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HomeMy WebLinkAboutHOCKER BLK 3 LT 2Hocker Block 3 Lot 2 #'042 081-17 Municipality of Anchorage Page I of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number:. SW000376 PlO Number:, 042--081--17 Name:WARD TESTA Wastawater System: [] New · Upgrade 14341 HOCKER PLACE ANCH AK 99516 ABSORPTION FIELD Ph°ne:(907) 276--2209 2 IDeep Trench OSholfow Trench rlBed r'lldound 13Other LEGAL DESCRIPTION 1.2 ~o/~ r~ 7.18 - 9.0 2 3 HOCKER 1.18 - .3.0 ~ 6 WELL: [] New [] Up 2.5r~ 1 r~ r~ 252 so. ~. D 3034/ F-810 ~. EAGLE MTN EXC. 10/13/oo TANK SEPARATION DISTANCES · s.ptic a .old~ng a S.T. EP. To Septic Ablorption Lift Hold;ng ~,-/~, ANCHORAGE TANK 1000 From Tank I~mld Station Tank Well *90'+ 100'+ - - 25'+ STEEL 2 Su,oce '80'+ '80'+ - - - LIFT STATION Water Une Lot *'1'+ '1'+ -- - - =:J ~ ~ou.~atio. ~'+ 10'+ - - - Curtain~ Droln NONE KNOWI R,r, arks: BENCH MARK · WNV[R$ CHANTED W[I'H ISSUANCE OF PERUrr. SOUTH END OF NORTHERN DECK. THE OLD SEPTIC TANK WAS A~DONED PER UPC. ;'-"-: ~"~"~ 121.13 ..~ :.'/I / ~1 ._'-~.~?~ ,nspoctions performed by: AWWC, INC. Dates: 1st lO/13/oo '1 ...... '~ '~ ........... 2nd lO/13/oo .,,.x., .................... 3rd 10/18/00 , ',, ffr~, A. Oarness...' Department of Health and Human Services approval (~_ -.. ............ . .. ':~,*~ Reviewed and appmved by: ~/'~/~' / ill. ~f?,~l.. Date: ./-/~"~) J~:'°-%~.~,~,ore,,~o~.='<:? p£RUrrswooo376NUMgL'~: AS m BUILT D RAWJN G pA~¢EL042_081mD ~U~:m_l 7 . %~%.~.~'~' I ' /' '~';~ ~ ~ ....-/ x x ST2 56.8 55.9 FD 55.6 57.8 C01 68.1 71 002 69.6 83.9 SUMP 58.0 75.3 ~ ~o/2~/2ooo ~.~.W. ~S~ WATER & ~5~STEWATER CONSULTANTS, INO.' ~ ..... ~ .... WARD TESTA (907) 267-2209 2 OF HOCKER SUBBIVISlO~; LOT 2. BLOCK 5 AS-BUILT O~ SEPTIC SYSTEM UPGRADE BUILT DRAWING pERUff NUMBER: AS ~ 042--08 SW000576 - ~.24 , ~ ~ o/2,/2ooo CONSULTANTS, INC. 6~o, ~ ~, ~ ~ ' ~.~o~. ~ e,~ · ~ (~o7)~,~ · .~ ~o?~-~6 1" = 20' PREP~ FOR: PHONE NUUBER: P~E NUMBS: WARD TESTA (907) 267-2209 5 OF 5 ~[HOCKERoF WORZ: SUBDIVISION; LOT 2, BLOCK 5 AS-BUILT PROFILE OF SEPTIC SYSTEM UPGRADE Mtmicipality of Ancho.rage Department o! He 2a t. Lh' as tHuman Serv,¢es Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor hit p://www.cLanchorage.ak.us September 14, 2000 Jeffrey Gamess Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B, Anchorage, AK 99504 Subject: Waiver Request for Hocker, Lot 2, Block 3 Waiver Request #WR990102 Parcel ID//042-081-17 SW000376 Dear Mr. Garness: Your request for a waiver of the required separations between the water well, surface water and wastewater systems have been approved. The approved separations are as follows: 1 foot lot-line from the proposed absorption trench to the south and west lot lines. 90 feet from the water well to the proposed septic tank. 95 feet from the water well to the existing absorption trench. 63 feet from the surface water to septic system. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concems or questions regarding this waiver, please call our office at 3434744. Sincerely, Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Sen/ices On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sap 14, 2000 Expiration Date: Sap 14, 2001 Permlt Number: SW000376 Legal Description: HOCKER BLK 3 LT 2 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Testa J. Ward Owner Address: PO Box 230814 Total Bedrooms: 2 Anchorage. AK 99523- Parcel ID: 042-081-17 Site Address: Lot Size: 39776 SQ. FT. Permit Bedrooms: 2 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Aiaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. ALASKA WATER & WASTEWATER CONSULTANTS, INC. September 5, 2000 Municipality of Anchorage Department oftIealth & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 ...... Ref: REVISED DESIGN: Sewer Upgrade for Lot 2, Block 3, Hocker Subdivision To whom it may concern: The existing I bedroom house is served by a private well and septic system. The original design upgrade was submitted to your department with the septic tank and drainfield positioned such that the following waivers would be required: Well on property and septic tank and drainfield: 70 feet Septic tank and drainfield to surface water: 70 feet The sewer permit fee and waiver fees were paid at that time. Your department rejected the proposed layout and asked that the drainfield and tank be placed as far away as possible from the well. The property owner retained a surveyor to have 70 foot and I00 foot well radii flagged as well as the properties lines. After evaluating the space available we have modified that layout so as to maximize the separation distances to the well. The proposed waivers are as follows: 1' separation from septic system to south and west lot lines. 