HomeMy WebLinkAboutELMORE #2 BLK 7 LT 6I mor'e lock 7 Lot 6 018-172 ·-.MUNICIPALITY OF ANCHORAGE ...... He~/ ~;h and Environmental Prote~-~on Fourth Floor West · 825 L Street Anchorage, Alaska 99501 264-4720 J INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: O,STANCE ~.,.-~ ~.1 INSIDE LEIqGTH INSIDE WIDTH --' LIQUID DEPTH '"'"' LIQUID CAPACITY /00~)OALLONS. TILE DRAIN FIELD: $1,~ DISTANCE FROM WELL ~FOUNDATION - ~ of Lines J DISTANCE BETWEEN LIHES ABSORPTIO;I AREA 50. FT. LEITH OF EACH LINE ~ I DEPTli OF FILTER DEPTII: TOP OF TILE TO FINISH GRADE MATERIAL ~ENEATH TILE I TOTAL LENGTH_ NEAREST LOT LINE ~ZOI 4- OF LINE '~> 3 ~/~ TRENCH WIDTI.~8 IN. TOTAL EFFECTIVE SEEPAGE' PIT: Log Crib Rings 8UI/OI~IG FOUNDATION DIAMETER OR WIDTH Crib Size: DIAMETER, NEAREST LOT LINE LENGTH , DEPTH , ..DEPTH DISTANCE FROM: TOTAL EFFECTIVE ABSORPTION AREA {WALL AREA) WELL SQ. FT. Well ~ ''~'' J Class: ~ Depth: Well Distance To: Lot Line __ Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: Installer: .~..~ Remarks: _~'1 t J ¢~ _~? !. RPF'L T CANT L 3F:AT I ON I0148 TYF'E OF SOil. AR'SCIRF:I'I[IN ST_TFH IS: DR:AINFIEL[) Mt' -r RF'T .. 5 LOTS ,-. II .... -. ,--",.- . <SQ FT/E:R>= I1H..TH.I1 NIJHrEE I:.IF EEDE ij 1_-, = m: SOIL RRTINI3 THE REI:.!LIIRE[:, ~;I2;E ElF THE SFIIL_ RRSI-IRPllFIN _T_I-FIt IS: THE I FNGTH F)IHEN'RTON IS THE L. FNGTH ,:IN FEEl'> OF THE TF:ENCH [iR DRRIHFIELD. '1HE [lEE'TH OF R T~'FNCH OF' PIT IS THE F)TSTRNI3E F;ETHEEN THE SIJRFRCE OF THE %F'-i N') AN[:, THE RCITTEIIt ElF THE EXiZ:R',/RT]Ori ('IN FEET>. % ~ THE I~'FN,]H HIr)IH FOR DRRINF]EI.I)S I5 $ FEE~. THE FiE'~VFI. DEPTH IS THE HIHIHtlH DEPTH OF 6RR'¢EI_ RETHEEH THE OUTFBI.L PIPE RNF) THE F;nTTOH AF 7HE EXCRVAT]CIN (IN FEET). F' t-~ I _-; i ::; I:~ I.--.~ E-~ F' I_.R ['4 T i;I F" T I R PRnF;'RAE F'I_RNf Hfl'T' BE INSTALl.Er) RT 3HE PERHTTTFE"S FIPTION SUE:JEC:T TO THE FFd I.l-tbJ I f. JR I-:I-IN£) f T I I'-It.J'q: :1 EI'TNFR R £:l_R'q'-q I OR TI N'qF RF'F'Rf]VEI:, PLANT HAY F:E IN'_qTRLLED. ]'..~' 2. R C:AI-~T]I41_IOI.I:5 1,1RINTENRNF:E RGREEHENT IS REC!I_IIRED. IF A HRINTENRNCE ~'~ RGRFEI,1FNT IS NOT KFPT CIIA'RFNT YOll I'IRY RE F:EE~I_IIREP TO ENL_RRGE THE $FlIt. ARSOP~PTIAH SYSI'FH ANF)/nP YOll f'l~'f F:E SI.IBJECT TO PROSECIJT]ON _ , ~., )' I'-i:------;_.F'EIE:T ;Il iTit-.l'_--_~ RF--:F__ F.:EiT~I_I I F=:ED '-F I..I I--I ;'. _ri" "-'' - _ _,Y_,TEll HITHOUT Fit.iAI. INSPECTION RN[:i HPEF. I_ /HI_ E,T THIS F,H.F. FILI.TIJL, I-I~ ~'~ ~ ~ '' - ' '-I',- "' F)F~R~'TH~NT WILl. E',E St. tE:JECT TI_-I PROSECUTION. HINIHUH DISTFtNCE BETHFFN R 14Eli. ANI> Rt.l'¢ ON-SITF SEHRGE DISPOSAl_ SYSTEbl IS *1AA FEET EAR R PRIVATE HFI_L OF' 2~1C1 FEET FITIR R pI.IF:I_I6 14ELL HELL LOGS RF:E REIpI_IIRED Rr.~D HII'ST F:F RETURNED TO 7HE DEPRRTI'IENT HITHIN SF~ DRYS OF TH~ NFl]_ CFIPlPI ETLON RTHFR' RFIT¢IIIR'FI.1KrITS HAY RPF'I_Y ¢F'KF;IF]CRTI[IN$ AND CONSIRUCTION DIRGRRHS ARE R',/RTLRRI.E TA INSURE F'F'OF'ER TNSTRI_I.RTION I I-:FI~TTIFY THaT :I: I Fill FRI,1TI_IRR [,IITH THE I?EE!IITI~:Er,IENTS FOE: OH-SIIE -C. EI,iEF:S RND [.JELLS RS SET FFiE'TH F:"r' THE HI.ItJICIE'FiLITY OF R[~ICHI]RAI3E. 2: T HILl_ TNSTRI.I. THE SYSTEH IN RCCORE:,RNCE WITH THE CODES. _~: T LItIDEF'STRIIr) THAT THE CIH-S]TE SEL.JER ?T'STEH I'IR'T' REt?