HomeMy WebLinkAboutABBOTT LOOP MANOR BLK 1 LT 12Onsite File
Abbott Loop
Manor
Block 1
Lot 12
#014-181-12
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
CONNECT PERMIT
WATER & WASTEWATER UTILITY
3000 ARCTIC BOULEVARD
PHONE 277-7622
LOT/TRACT
SUBDIVISION
DATE OF APPLICATION
SCHEDULED COMPLETION DATE
SINGLE FAMILY
MULTI -DWELLING
No. APTS_
COMMERCIAL
BLOCK INDUSTRIAL
i°
TAX CODE ' GRID
BUILDING ADDRESS
OWNER -
MAIL ADDRESS a
CONTRACTOR: -r—
(License & Bond required)
k'ON PROPERTY ONLY
MAIN TAP—TO PROPERTY LINE ONLY
(MOA or State ROW Permit Required)
L:., MAIN TAP & ON PROPERTY CONNECT
(MOA or State ROW Permit Required)
CONNECTION SIZE
INSPECTION
PERMIT
REIMBURSIBLE
NUMBER
REMARKS.
CHARGE $
FEE $ _
FEE $ _
DEPOSIT $ _
TOTAL $
M
DRAWING No.
_ _` PHONE
ASSESSMENTS
Paid previously
Main extension agreement
Subdivision agreement
❑ Extended connect agreement
I Pending—AMOUNTS __ __
PERMIT ISSUED BY;
PAI -CASH
L 1 CK#—
JYLCTED BY_:
DATE; C_ ?
I
PERMITTEE (Please Printf _ __ _ _ - MAIL ADDR. _
PHONE _
I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE I
TO COMPLY WITH THEM.
PERMITTEE SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
80.021 (10182)
AWWH INSPECTOR
LU
J
J
LU
w
cc
N
LU
Z Z
i Mna:IW WrIl I''I=IACAJi W:IAA74Z
F
0
w
J
U
=w
w0
Y =
W Z
Lu
z
J D
wcc
U�—
> z
c
W
(n
cc Li
wQ
w 0
(n
0
J
0
V]
CONNECT PERMIT 83 8226
WATER & WASTEWATER UTILITY
3000 ARCTIC BQU EVARD
PHONE WAAW 265-5557
DATE OF APPLICATION 9/29/33
SCHEDULED COMPLETION DATE
11SINGLE FAMILY
- MULTI -DWELLING
No. APTS
COMMERCIAL
LOT/W= _-3? _ BLOCK 1 - INDUSTRIAL
SUBDIVISION _ Abbott Mawr
TAX CODE 014-181-12 GRID 2233_ _ _ DRAWING No. now
I
BUILDING ADDRESS _ Adobe Urine
OWNER Rare" KOVSCS - - -- -- PHONE _
f MAIL ADDRESS 7631 Adobe 99507
CONTRACTOR: Peninsula ASSESSMENTS
(License & Bond required)
L Paid previously
i ON PROPERTY ONLY C Main extension agreement
i
MAIN TAP -TO PROPERTY LINE ONLY L Subdivision agreement
(MOA or State ROW Permit Required) Extended connect agreement
MAIN TAP & ON PROPERTY CONNECT Pending—AMOUNTS
(MOA or Stage ROW Permit Required)
I
CONNECTION SIZE
INSPECTION
PERMIT
REIMBURSIBLE
NUMBER
V CHARGE$
_ —FEE $ RSC
FEE $
DEPOSIT $
'ERMIT ISSUED BY:
jrii�- -
CASH
AS H
-- CKO
INSPECTED BY:
TOTAL $ N/C _ I DATE:
REMARKS.
WaQ, f0382 -42171-3152A
PERMITTEE (Please P►iniy
MAIL A€3DR.
PHONE—
I HAVE READ THE CONDITIONS AND REGULATIONS ON THE REVERSE SIDE OF THIS PERMIT AND AGREE TO
COMPLY WITH THEM.
RERMITTEE SIGNATURE
POST IN A_CONSPICUOUS PLACE AT THE JOB SITE
80-021 (10182) AWWU INSPECTOR
U
0
an
0
V)
m
}
W
J
a
i9or
LU
❑0
Z Z
laQd3a N01133dSN! 83M3s
W
z
J J
wa
t� r
>z
�o
(n�
c❑
W
w0
0
r
en
°' [ ~ MUNICIPALITY OF ANCHORAGE ~ ~ //
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
Well
Depth
Building foundation
[~PGRADE
W dth
NO. OFBEDROOM~
No. of compart~s
Liquid depth
PERMIT NO.
IMaterial
Nearest lot line
Trench wldth
Liquid capacity in gallons
Foundation PERMIT NO.
