HomeMy WebLinkAboutELMORE #2 Block 7 Lots 11 & 12
GRE, ER ANCHORAGE AREA BO,.. UGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS ~'0 I
SEPTIC TANK:
DISTANCE:
FROM WELL
INSIDE LENGTH
· ' NUMBER OF
MANUFACTURER ~" ~l~l~ 'P'~ MATERIAL ~'/~u~/'Y,X'~ COMPARTMENTS /
~ INSIDE WIDTH ~ LIQUID DEPTH ~ IIQUID CAPACITY I~'(~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS f . DIAMETER '" OR WIDTH ~ol/,3. LENGTH;Lf~', DEPTH (Z'21/'~-/'
LINING MATERIAL ~Y'~/,~,.~' I CRIB SIZE: DIAMETER (~ ~DEPTH ~ DISTANCE FROM: WELL [~)(t~ /
BUILDING FOUNDATION '"~0I, NEAREST LOT LINE ~ ~ TOTAL EFFECTIVE
· ABSORPTION AREA (WALL AREA) ~ 7 [:) SQ. FT.
ADDITIONAL ABSORPTION ~ ~v"ct;~ ~'1C~ ~6 ¢~'u~*~"$ O~c ~;"tf'5 ..~m(.~.~ ~O~¢r~C( ~
"~ (~,e.s ,~.. ~" I~.~I ~ I Ii~,~ i~ lo' I~,.~
WELL:
TYPE ~J~;Vic~u,(~ I CONSTRUCTION ri r': I1~" ~ DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE /
FOUNDATION LOT LINE 5EWER LINE TANK ~'~ SYSTEM (O~/
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES: i~) ~'~'-
DIAGRAM OF SYSTEM
INSTALLED
PIPE MATERIAL, ~'~ ~V'O¢'3
LOT SLOPE: ~Ou ,~
REMARKS:, ~. I~e.f
Form NO. EQ-031
ANChOrAGe Area bOr~gH
/ DEPARTMENT OF ENVIRONMENTAL QUALITY
· 3330 "C" STREET ANCHORAGE. ~LASKA 99503
TELEPHONE Z74-4561
IHSTALLA~ION OF: SEPTI~ TANK ~ ~[EPAG[ PIT DRAIN FIELD OTHER
~F
soil TrST .[SUETS O~ ~ / '' ~ W ~T ; ~ ~ .O~, THIS PER.IT IS NOT VALID WITHOUT
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. I3ACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SE.T,c TANK .,. /z~O0 TTPE Ce~-.~'F .EPAGE A.EA S':E ~ '~ 5~ ~'PE ~
MINIMUM DISTANCES. REQUIREMENT~
FOUNDATION TO SEEPAGE PIT ~'~ DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
DRAIN FIELD .----~/ ALSO CONSIDER AREA WELLS.
CAST IRON INTO AND OUT OF SEPTJC TANK AND INTO CRIB
EXCAVATION ~ FEET INTO UNDISTURBED SOIL.
GRAV£~. "ACKFII..I. ~ ~
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
This fo~ reports: S~i)s log -~, .~ ,
Dep th
Feet
1
3
4
5
6
7
8 .---
9
10
11
13-
14-
GREATER ANCIIORAGL AREA DOROUG,..'
Department of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99b03
SOILS I,()(; - I'I';ROI,ATION 'I'I':ST
Da te Perfon:~:d_~-L~ ,~'- 7 ~
Percolation test
.,%
Was ground water '~hco-ur]tered? ---'/~0 .... If'y6s; ,it' what depth?
Reading Date Gross Time
Percolation Fate .....
-Proposed i ,,s ta 11 a~n'~. --
Depth of Inlet ............ .
COI.I{.IEHTS:
Net Time
minute.
Seepage Pit Drain Field
Depth~%~ttom of IHt or trench
__Depth to Water
rlet Drop
.~0 (6/74)
GREATER ANCIIORAGE /',R'JA I,;OROUGII
Department of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99603
.";OII.S I,O(l - I'EROIoATION TEST
2
3
4
5
6
7
8
9
IlO
11
12
13
14-
Perforn~d for L.l~/~ ~/~h ~l?m,',Lo~, Date Perfon~d ~-~
Legal Ue~crlptlon. (~~ _~ hl~~ ..... ~'~0~- ~,,_~ ~-- --
This fo~ reports: So~ls lo9 ~ ~~ test
Depth
Feet
cltr t ro d 0
Was ground water encountered?