~UIF.'E ENI_RE'GEF1ENT IF THE F'ES'fDFNF:F IS REr,IOF)EI.FI') TO INCI.I. IE>E I.IORE THAN ~ LOCATION SKETCH LOG OF TEST HOLE NO. 1 Scale: 1"=3' RIVERTON AVENUE ~ TH-2 105' Lot 6, Block 7 Addition No. 1 Elmore Subdivision Not To Scale Distances shown are approximate and have not been measured by surveying methods. 6o51 ORGANIC SANDY SILT (ML) Brown, Moist, Firm ----1.5' SANDY SILT W/SO~ GRAVEL (}iL) Brown, Moist, Medium Dense -- 3.0' SILTY GRAVEL W/SOME SAND (GM) Occasional Cobbles, Occasional Boulder, Brown, Very Wet, Dense -- -- -- 9.5' GRAVELW/SO}~ SA}~D, SOME SILT (GM) Occasional Cobbles, Brown Very Wet, Dense ...... 14.0' GRAVELLY SAND W/SOt~ SILT (SM Brown, Wet, Very Dense Refusal on Boulder @ 17.5' 17.5' T.D. This log depicts subsurface soils observed within the test hole at the location shown. See Drawings B-01 and B-02 for explanation of symbols. CKD: JMA' DATE: 5-17-77 SCALE:see above R&M CONSULTAN?B, INC. LOCATION SKE'i~U AND TEST HOLE LOG MARY K. IIESSION jLow ..o. 8tW.D. - LOG OF TEST MOLE NO. 2 Scale: 1"=3e 0.0' SANDY SILT W/SOME GRAVE. L (ML) ~rown}~ry W~.t_ __ __1.5' SA~IDY GRAVEL W/TRACE SILT (G~) Many C~les, Brown, Very Moist --4.5' GP~VEL W/SO~E SAND, TRACE SILT (GW) Many Cobbles Brown, Very Wet, Very Dense -- -- ~-' --12.0' GRAVELLY SAND~'~/SOME SILT (SM) Brown, Wet, Very Dense --~-- --16.0' SAND W/SOMS GRAVEL, SOM~ SILT (SM) Brown~ Moist, Very Dense 19.0'T.D. This log depicts subsurface soils observed within the test hole at the location shown. See Drawings B-01 and B-02 for explanation of symbols. 5-17-77 [SCALE: see above LOCATION SKET~I! AND TEST HOLE LOG MARY K. }~SSION Ma.y 19, 1977 R & M No. 751160 Mary K. Hession 3304 Iowa, Apt. #5 Anchorage, Alaska 99503 Subject= Investigation for Sanitary Sewer System, Lot 6, Block 7, Addition No.1, Elmore subdivision, Anchorage, Alaska Dear Ms. Hession: At your request of May 10, 1977, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage, Department of Health and Environmental Protection. This investigation, which was accomplished on May 16, 1977, consisted of 2 test holes. Test IIole i drilled to a depth of 17.5 feet below ground surface and Test Hole 2 drilled to a depth of 19 feet below ground surface. The location of the test holes is shown in attached Drawings A-01 and A-02. Drilling took place with rotary drill rig using contin- uous flight solid-stem auger with an outside diameter of 6 inches. Samples were taken at the depths shown on the soils log in attached Drawings A-01 and A-02. These will be held in storage in our lab for approximately six months. In addition, all material brought to the surface by the augers was continuously monitored by an experienced engineering geologist. The topography at the drilling site is generally horizontal. At the time of the investigation the site had original vegetation and ground cover. The tops of the test holes were located a~ original ground surface. The soils encountered in the ~ore hole are shown in the test hole logs, Drawings A-01 and A-02. Gro~dwater was encountered in the test holes while drilling. Bedrock was nos encountered. ~u~sur£ucu conu~u~o~ may vary in other parts of the lot. Page -2- Ms. Hession: We appreciate this opportunity to be of service to you. us if you have any questions concerning this letter. Very truly yours, R & M CONSULTANTS, INC. Jeffery M. Ayres. Staff Geologist ~ : ~B/sl Attachments .. Please contact cCaslin Brown, Ph.D. Head, Earth Science