Total length of lines Distance between lines
inches
Material beneath tile Total effective absorption area
inchss
Depth
Crib depth
Building foundatlo~ ~)
Driller
; Sewer line
PERM,T NO. '7~'O~2-
, Total effective absorption
Nearest lot line
OTHER
PiPE MATERIALS
O,LTEST.AT O
Y
,NSTALLER
PE.M,T NO. '7
Absorption area(s)
APPROVED3~ DATE / LEGAL
72-013 (Rev.
r'IUN I C I ('~L I TY OF Rr4C-_-H~:RGE
DEPARTMENT OH HEALTH AND ENVIRONf'IEHTAL PROTECTION
825 'L' ~TREET, ANCHORRGE, RK.
264-472~
I,.IELL Rr-ID
PERHIT NO. < 788682 )
APPLICANT ' HOHRRD HEDE
LOCATION ADOBE DR
LEGRL
Ot4--S I TE SEI--IER
7631 ADOBE DR
PERI'I I T
-?-49
L12 Bi ABBOTT LOOP MANOR
LOT SIZE
0 SOURF:E FEET
TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH
MRXIMUr'I HUHBER OF BEDROOriS = 3 SOIL RRTING <SQ FT/E:R)= 150
THE REO. UIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DP~c'~--P,~f. I_~,
DEPTH= Ii LEf4GTH=~--~1 GRR%-'EL DEPTt4= 7
L.~ JS~
THE LENGTH ~Z~ENSZON ZS THE LE~IGTH (IN FEET) OF THE TRENCH OR
THE DEPTH OF ~ TRENCH O~ PIT ]S THE DISTANCE BETWEEH THE S_IRF~Ce OF THe
6~OUND ~Nd THE bOTTOM OF THE EXCaVaTION (IN FEET).
THE~E ]~ HO SET W~TH FOR TRENCHES.
THE gR~VEL DEPTH ~S THE H]N]~UM DEPTH Of gR~VEL ~ETWEEN THE OUTF~LL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQLi I RED SEPT I ¢ TRI'-.II-.-. S I ZE= "i 000 GiRLLO[-IS
F'ERMIT APPLICANT HMS THE RESPOMSIBILITY TO INFORM THIS DEPARTMENT DLIRING THE
INSTALLATION INSPECTIOrIS OF RHY HELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE HELL WILL SERVE.
TL40 < 2 ) INSPEOT I Of-IS RRE REQIJ I RED
BRCKFILLIHG OF ANY SYSTEM WITHOUT FIHRL INSPECTION RND RPPRO",,'RL E:Y THIS
BEPRRTMEHT HILL GE SUBJECT TO PROSECUTION.
MINIHUM DISTRHCE BETWEEN R HELL AMD RHY OH-SITE SEHRGE DISPOSRL SYSTEM IS
100 FEET FOR 8 PRIVATE WELU OR
150 TO 200 FEET FROM R PUBLIC WELL DEPENDIHG UPOH THE TYPE OF PUBLIC [.!ELL.
HELL LOGS ARE REQUIRED AND HUST BE RETURNED TO THE DEPRRTHENT WITHIN -~0 DAYS
OF THE WELL COMPLETION.
OTHER REOUIREMEHTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRHS PRE
RVRILABLE TO INSURE PROPER INSTRLLRTIOH.
PERF'I I T EXP I RES DECEFqBER
I CERTIFY THRT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPALITY Of ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM I'IRY REO. UIRE ENLRRGEMEMT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRH ~ BEDROOMS.
APF'LICAr~T HOHARD HED~ ~'
'v' Z<.. 2
unlc pal ty
o¥
Anchorage'
PO b..I-t 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit ~: 840283
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 12 Block 1 Abbott Loop Manor Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
$ipcerely,
Keith E.
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
PEAr.lIT NO:
DATE ISSUE[.',:
84028-~
05/'0.~784
RPPLICRHT: KRR~N R.
RDDRESS: 76~1 RDOOE
ANCHORAGE., RK 9-~. 507
LEGAL DE$CRIP:
LOT SIZE:
SUBDIVISION: ABBOTT LOOP MANOR LOT: 12 E:LOCK: l
SECTION: 8 TOHNSHIP: 12H RANGE: ~L,I ~
l~ (SQ. FT. OR ACRES)
I CERTIFY THAT
1. I RM'FRr'IILIRR NITH THE REQUIREMENTS FOR ON-SITE SEHERS AND NELLS RS SET
FORTH BY THE MUNICIF'RLITY OF ANCHORAGE (MOA> AND THE STATE OF ALASKA.
2. I HILL INSTALL THE SYSTEM IN RCCORDRNCE HITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE HITH THE DESIGN CRITERIR OF THIS PERMIT.