.~__C~ ..~ If yes, at what depth? __
Reading
Date
Percolatio~rate
· Proposed installat-T6'~
Gross Time
----~iinute.
Seepage Pit
Net Time
Drain Field
Depth to Water
I;et Urop
Depth of Inlet ~. Depth to bottom of pitor trench
.........~ ~ ~crtified By: aate:
Eq-040 (6/74)
MUNICIPALITY OF ANCHORAGE .~,., . .
DEPARTMENT OF HEALTH&HUMAN SERVICES, ': *' *':' '
Division of Environmental Services. '
· . .... , . *On-Site Services'Section...
· P.O. Box196650 Anchorage, Alaska 99519-6650'* - '. ~ ' ..-, '*'.~.: ' ..'~,
· ~343..~,7,44' ::~:' ' ~ ;' . · :* ': :'
CERTIFICATE 0F H~LTH AUTHORIT~ ......
""""""'-' ~"~"'-'""'"'"/~rr~'~v/~. r~M ,~ o~r.~ FAMILY DWELLIN(~
i:D # i'~;~<~ .... ~ ..... ''" '*' ' " L ' ~' ,',,,: ....
:'":" Parcel -~-/~- ' C~L~L' : , ..-, ,., . -
. . . . -___L' ~. '"': ,. *~" ..... . ......
:
~;.';:. I:'.':GENERAL'INFORMATION ' :~':~ * ':', ' .. , '::" - '~:' ', ',.
.'.'~: "*~'~:'-':~' :~ Complete'legal description?'i: ,.,:Lo~e Ll,,~,~l.~;;~o~.;~o~ S~b~u~Zon'~
~.:.,, :..., , ..~;~:.. ., , .,....,., ....... :~...,. ........... ....,.;,:,...A~q¢.:.. A~., .. ,..:. . . . . .
?,.-.~ .~....,,.~, .... ~ , ,. ,.~.~ ..,:.~ ~ :,. ~ ,,., .,,,. ~'.'.. ~ . .... · ,. ..... ..... ~ ~,.~
.,~:'"'""' ~ '~ ~¥,. · ,. ~-""...'~;~r~pe~ ...... owner. :~; ~o~~ ;.,~..,.. ,...;: ,. ~ ... '. ': : :Day ....... phone ...47~-57~5',', ' .
~_ ~.,. ,~ ,:;,:,: .,..Lending agency ; ~~"~: -';.' ~ "/' ': ~'-': :;;:Day I)h ; "' '.~"
~ ................ ..~ .. Dayph e
An t .... ' '' ''' ' ..... ' ' ~ .... "
,.,,,,,, ~,. en ........
-,'.,,',: '-" ' AGere~ · - - ................. ....... '-' ·
;'~ '.'~' . Unle~ othe~i,e r~ueste~,'H~ will be held for plckup. ·. .. ~.:...,: ..-~
...Z,.:..~B[~O~ ~[~OO~8:, .... '- ~ ~ ~' ~ · , ....... :~-. · .: .... ..,~.~ .~., .. ?'.~. ' ~ .?
....... ~ . ~'... ~-. .~.
~.': '~". ":} Community well "~ .'.?~" q::' ': ......... . ,,:.:.:~ .....
,..... _.,::,. ............ .. _ , ....................
. * Pub c water ........... ~
-.'. ~ ,1. NOTE: :.~ If communl~ well ,~stem;~provide;~rl~o~*confirmatlon,trom State ADEC a~est.
.. ~ ........ Pubhcsewer .... ~ .... . ............ ..- . ........ .,
~, :-., ~ **:-*" NOTE:: ~lf communi~,wastewater ~ystem;,provide written confirmation from SMte ADEC
.... ~; _C=TA'~:MFNT OF INSPECTION BY ENGINEER , ,
~" ,' ' ' As cert f ed by my sea afl xed hereto and as of the va dation date shown below I ver,fy that my..-.,...,
', ,i:'~ :: .... '. '" re;est gat on of th ~ Health Aoth0rit~'Api3r0~al 'alSpliCation Shows that the on-site water ~.u. pp y
i ' ." ',' ': ~ ~ a~nd/~r wast~wat~r disp~sa~ syst~m ~s saf~e~?`n~t'~n``a!~`a`n.d, ad~.~ u~ ?t~ f~r~th, e. ?mbe. r'~[ ~ [~ ::) '~ ~ ~ ~:
:" '::' ":. ~'. ' '~n'd tyl~e'o'fstruc~ur~ind ~a~ed'fi~iein. I ~;J~h~i:~,e~'.ify th. at ba~::l On th~'Informati0n 0bt,a ~.,.e~l.,f?.m
, ,... -.'.. '* the Mun c pal ty of Anchorage fllo~ and from my Invo~ttgahon and Insp~_ jon, the on~!.te wat?r..
~.:~, .', i ". ~.,:~.nn 0 and/or wastewater d soosal system is in (~'~mpliance with all Muh'lcl~l ~d S~i~'~(:~;
~-' ,' .~,., . :~ordnancas and regulations in effect on the date of,this lnsp~., ,.i.on. ~ .-, :! ..... ,.': ; .;..'.
"~' ""''" .... fFrm · :" .... ,:.._~ .... ~ , ;.-<:', "! .... Phone -, ~'~-/z//'~ , ,...,
.... ;. ' ....... .,- ..... · .... · .......... -.; Eagle River~Alaska..~$~:"%"-'~-?~..':::'M'' "': ~'' · . '?; '.'.;.~,'J ) .~,'"
.~ ,' ...,. = ...,.x..,~..;,,,,.+,,.o.. ~ :- ........ /~~'" ....... '...Date..--' . ~..--~ ...'~' ~ ....... ~
~1 ' :" . . - -: .:-. :.~. . ' .'--:~ .~- ..... .. '.--:.: ' '.' .'.':; .~'' ~' ".....';..~:
..
'.: ..: '. -= ' · . ~, . . ~,~ /.~/..-a."Y ~ ~". ........
.~:>-~ . ..... . ........'.. ·: :' -.... ... . .............. ~ ................... [;: ' ........ ..
~:...... ............... ~~~ ~'.~-7~ ?.,~
.',",' '~"'"* "'*'t~ '"~' '':' '~:~';* ":' ' ' *;':: :' ;' ':*"*'~*'~' ' " ' "}";". .='-
z" ed *for. -' ,
.' .:Approv be~lroon~s. ,.: ........ :'. -.
.....
'""'"" ' : .. ' ' ' , ' , , ' · .: ' . ' · ' tp n'
~ond t ona approva .for . bedrooms, w th the foflowing s ula
.... :. . ......... ..~.~"'. ,:,::,;~ .... ..., ...
·.:.....1 'Ad;'""~onal'~o'-'~'e'~tsu,~ ,., ,,,,,, . :'
: .,.. ': ,The. Munlc~pahty of ~chorage Department of Health and Human. Se.rv~ces (DHHS) Issues Health Auth0. ty
! '::'-, ,' ,'.: . A~lJr(i',~ai.certific~t~ ba~l oniy'bpon th~ representatlons'give~ In"l~a~ag~aph' 5 above by'an IndePendent .: :::~.;.-
~ .'-",~' '.'~: i'l~r~f~si0'n~l ~ngin~er i:~gl~tered ir~thr~ State of Alaska. The D. HHS noes !hi,'as a courtesy to purchasers of hom. e~ ..
~' ;',:' '.;, ~'d'tl~e rie~li~(3 ~st tut o~ n&rde~:to sat {fyc~rta rYfederal and state r~lui~:emehts. Employees of DHHS d.o ?t "' : .... ,..
".-. .... conduct .nspect~ons or'analyze data, before.a cert~hcata is Issued.. The Munlclpahty,of,Anchorage Is..° .:..,,.
professional engineer's work.
:..' L.' : r~0~ibl~ for errors or omis~i~'h~ i~ th~ ...... ' ' '"" " '
Municipality o! Anchorage,
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Well Data
Well type P~/.I
Log present
Total depth
Sanita~ seal~l)
Parcel I.D.
If A, B. or C. attach ADEC letter. ADEC water system number
Date completed ~c~/4/~ Driller
Cased to
Casing height
Wires properly protected ~1)
FROM WELL LOG
D.-,teo, test '
Static water level I~ /
Well flow ~-(~ g.p.m.
Pump level1 L~
SEPARATION DISTANCES FROM WELL
Septic/l~ank on lot
Absorption field on lot / O0 I../.
AT INSPECTION
15 /
4,3
; On adjacent lots
; On adjacent lots
g.p.m. ~ ~o
Public sewer main ?~'/' ~
Sewer service line 2[ "4--
WATER SAMPLE RESULTS:
Coliform ~)///0~ J~. Nitrate
Date of sample: .~/,,.~/ ~'z~
Public sewer manhole/cleanout
.Petroleum tank
B. SEPTI~ TANK DATA
Date installed (~:~/~/ ?--.<"' Tanksize ].~'(~ -~(.--
Cleanouts~N) _~,~' Foundation cleanout (v~.
Compartments
Depression (Y~)
High water alarm
Date of pumping
SEPARATION DISTANCES FROM SEPTIC_,~q-1~4N~TANK TO:
Well(s) on lot ~- ~-.-' ~ On adjacent lots ,/(">C', t.,/.--
To property line [ G t./5.... ,. Absorption field //(3 t.~...
Sartace water/drainage [0(,~/-/~-'
72-o2~ ~3~3}' F~'~ ' '
Alarm tested (Y/N)' ~f~'//~
Fou.datio. ,5'-%
Water main/service line
CONTINUED ON BACK PAGE
C. UFT STATION
Date installed
Size in galions
Vent{Y/N)
High water alarm level
'Pump on" level at
Manufacturer
~Level at
Meets MOA elect~cal codes (Y/N)
sEpARATI~STATION TO:
~ ' ~ On adiacen~ lots
D. ABSORPTION FIELD DATA
Date installed
Totalabsoq~,i?n, area ~ ~O
Surface water
Gravel thiCkness
il. b~te test
'= Water ~eVel l~t-~;)sorp~ion field before lest
: Peroxide treatment (past 12 months) (Y/N)
Cleanout present'N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
we, o~lot
TO building foundation / 0 I./._
-m adi~nt ~ot~
Surface water
System type
Total depth ~'
Depression over field
for --~ Bedrooms
* Curtain drain
Nter test
If yes, give date
On adjacent lots ~'00/'~' Properly line
To existing or abandoned system on lot
Cutbank ,,'C"O/'~/~ f"~:3~T' Water maln/sewice line
~/C,'O I--~ O~veway, pa~ng/vehide storage a~ea / 0 ~
E, ENGINEER'S CERTIRCATION
Signature
'.
~,~¢s N~~, -. .~ ~.~ ....
HM Fee $ ~
Date of Payment ~'~ '-~ 0 - q ~;/ ,-
CT&E Ref.#
Client Sample ID
Ma~x
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~'.4'~-.#'~'.~'~'ffff~:~e.~fftt~'~-~-~-fjffffjftffffjff~
LABORATORY ANALYSIS REPORT
94.0929-7
LOTS I 1 8:12 B7 ELMORE S/I)
WATER
Client Name S & S ENGINEERING WORK Order 76283
Ordcn~ed By R. $1IAFER Printed Date 03/07/94 /~ 10:39 hrs.
Project Name Collected Date 03/03/94 @ 15:45 hrs.
Project// Received Dui e 03/03/94 {~ 16:00 hrs.
PWSID UA
Technical Director STEPIIEN C. EDE
Sample Rcmarks: ROUTINE SAMPLECOLLECTED BY: S.S.
QC Allowable Ext. Anal
Results Qual Units Method Limits Date Date
Nitrate-N
0.10 U mg/L EPA 353.2/300.0 10
03/04194 CMP,
* See Special Instructions Above
** See Sample Remarks Above
U = [h&t eeted, Reportedvalm is the practical ~ntification limit.
D = Seeonchry dilution.
UA = Unavailable
NA = Not Analyzed
LT= Less 'lhn
Gl'= Great er 'lha.,'L
5633 B Street, Anchorage, AK 99518-1600 -- 'fei: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA, ILLINOIS. MARYLAND. NEW JERSEY, OHIO, UTAH. WEST VIRGINIA
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
April 19, 1994
Robert Shafer, P.E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lots 11/12 Block 7 Elmore Subdivision
Waiver Request 9WR940013, PID 9018-172-50, HA940161
Dear Mr. Shafer:
Your request for waiver(s) of the required 100 foot horizontal
separation of a septic system to a private well has.been approved.
The approved separation distance(s) are a private well located on
Lot 11 Block 7 to the septic tank located on Lot 12 Block 7 of
62 feet.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur:
ljm:96
MUNICIPALITY OF ANCHORAG-
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR940013 PID# 018-172-50
Date Received: March 30~ 1994
HA# Ha940161 Permit
Legal Description: Lots 11/12 Block 7 Elmore SubdivisiQn
Engineer: Robert Shafer~ P.E.~ S & S Enqineerinq
17034 Eagle River LOOp Road, Suite 204,
Applicant: Howard Hardee
Eaale River. 99577
Waiver Requested: Private well
located on Lot 12 of 62 feet
located on Lot 11
to the septic tank
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
Points:
3. Other:
Waiver is Granted: ~/ Waiver is NOT Granted:
List Conditions or Reasons for above: ~E ~U~6H~O
Date: 4-/~-~''
By: Name~o~R~eviewer
Rec #: 25759/3464 Amount: $ 625.00 Date Paid: March 30, 1994
~WalV£~ ~£quEs7 FOR
~TtlVER rtEq~$r Ivu~z~/~ WR¢4001~
-$E?Ttc
2.4
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694*2979
19, 1994
SEWER & WATER
INSPECTION
ROAD DESIGN
SOIL TEST
MUNICIPALITY OF ANCHORAGE
Dep~rt~ent o{ H~ha~d H~n Se~uZc~
P.O. Box 196650
Anchorage, AK 995~9
REFERENCE: Lot 11 ~ I£: B~.ock 7; E~,noce Subd. iuZ6lon # ~
Requ~6t Fou approve the a~t~ch~/ He~th Au~ho~/~ ApprouaZ (H.A.A.)
~ I~ ~e both owned b~ Ho~d H~dee o~ F~b~n~, A~6~. The
prop~F ~ b~e~ Lot 11 ~ 1~ ~ ext~ ~o~gh ~e
6~e on Lot 11. ~ed ~ ~ ~e~ 6lgneE bE ~r. H~de¢
p~oul~ ~o~ ~e ~ep~c ~F~t~ on Lot I~ ~ co~e ~ul~ ~e
~ app~e~ l~e ~om ~e ~nk ~ng the ~t. The ~nk ~
~he aep~c ~n~ ~d ~he ~ ~ ~ Zn 1974. Rece~ ~
~ple ~6 ~ken ~ June, 1991 ~nd 6bowed ~e leu~ o~ .26 ~
6~o~ b~ ~. The ~ ~o~ on t~ prop~
6ho~ 6and ~d gr~u~ ~y~6 to 46' ~h a ~gh ~ yi~d, and ~
be~ ~ ~n~ ~or 20 y~6. It ~ obvio~ ~¢om ~ ~ 6~pl~
~ ~ted.
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577
l>~ge Two
Lot 11 ~. I~; B~ock 7; Elmor~ $~bdlui6J~on#~
19, 1994
(~hen the ~ppllca~on {o~. on-6it~ ma6te~er ~po6~ ~ ~pp~ed for on ~ 7,
197~, Roll S~c~ ~ ~he Gr~ An~o~ge Ar~ Bo¢oag~, ~o~ on
appian ~ ~ ~u~ o~ SO ~t. ~ g~a~ed. Thee ~ po~ue euid~ce
~ l~. We do ~o~ fe~ ~ ~ ~ ~pp~op~e~ ~o~ ~gethe
~~, ~ ~ ~ : -~- . ~ % ~ ~ .
· ~ . .., ,~ ,.~ ~ ......................................
'
'
'
,
ROBERT SHAFER. P.E.
ROGER SHAFER. P.E.
FLOW TEST DATA
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
SEWER & WATER
INSPECT[ON
ROAD DESIGN
SOP, TEST
PERCCLATION
TEST
I~1 SITE
WASTE WATER
OtSPOS~J. SYSTEM
DESIGN
CLOCK DEPTH 'z~0 DRAWDOWN PUMPING REMARKS
TIME WA'I.'= K RATE ( GPM )
!1:~ a~, Io' q.z ''"
MISC. DATA~ CASIN(~ HEIG"~T~ ~' SANITARY SEAL?g ~'~
WIRES IN CONDUIT?~ ~'~___ GRADING O.K.?~ ~'E~_._
BACTERIA & NITRATE SAMPLES COLLECTED~ ~[~[~_W,.
FLOW RATE NOT ~UA~M~"~EED--~uuSEQO~T VA~T. ATIONS CAN OCug*~l
17034 NORTH EAGLE RIVER LOOP · SUITE 21)4 · EAGLE RIVER. ALASKA 9957?
I~ECLAP, AT~ON OF EASF. UEKT FO~ SEPTIC SYSTEU
p.f..c~ :t. he/ceo{ , {.i.~ed u.~de.~c P~:~J Nu. mbe.,[ #69-96, R~.co~.cl.6 o{ ,t.h~. Ancl~o,'cccg~_
co~onZ~ ~z~,tmun a.~: 7548 Sp.,u. tc~ S,t.,,te~,~, Ancho,~ccg~., A.~t,~h.~. 99507;
Lot 11.
Tl~e 6aZd ea.6e~oz.~ 6ha~ ~zm mL,t~ ~h~
upo~ .,the o~u~.6 o{ Lo.~ 12, {oe..60 ,~o~
~.~, o~ ~,~ ~¢c~,,~' ~ep~c~ .t.h~¢o{, .~, ,ee,~ {o~ .the
t~bJ.,t.~ort o{ Lo.~ 11.
~ATF..O ~ ~ c~tF o{,l~l~r¢~, 1994.
-.. IvtUNICIPALII¥
MUNICIPALITY OF ANCHORAGE DEPT.
DEflAR~ENT OF H~LTH & ENVIRONMENTAL PROTECTIO~I~ONM[~AL
~ L Str~ · A~or~, A~a ~1
;.WRON~E,~A~ E,~,;;m.~ mws~o. JUN 1 g 1979
RECEIVED
1. pROPERT¥OWNER I PHONE
I
MAILING ADDRESS
PROPERTY RESIDENT Jif different from above)
JPHONE
2. BUYER
MAILING ADDRESS
MAILING ADDRESS
r
PHONE
.~ 7 7- 7.~'//
PHONE
E. LEGAL DESCRIPTION
~o~-~ //~ /2
~REET LOCATION
6, TYPEOF RESIDENCE
SINGLE FAMILY
r-I MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One r-I Four
1--1 Two [] Five
[] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTI LITY
SEWAGE DISN)SAL SYSTEM
~ INDIVIDUAl/ON-SITE**
I-'1 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.)
* *1 f individual/on-site, glve installation date / q 7(~' ·
If system is over two 12) 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) //,,~ ,]J ,
THIS SlOE 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 r-I TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER
[] INOIVIDUAL DEPTH OF WELL
[] 'COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
r-'IINDIVIDUAL/ON -SITE DATE INSTALLED
Connection Verified
r-'lSeptic Tank or r--IHolding Tank INSTALLER
Size: /"~(~ IfTankishomemade SOILSRATING
give dimensions: / ~...~,~
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL
4. DISTANCES ~eptic/Hold~ng Tank Absorption Are'~ I~ewer Line I Neare~ Lot Lin' -- e
WELL TO: ~ I /o,.-f' I I
5. COMMENTS
~"~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany 9e"~ficate)
[] DISAPPROVED //
DATE BY (Title) //'~} I /
72-010 (Rev. 3/78)
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 204-4111
June 25, 1979
Robert H. Padgett
% GAllery of Homes
1709 Bragaw Street
Anchorage, Alaska 99504
Subject: Lots 11 and 12 Block 7 Elmo~
Edna Sharon/Littleton Frank~roperty
Approval for the individual sewer and water facilities will
not be granted until the following items have been completed:
(~ A well log is submitted to this department.
(~. The water analysis report be delivered to this office
~ from Chem Lab, 5633 B Street, for our review.
(~ The septic tank be pumped with a receipt submitted to
this office.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
CC:
Peoples Bank and Trust Company
Mortgage Loan Department
Pouch 7-007 99510
C) GREATER '
ANCHORAGE AREA BOROUGH
/~ Department of Environmental Quality
/,,' "C" Street, Anchorage, Alaska 99503 274-4561
~330
1. Approval requested by:
J~' Mailing Address:
2. Property Owner: ~
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Phone: '~'-'1 C~ _ .~,._%/q ~..~.,
Phone:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
No. of bedrooms
Well Data:
A. Type ~'
C. Construction
7. Sewage Disposal System:
B. Depth ~
D. Bacterial Analysis
A. Installed
B. Installer
C. Septic Tank: 1. Size / ~-f-~ 2. Manufacturer
D. Seepage Pit: 1. Absorption Area S~70 2. Material
E. Disposal Field: Total length of lines "''
8. Distances:
A. Well to: Septic tank l~ 2 t, Absorption area
/o~/ I Sewer Lines
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (I/74)
Page 1 of two pages
GREATER ANCIIORAGE AREA BOROUGIt.
Department of Environmental Quality \\'.~o
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
1. Type of Inspection: CMRO
2. Property Owner: /, ~..(~f
.~.$ai.l ing Address:
3. Name of Buyer:
VA FHA
CONV
Mailing Address: Day Phone
Mailing Address: Phone
Name of Realtor or.Agent:
e
Location:
Type of Facility to be inspected:
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
No. Bdrms.
Individual
presently served
Individual {on-site)
Eq-037 (1/74)
