression over field (Y/N)
',pass/fail) ~ for
Curtain drain
E. ENGINEER'S CERTIFICATION
'~ After test
FIELD...TO: '~
.On adjacent lots ~Pmpe~ne
.To existing or abandoned system on lot '~
.Cutbank Water main/service line
Driveway, parking/vehicle storage area
I ~em'~ that I have checked, vefified,~ conformed to all MOA and HAA guidelines in effect on~e ~a, te of this inspecfior~
,-'".
S,gnature ,/-~ ~
Engineer's NaI~'3~ ~e ~!;':r '.;~. =__~.' ~,.. --- ~/~"~~'~'~-: ?" ~?
/=
HAA Fee $ ~ -~"' Wa~r F~ $
Date of Payment
Receipt Number
~z-~e (3~3). ~ac'k
Date of Payment
Receipt Number
11x30/93 12:51 CT&E ENUIRO~.IEtlTAL LAB SEPUICES
ESTING & ENGINEERING CO.
REPORT of ANALYSIS
Chemlab Ref.~
Client Sample ~D :L19B B3 CAMPBELL HEIGHTS
t~atrix :WATER
NO. '884
$~33 B STREET
ANCHORAGE. AK
Client Name :S & S £NGINEi~IN6
Ordered By :R.
Project Name
ProJect~ :
PW$ID :UA
sampl~'~emarks, ROUTINE SAMPLE ~ECTEO BY: UA.
WOP~ Order
Report Coppleted :11/30/93
Collected :11/23/93 @ 11:20 h
Recelved :11123/93 @ 13:15 h
Technical Director:$'~%~tEN~. £DC
Hale,Ged
/-
OC Allowable Ext. Anal
Parameter Results Oual Units ~ethod Limits Date Da~e In
Nltrate-N 0.34 ~/L }~A 353.2/300.0 10 11/24
* See Special Instructions Above UA - Unavailable
** See Sample Remagks Above NA - Not Analyzed
U - Undetected, Reported value is th~ practical quantification l~mit. ET c Less Than
D - Secondary dilution. GT ~ Greater Than
£NVINONME~JTAL SERVICES IN ALASKA COLORADO, UTAH. ILLINQ!~. OWIO, ~ ARt'LAND. WiST VIRO;N A'. NEW JED$-'Y, SOUTH CA~OgI~--
MUNICIF;ALITY 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)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
on (a, ddre~s or
Locat
directions)
, '.
Prope~,;6~ner ..... "~'~'~'~: "'
Lending rnstit~tion ·
Mailing Address
· Telephone: (home) Business
Telephone
(d) Real Estate Company and Agent
Address
Telephone ~,~'4, ~-
(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-Family'S' Number of bedrooms
3. WATER SUPPLY
Individual WelI~E~- Community I-I Public r~
Note: If community well system, must have'written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public~J2~ Community ~ Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 com, pliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection·
Date
6. DHHS APPROVAL
Approved for'
Approved
bedrooms by
Disapproved Conditiona~
Terms of Conditional Approval
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
0 r analyze data before a certificate is issued. The M u nicipality of Ancho rage is not responsible for erro rs or omissions
in the professional engineer's work.
72~s(.~,. 7~) S,=k Page 2 of 2
.,~'~ ct~ Health Authority Approval (HAA)
y,.~-~,~tk,.~ CHE. CKMST - FEBRUARY 1984
· '. ' · Legal Description: /- ~,~/(~z-/_./-
A. WELL DATA
Well Classification ' ~'~////~/'~' : If A, B. C, D.E.C. Approved (Y/N)
Well Log Present Y~) Date Completed /~-~4/'-~/ Yield -,~, v.~
Total Depth 7~ Cased tO 7~~'/ Depth of Grouting /*)//+'
.. Static Water Level ~/' Pump Set At ~J/,~r
/
Casing Height Above Ground ,/ --- Sanitary Seal on Casing(~) ~'
Electrical Wiring in Condui N) "" Depression Around Wellhead (
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
; On Adjoining Lots
; On Adjoining Lots
/O ~' · To Nearest Public Sewer Cleanout/Manhole
; Date
,J / 7'/'~-'/-~ o. / ? ---
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot ,~'.~
Water Sample Collected by /~'"'"~--"~
Water Sample Test Results ~/~.~'7'" ~
Comments ~J'~t/- ~"/.~ -/"'~"~7"" /~-Z-*~-~*.
B. SEPTIC/HOLDING TANK DATA ~# ~z./(~ ~'~/~---
Date Installed Size No. of Compartments
)N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N)
· Date Last Pumped ~ __
PumpinglM.ain,.t.e~a~c.e Co ,~,.~n File (Y/N) ~ ~; for ~ __
~~.t'er_A la r m~_ Temporary Holding Tank Permit (Y/N)
,~ ..'. ~..- : '..".,..\',, ~
~EPABATIO~. DI,ST..,~N.CES FROM SEPTIC/H~G TANK:
7o. atar -,pply e,"'°: o .Foundation
:[o Pr..opg~[~;?.~e;~.;.',"7' ~' To DisposaT'Fie~ _ .