I HILL RDHER[ TO RL~ MOA BND STATE OF RLRSKR REQUIREMENTS FOR THE SET BACK
DISTANCES FROH ANY EXISTING HELL, NRSTEHRTER DISPOSAL SYSTEM OR PUBLIC
SEHERRGE SYSTEM OH THIS ~N'~ R~RCEHT OR NERRBY LOT.
...........
August 1, 1970
United Bana of Alaska
645 G Street
Anchorage, Alaska
SubJect~ Lot 12 Block I Abbott Loop Manor
Temporary approval may be granted if monies arc escrowed for
the following ~
1. Ralocate the s~wer system and well so that there is a
100 foot seperation between the two.
2.- Xnsta11 a 1000 gallon, 2 compartment septic tank.
3. ILxcavate 33 feet to a depth of 11 feet, backfill with
7 feet of 1/2 ~nch to 2 1/2 inch screened gravel.
All the £tem= mentioned should be completed by August 30, 1970.
A permit has been issued for all of the above items.
Sincerely,
Robert C. Pratt
Sanitarian
RCP/daa
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 014-181-12
1. GENERAL INFORMATION
Expiration Date:
Complete legal description ABBOTT LOOP MANOR BLK 1 LT 12
Location (site address) 7631 ADOBE DR, AN -CH AK
Current property owner(s)
Mailing address
Real estate agent
TOMMY OSWALD
SAME
2. -TYPE OF DWELLING:
F Single Family (w/wo ADU)
El Duplex
0 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well nX Private Septic r_1
Water Storage El Holding Tank FJ
Community Well El Community F1
Public Water System n Public Sewer F1
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ Waiver Fee $
Date of Payment toj�QV Date of Payment
Receipt Number 0106,57 Receipt Number
COSA # 0 5 ca 11 -7 0 -7 Waiver #
6. 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, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727_8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 12-9-21
6. DSD SIGNATURE
N% System #1 Approved for 4
System #2 Approved for
Disapproved
Conditional approval for
Isf
bedrooms
-,%P MICHAEL N. ANURSC,I ;1`=
bedrooms ¢� •,• CE_9149
r.
\ ^ e
�'Pui c�'`
bedrooms, with the following stipulahtbl¢-�.�-��
\`�(y OF q j�C�/r��i
7
S� VC)w sup
�rr
Q
.�
Z WATER AND
o WAST +-v' o
A8Y= Original Certificate Date: O'k d 0 2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: ABBOTT LOOP MANOR BLK 1 LT 12
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled `UK
Total depth ,«184 ft
Cased to UK ft
❑� Sanitary seal is functioning correctly
Q Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 4/15/21
Static water level at beginning of test 50 ft.
Comments ` MOA doc show 1971? "measured 120'
B. TANK DATA
Age of tank(s) _ years
Tank type/material _
Measured operating fluid level in septic tank
a Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA 'AWWU SERVICE
Which system tested (date installed) _
X ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 014-181-12
Structure served by this system _
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑E No
X Coliform bacteria is Negative
Nitrate mg/L X Nitrate less than MRL (ND)
Arsenic ug/L S Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 11/15/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material _
Comments:
Adequacy test date _
Results ❑ Pass For _ bedrooms
Fluid depth prior to test in
Water added _ gal
New depth _ in
Elapsed time _min
❑ Code -required soil cover over field Final fluid depth _ in
❑ System presoaked Absorption rate _ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: ' SEE AW WU CONNECT CARD ATTACHED.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑ Yes if No _ ft 0 Yes if No _ ft
Neighboring Tank > 100'✓❑ Yes if No _ ft Private Sewer/Septic Line > 25'El Yes if No _ ft
Absorption Field on Lot > 100' ❑ Yes if No—ft Holding Tank > 100' ❑✓ Yes if No ft
Neighboring Absorption Fields > 100'
v❑ Yes if No ft
Community Sewer Main > 75' El Yes if No ft
Animal Containment > 50' 0 Yes if No ft
Manure/Animal Excreta Storage > 100'
❑✓ Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No _ ft Surface Water > 100'
Property Line? 5'
Absorption Field > 5'
Water Main > 10'
Water Service Line > 10'
❑ Yes
if No ft
❑ Yes
if No ft
❑ Yes
if No ft
❑ Yes
if No ft
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
❑ Yes if No ft
❑ Yes if No _ ft
❑ Yes if No _ ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑ Yes if No _ ft If absorption field is under driveway comment below
Property Line > 10' ❑ Yes if No _ ft Wells on Adjacent Lots:
Water Main > 10' ❑ Yes if No _ ft Private Wells > 100' ❑ Yes if No_ ft
Water Service Line > 10' ❑ Yes if No —ft Community Wells > 200' ❑ Yes if No ft
Surface Water > 100' ❑ Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / 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.