90'+ from the well to the septic tank & drainfield. 90'+ separation from septic tank and drainfield to surface water. I am unaware of any adverse impacts this installation would have on adjacent wells or septic sys!ems. If yo~f ~ve any questions, please contact me at 337-6179. Thank you for your ~ .E., M.S. r i e(J - 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwc.com Alaska Water & Wastewater 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 : Consulting Engineers June 4, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reference: Sewer Upgrade for Lot 2, BIk 3, Hocker S/EL Subject: Septic permit/waiver requests: Attn. Dan Roth We request that your department issue a permit to upgrade the septic system serving the referenced property and issue the following separation distance waivers. Waivers requested: 1. Between referenced well and proposed septic tank at 70 feet. 2. Between referenced well and proposed septic trench at 70 feet. 2. Between proposed septic tank and surface water at 70 feet. 3. Between proposed septic trench and surface water at 70 feet. Special attention will be given during construction as to maximize the separation distances between the new septic system, the well, and and creek. The requested waivers are conservative distances, actual separation distances will be greater than 70 feet. The separation distances will be reflected in the asbuilt drawings and which time we will amend the requested waiver distances in accordance with AMC 15.65.140. 1. GENERAL: The referenced property is bordered to the east and south by Chugach State Park. The dwelling located on the referenced property is a one bedroom chalet and is served by a private well and septic system. The existing system was installed in May 1980 and consists ora 1000 gallon septic tank followed by a 24 foot long, 12 foot deep trench with 8 feet of drainrock. During the construction of this system a 60 foot separation distance .waiver was granted between the septic ianl~ and well. The existing septic system will not pass an adequacy test (surcharged) at this time, and must be upgraded prior to the sale of the house. There are a number of site restrictions which limit the available spots to put the new drainfield. These restrictions are summarized as follows: · The 100 foot protective well radius encompasses the majority of the lot. · The lot slopes down steeply from north to south (from the well towards the proposed septic upgrade site), at approximately 25%. · In addition to the steep slope on the south side of the house, there is a creek which runs across the property. · The existing septic system is located adjacent to the southwest lot comer. · A cuthank exists along the uphill side of the existing road located near the southwest lot COHICL Given these restrictions, it appears that the only suitable site for the septic upgrade is the location shown on the site plan (short ofinstalling a lit1 station and crossing the creek in hopes to finding an area on the property to place a new drainfleld greater than a hundred feet from the creek). 2. SOILS: On May 18, 1998 a test hole was excavated and a percolation test performed at the area of the proposed septic upgrade, see attached soil log. 3. TRENCH DESIGN: a. Percolation Rate: less than I minute/inch b. Allowable Application Rate: 1.2 gallons/day/f~2 c. Number ofBedrooms: 1 d. Design Flow: 150. gallons per day,, e. IVfinimum Absorption Area: 125 f~ f. Maximum depth 9.0 feet g. Effective Depth: 6.0 feet h. Width: 2.5 feet i. Length: 21 feet. j. Effective absorption area-- 252 fl2 (>125 1~2 OK) 4. SURFACE WATERS: There is a creek which runs from east to west through the center of the lot. The creek is uphill from the proposed upgrade. We are requesting a waiver to this surface water. 5. TOPOGRAPHY: See the site plan for slope information. The slope is approximately 20 to :25% at the proposed site for the new trench. 6. WAIVER JUSTIFICATION: The existing septic tank is located approximately 60 feet from the well, and has been there for approximately 18 years. Given the age of the tank is is reasonable to assume that it is leaking. Recent water analysis shows zero coliform bacteria and nitrate levels of 2.27 mg/i, indicating · that there has been no significant adverse impact to the aquifer. In short, the potential for subsurface contamination of the aquifer appears to be minimal. The topography between the well and proposed upgrade slopes downhill, from the well to the septic system, at Z approximately 25%. Overflowing sewage will not migrate towards the well. The creek is uphill from the new septic system, thereore, it is not possible for daylighting sewage to flow towards the creek. A well flow test performed on 5/21/98. The static water level was 56 feet below top of casing. The flow test revealed the production to be 2.1 gpm with a 78 foot drawdown. Water could not be heard flowing into the well casing when the water level was drawn down to 134 fl. during the flow test. In short, it appears that the groundwater source is below 50 feet. It is unknown whether the casing extends to 40 foot below ground level or is seated into bedrock at a shallower depth. 7. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware ofany adverse impacts this installation would have on adjacent wells (there are none within 100 feet) or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. S ncerely, ames P. Williams, P.E. 2ivil Engineer j NOTE: I ~o~ ~o ~oN, ~£ ~o~ ~ ~ou~ ~o ~ J I II ,,, ~ om"/ o~ ~ / / / I ~ / ~' / ~b I ~ 0 / /~ .' ~ m I / ~ ' '- "~ ~ ~ I .............. J.WM. ~SI~ WATER & ~STEWATER ~: , OONSUtTANTS, ~N~. '="%lf't~"' : .............. , ~ wARo TESTA (~07) 2~7-220~ 2 or 2 ~hT~ ~TL~,,~ ~' ~OOK~R SUmWStON: LOT ~. e~OOK ~ 'U~[,'.?.g .......... .'~ DESIGN DRAWINg FOR S[PTI~ SYST[~ UPGRADE. __ FLAT TOP AVENUE.__ _ ~ _ --~ ALASKA WATER & WASTEWATER HOCKER SUBDIVISION; LOT 2. BLOCK SITE pLAN CLAIR DALTON ptto~l[ NUMBER: (907)229-1275 p/~r'. J.l...M. 1 = 100' I OF' 2 IdES P. NO. 9608 C.E. A/I.~&SKA WATER. &:: WASTEWA'.L'EK ~,. ,..4 I SOIL LOG - PERCOLATION TESTI ~[."'49-~[ r r IFC. AL DESCRIPTION: HOCKER SUBDMSl0N. LOT 2. BLOCK 3. TEST HOLE I {.~.~.... ....... ~.,~.,.:, · ...... , PERFORMED FOR: CLNR DALTON /'.JAMES P. WtLUAIdS.: DA'rE PERFORMED: 5/18/98 ~ ~ '.... NO. 9608 ...' I TEST ,O,E I .......... W/ Sw LENSES ° ..-,,"---'-- Bp ~ Ifil '"'-., r~ THROUGHOUT & , I BM CL ' ' r;w 2o' °~. 6C I OL ~r. Pll~SY51~M BOULDERS SW ~ MH DENSE IN AREAS. ~ SP CH I' , ,. : ; D~. TO DAT~ II I ~'~.....____ ' --;' - ! 8ROUNDWATER ....... .//' D~ 5/le/9~ OEY 5/27/96 f.-~ '~ 5Y~M , - SITE I' = I00 _! 10 CLOCK NET TIHE WATER LEVEL: NET DROP 11 DATE READING 'TIME (MINUTES) READING (INCHES) 12 '5/30/98 - FILL/I PERC HOLI 3X, DRNNED IUT 13 BECOMING DENSER __ J WITH Dr.Y fH 1 12:01 6' 14 ~ ~70W 12' -- 2 12:01:30 30 SEC 1' 5' m' 3 12:02 ~ 6' 15 B 0 -- 4 12:02:30 30 SEC BEY 6' 1 17-- 19-- PERCOLATION RATE < 1 .(MIN./INCH) PERC. HOLE DIA. 6 .(INCHES) 20- TEST RUN BETWEEN 6.0 ~ 6.5 FT. COMMENTS: CM MAI~-RIAL BELOW THE 12° D[.PTH CON ;ISIS OF S )y (;RAVEL AND WILL SERVE AS A FILTER. /~j PERFOMED BY ALASKA WATER & WASTEWATER ~ ~,~tl~L J~/.~,,~. , CERTIFY THAT T^~:' ~.0 ~U,~C=,~- aU,~EL~ES ,~ .~.~cr ON ~H~S TH~S W*S P..E. RFO~DI~N ^CCOROANCE'W~H'~ Rick Mystrom. Mayor Mmficipalit3, of Andxoragc Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage. Alaska 99519-6650 http:llwww.ci.anchorage.ak.us September 14, 2000 Jeffrey Gamess Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B, Anchorage, AK 99504 Subject: Waiver Request for Hocker, Lot 2, Block 3 Waiver Request #WR990102 Parcel ID #042-081-17 SW000376 Dear Mr. Garness: Your request for a waiver of the required separations between the water well, surface water and wastewater systems have been approved. The approved separations are as follows: 1 foot lot-line from the proposed absorption trench to the south and west lot lines. 90 feet from the water well to the proposed septic tank. 95 feet from the water well to the existing absorption trench. 