· %'% ;.:..., ...... .';&'~, ~
To Stream;. ,Pehd. J.~ke;or Major Drainage Course
Comments'"'" '~ "
Page 1 Of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
, D~nstalled
Width~
Sq~re Feet of Abso~io~
Depression o~ield ~/N)
Type of System D,.e.sign
Length of Field
Depth of Field '~ ~
Gravel Bed Thickness
Statndpipes Present (Y/N) "':
Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DIsTANcE FROM ABSORPTION FI~'c{~
To Water-Supply Well _ :. T ' ~To~:~r~e~y Line
To Building Foundation ~- To Existing or Abandoned System on
,
Lot ; On Adjoining Lots
To Water Main/Service Line
To Stream, Pond, Lake. or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Comments
To Cutback (if present)'~ ~
D. LIFT STATION
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump'Off" Level at '
~ Vent (Y/N)
~ Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request'* ,. '~ ,
I certify that I have checked, verified, or conformed to all .MOA and ,HAA g~
inspection.~/~--.~- ~ ~,~ /~ /. /~__... . ' .... .'
Signed " ,-
Company
Date
MOA No.
Receipt No.
Dateof Payment ~ -~,~-,, 7'-~ ~
Amount: $ t/2 0,-'~OC~
72-026 (Re~. 7/88) Back
Receipt No
Waiver Fee: $
Date of Payment
Page 2 of 2
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 (ad~l{ess o~irection, s) · ..
(b) Property 0V~' ",'~ ~Y~,~'~":" ',"
Mailing Address ' ..
Telephone: (home)
Business
(c) Lending Institution
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
I
Telephone
(e) Mail the HAA to the following address: (or check here'S, If hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family,~ Number of bedrooms ~
3. WATER SUPPLY
Individual Well~.. Community [] Public n
Nole: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site I-1 Public ~ Community [] Holding
Tank
[]
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
Page I of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 end 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 ,.'~-~'~" ~ Telephone
Address
Date
6. DHHS APPROVAL, ~~~
Approved for ~,,~* ' bedrooms by
Approved ~ Disapproved Conditional
· Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Sen/ices (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
o r analyze data before a certificate is issued· The M u nicipality of Anchorage is not responsible for error? or omissions
in the professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Classification '~'"//-'"~'7~
Well Log Present j~)
Total Depth ::~Z:~ / Cased to'
Static Water Level .~ ~Z:!
Casing Height Above Ground
Electrical Wiring in Conduit
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /~//~
/
To Nearest Edge of Absorption Field on Lot'
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water sample Test Results _ ~'-'"/"~
If A, B, C, D.E.C. Approved (Y/N)
Date Completed .//)-Z' ,~--~'./ Yield _~. -~- ~(~',,o/,?~
~/ Depth of Grouting
Pump Set At ~
//
Sanita~ Seal on Casin~)
Depression Around Wellhead (~
W/~ ; On Adjoining Lots
TO Nearest Public Sewer CleanouUManhole ~
/
;Date /~-~ ~-~
Comments
B. SEPTIC/HOLDING TANK DATA ~
Date Installed Size ' No. of Compartments
Standpipes (Y/N) ' Air-tight Caps (Y/N) .~ Founda ~o~n Cleanout (Y/N)
Depression over Tank (Y/N) / t~Pumped
Pumping/Maintenance Contact on File (Y/N) ~/1~/~''f I ', for ~.
Holding Tank High-Water Alarm (Y/N) ~l/~-~/~-;mporary Holding Tank Permit (Y/N) .
SERA~ATJO~ST~CES FROM SEPTIC/~IN~ANK: -
~o ~at~[-Sbpply weLb~,'. _/ TO Building Foundation . .
;'TP ~/PP2~Y,~Jg~-~.;'.;./~ ~ -/ TO Disposal Field _ .
'=T0. W~ter Main/Se~ic~ ~~
, . , = . .
TO Stre~m.~h~ajor Dra,nage Course .....
...:...
Comment * ~. ~' - ,
t2-~ (,~,.?,'~) ~,~t Page I 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)
Type of System Design
Length of Field
Depth of Field
Statnd pipes Pr~3t-(~/N)
Date of La,~equacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIEL~' '
To Water-Supply Well ' ,,~ To Property Line
To Building Foundation J To Existing or Abandoned System on
Lot J ; On Adjoining Lots
To Water Main/service Line J To Cutback (if present)
To Stream, Pond, Lake,~C.Major Drainage Course · ~ '
To Driveway, Pa.~.~j~Area, or Vehicle Storage Area
Comments ,~
D. LIFT STATION ~
Date Installed Di
Size in Gallc~n's -- . £ I ~ . a.M~nhole/Ac~ess (Y/N)
"Pump On" Level at J~_~ ~J
High Water Alarm Level at
Tested for
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAh Request**
I certify that I have checked, ~erified, or conformed to all 'MOA and HAA guidelines in effect on the date of this
inspection.