COSA Checklist yellow sheet
�. TCE-94 9
y+�,
i.wj`.^� �91CH�'cl £iJ Art, •r:SC� rt
n ^ r
LOT 13
Sip '25'37"SA SIS DF BARRING
107 .72,
x�x xM
CV
N
~ U71LITy ESM 7-
®
VEILCri
"t20'—
N LO J
rs .
N ^7'
Z�x
1
' 14.
c�
ry
LOT 12
BLK 1
�r
e*/S
H0�SE c
s6-
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
ABBOTT LOOP MANOR
LOT 12 BLOCK 1 PLAT: P -647A
SURVEY CERTIFICATE: Z, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences.
structures, improvements, or for estab€ishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBO: BATE SCATS. �U11t1
DEC 10. 2021 1 1"=30' echun�rW� not
21 —158 NATM BT artaam Boat ALS
JLS SW2233 220105
VL
`Aw
or
�!
49TH
..�.....................L.�
-.JW L. SCI ULLER.-
LS -10408
= FN❑ CENTERLINE MON
= FN❑ 518" REBAR.
0
�'pt� ND
r
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227--1455 office
(907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOn*'
~25 L Steer * A~m~, A,~m 99~01
ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
)IRECTIONS: Complm all parts on peoe 1. Jnitomplete ra(lUgfl~ will not be precelled. Please alSow ten (10) days for pr~if~.
I1. 'ROPERTYOWNER ~4~E~,~ ~
I MAILING ADDRESS. · ~.
SINGLE FAMILY [] One ~ Four I'-1 Other__
Five
MULTIPLE FAMILY [] Six
7. WATER SUPPLY
~ INDIVIDUAL*
i'-I COMMUNITY
I'-t PUBLIC UTILITY
&$EWAGE DIEIN3SAL SYSTEM
...... '~ iNDiViDUAL/ON.SiTE T*
[] PUBLIC UTI LITY
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For Wells drilled prior to that date, give well
depth (attach log i~ ~vailable.)
**If individual/on-site, give installation date
-If system is over two (;2) y~er$ old an adegltlacy test |$ required _
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
~' ' THIS SIDE FOR OFFICIAL USE ONLY ~;. -..
DATE RECEIVED · ·
INSPECTION APPOINTMENTS
i TIME TIME TIME
' DATE DATE DATE
INSPECTOR. INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
r-1 SINGLE FAMILY I--I ONE [~ THREE [] FIVE I"'] OTHER
[] MULTIPLE FAMILY [] TWO r-i 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
[-'1 INDIVIDUAL/ON -SITE DATE INSTALLED
[] PUBLIC UTI LITY
Connection Verified
iNSTALLER
f--ISeptic Tank or r--IHoldingTank
Size: If Tank is homemade SO~LS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL A~SORPTION AREA MATERIAL
'4. DiSTANCESwELL TO: SePtic/Holcling Tan k IAb~orptlon Area [Sewm' Lirm [ Neete~ Lot Line
Ab~gptio~ Area to nearest Lot Line
5. COMMENTS
/ PF.OVEO FOR -,- BEO.OOMS
CONDITIONAL APPROVAL (fetter must accompany certificate)
r-I DISAPPROVED
DATE ~--~-~')~ BY(Title)
LEGAL DESCRIPTION
72~)10 (Rev. 3/78)
Gcto~er 12, lg7~
15~3 Tudor
Anchor&ge, Alaska
Subject: Lot 1Z, Dlock 1, Abbott Loot Banor,
Deer Ers. Drakes:
revealed thlt the sewer
An inspection of the cubtect ~roperty
D~ceusc of thc clOSe proximity of
because a cesspool alone ts not an approve~ sewer syste~ this
Oe~artment man neither give its approve1 for the Sewer nor the
water systems.
If you have amy questions r~gerdtng the above, please do not
hesitate to contact this office.
Sincerely,
Lynn S. Coed
£nvtronmentel Srectallst
cc: George RInkevtdge
VA Administration
st
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
APPROVAL
ADDRESS:
/ _...--/
PHONE:
2. PROPERTY
3. LEGAL DESCRIPTION:~?_~'~/,~
4. TYPE FACILITY TO BE INSPECTED:
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE
DEPTH /,,~:'/'
C. SIZE
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) /
1. SIZE
2. AGE '~
3. MANUFACTURER
4. INSTALLER
.A~PROVAL REQUEST FOR SEWER & WATER FACILIT-iES
P.AGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
7. REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL
F.
G.
H.
8. COMMENTS:
TO OTHER POSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEEPAGE PIT TO PROPERTY LINE
APPROVED:
DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY