The URL can be used to link to this page

Home My WebLink AboutELMORE BLK 1 LT 10 ': Municipality of Anchorage Page ~ of ~ 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: ~'L~ ¢[q0QO~ PIDNumber: Ol~'- [7 [--~ Na.~: .~C>.~.C~ /~lol(.e.~,a$ Wastewater System: D New B Upgrade *~"": H~OI 5h~ko~; ~v~. ABSORPTION FIELD ~D.pTrench .ShallowT.nch DBed ~Mound ~Other LEGAL DESCRIPTION S°""'"n": I.~ OPD~q Ft. J T°ta' Depth ff°m °rigina' grade; ~~ LOt: ~ 0 Bi~R: J Su~iv~ion:~/~O~ ~1 ~ ~ pi~ ~om Eom oHgi~l~e; Ft Gm~l depth ~neath pi~ Ft WELL: m New = Upgrad~ ~.ve,.,a,,: ~ n ~ Iff n /SEPARATION DISTANCES . Septic a Holding 0 S.T.E.P. S.,,ce LI~ STATION~ PERMIT 1~o. ~;W990004 D ..........Muoidp. at{tV oF Anchor~ne EMARTN~NT OF H~ALTH AND HUMAN SERV[CES ENV{RONNENTAL SERViCeS · p.n. Box 196650 ~_Anchor~ge0 Al~sk~ 99519-6650 m Telel~hone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 10, BLOCK 1, ELMORE #1 S/D P.I.D. NO. 018--171--26 I J 10' UTILITY EASEHENT I SEPTIC TANK --N / SPLITTER / / TRH~ ~<~ l~%,~ ~ ~ I I,I cua~n p~C03 ~ I ~ SC~: 1' - 40' , ~ ' SHOSHONI AV PER~XT No. SW990004 PAGE ~ OF ~ Municip. ~[i~c oF Anchor~Qe DEPARTHENT OF HE~[THAND HUi~AN SERVICES' ENVlRONHENTAL SERVICES DIVISION P,O, Box 196650 e~Anchorage. Alask~ 99519-6650 · Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 10, BLOCK 1, IrLMORE #1 S/D P.i.D. NO. 018-171--26 ST1 ST2 96.7' NEW [250 GAL SEPTIC TANK CO1 FINAL GRADE A B FCO 28.5' 9.0' ST1 55.5' 36.0' ST2 62.0' 44.0' DBL1 64.0' 46.5' DBL2 65.0' 47.5' FS 67.5' 63.0' C01 68.5' 64.5' MT1 100.0 98.0' C02 102.5 100.5' MT2 72.0' 75.0' C03 70.5' 72.0' C04 105.5 108.0' C02 MT1 C01 = 95.5' ~~AL GRADE I '"~L~L_~C01 = 92.8' , TRENCH 1 ,co2.=92.9' 8S.~WATER FOUND 7~.7' B.O.H. ~90.7' C03 C04 TRENCH .~C03 = 95.5' C04 = 94.8' /FINAL GRADE ~_tC03 = 93.2' C04 = 93.2' MUNICIPALITY OF ANCHORAGE Department of Heath and Human Se~ices On-Site Se~ices Program 825 L Steer, Room 502 P.O. Box 196650. Anchorage. AK 99519-6650 (907) 34~744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jan 21, 1999 Expiration Date: Jan 21, 2000 Permit Number: SW990004 Legal Description: ELMORE BLK 1 LT 10 Design Engineer. 0007 Tobben Spurkland, PE Owner Name: Sandy Andrews Owner Address: 4201 Shoshoni Ave. Anchorage, AK 99516-3638 Parcel ID: 018-171-26 Site Address: 004201 SHOSHONI AVE Lot Size: 37299 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska 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. 5. The following special provisions. 1. Groundwater at testhole #2 shall be monitored through spring high groundwater, approximately May 15th. 2. A percolation test shall be performed prior to construction of the absorption field. Results shall be reported to DHHS prior to construcion.- ~, ~,J~ O.~,c,~ ~.~,;S ,~,~cc · t ,-~,~/~ , ~ '~ 3. Maximum system depth -- 7 feet from existing grade. '-~-~.!, ~ = q 4. Construction and final inspection of the wastewater disposal system upgrade shall be completed no later than June 15, 1999. This permit is issued in conjunction with the conditional certificate of health authority approval #HA990021. Received By: Issued By: Date: 1' ~-J '~' ~ Date: 1. 21. ToSPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 Subject: Septic Upgrade Permit Application Lot 10, Block I Elmore//2 PIN 018-171-26 January 19, 1999 Gentlemen; Enclosed is an application for a septic system upgrade for this lot. The existing system is surcharged and will not pass an Adequacy Test. The property is being transferred and a replacement system is required. The seller and buyer have agreed to escrow the necessary funds to do this work after breakup. The proposed design is based on groundwater at 11 feet, based on a note on the as built of the existing system, and a percolation rate of less than 6 minutes per inch, based on a visual observation ofthe soil. Both these assumptions will be verified. Groundwater conditions will be monitored during breakup and a percolation test will be performed as soon as groundwater conditions has been established. Please issue a conditional permit and a conditional HAA for this property. Yours T. Sp~ 203 W 15th. Avenue, Suite 203 ANCIIORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 10 BLOCK 1 ELMORE #1 S/D SANDY ANDREWS Municipality of Anchorage Department of Health and Social Services 8201 Street Anchorage, Alaska 99501 January 18, 1999 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properlies, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Ground Water at I I Use Standard Trench with STEP tank Soil Rating. From Testhole 01/18/99 <6 mia/in ~ 1.2 gal per sq.tVday No. of Bedrooms Required Area per Bedroom: 150/1.2 = 125 sq.ft. Total area required: 125 x 4 = 500 sq~ Bottom Rock At 7 feet Top Rock At 2 feet Rock Depth $ feet Total Trench Length 500 / 10 SYSTEM CONFIGURATION STANDARD TRENCII TOTAL LENGTH 50 let TOTAL WIDTH 2 FT TOTAL DEPTil 7 FT ROCK DEPTH 5 FT COVER 2 FT INSULATION 2 IN SEPTIC TANK 1500 GAL STEP The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. DE ARMDNB ROAD tOT ~ SCALE, 1' = I~O pO0 lO0 pl. 9 pSO 300 I I 3LB£K 3 I IOBBENSPURKLAND ~£ 205 W 15tH. AVENUE ANCN. A~ 99501 279-3916 ELMORE I{ll BLOCK 1 LOT 10 SANDY ANDREWS 4201 SHOSNONI AVE SEPTIC SYSTEM DESIGN DATE: JAN. I$, 1999 SHEEI': I/$ GRID: $036 PERMII # Sh/9900XX PID # 018-171-86 ELMOIlOI. DI'IG STANDARD TRENCH: TOTAL LENGTH 50 ~T TOTAL DEPTX 7 t'T ROCK EFF£CTIV£ 5 FT INSULATION ~ IN, COVER Z ~ STEP 1500 ~L SYST. SCAtD I' = 50 'T. AVE. 150 .~ lYell 8£NCNtlA£K: 801~0M SIDING ,~$SUIIEO ELEVATION 100.00 FT TOBBEN SPURKLAND P.E. 203 IV 15TH. AVENUE ANCH. AK. 99501 EL31ORI:; ///1 l/LOCK I LO7' I0 SANDY ANDREPIS 420! SHOSHONI AVE SEPTIC SYSTEM DESIGN DATE: JAN. 15, 1999 SHEET: 2/J GRID: J056 PERMIT # SV9900XX PID # 018-171-P6 ELMOllOP. DWG I-1/4' PV¢ WITH I/8' HOL£$ · 30' o] Standard Trench: 2' Vide 50' Lon9 7' fleep 5.0' Se~rer rock 2' Cove?' (iNsu~rc) $il~c ~rr/er 5.0 £t o£ Sept;c Rock Effe¢tNe NO SCALE 1500 GAL STEP TANK MoniCor //~ 2 Cover (/Nsutm/~) \ / ~ 1500 GAL STEP TANK ND SCALE IIUBBEN SPURKLAND P.E. 203 W15th Ave Anchoroge Ak 99501 PE£WIT // SV/9900XX SANDY ANDREP/S ])ATE, JAN. 19, 1999 4~,~, ~,(~NfN, ~,~ SHEET, $/$ ~: 3036 PARCEL Iff I~ 018-171-26 ELIdOIIO$.DV/G PERFORMED FOR: Munlcl;allty of Anchorage DEPARTMENT OF '~EALTH & HUMAN SERVICES 825 "L" Street, Auchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST (ENGtN. EER'S SEAL) DATE PERFORMED: 13- 14 15 16 17. 18- 19- 20- DISCLAIMFP · Rrnttndwa t.~r Past and future presence · °rom these oD es.~Va:lons. PERFORMED BY: I . .~ 4- 5- 6- 7 8 9 10 w aS GROUND WATER $ O EIJCOUNTEREO? IF ','ES. AT WHAT D:PTH? pO E ' 1! e,,,: '~'/'l't Gross Net Oepth to Net Peading Date Time Time Wa°et Drop SLOPE SITE PLAN PAllCOLATION RATE (m,~ ';te~mch) PERC HOLE DIAMETER __ T.:,TRUNBETWEEN~--FTAFD 7 a ,T c~ndft~nnR ~ndtcat~d ar~ fn~ the dates and/or depth of groundwater can not be shown only. predicted I ~'~ ~"~"~"~"~"~"~' CERTIFY THAT THIS TEST WAS PERFORMED IN 'ACCOROANCEWITHALLSTATEANDMUNICIPALOUI[ELINESINEFFECTONTHISOATE. DATE: I'[f~/,~ 72-008 (Rev. 4185) $? ? LEGAL OESCRIPTION:~ICLHoe'E ~1: ~1~.1: ~.0TIC) Township, Range, S.~ction: Munl;li~alHy of Anchorage DEPARTMENT O~ "tEALTH & HUMAN SERVICES 825 "L" Street, A.~:horageo Alaska 99502-0850 SOILS LOG- PERCOLATION TEST 10 13- 14 15 16 17 19- 20- Township. Range. Section; SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED~ PERCOLATION RATE {m~nules/~ncl~) PERC HOLE DIAMETER __ DISCLAIMKI) ~ Rrm,ndwater rnnditinnR indicated awe fnr the dates shown only. Past and future presence &nd/or depth of groundwater can not be predicted trom ~nese oDservatlons. .~.~ ACCORDANCE WITH ALL STATE AND MUNICIPAL Gl,I;* ELINES IN EFFECT ON THIS OX'~. DATE: ~ /~11~ I 72'0~8 (Rev. 4/85) GRE/~,ER ANCHORAGE AREA BOR~.dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM O,ST^"CEFROM WELL f/Z')n~' .- / MANUFACT..E. ~MATER,AL ~-'~[ COMPA.TME.TS ~ TILE ~ ~ O,ST~.C~ ~RO~ WELL/~O ~ ~ ~ / ~OT~L L~.~.~ ' FOUNDATION NEAREST LOT LINE OF LINES ~ ABSORPTION AREA SQ. ~, LEITH OF EACH LiNE ~ ~ DEPTH: TOP OFTILE TO FINISH GRADE MATERIAL 8~NEATH TILE IN. ABOVE TILE IN. TypE _.~J~_~/ CONSTRUCTION DEPTH BU''D'"G ,/rO .EAREST ~,.~ ~ NEAREST 0,~, SEPT'C/f;tJ ~ ~"~ FOUNDATI~~LOT LINE~-- , SEWER LINE TANK , SYSTEM CESSPOOL .. , OTHER SOURCES ~ APPROVED DISAPPROVED REMARKS DISTANCE FROM: /OOr/--- DISTANCES: INSTALLED BY: SEWER LINE DEPTH: LOT REMARKS: Form EQ-032 DATE ~"e~'J'"~'/~PROVED . (2(1 .~ G.A.A.B. [ ,~ ~EHKINS .V/ELL DRILLING · ~'~.'.'~ / P.o..o~ ~.1~ EcR ~ ANCHORAGE, A~ 99501 'H~.k DR I LL'ER~S WELL L'OG LOCATION~ ~:,(' ~, X'~7' SIZE ~'" DEPTH YIELD /;'/-77r'.~ STATIC ~/ATER LEVEL .~/) / HC~ TESTED, P~4P INSTA~ m Y2-..,'7-4 /;722 TYPE FO~TZONS ENCOU,'frERED AND APPROPRIATE DEPTHS CASING DEPTH /'~" GROUTING DEPTH __ TO __ TO __ TOq TO__ '1 .**' 825 ~ STREET.. F~I~,ICHORAGE.* AK.I ~c"--'01 .-. * · 27~-~ ~ ~ ~~ ~, WELL R~D Ot~--S I TE SEi~ER PE~I APPLICA~iT JIM BUMOARDNER. SRA BOX 474E k ~ sNos.oN LEORL L~8 B1 ELMORE SUBD LOT SIZE TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH · THE ~EOU%~E~ ~%ZE O~ THE ~O~ ABSO~PT%ON ~YSTE~ IS: ~// THE LENGTH DIMENSION IS THE LENGTH <IH FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RHD THE BOTTOM OF THE EXCRVRTIO~I (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH~OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTIOH (IN FEET). REQUIRED SEPTIC Tli~t( SIZE= TWO (2) IhlSPECTIONS tIRE REQUIRED BRCKFILLIt.~G OF RNY SYSTEM WITHOUT FINAL INSPECTIO~I RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTIO~J. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR 200 FEET FOR R PUBLIC WELL. ~IELL LOGS 8RE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETIOt'~. SPECIFICRTIONS 8ND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO IHSURE PROPER I NSTRLLRT I Oti. PERr~IT VliLID FOR O~E YEliR FROr~ ISSUE I CERTIFY ~HRT 1: I RM FRMILIRR WITH THE REOUIREMENTS FOR ON-SITE SEPlER$ AND ~IELLS RS SET FORTH BY THE MUNICIPRLITY OF 8NCHORRGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE ~ITH THE CODES. , 3: I UNDERSTRND THRT THE O~.i-SITE SEWER SYSTEM WRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THR~ 4 BEDROOMS. SIGNED: ISSUED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchor.g% Alike 99502 276-222! SOILS LOG -- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST DATE PERFORMED: M~Z~H I~- .. '27 LEGAL DESCRIPTION: ~.~?-' 1 2 SLOPE SITE PLAN 10 WASGROUNDWATER ENCOUNTERED? 12 Ho/drt~l~ d~9~ IF YES, AT WHAT 13 ~ ~0~ DEPTH? 14 16- 17- 18- 19- 20- ~HOdHO~ ~T ~0 Gross Net Depth to Net Reading Date Time Time Water D~op PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS ~,~'~'/~/ C~'.~ft~',""~'~Y) .,"~.~t~r~, ~.~-/,~¢~/~/',--I'~ ~O~t ~/1~ ~ ~'~ PERFORMED BY: ~O~J~r(/ ~ ~8 CERTIFIEDBY: ~A'/~I~--~'/ ,~ DATE: ~/~ /~,77 72-008 (7/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING OI ~ - I"l ~' --~-~ NAA# 1. GENERAL INFORMATION Complete'legal description Lot 10~ Block 1~ ~.lmo~e' Jl Location (site address or directions) 4201 Shoshoni Avenue , I~rope..rt~,. owner ~: Sandra ;mdrews Day phone :" '.Mailing address "Po-]~Sx ].12593, /mchorage, ~ 99511 265-9107 .. Lending agency · · Mailing address .... Day phone Agent Day phone Address ' e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system· e TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: Holding tank Community on-slte . If community wasteWater system, provide written confirmation from State ADEC attesting to the legality an'd status ~of system: . 5. 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. $ & $ ENGINEERING Name of Firm ,.,,,~, ~._,A ~,;..~, t ,,,,,, ~,,,,~ ~,, ,~ Phone Address Eagle River, Alaska 99577 Engineer's signature Date ~/~'"'"'/"/ ~ · DHH8 SIGNATURE ~ A.p. proved for FO c//~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of'Health and Human Services'iDHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional enginear registered in the State of Alaska. The DH HS does this as .~ .c.o. urtesy to purchasers 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 M.unicipality of Anchorage .is not resp°nslble f°r err°rs °r °missi°ns In tl~'pr~fess!°.'n'*al engineers w-°rk' .: :',;: 'i, ' .... Municipality of Anchorage ~ C E IV E D DEPARTMENT OF HEALTH & HUMA, N. SERVIC__ E Environmental Services Division MAY 251999 ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Municipality ot AnChorage ................. Dept. Health & Human Sen~ces Health Authority Approval f,,;neCKIl$! Legal Description: .L. OT /0 A. WELL DATA Well lype ~t~,VifTe- Log present (~I/N) 'y t. j Total depth ! 0.5- If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to / 0~- Casing height (above ground) Wires pmperh/protected ~}N) ~ ~ -J' Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform C~ Date of sample: FROM WELL LOG AT INSPECTION I t/,, I -~ o $-~- / o ~ I ~ g.p.m. ~' ~ Nitrate /, ~- Other bacteria I I , { fl ~ Collected by: 7% $/*v,~e~-,e,,,x> g.p.m. 3 B. SEPTIC/HOLDING TANK DATA Dateinstelled-~'//~/el~ Tanksize Foundation cleanout (~/N) ¥ ~- ~ Depression (Y~ /~ 0 Date of Pumping ~V /~ - /-,~t~v Pumper - C. ABSORP'RON RELD DATA Date installed 5~/' ~ I q OJ Length ~/0 7~q~ Width Effective abeorpl]on area Date of adequacy test ~/'~ Number of Compartments ~' High water alarm (Y/~ Soil rating ~or fff/bdrm) /' ;~ S~m ~e Cleanouts Gravel thickness below pipe ~ Total depth Monlte~ng Tube present (~lq) ¥4~ .~ Depression over field (Y,~. /v c Results (Pass/Fall) For y bedrooms Fluid depth in absorption field before test (in.); Immediately after al .): Fluid depth (ins) Minutes ~ter. Absorption rate = g.p.d. Pemxtd~--'~T'~-~ 12 months) (Y/N) ff yes, give date 72~2e (Rev. 3/96)* De UFT STATION Date installed Manhole/Access (Y/N) Size in gallons ~ mp off' level at* High water alarm level at' *Datum E. SEPARATION DISTANCES R Absorption field on lot Public sewer main Sewer/septic sewice line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ) OO /-/- On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 3 ~,/ / Property line ~" 5" ' Absorption field. ~ ' -/' Watermain/servicellne /0 -/- Surlacewater/draJnage /0o -/, Wells on adJacent lots /00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: ' ~3 ' '-,~ Property line ;z ¥ Building foundafion Water main/service line /0 Surface water /00 "/'* Drtveway, parking/vehicle storage area 30 Curteindrain /,/~,v¢ ~,,-'0~ Wells on adJacent lots / 00 + HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Location (site address or directions) c{ 2.o I Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: /7/ TYPE OF WATER SUPPLY: NOTE: NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ~ · ' ': · TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer Individual well Community well Public water · If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certifie**d by my seal affixed hereto and as o'f the validation date shown below, I verify that my investigation of this Health AUthoritY ApPrOval appli~:ation 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. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for "~'~- bedrooms, with the following stipulations: The septic system 6n this lot sh~ll be upgraded pursuant to the attached eermlt ~SW990004 no later than June 15~ 1999. Money shall be placed in escrow for 1½ times the high bid from a minimum of three (3) bids. Certificate of Health Authority Approval has been issued by this Dcp~:~mc~t. Additional Comments The Municipality of Anchorage Department of Health: -.~an Services (DHHS) issues Health Authority Approval C¢'lificates based only upon the represents: ;,~',~en in paragraph 5 above by an independent professional engineer registered in the State of Alaska. T~~, ~S does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain fec~.: :~td state requirements. Employees of DHHS do not conduct inspections or analyze data before a certifica:~ is issued. The Municipality of Anchorage is not' responsible for errors or omissions in the professional engineer's work. · Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist " LegalDascription: ~J. Her4.E. ~l '~K I, LeT ~o ParcelI.D.: O/-° - 1'//-' ,E,~ A. WEII DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level. Well producfi~)n Y Io4 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Io.~ Y FROM WELL LOG g.p.m. Casing height (above ground) Wires pmperiY protected (Y/N) AT INSPECTION II g.p.m. WATER SAMPLE RESULTS: Coltiomq ~ ' Date of sampla: i ]ttJ ¢i'~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed I~ ?"7 Foundation claanout (Y/N) Date of Pumping Tank size I~..~ D Number of Compartments' ~- Claanouts (y/N) . Depmseion (Y/N) /~ High water alarm (Y/N) r~ pumper J Y C. ABSORPTION FIELD DATA Date installed 19 7'7 Leng~ ~//:'~ ,Soil r~ng (g.p.d~fF or ~/'oclrm) I~o System type 'T'.u..,~ ~ ~ Gravel thickness below pipe Total depth //~ /'~/~ Effective absorption m'ea ~.,C:> Monitddng Tube present (Y/N)_)/_._ Depression over field (Y/N) /~'/ ~'~ ~'~' I dj bedrooms Date of adequacy test !/~t/¢~ ~t Results (Pass/Fall) /'"-- For G Fluid depth in abso~on field before test (in.); ,~/" ~ 4 Immediately after/~'O gal. water added (in.): /0" FluM depth ~" (ins) Minutes later:. ~ Absorption rote = '"" g.p.d. Peroxide treatment (past 12 months) (Y/N) -" If yes, give date. 7'2-0'26 (Rev. 3/96)* D.. UFT STATION" Date instelled Size in gallons Manhole/Access (Y/N) 'Pump on" level at' 'Pump off level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic sen~ice line On adjacent lots :>/ ~ On adjacent lots ~ / ~ __ Public sewer menhole/oleanout I~//.~. Lift station I~t/,~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ I Property line e/O 3f.- Absorption field, /o Water main/sswice line ~ ,..~'O Surface water/drainage ba/O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /-/O' Building foundation ~'o ' Water main/service line Surface water I~l [o . Driveway, parldng/vehiole storage ama Curtain drain 1,4/o Wells on adjacent lots ~ F. ENGINEER'S CERTIRCATION ~' ..,-~°~ ~. , '.. I certify that I have determined thru field inspecUons and review of Municipal reco~d~t~'~Ore sys*tems are in conformance wi~ MOA HAA guidelines in effect on this date. /.~' c~' .. ..... .... . ~ . , , Signature ~ Engineer's Name' Data oa. te of payment 72-026 (Rev. 3/96)* Waiver Fee $ Data of Payment Receipt Number CT&E ESI AIICHORAGE 9075615~01 P.O2/OB CT&E Client N~une Project Name/~ CEent Smnple ID M~trlx Ordcr~ By PWS~ S:mple Rera~rk' · 986058017 Tobben Spurkland P.E. n/a Lo! 10,Bk I Elmore Drinking Waier Client POi Printed Date/Time 01114/99 14:10 CollectedDate]Time 01/11199 14:00 Received Date/Time 01111/99 15:20 Technical Director: Stephen C. Ede Alterable Prop Analysis Results POE Unite Hethod timit~Data Date init Total cot$for~ Nitrate-# OB/100 HL, kO rOLl $R18 92223 01/11/99 trA~ 1.20 0.100 ~J/L EPA 3C0o0 10 m~x 01/12/99 01/1Z/99 SCL RECEIVED MunicipalitY of Ancho~a0e Dept. Health & Human Services :' .3At1~-15-1999 10:21 CTg~ ESI 'AHCHORAGE 90?5615301 P.03/0~ CT&E Environmental Services Inc. Laboratory Division Drinking Water Analysis Report for Total Coliform Bacteria ,oo w. to:ts, Anchorage. AY, 99518-1605 READ INSTRUCTIONS ON E. EVEJ~E $1DE B£FORE CO~,£ECTING SAMPL£ Tel: (907) 562.2343 Pax: {907) 56t-S301 s Wa~er SAMPLE to be.' ~ ' ~' t~$atisfac~o~ ~pB. IVAT£ WAT£R SYST£~~ [ IJ ~ L'~sadst'.¢to~ .... C3 $,~tz~':~.-.. _ fl,, $~,~ I,,~.~l ~ j'~ fl Sample over 30 hourS old, r=sultS may ~ CO~,/-,~ t// "L.~/L,~.~'L~L~,~' . b~ un.liable · O S~ple ~ on~ in ~it; s~ple should not ~ ov~ to indica~ ~liable ~u[~. ~lc~ send ' 'm2 ' '1 ~ c~ Date R~eiv~ ~me ~1onth Day Year SAMPLE 0 Routine O T~at~ Wirer ~ Rep~t Sample (for routine sample O Unt~t~ Water with lib ~f. n~ ) ~ Sp~lal Pu~e ~me Coll~ted SA~LK LOCATIOH Coll~td By Analytical Mefliod: ]:Ii" MembraAe Filtrr 'Ox MMO-M1JG * Number ofcolonica/100 mi. Lab Ret- NO. R~lult· Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG R,.,ule Total CoUform Membraa. gUt.r: DIrettCouat ,'~t __t~..~ ~0 Verification: LT8 BGB Flnol Membra ne Y'.dt~r R~ults RECEIVED [OLIFIRM,~--~tgh3r~lpality O! Anctmmge DepL Health & Herne~S~ Collform/l~l mi Time' / (~ 5.r.) h. ~I~]=~NI~)K] S Oh't>' S TT~T~,$gL05 E9 :S{~ BE, GT/Z;T/c:o APPLIC"~T FILLS OUT UPPER HAL'~ONLY Address Address Zip ~ngle Family ~ Other J~./ A~ACH ~LL L~, A w~l log Is t~ulr~ for all wells drll~ since June 1975. ~ ~mm~ity For wells ~llled pdor to th~ dale, give well depth (attach I~ If available). ~ Public Uttlily Sewer Disposal ~ndlvld~l Year Indlv~ual Installed: ~ Holding Tank NOTE; THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST SEFORE ~ESSING CAN BE INITIATED. Date Date Date Date Inspector Inspector Inspector Inspector DEPT. OF H~ALTH & E~IRO~[NT~ PROTECTION UAY 1 9 1983 RECEIVED J J APPROVED ~DR~MS *CONDITIONS OF APPROVAL I ~SAPmOVED ( ) COmmUNAL ~L* ~- ~ Well tO Tank ~r O0 ~pttC T'k Size ~ ~ ~ May 25, 1983 Raymond J. Eastlack 4766 Mills Drive Anchorage, AK 99504 Subject: Block 1, LOt 10, Elmore Subaivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: " The septic tank pumped with a receipt submitted to this department. well log submitted to this office for our files and revie%~. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, RP10/ej/E2 Robert C. Pratt Associate Environmental Specialist MUNICIPALITY OF ANCHORAGE ~) / DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 H87-0177 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10 Block 1 Elmore Subdivision Location (address or directions) Elmore & Shoshone Business (b) Property Owner Ra~mond Eastlack Telephone: Home 345-3087 Mailing Address BOX 110975, Anchorage, Alaska 99511 (c) Lending Institution Telephone Mailing Address ~ (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or:. Check here el, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family Number 6f Bedrooms four ( 4 ) WATER SUPPLY Individual Well []~:X Community I'1 Public I-I Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL OnsiteCAX Publicl~ Community1-1 Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As c'ertified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm Bevan Enqineerinq Telephone 522-1383/258-0584 Address PO BOX 112852, Anchoraqe, Alaska 99511 Date Engineer~Seal This department has received written confirmation from the engineer regarding the Conditional Approval of' April l, 1987. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property now meets with Municipal standards and is approved. Approved for ,edroomaby ,,,- . Approved ~ Disapproved Conditional Terms of Conditional Approval ~/?~ ~,~ ~, ~ ~- CAUTION 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 satisfy certain federal and state rec~uirements. 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. BEVAN ENGINEERING Approved Well & Septic Engineers April i£~, IC2~7 Municipality of Anchorage Department of Health & Environmental Protection 825 "L" Street Anchorage, Alaska 995~1 P.O. Box 112~2 ~NVI~ONIVI~NTAi P~O~ (~07) 522.1383 (907) 258-0584 'AP ] 0 RECEIVED Re : Raymond Eastlack, Health Authority Approval Application Lot lQ Blk 1Elmore Subdivision Gentlemen On April 9, 1987 I reinspected the subject property for HAA compliance. The well casing has been extended to a total stickup of 18", the sanitary seal is in place, and the wiring is enclosed in conduit. I believe that the completion of these work items satisfies the stipulations you placed on the conditional approval. Sincerely, Hugh R. Bevan P.E. 872~4-ws 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Date '~' °"~J- ~,~ DHHS APPROVAL Approved for ~ bedrooms by CAUTION 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 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. Page 2 of 2' ~'~, ~ ?;'-ms ~ev a~s~ a~c~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY ' 2~-~744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) P r o p e r ty (~'~, e r,~.Y?'/~"~'~'-I'X,~"~:~- "' ' Mailing Address (C) Lendin~l]n. sti.tuti4n..'- · Mailing A, ddress Telephone: Home .~.=5"-.~o ~';~ Business Telephone (d) Real i=state Company and Agent Address :' ' Telephone (e) Mail the HAA to the followino address: or;. Check here i-I, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Family,~ Number of Bedrooms WATER SUPPLY Individual Well~ Community D Public I-I Note: If community well system, must have written confirmation from the State Department o! Envin attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public I-I Community r-I Holding Tank CI ~'.". Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ,nmental Conservation Page I of 2 72,.025 (Re~ 8'861 Front MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) /VtUNIcJPAtI~, OF ANCHO~,~(3~HECKLIST - FEBRUARY 1984 ENVIRONMENTAl. SERVICES DIVISION 264-4744 I ]987 Well Classification /~/~,'~f'~ Legal Description: If A, B, C, D.EC. Approved (Y/N) '~,/~ Well Log Present (Y/N) Y Date Completed ~'-2"~, o~ ' ' Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots J~'~ ~ ; On Adjoining Lots "~ '~' To Nearest Public Sewer Total Depth /'~--"'" Cased to Static Water Level ~/''~f' 'd~'fl Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~'/,.~ To Nearest sewer Service Line on Lot '~'*/~'~ Water Sample Collected by ~,,c~'~:--,,,~ ; Date ,-~°-;~' - ~',~' ~ Water Sample Test Results _~/~o~, .~ ~'~J ~,,,~'~.-~,~ ~ Comments B. SEPTIC/HOLDINGTANK DATA Date Installed ,~--.z"~- ~ Standpipes {Y/N) f Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) " separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~ To Water,Main/Service Line t ~ ~;ourse .... "' ,'~//~ ~Cor~ments'. ' -- '.' "T Size ,,/,z"~ No. of Compartments '~' Air-tight Caps (Y/N) ,~ Foundation Cleanout (Y/N) ,Y~ Date Last Pumped. L----"'~"~'~'O 'Z~'~ -- ~-'"'-- ~_' ' ~',~//~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~ ~'' To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed -~"'- ~-~ Width of Field ~"' '-~ / Square Feet of Absorption Area Depression over Field (Y/N) ~'~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Type of Syster~ Design i Length of Field ~ Depth of Field '~ ,"' ,~'~ '~, Gravel Bed Thickness ,~"-? Standpipes Present (Y/N) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ''~ Date of Last Adequacy Test To Property Line ~ ~ · To Existing or Abandoned System on ; On Adjoining Lots ~ .~ To Cutbank (if present) LIFT STATION Date Installed Size in Gallons 'Pump On" Level at High Water Alarm Level at Tested for ·.,: Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Oft'' Level at Vent (Y/N) Pumpir{g Cycles during Adequacy Test. Meets MOA Comments °° Check Permitted Bedroom Rating Against HAA Request I certify that I h. av.e check~..~, verified, or conformed to alI. M.. OA and HAA guidelines in effect on the date of this inspection. Signed ~"'~~ Date Company ,~/."~'/? Receipt No. ~ Date of Payment Page 2 of 2 BEVAN ENGINEERING Approved Well & Septic Engineers P.O. Box 112852 Anchorage, AK 99511 (907) 522-1383 (907) 258-0584 March 51~ 1987 Municipality of Anchorage Department of Health & Environmental 825 "L" Street Anchorage, Alaska ~5~1 Protection Re : Raymond Eastlack, Health Authority Approval Application Lot 1~ Blk I Elmore Subdivision Gentlemen During the period from March 25 to March 51, 1987 I performed research, site investigations, well flow testing, and absorption field testing pursuant to Health Authority Approval on the above referenced lot. I performed a well flow test and found the well production to be 5.6 gallons per minute (gpm). This exceed the ~.4167 gpm required for a 4 bedroom home. I took a water sample for coliform analysis and the results were satisfactory. I performed an absorption test on the septic system and determined that it absorbed at a rate of 68~ gallons per day (gpd). This exceeds the 6~1~ gpd required for a 4 bedroom home. The septic tank was pumped and the volume removed was 125~ gallons. To my knowledge I have assembled all of the information requested on HAA Application and Checklist. I am submitting this data to you for your review. Please contact me if I can provide any additional information. (ph 522-1585) Sincerely, ~ Bevan P.E. Attachments : HAA Applicati'on HAA Checklist Sewer As-built Original Soils Investigation Well Log Total Coliform Analysis Septic Pumping Receipt cc Raymond Eastlack 872Z4-ws DAT~-RECEIVED .--' INSPECTION APPOINTMENTS ,ME T,ME T,ME DATE INSPECTOR INSPEC INSPECT~ ~UNICIPALI~ OF AN~O~GE MUNICIPALITY OF ANCHORAGE DE~. OF HEALTH & (~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~IRO~ENTAL p;~OTE~ION ~_~ 825 L Strut · An~ora~, A~a ENVIRONMENTAL SANITATION DIVISION APR 3 1981 T~e~e ~7~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW PI RECTIONS: ~mplete all pa~s on page 1. Incomplete r~u~ will not ~ pr~. Please allow ten (10) days for pr~ess[~g. MAILING ADDRESS PROPERTY RESIDENT (If different Gore abo~} PHONE 4. R lA / ~ / ' ' I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Z--:V-- STREET LOCATION 6. TYPE OF RESIDENCE ~N SINGLE FAMILY [] MULTIPLE FAMILY WATER SUOPLY r-I INDIVIDUAL* r-I COMMUNITY r-i PUBLIC UTI LITY NUMBER OF~BEDROOMS [] One ~ Four [] Two '[] Five [] Three [] Six r-1 . Other · ATTACH WELL LOG. A well log is required for all wells drilled since June $975. For wells drilled prior to that date, give well depth (attach log if available.) SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE'* [] - PUBLIC UTILITY /975 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72.OLO (Rev. 6/?9) .._ THIS SIDE FOR OFFICIAL USE ONLY __ 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I-1 SINGLE FAMILY I-~ ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY I-1 TWO I'-I FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] 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 ~----"-~ q Connection Verified INSTALLER []Septic Tank or r-lHoldingTank J Size: ; -~ :~'-0 If Tank is homemade SOII. S RATING give dimensions: TYPEOFTANK MANUFACTURER ~ TOTAL ABSORPTION AREA MATERIAl. ~.~[ 4. DISTANCES Sept,c/Ho,cling Tank ~Absorptlon Area ISewer Line I Nearest Lot Line / I I WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS [~PPROVED FOR ~- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) r-I DISAPPROVED -~)~. ~ DATE BY 72.010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGe.,,% DEPARTME"=%OF HEALTH AND ENVIRONMEN ~ PROTECTION 825 ' L Street, Anchorage, Alaska -99501 279-2511, ext. 224 or 225 ~ ~ Date Received: ~2. Time May 19. 1977 ! :~[')P~! # 3: Time Date ~-~/-77(~/~,~4~. Date Date Insp Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 4-2090 99509 Phone: 274-1521 2. Property Owner: James/Esther Bumgardner Mailing Address: Phone: 344-1933/272-0571 3. Legal Description: Lot 10 Block 1 Elmore Subdivision 4: Single Family Residence: (~ Number of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms: Se Well System: Permit # Construction Individual well (~ Community/Public System ( ) Depth of Well Well Log on File Bacterial Analysis ( ) ® Sewage Disposal System: On-site System (~ Public Utility Permit % Installed ;~7 Installer Septic Tank Size I~'~ ~ ~/f~15 Manufacturer Absorption Area O~,~, Soils Rate ~f%~ Material ( ) e Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area 16DO' Absorption Area Pa~ Department of }lealth and Environmental Protection Request for Approval of Individual Sewer and Water Facilities' Legal Description: Lot 10 Block I Elmore Subdivision Comments: Affadavit Attached: ~p. proved~~ ~Q., Disapproved: Letter Attached: Date:-7--2 ~ Date: Department Worksheet: ~:UNIClPALITY OF ANCO"3' MUNICIPALITY OF ANCHORAGE DEPT. Or H~ALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONENVlI, OI':'.'"-!~:;~L P~OT~.CI';CN 825 T. Street, Anchorage, Alaska 99503. 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF IN DIVIDUAL SEWER and WATER FACILITIES .RECEIVED 1. Type of Inspection: VA 2. Property Owner: James & Esther Bumgardner FHA_ CONV XXX Mailing Address: Name of Buyer: James & Joan Eastlack Day Phone:. 344-1933 272-0571 Mailing Address: 4. Name of Lending Institution': Mailing Address: ?.0. Box 4-2090 S. Name of Realtor or Agent: Esther Bum~ardner Mailing Address: 6. Legal Description: Day Phone: First National Bank of Anchorage Phone:. Totem Reality Lot 10 Block 1 Elmere Subdivision Phone: 274-1521 272-0571 Location: N}~ Shoshone Avenue 7. Type of Facility to be Inspected: Indv. will & septic 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms 2 Individual Xxx 1 Individual (on-site)