Signed
Company
Date
uOA No.
Receipt No. 0_~
Date of Payment
Amount: $
~'..-'~%.: ' ~ine~eal
~e eeee eee~e~eee ee~ e~ ·
~ Receipt No.
Waiver Fee:.
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF,AlASKA, INC.
/ ~,~_;t-.-.-~" ~ ' 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
~""~.~o~,~ FEDERAL TAX ID # 92-0040440
Date lispers }'~lntsd: OC! 27 88 t 15:13
~W$ID :UA
~eceive~ OCI 24 88 ¢ 15:30 h~l.
Client ~a~e :A[C$
L&bozeto~ ~upervleo~ :$T~PE~ C. ~O! l)l~C3
Tested ~esult/~nlts
0.18 ~/1
[er~xke: 3A.~LE COLL!CHD BI L.[.
~- ~one Detected "See ~a~le [eaatke Above
XA- ~ot in~l~e~ ET-Less ~han, GToG*eats: Than
.. . APPLICANT. FILLS OUT UPPER HAL~-'~NLY
.a;;,ng Add,*. z,p me q7 ~-(> ~
Street
L~atim
Type of Re~
Ule Family
~ Indlvld~l Yeat lndlvUual InstallS: ) ~ ~ ~
~llc~illty When ~ted to Publlc Utility: / ~ ~
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspec or
MUNICIPALITY
(6) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
:1~ DATE RE CE,V ED
~ INSPECTION APPOINTMENTS
IME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR~
MUNICIPALITY OF ANCHORAGE
/ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~JNi~PA[i~ OF A~CHO~GE
~ L Strm - A~or~, Al~a ~1
[~dlRC~M~NIAL
( ENVIRONMENTAL SANITATION DIVISION
T~e~e~47~ ~]0~7 2 1981
DIRECTIONS: ~mplete all pe~s o~t page ~. I~eomplete r~u~ will net ~ pr~. Ptease allow ten (10} days for pr~essing.
MAILING ADD~ ~
PROPERTY RE$~rent from abo~} PHONE
2. BUYER PHONE
MAILING ADDRESS
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
I
MAILING ADDRESS
5. LE6AL~)ESCRIPTION ~
&/-- /?/<
STRE OCA22
6. TYPEOF RESIDENCE
~ SINGLE FAMILY
NUMSER OF~EEDROOMS
.~ One [:::] Four [] Other
Two [:] Five
MULTIPLE FAMILY I'-I Three I--1 Six
7. WAT R UPPLY
:~ INDIVIDUAL*
[::::] COMMUNITY
[] PUBLIC UTILITY
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date. give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE'*
[~ PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
L ' THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
f--1 SINGLE FAMILY I--I ONE I--I THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY I--I TWO I'-I FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[--I PUBLIC UTILITY
'Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
DINDIVIDUAL/ON -SITE DATE INSTALLED
f--IPU BLIC UTILITY
Connection Verified INSTALLER
f--ISeptic Tank or [] Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Sept,c/Hold,ng Tank IAbsorpt,on Area ISewe~' Line J Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
{Z~--~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY ~
72-010 (Rev. 6/79)
unicipalit¥ of Anchor ¢
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
November 10, 1981
Laura Crow
Senior Office Assistant
Sewer and Water Program
Request for Refund - Account ~2460
Please make arrangements for the following refund. A private
engineer has made the inspections rather than this office.
Quest Enterprises
4325 Laurel
Anchorage, Alaska
99507
Receipt ~161631
$25.00 Sewer and Water Other
Lot 19B Block 3 Campbell Heights Subdivision
Thank you.
Sincerely,
Laura J. Ward
Senior Office Assistant
Sewer and Water Program
attachments
91-010 (5i78)
WATER DELIVERY SYSTEM INSPECTION
LOT 19B, BLOCK 3, C;%~PBELL HTS.
On November 4, 1981 at 12:00 Noon I visited the subject property
for the purpose of inspecting the exterior water delivery system and
to obtain a water sample for chemical analysis. At the time of the
inspection it was snowing with an accumulation of 6" on the ground.
The well is located approximately in the middle of the lot ~0'+
from the front lot line. Backfill around the well is good with a
mound around the riser which will eliminate runoff water from flowing
down the casing. The casing is capped with a sanitary fixture. The
control wire exits the casing through flexible conduit. The conduit
continues into the ground.
With the snow cover it was impossible to determine the actual
topography of the surrounding terrain. It appears the yard around
the well is flat. The builder said the back yard would be landscaped
in the Spring and all irregularities would be corrected at that time.
A sample of the water was taken from the Kitchen tap. The
aerator was removed from the tap and the water run for three minutes
before the sample was taken. The sample was then taken to the
Chem Lab for analysis.
Michael E. Anderson,