63 feet from the surface water to septic system. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Civil Engineer On-Site Water Quality Program WR~ WR990102 Date Received: MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Wa'iver Review Worksheet PID# 042-081-17 HA% December 27. ]999 Legal Description: Engineer: 6901Debarr Rnad. Anrhnrn~P: A~ Applicant: Permit # ~*0~7~ Waiyer Requested: 70 feet h.rw..n ~.11 mnM prmpmeaa o"~t4C e~"k. 7~ ~aae ~-ewean Criteria: 1. Geology: .Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~U~C~ Date: ~--14--00 By: Rec %: 05486 Amount: $ 920.00 Name of Reviewer Date Paid: I~-21-99 I t~Ttc r~/< ~ ~$P~/o~ PttLO. 7~ SlTu~TIv~ ~T I I?.o WELL FLOW TEST DATA YES CASlNB DEPTH (PER WE~ LOB): ~ ' CASING HEIGHT (ABOVE GROUND)= t~'~ DEPRESSION AROUND WE~ YES ~ NO SANITARY SEA~ YES ~ NO WIRES IN CONDUIT= YES ~ NO WATER SAMP~S TAKEN= ~/ NO IF YES, DATE= WATER L~EL ~IME M~ER READING FLOW (BELOW TOP OF CASING) DRAWDOWN tt °~ ~o~0 ~ STATIC = ~/ IZ ,o IZ~r 23g0, ~ glO.~ WE~ PRODUCTIO~ M~SURED 0 ~, 0 ~ ~' SOUTH m al-. 106.60  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~16~'~ ~]NEW LOCATION NO, OF BEDROO~ DISTANCE TO: Well GO~ I AbsorPtion area Dwelling PERMIT NO. Manufacturer Material No, of compartments ~ Liq, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERM ~ NO, O Z ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest lot line~ PERMIT NO, ~ DISTANCE TO: ~ O0 ~ ~0' O l ; ~ Top of tile to finish grade Material beneat , ~s o~t~. ~ ~' ~ _~s Tota effec[ive area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~--~~r~~- Depth Driller Distance to lot line PERMIT NO, ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank ~0 ~ Absorption area(s) OTHER PiPE MATERIALS I~5 X REMARKS ,.,,.~~ ~ ~,,, ,,, ~ ~ ~-t. ~./~ / .~. ~ _~ PERMIT NO. I,;IPRLITY OF RNC:HC, RAGE DEPRRTMENT OF HERLTH 8ND ENVIRONMENTRL PROTECTION 825 ~L~ STREET, 8NCHORRGE, PK. 99501 264-4720 ,:~[4--SITE SEL-~EF~ i"i~:r'l IT 80007~ ) RPPLICRNT DQN R HENSLEY 420 L ST LOCRT I ON LEGRL :hZ B~ HOOKER SUBDIVI=I ~ > TYPE OF _,OIL 8BSORPTION =.'~_.TEM : TRENCH LOT SIZE MRXIMUM NUMBER OF BEDROOMS SQUARE FEET SOIL RRTING (SQ FT,'BP ~ I I~ THE REQUIRED SIZE OF THE _OIL RBSORPTION S~--,TEM IS: [:"iF"TH= :1.2 LEI'4GTH= 24 GRR"'/EL DEPTH= 8 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE EXCBVBTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTF~LL PIPE 8ND THE BOTTOM OF THE EXCRVBTION (IN FEET). RED SEF'T I C TRNI<; S I ZE= 100E'" 6RL. LC~I%IS PERMIT 8PPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE e~ 1' ~ " I' ~ . - IN=.TRLLRTIJN IN~PEGTI3N_. OF RNY WELLS RD.TROENT TO THIS PROPERTY 8N[:, THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI-JO .:: 2 ) I I'-JSPEL--:T I ,_--',NS lIRE REL%~L! I REP, BRCKFILLING OF RNY SYSTEM WITHOUT FINRL IN=,PE_.TION 8ND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSEEUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS PRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PER["1 I T E~'-~:P I F-:ES DECEr-IBER ~-l., 1-'~ 0 I CERTIFY THQT ~ i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF 8NCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES. ~: ! UNDERSTRND THRT THE qN-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE APR>-? MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2223' SOILS LOG - PERCOLATION TEST SOILS LOG I--I PERCOLATION TEST PERFORMED FOR: ~ -~> .~ ·, t..' , , ,, ,, :, ,,,. ,./ DATE PERFORMED: _~, ~D ~'-~,~"' ~': LEGAL DESCRIPTION: 2 :t 10- 11 13 18--{ / SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN / Gross Net Depth to Net Reading Date Time Time Water Drop !'i o,~' '?~F ~, ! * %...- PERCOLATION RATEe ~ ~. ~.~,~ ~ TEST TUN. BETWEEN FT AND Municipality of Anchorage Development Services Department Bullding Safety Division On-Site Water & Waste~ater program 4700 South Bragaw St. " " .... p O~ B~x 196650 A~chorage, AK 99519-6650 ..... wWW.ct.anchorage.ak.~s - . :. ,' (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING · P~rc~el I':D.~' ' '-042-;081-17-' 1. GENERAL INFORMATION Complete I~gal descripti'on Expiration Datei '/ HOCKER 5UBDMSION; LOT 2~ BLOCK 3 Location (site address or directions) Current Property owner(s) . ~ Mailing address .. -- Lendlngagency Mailing address Real Estate Agent 14341 HOCKER PLACE, ANCHORAGE~ AK 9951 WARD TESTA Day phone 267-2209 P.O. BOX 2308141 ANCHORAGE AK 99523 Day p~one SALUE MAHOY Mailing address : "' ' Unless'otherwise requested, HAA will be held by DSD for pickup. 2. ' NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual Well [] Indivld~Jal Water Storage Community Class Well ~. Public Water System Day phone RESIDENTIAL MORTGAGE, 1400 W. BENSON, ANCHORAGE, AK 99503 TYPE OF WASTEWATER DISPOSAL: Individual On-sita Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificetes of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professlonal civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are requlred for the transfer of title (except between spouses) for properties served by a single famliy on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Ce~ficates of Health Authority Approval are valid for 90 days from the date of Issue for properties sewed by a private or Class C well and may be reissued with new water sample results less than 30 days eld. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid fot"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. STATEMENT OF INSPECTION BY ENGINEER* ' ~* ~* As co,tied by my seal affixed hereto and ~s of'th*e valida~n date shown below,*l ved~ that my' InvastigaUon, based on proceddres outlined in the Health Authbri~ Approval Guldetines for this application, shows that the on-site water supp~ and/or ~aSteJvat~ dis~:~o~al system is(are) ~afe, functJonal and adequate for the*number of bedro°ms and type of stmcture indicated hereln. I further varify that besecl on the Information obtafned from the Munlclpa[lly of Anchorage tiles and from my lnvestigation_ 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 regula~o~ts In effect at the time of Installa#on. Na,me~of,F. irm' ALASKA WATER & WASTE'WATER CONSULTANTS. INC. Phone 357-6179 A~ DEBARR ROAD. SUITE 2B * ANCHORA(;E. AK 99504 ' *" dr Engineer's Printed Name JEFFREY. A. CARNESS. P.E. Date Engine'er's Comments: "" ....... ' ~: consdentious engineering analysis of the system In accordance wlth ADEC and MOA DSD Guldelinea & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation In conductl~g thls evalua#on, AWWC, inc. attempted te provlde a thorough, -.,- : - distances measured to madi~ identifiable features. The qoerational lifo of all wells and septic systems depend on the Iocal seils condition, groundwate~ le{,els that may .., fluctuate dudng the year, and the water usage of the family being served by the system. · These condigons are m,,telde the'control of the evaluater of the system. Satisfacteo/test rseulte do no~ guarantee future performance of the system, nor do lhey guarantee that there are no bidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or fulure estimate Of how long the system ~II continue to meat the operational requlremente of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owtter listed above. Any reflanse upon ~r use of ~Is report by any other person or perty ls not authodzed, nor wlll lt confer any legal, rlght whatscever. 5. DSD SIGNATURE J,""/ Approved for ~ Disapproved. Conditk~nal approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Englneefs Reort Other Municipality of Anchorage Development Services Department Building Sa;~y DM~ion (3n-Site Wa~r & Wastewater Program 4700 ~ou~h Bmgaw SL P,O. ~ox 196650 A~:horage, AK ~9519-6650 wYM. d.anchorage.alcu~ Legal DasatpUon: A. W1;LL DATA Well typ,~ PRIVATE Dam c~mpleted Total depth 150 Date of test Stetlo water level Well pnxluctlon HEALTH AUTHORITY APPROVAL CHECKLIST HOCKER SUBDMSIONi LOT 2, BLOCK 3 Parcel ID: 1966 IfA, B, orC provide PWSII:~ N/A. ~anlte~y ~eal (Y/N) YES ~ to 40+* ft. *PER 1994. HAA FROM WELL LOG N/^ I 042-081-17 NO 18+ .in. WATER 6AMZLE RESULTS: Date of sample: 7/20/2001 Collected by: e. 8EPTIC~IOLDING TANK DATA Tank Type/Material STEEL Tankelze 1000 gal. Number of Compertmants 2 FoundalJon cleanout (Y/N) YES Date of pumping NEW C. ABSORPllON REID DATA Date Installed ~o/le/2ooo Length 21 ft. Dapresslon over tank (Y/N) NO Pumper N/A Soil raling (t~r ~/t)dn~) 1.2 Width 2.5 .It, AWWCi INC. System type TRENCH Gravel below pipe 6 It. Depression over field NO For 2 bedrooms New depth N//A In. N//A g.p.d. ff yes. give date - Total