Department Drawings A-01, A-02, B-01, B-02 Department of IIealth & Environmental Protection June '13, 1977 R&M NO. 751160 Mary K. Hesslon 3304 Iowa Apt. #5 Anchorage, Alaska 99503 subject: Soil Investigation for Sanitary Sewer System, Lot 6, Block 7, Addition %1, Elmore Subdivision, Anchorage, Alaska Dear Ms. Hession: On May 16, 1977, we conducted a subsurface soils investigation at the proposed location of the sanitary sewer system on the subject lot. That investigation is described in our letter to you dated May 19, 1977. At the time of the original investigation, our geologist determined that a percolation test would not be necessary. He encountered a layer of well-graded gravel extending from 4.5' to 12' in Test Hole 2, and based his decision on the knowledge that the Municipality of Anchorage does not require a percolation test in that type of soil. However, groundwater was encountered in the test hole at a depth of 8'. Since it is required that the bottom of the sanitary sewer system be at least 4 ' above the seasonal water table, the system will be constructed above the 4' level. A percolation test was required in the more silty gravel encountered at that depth. On June 7, 1977, a third test hole was excavated on the subject lot near Test Hole 2. The test hole was excavated with a hand-operatedpost-hole digger to a depth of 3.3' below the existing ground surface. A percolation test was performed within the hole at the depth shown in the attached Table 1. All depths were measured from the top of the hole. The data in Table i show average infiltration from the depths indicated to the bottom of the hole. The measured percolation rate was 4.4 minutes per inch. This test complied with those procedures required by the Municipality of Anchorage Department of Health and Environmental Protection. We have performed this additional investigation at no additional cost to you, and would like to apologize for any inconvenience we may have caused. June 13, 1977 Ms. Hession Page -2- Please contact us if you have any questions concerning this letter or if we can be of additional service. Very truly yours, R & M CONSULTANTS, INC. Stephanie Hoag Staff Geologist Jim McCaslin Brown PhD. Head, Earth Sciences Dept. SH/JMMB/gld Attachments: Table 1 xc= Department of Health & Environmental Protection TIME 11:45 11:46 11:47 11:48 11:49 11:50 11:51 11:52 11:53 11:54 11:55 ~, PERCOLATION TEST MARY K. HESSION R & M No. ;751160 June 9, 1977 ELAPSED TIME INCHE~ 0 ~ 10 3/4 I ,11 i/2 - 2 \ 12 '\ 3 12 1/2 4 \ '"-" 13 ,. 5I~~ ... ,.,:\ 13 1/2 6 ' X, ~ ~ \ 14 ;-._% 7 ~ 14 3/4 <'\ · I 8 '\' -- '~' -15' 9 ,?-- 15 1/2'' 10 , ! 15 3/4 DROP IN INCHES 3/4" 1/2" :1/2~ 1/2" 1/2" 1/2" 3/4" 1/4" 1/2" 1/4" 12:00 12:10 12:15 12:25 12:35 12:45 15 20 25 30 40 50 60 17 1/2 19 1/4 20 22 1/2 1 3/4" 1 3/4" · 3/4" j!, , 1' 1/2" '1" 13 3/4 Inches 'T0tal Drop 4.4 Minutes/Inch i f. 'i. SIX INCH WATER.WELL DRILLED AND CASED 'OUT.'TOTHE DEPTH · ~ ~., .,-,~"~ .., ,.- ..... ~ .;, .~a?~:~ ,j.~.r~l.~ ;.. _ DRILLER :_ WELL LOG.~ .... ~,~'- ~ - 27~[ ~ ~ '- .-"-.-' ~.~w:' :'"~' ~',"a',~:,-~-;~'-~?"-:'.- V. 121-1~ ~ater..b~t-E.~a~l F~uc~ b;~:~ vat~ recove~ .~ .,..-,,.~.~' ..'.,,. ~- ,- ,'. - ~-~.- ,~ ..... .., ,- ......v-~.. ;,,. ...,.- ~-... ~. ~,~:.?..: ~g,,'.-;?:.?~ . ? ~ - . ,~., ...... , ..... :~.,<..;'q..~"..~ '- ,"!. i} ....... J%'<'.'