depth g.3s+o ft. Eft. abSol~on ama 252 ftj Monitoring tube YES Date of edequacy test NEW Results (Pass/Fall). PASS Fluid depth In abso~Uon field before test N//A In. Water added N/A gal. El~Mled Time: N/A min. Final fiuld depth N/A ill. Ab~otl~on rate >= ~ mJuvanatlon treatment (past 12 mo.) (Y/N & type) NONE KNOWN Date b. flalled 10,/1.3/00 cmmouts (Y/N) YES High water a~11 (Y/N) N/A D. UFT STATION Date Installed. SIze In g~eea ~ "Pump on" level at in. "Pump n. High water alarm level at __ Jrt. ~ Cycles tested Meets alarm & drcult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 8epUc tenk/11ff 8tetlon on lot *'90'+ Ab~on field on lot 100'+ Public sewer meln N/A Sewer lespUo esrvlce line 25'+ *W~S GRANTED: IfWR990102 On adjacent lots 100'+ On adjacent lots 100'+ Publlo sewer menhola/deenoot N/A Holding tank Nj/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Bulldlng foundation 5' + Property line "1'+ Absorption field, Water main N/A Water ee~ce llne. 10'+ Surface water Wells on adjacent lote 10o'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. .1 '+ Building foundation 10'+ Water main N/A Water sewlce line 25'+ Surface water .80'+ Driveway, peddng/vehlote storage 5'+ Curtain dmtn NONE KNOWN Wells on adjacent lots 100'+ :,..-~.:~..,,-./, .F~:,:;~CO~aME.. ,,o .,.,,. ~:"O. 'ENOiNEER~8 CERTIFICATION .~'FTJI'TC'"/' ..... HAA Fes $ '~)0.°° Oeteo yment ?/ olo/ Receipt Number Waiver Fee $ Date of Payment. Receipt Number Sent By: AZasRa Water and Wastewater Con; 907 338 3246; Aug-l-01 8:06; Page 1/1 Sent by:^^RO~ PUMP AND WELL Jul-31o81 08:57pm from 90733389764907 338 3246 page 1 Aarow Pump & Well Service, LLC P.o. Box 110496 Anchorage. AK 99511 office: (907) 346-9355 · Fax (907) 333-8976 E-mail: aarowpumpandwellsvc ~ hotm all.corn 5614 CUSTOMER JOB ~ F -] ,t< /0,%/,,~'-F-~, ~,.,/,,.~,,.o,-,,,,~, - , 'r / LABOR HOURS RATE AMOUNT TOTAL MATERIAL · -, TRANSmISSiON [NTERRUPTED ""' JUL-2?-OI 17:27 FRO~I-CT&E EN¥1~OIOENTAL S~'.' ~07%T530~ T-$64 P.02/~3 F-IT5 .~1~__. CT&E Environmental Services Inc. 1014525001 AK Water & Wastewalcr Consultants Inc. Hocker S/D Lot 2 BIk 3 Hocker S/D Lot 2 [Ilk 3 Drinking Water cf&g Ref.~ Client Name Clleat Sample ID Ma~x Ordered By FWSID 0 San~lc Remarks: Client ['tinted Date~l'ime 07/27/2001 16:00 Collected Date/Time 0'//20/2001 13:10 Received Date/Time 07/20/2001 13:25 Technical Director Stephen C'. £de Allowable p[cp Anal/aCs LimiL~ Da:e Date Init Waters Dop&gtnent Nirrate-N 2.14 0.5,')0 mg/I. EPA 3{)00 (<10} 07/20/01 SCL Fd.c:ob$o~-ogY La~o:ato:'Y Total Coliform 0 col/100mL SMI89222B (<11 07/20/01 SKW 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description ~ot 2. Block 3. Hocker , S~b, Location (site address or directions) 14341 Hocker. A~chora_~e Property owner Mailing address Lending agency Mailing address Agent Phyllis Hackitt Dave McEllrov P OB ox 112243, Anchorage~ N/A Day phone 345-2279 AK 99511 Day phone Day phone 276-2001 Address 2600 Denali, ~,~400, Anchorage, AK 99403 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual well X 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: X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev. 1/91 ) Front ~OA #21 o 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 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. See attached letter dated Jan~J~ry 26, 1994. Name of Firm Environmentat/~agement, Ino~ Phone DHHS SIGNATURE Approved for ~-- Disapproved. Conditional approval for bedrooms. (907) 562-2580 bedrooms, with the following stipulations: Additional Comments ' ' /~; , / . ) .-'i~ By: .~'~? . i .~7~ .--- Date 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 pumhasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA~Y21 Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2, Block 3, Hocker Sub. Parcel I.D. A. Well Data Well type Private Log present (Y/N) Total depth 150 ft. Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed 1966 Driller [~n~ Cased to More than 40 £t. Date of test Static water level Well flow Pump level1 Y FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: .g.p.m. Casing height 2 ft. 2 in. Wires properly protected (Y/N) Y AT INSPECTION 1-11~94 64ft, 4in. 2.9 from G.L. Septic/holding tank on lot 60 ft. (waiver was approve, d~n adjacent lots 300 ft+ Absorption field on lot 100 ft. ; On adjacent lots 300 ft.