-~". ..... . ,'- .... ."...* ~' ? 'c-:? '. - ~'.,' ' , . ' '":. -.,'T,.,' ,:-:-./~2-;~"~"'"'.'- ·~ .-"' '-,'-,', ,~. ', . .~-.'-7', · ; .,,: .:..,., ,. ~.. Q.S~.!.N..C:LUDE~ A!~L.~.I~. BQR ~ND~MA.T. ERIAL FOR COMPLL~I'ION '. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS -' -' ~ T A ~ , -~- .-.. -': ...... ~ } ..... H NK,YOU VERY MUCH.,~ ~_~ .... ~ .... :': f" ,.;,',';' '-% ?: ~' ':'.-~--~ ~.; ~ ;.~..: ,. BERNIE: CLAUS~RAMPART.DRILLING F' DATF- A~ AO~eT/~).~.~f~':~,~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anbhorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. ©i9 - i 32 - 33 GENERAL INFORMATION Complete legal description ~.l,~¢r¢ 62. LOcation (site address) z'/~OO /~h~z~L~ Current Property owner(s)~r,~j ~v J / Maiii~g"'ad~re~s .; ;: - 5;~¢ - GiocJz COSA# O ClOIZ-qO Expiration Date: ¥ Lo36 Day phone ~YS- tO'~O Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address unless othen4,ise requested, COSA will be held by DSD for pickup. 2. ' NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public SeWer [] [] [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional .civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissUed with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for propedies served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown belOW, I vedfy that my. investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Phone DSD SIGNATURE ~,~ Approved for '~ Disapproved.· Conditional approval for bedrooms. Date I d~; / .,~-cR, . ~,e , ,.L..z~ .... _- ..%\. bedrooms, ~th the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11105) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. BOX 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ~more 't'Z ~/~ T~ ~,t G Parcel ID: OIf~ - I?Z- ~ A. WELL DATA Well type ?~iVa'~ Date completed ~J1~]l~7:7 w I Total depth 12. 7. ff. Date of test Static water level Well production WATER SAMPLE RESULTS: If A, B, or C provide PWSID # Sanitary seal (Y/N).,, Cased to I?.'Z. ff. FROM WELL LOG Ex~ ft. (o g.p.m. Coliform /V'~.~ coloniesll00mL Nitrate 0,15~ mg/L Arsenic: /VD ug/L 'date of sample: B, SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size J000 gal. Numberer.Compartments Foundation cleanout (Y/N) 'Date of pumping lO/J~ . c. A SORPT O. F ELD D^TA Date installed ~ I~ll ~"Jr' Soil rating Well Log (Y/N) "// Wires properly protected (Y/N) casing height (above ground). AT INSPECTION I o/l~t /ZO. lO 5'~,' ft. ,,/ · ~12 in. g.p.m. Other bacteria Collected by: ~,~ 'colonies/100 mL Depression over tank (Y/N) ./V' Pumper Date installed. Cleanouts (Y/N) High water alarm (Y/N) (g.p.d./ft~ o~ 1~,5 System type Length ~55 ft. Width ~ ft. Total deptl'i ~,~ ft. Eft. absorption area HCl5 ft~ Monitoring tube Date of adequacy iest ~0{ ,~ll?.OtO Results (Pass/Fail) Fluid depth in absorption field before test '~ in. ~,5 Water added 5C0 gal. Elapsed Time: J~0 min. Final fluid depth ~' in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~o~. ~o~r~ If yes, give date Gravel below pipe 'Z. ft. Depression over field iV' For ~ bedrooms Newdepth I~ in. q...~O g.p.d. D. EIFT .STATION Date installed ~"'"'Size in gallons · ,,,,'"rVlanholelAccess (Y/N) ~ ~Pump on level at .,,,,~in. "Pump off" level at X High water alarm level J in. Datum J Cycles test~/'' Meets alarm ~uirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I ?_0 ! Absorption field on lot ! ~0 ' 'Public sewer main /V/A, Sewer/septic service line ~ 5 Animal containment areas · ~ On adjacent lots t On adjacent lots ~ I OO Public sewer manhole/cleanout Holding tank ,~,/,,a, Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main /V/A, · Wells on adjacent lots '~lOI Property line ¥10i Absorption field water service line '7 25 ~ Surface water 7 I001 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ lOi Building foundation '7 I 0~ Water Service line ~'ZS' Surface water 7100' ~A/~,O~)' Curtain drain ~ 50' (/V,o~ Wells on adjacent lots '~ 1o0 ~ Water main A//~ Driveway. parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date I COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number LOT 5 ,~ I VE/R TOA/ A Al ~.~° ZZ' O0"E · W£LL /82° 2~/ /0 ~- UTi/. S~°,.5~' 17"W o! E S ~ 7: ': Lot ~ , Block Anchorage Recording Districtt Alaska LOT SURVEY CERTIFICATION I hereby certify that I have surveyed the property shown Qnd delorlbecl hereon, and that the Improvements situated thereon ore within the prop- arty lines and do not ovsrlnp or suor~Ooh on ndJaasnt property and that no improvements on odjooent pro~)erty OVertop Or eltoroooh ol1 t~ prefltJsee , in question and that there are no roadwoyl, utility linnet or ether villi)lo easements aG ~aid property exo.ept as Indlonted hereon, /Vo. Z Ea#mente of re~ord of#er than thane shown an the plat Of tabard are not 8hown hereon LEGEND Brass or Aluminum capped monument recovered 0 Iron pipe and/or rebar recovered. I:) 2 x ~ hub & tack reoovered · 5/8"x :50" rebar set this survey x · Fence Lithe (Approx. Location) Scale Ref. Date © 10-13-/0 Prepared by: (907)£79-S200 t~. L. BUTTON Registered Lond Surveyor 519 ~ £/ghth Ave, Anchor~ Al~#a .............. SGS SGS Ref.# 1105558001 Client Name Spurkland Engineering Printed Date/Time 10/21/2010 8:11 Project Name/# Water Samples Collected Date/Time 10/14/2010 14:25 Client Sample ID Water Sample -Li,~ze a~Z t3~ L(a Received Date/Time 10/14/2010 14:35 Matrix Drinking Water ~ .~£~-d.~,~ Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/15/10 10/18/10 KDC Waters Department TotalNitrate/Nitrite-N 0.152 0.100 mg/L SM20 4500NO3-F A (<10) 10/14/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/14/10 DLC Total Coliform Negative I 100mL SM20 9223B A 10/14/10 DLC MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 8~ L Itreet. AKhor/~, A~l~l ggso1 DIRECTIONS: Com~m dl ~m on p.~ 1. I~omplm ~1.---- will; b~ p~;cwil~. P~.. ~low l*n (10) dlyl for pro..i~. 1. ~G~TY OWNER Jack M/Mary Kay MAILING ADDRESS I PHONE Hession 344-1962 Star Route A Box 319 99507 'PROPERTY RESIDENT (If diffm~nt from abram) 3, BUYER n/a MAILING ADDRB~ 3, LENDING INSTITUTION Ph'st Nat;onal Bank of ~'~chorage 279-5577/224 PHONE PHONE PHONE 274-1521 MAILING ADDRESS Post Office Rox 4-2090 4. REALTOR/AGENT MAILING AGDRES~ 99509 PHONE LEQAL O ESCRi~'TiO~i Lot 6 Block 7 Elmo=e Subdivision ~2 $¥~¥ LOCATION Biverton Avenue 6. TYPE OF RESIDENCE :~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER BUPPLY INDIVIDUAL' [] COMMUNITY [] PUBLIC UTILITY INDIVIDUAL/ON-SITE'* [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four I'--I Two [] ~ Three [] Six [] O~her * ATTACH WELL LOG. A ,,,,~11 log is required for all wells drilled since June 1975. For wells drilled prior to that date. give well depth (attach log if available.) If md,vldual/on-Me, g~ve imtallation date. .. If system is over two {2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. '72..010(3/78) :1 THtS SIDE FOR OFFICIAL USE ONLY**._ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL D COMMUNITY CATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMSER [] INDIVIDUAL/ON -SITE DATE INSTALLED •PUBLIC UTILITY ~' --'-'J "-] Connection Verified INSTALLER [] Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL ~ ) ~'-~J 5. COMMENTS ~-~'APPROVEO FOR -~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ITitle) LEGAL DESCRIPTION 72-010 (Rev. 3/78) . '.. ..-. "i -- ]' MUNICIPALITY OF ANCHORAGE ' , '. ' ....  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~I , .... 82B L Etmet · Am:hom~, Almim g9501 ENVIRONMENTAL ENGINEERING DIVISION .... ; ' Tdephone 264-4720 , .... . REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES PROPERTY OWNER ,ADDRESS SRA Box 319 PROPERTY RESIDENT( ~ Riverton Ave. ~ BUYER ./A MAILING ADDRESS First Nat iou~ MAILING ADORE~ ~ P.O. Box /*-2 ARc 4, REALTOR/AGENT ~ MAILING ADDRES~ LEGAL DESCRIFTION TYPE OF RESIDENCE ~ SINGLE FAMILY t'-I MULTIPLE FAMILY PHONE 344~1962 PHONE PHONE PHONE NUMBER OF BEDROOMS [] One I--1 Four [] Two [] Five ~ Three [] Six I-'] Other 7. WATER SUPPLY ~ INDIVIDUAL· r-}' COMMUNITY [] PUBLIC UTILITY 8. EL=WAGE DISPOSAL EY~TEM ~ INDIVIDUAL/ON-SITE** [] 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 (at~ach log if available.) · 'if individual/on-site, give installation date If ~tem is over two (2) years old an adequacy test is muired by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED 72-01043178) 'J THIS SIDE FOR OFFICIAL USE ONL '; ' DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE I'-I THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMSER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELt- [] 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 r-'lHoldingTank S[ze: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 5. COMMENTS [] APPROVED FOR BEDROOMS t'-I CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72~10 (Rev. 3/78) - Florence ' F&~ith Floor F Laura Fourth SUBJECT Lot 6 Block 7 ~.lmore Subdivision - Refund DATEJUly 20, 1978 Pleaee make the necesaary arrangements for refund. We have been unable to make contact with these people for setting up an ins99ction. Thank you. ~:. SIGNED ~ '.¥" :: i.. ' ...... : /. :-~ ~- : ...... laura/.%720~ .~.. I::IEPLY I~ledifprm® 4S 471 .%lleO PARTS ~ ANO 3 WITH CARBON INTACt' - . ' PART 3 WIU, BE BETURNED WITH RIIq. y. DETACH AND FILE FOR FOLLOW-UP ~"Fir~t National. Ban~ ~ Anchorage '~ost Office Box 4-2090 99509 Anchorage, Alaska 99510 E O Se and Water Health & l~nvironmental Protection 825 L Street 99501 SUBJECT Lot 6 Block 7 Elmore Subcliviston DA?E July 20, 1978 Jack Ii./Mary 'Kay Hession Property I~IESSAI~E . The above property has bean returne~ to you uncomple~t~l. We have been unable to get a hold of ~ny one to set up for an inspection. A refun~ is on its way to your office since we w~re unable to make contact with the property owner for inspection. Any questions, please contact this office at 264-4720. REPLY SIGNED Laura J. Harrison Sewer and Water Redi~prrn® 4S 471 SIGNED $1ENO P*ITS I AND 3 WITH CA~I~ON iNTACT DETACH AND FILE FOR FOLLOW-UP