+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer service line N/A Petroleum tank None WATER SAMPLE RESULTS: Coliform 0/100 ml Date of sample: 1-11-94 Nitrate 1.80 mg/L Collected by: Other bacteria D, Neogi B. SEPTIC/HOLDING TANK DATA Date installed 1980 Cleanouts (Y/N) High water alarm (Y/N) N Date of pumping 06-01-93 Tank size 1000 Gallons Compartments Unknown Foundation cleanout (Y/N) Y Depression (Y/N) N Alarm tested (Y/N) N/A Pumper A+ Hor~ Se~-v~ces, Inc. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~ - ' e ~ 300 ft+ Well(s) on lot ~ft; (wa, iv d)On adjacent lots To property line 20 £t.+ Absorption field 20ft.+ Surface water/drainage 100 ft,+ Foundation 15 ft,+ Water main/service line N/A 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION N/A Date installed Size in gallons Vent (WN) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: N/A Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1980 Length 24 ft. Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) 125 ft 2/Btm System type ~ Width 3 ft. Gravelthickness 8 ft. Total depth 12 ft. 384 Sq Ft. Cleanout present (Y/N) Y Depression over field (Y/N) N 1-11-94 Results (pass/fail) Pass for 3 Bedrooms 4 ft. 10 in. from G.L. Aftertest 4 ft. l0 in. from G.L. N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 100 ft. To building foundation 54 ft. On adjacent lots .300 ft,+ Surface water 100 ft, + Curtain drain None Observed On adjacent lots 300 ft. + Property line 55 ft Cutbank To existing or abandoned system on lot Distance of Previous crib is unknown N/A Water main/service line N/A Driveway, parking/vehicle storage area 36 f~, E. ENGINEER'S CERTIFICATION I cert/~ that I have checked, verified, or conf~/~d to all MOA and HAA (se~. attache~ l~etter) / / o© HAA Fee $ ~ 0 0 Date of Payment /_~. {~ _c~ Receipt Number ~:~ .~ / (' ~" ~-3~ ~'-~., Waiver Fee $ Date of Payment Receipt Number inspection. ENVIRONN~N'I~\L MANA(;EMENT iNCORPORATED Janua~ 26,1994 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AK 99519-6650 RE: Well & Septic Adequacy Test for Lot 2, Block 3, Hocker Subdivision Our inspection and test of the above system indicated that it is functioning adequately to meet it's intended use. However, it appears the system was not installed properly. Based on our on-site inspection and observations during the test it appears the perforated pipe in the absorption field is not level. ~:.measurements taken from the clean outswe estimate that it has approximately at a 10 '/,;~i~::. If this is the case, only the doWnhill pOrtion of the drain field is being fully utilized. There was nothing to indicate any change to the system since it was installed and approved in 1980. It appears to have been functioning well since that time. For passing the standards for a 3-bedroom the system is safe, functional, and adequate for this 2-bedroom house. Therefore I recommend approval of the system. ~...~ ,~~)n enta Man~ e ent, INC. Jo.~yflr Simpson PE Engineer E.v .o. ME.'r^..^,=,o.^-ro.¥ S,=.v,c - & ENGINEERING CO REPORT of ANALYSIS Chemlab Ref.~ :94~0168,1 Client Sample iD :HOCKER SUB., LOT 2 BLK 3 Matt ix : WATEE Clie~nt Name :ENVIRONMENTAL MGMT INC (EMI) Ordered By :D. NEOGI Project Name : Project~ : PWSID :UA Sample Remarks: ROJT~NE SAMPLE COLLECTED BY: D. NEOGI. 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 WORK Order :74874 Report Completed :01/13/94 Collected :01/11/94 @ 10:00 hr Received :01/11/94 @ 17:00 hr Technical Direct. or:STEPhEN C. EDE Released By : ..~.~. ~_/_.~. JOB ~6225. Paramefer QC Allowable Ext. Anal ................. j ............. Result:~ Qual Units Method Limits Date Date Inl~ Nitrate-N 1.80 mg/L EPA 353.2/300.0 10 01/12 See Special Instructions Above -' See Sample Remarks Above UA = Unavailable NA = Not Analyzed Undetected, Reported value is the practical quantification limit. Secondary dilution. LT = Less Than GT = Greater Than ~SGS Member of the SGS Group (Societ6 G~n6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA DATE RECEIVED .~-' INSPECTION APPOINTMENTS T,i'M E TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTO,~ ~UNICIPALITY OF ANCHORAGE NIUNICIPALITYOFANCHORAGE=~ T ~- DEPT. OF I:~>J.i I &  DEPARTMENT OF HEALTH & ENVIRONMENTAL 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION ['~AY 8 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEV~I~ ~'A~LYT~E~/ DIRECTIONS: Complete all parts oa page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. 1. PROP~T~YOWNER /~~: ~*' PHONE PROPERTY RESIDENT (If different from above) PHONE PRONE MAI LING ADDRESS 3. LE~?ING INSTITUTION MAILING ADDRESS 4. R EALTOR/AG ENT-"~ ~ L~HO,NE 6. TYPE OF RESIDENCE ,~, SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four ~ Two [] Five [] Three [] Six [] Other WATER suPPLY ~ 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 DISPO..SA~L S_Y.$~TEL.~.~._~_._~ DUAL/ON-S TE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS __ [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS ~ APPROVED FOR "~, BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY HogE, LeKi$¢h, CARDWELL, [VIARQUEZ & LAWRENCE ATTORNEYS AT LAW May 11, 1977 Municipality of Anchorage Dept. of Health & Environmental Protection 825 L Street Anchorage, Alaska 99501 Attn: Laura Harrison ANDREW E. HOGE PETER A. LEKISCH WALTER W. CAI~DWELL,]E[~ DAVID W. MAROUEZ BILL LAWRENCE G. CHARLES SCHMIDT Re: Inspection of septic tank and well located on Lot 2, Block 3, Hocker Subdivision Dear Ms. Harrison: Enclosed please find a Request for Approval of Individual Sewer and Water Facilities for the above-described property. Although I realize that there is a certain time frame involved in obtaining the results of the inspection, we would appreciate having the inspection completed as soon as possible because the parties are anxious to close this transaction. If you have any questions or are in need of further informa- tion, please do not hesitate to contact us. Very truly yours, HOGE, LEKISCH, CARDWELL, MARQUEZ & LAWRENCE By Terese A. Follett Assistant to Bill Lawrence Enclosure cc: Judy K. Sheldon Dan A. Hensley HAND DELIVER ~/~'~k MUNICIPALITY OF ANCHORAGE. /7~/-~ ~~;~~F ~!! , . DE~ARTME-~.~ OF HEALTH. AND ENVI RONMEN~ ~,.~, PROTECTION ~--~"'" ~'~ 0~ ~ Da~e Received: May 12,_ .1977 ~1: Time //:d~.~ _ ~2: Time ~3: Time Date .~-~7 ~o Date Date Insp _~~ Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER ~D WATER FACILITIES i. ~e~ing I~s~itugio~ ~e~uest: ~i~st ~e~e~al Sa~i~qs & ~oa~ Assocla~lo~ Mailing Address: Property Owner: Mailing Address: 813 West Northern Lights Blvd. Judy K Sheldon/Gary F. Oliver 1003 S Street 99501 3. Legal Description: Lot 2 Block 3 Hocker Subdivision Phone: 274-6561 Phone: 272-5215 4: Single Family Residence: (~ Multiple Family Residence: ( 5. Well System: Individual well Permit # Construction Number of Bedrooms: Number of Bedrooms: Community/Public System ( ) Depth of Well Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-site System (x) Public Utility ( ) Installed 1967 Installer Manufachurer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line ~ MUNICIPALITY =O,F ANCHORAGF~", Department of Hea-lth and En~ironment~ Protection ·. - ' , · 825 L Street, ~chorage, Alaska.4U~l~l~l~ - ' 225 D=PT O,- 279-2511, ext. 224, s,J'.'- · u~st for Approval of Individual Sewer and Water Property Owner: Judz K. Sheldon and Gary F. Oli e F l%/gD Mailing Address: 1003 S Street~ Anchorage 99501 Phone: 272-5215 o Name of Buyer: Dan A. Hensley , : 2A4_m5104 (h) Mailing Address: ~4-23"-~--Street,./d, L 5~/ Anchorage,~.c~,~ 99501 .. Phone ~5_53.____~0i,~ Lending Institution: First Federal Savings & Loan Association (Jeannme Damis handling closing) Mailing Adiress: 813 West Northern Lights Blvd. Phone: 274-6561 Realtor/Agent: None Mailing Address: Phone: Legal Descrmpumo - Street Location: Lot 2, Blk 3~ Hocker Subdivision, Sec 31. T12N, R2W, S.M. NHN Flat Top Avenue Single Family Residence: (x) Nmmber of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well (x) Dug in 1966 If Individual Well, well depth 150' Public/Community System ( ) If Community System, name of system Sewage Disposal System: On-site System ( ~ Public System ( ) If On-site System, date of installation: 1967 *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 ~age Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 3 Hocker Subdivision Comments: Affadavit Attached: ( ) Approved: Disapproved: ~.,~.~ ~'~0 ~epar tment Worksheet Letter Attached: ( ) Date: Date: