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Municipality of Anchorage y • ; we
Development Services Department
Building Safety Division s . ...
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: -,S'Lk)03 G 2 j'Q"Z PID Number: -5-G, ^ 74�? Z)-27
Name:
Wastewater System: New ❑ Upgrade
Address: '2 0571 I %T4 �� ;3LvQ �2 9F=
ABSORPTION FIELD
Phone: Number of Bedrooms:
v
❑Deep Trench Shallow Trench ❑Bed ❑ Mound IDF ❑ Other.
LEGAL DESCRIPTION
Soil Rating:
ZI-A
Total Depth from original grade:
S
GPDIFF
Ft.
Block: Lot: nn�ICj Subdivision: 1
���✓� �fi�
( 0�
Depth to pipe bottom from original grade:
3,. S Fl.
Gravel depth beneath pipe:
Z Ft.
Township: Range: Section:
Fill added above original grade:
/
Gravel Length:
//jj
; S Z 7
Ft.
Fl.
�.Sc�//lS
Well: L ❑ ew ❑ Ograde
Gravel width:
S
Number of lines:
Distance between lines:
FL
_2
Classification (Private, A, B, Cp
Total Depth:
Cased to:
Total absorption area: 7
� �
Pipe Material: FlFlfi
FL
FL
F1'
Driller.
Date Drilled:
Static ater Level:
Installer.
?IC#4pb Pr_(,Zsso W
Date Installed:
S � C:)
Ft.
Yield:Pump
Set at:
casing Hei t Above Ground:
TANK
GPM
Fl.
FL
SEPARATION DISTANCES
P Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
Public/PrivateManufacturer.
Capacity:
From
Tank
Field
Station
Tank
Sewer Line
(� �!%fK�
QO G.I.
Well
��`` 1
/06 r%
t' 06 l"f'
..�
----
�5
��V 7�
Material: �C
� ( lam(
umber of Compartments:
Surface Water
�Gr6'�"
loo's
_
LIFT STATICA
Lot Line
Z 6 f4—
0
--
Size:
Gal.
Manufacturer.
Foundation
��(( i
/ U 'f'
I
�d r('
�
'Pump on' level at:
'Pump off level
High wal alarm at:
!
in.
in.
in.
Pump Make Model
Electrical V.specticns ped; ed by:
Curtain Drain
Remarks:
�Gr�c �� 16'N
BENCH MARK
i7 0
��1
Location and Descrpticn:
ENF• ..—: Icieo�(( C F Cd2+.Y-A
ri %
H( Es �K C:L�,j L,,j JT'1 X68 Q I rQ
Assumed Ft.
UG G O Q i LL ci
0 41
AIV
* 49 �H =
.... ..
�
�ivr� E st
Inspections performed by: lVor l �'!f �irree% Dates: 1 5' / 9 0�....•,.,...s
2io-
nd /
i" ••�it.Oeise • a te.-. .. . s.
9n`:.
Development Services Department Ap roval
Reviewed and approved by: Date: ��-1"
Steven Eng 4'r
Od��••• PE 6256 •�.' ��
_ v
f�i�fi4�•••'•••"'� P� *�+
pROFES5�ON"
(Rev. 12/00)
MUNICIPALITY OF ANCHORAGE ' '
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESC.~ PTI.ON ~:~.~ ~-~
· PHONE E]NEW
IEDROOMS
Absorption area i Dwelling PERMIT NO.
DISTANCE TO:
Manufacturer Material No, of compartments
Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth
Well PERMIT NO.
DISTANCE TO:
Liquid caPacity in gallons
DISTANCE TO:
Length of each~p~)
Foundation Nearest lot line t PERMIT NO.
Total length of lines Trench width
· of tile to finish grade
Material beneath tile
Length (;~p ;h PERMIT NO.
DISTANCETO:
Suitding foundalion Nearest lot
DISTANCE TO: I~uildlng foundation Sewer line Septic tank
I OTHER
PiPE NtATERIALS
I SOiL T T~RA/~Ti.i~G
INSTALLER
REMARKS~
APPHOVEO
72-O1;J (Rev/~/78)
DATE LEGAL
PERMIT NO.
rqUr~I ¢ I~"~AL I TY OF
DEpART~IENT~ ~HEALTH AND ENVIRONMENTAL .~OTECTION
825 'L; STREET, ANCHORAGE, AK.
264-4720
O~--SITE SEI~ER UPGRADE
( 810235 )
APPLICANT JOhN E. THOMPSON 6005 HREN LAND
LOCATION PTARMIGAN ST. E.R.
LEGAL L2'P~- EAGLE PARK LOT SIZE
TYPE OF S ABSORPTION SYSTEM IS: TRENCH
6~-2852
43500 SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING <SQ FT?BR)= 125
THE REQUIRED SIZE Of THE SOIL ABSORPTION SYSTEM IS:
DEPTH= 12 LE~GTH= 25 GRA~'EL DEPTH= 5
THE LENGTH DIMENSION IS THE LE~GTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINI~IUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
RE~.U I RED SEPT I O tAf4t4 S I ;'E= 1OOO 6ALLOr4S
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM.THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TI-40 ( 2 ) I I'-.ISPECT I ON--c; ARE REQU 'ir RED
BRCkFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRf'ICE BETWEEN A WELL AND Af-JY ON-SITE SEI4AGE DISPOSAL SYSTE~I IS
100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTR~ICE FROM A PRIVATE WELL TO A PRIVATE SE~IER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LI~E IS 75 FEET.
OTHER REQUIREMENTS ~IAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERMIT EXPIRES DECEMBER
I CERTIFY THAT
1: I Ar4 FRMILIRR ~IITH THE REQUIREMENTS FOR ON-SITE SE[,~ERS AND WELLS RS SET
FORTH BY THE MUNICIPRLITY Of ANCHORAGE.
2: I t. JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEI4ER SYSTEM MAY REQUIRE ENLARGEMENT If THE
RESIDENCE IS REMODELED TO INCLUDE MORE THR~.J 3 BEDROOMS.
S I GNED: ...............
APPLICANT JOHN E.
ISSUED BY .......
THOMPSON
V4. 0
par ' : Health and Environmenta£ rotection
L Street, Anchorage, AK. 99501
264-4720
* * HANDWRITTEN PERMIT * *
~'~M~/0R ON-SITE SEWER PERMIT
Applicant: ~O~A)~. -7-/gDr~r~/q Mailing Address:
Phone
Location:
Type of Soil Absorption System Is:
Trench: / Drainfield: Seepage Bed:
Lot Size:
__Holding Tank:
Maximum Number of Bedrooms: % ~ Soil Rating(sq.ft/br) /~
The Requi~ed Size of the Soil Absorption System Is: '
DEPTH /,.Q,- LENGTH .D~ ~ . GRAVEL DEPTH ~ WIDTH'
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /O~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection.and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from ~ public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper.installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 i * - '
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3.bedrooms.
Applicant
SWP/024(1/81)
· er ifiei Drilling * og
by
A & L DRILLING COMPANY
8OX97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694.2588
DEPTII OF WELL 7J ! ~/!
STATIC LEVEL OF WATER FT. ~%/ I
I
DRAW DOWN FT. Id)
GALS. PER IIR 7~°
K~ND OF CASINO 6gOO
KIND OF FORMATION:
From O Fi. to / ,Ft.
From I rt. to--Ft.
From , ,
From [ ~ Ft. to c~O Ft.
From ce)O Ft. to'7O Ft,
From 70 Ft. toTZ~' Ft.
From Ft. to Ft.
From__Ft. to Ft~~
From__Ft. to Ft,
From Ft. to Ft.
From Ft. to " Ft.
From Ft. to Ft.
From__.Ft. to Ft,
From__Ft. to Ft.
From Ft. to Ft.
From Fi. to Ft.
From__Ft. to Ft.
From__Ft. to__Ft.
From__Ft. to Ft.
From Ft. to Ft.
From ' Ft. to Fi.
From__FL to__.Ft
From Ft. to Ft.
From Ft. to Ft.
From__Ft. to Ft.
From__Ft. to Ft.
From__Ft. to Ft.
From__FL to__.Ft.
From Ft. to Ft
From Ft. to Ft
From Ft. to Ft.
From Ft. to Ft.
From.___Ft. to Ft.
From Ft. to Ft.
MISCL INFORMATION:
,~,~ 0,~,,~,o~'~o
DRILLER'S NAME
PERMIT NO.
DEPRRTMEHT ~ "HEALTH AND ENVIRONMENTAL OTECTION
,~ ~510 E iUDOR RD. , ANCHORAGE, AK.
276-2221
WELL AND Off--SITE 5EWER PERrqI~ [ i~.
APPLICANT
LOCATION
LEGAL
JOHN E THOMPSOt'~ PSC2 BOX 3693 APO SEATTLE 9874 274-0772
L9 BLK 2 EAGLE PARK S?D E?R
SAME AS INSTALLATION LOT SIZE 45000 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TREHCH
MAXIMUM HUMBER OF BEDROOMS
SOIL RRTIHG
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= '1:::' LENGTH= :~:8 GRRVEL DEPTH= 5
THE LENGTH DIMEMSION IS THE LEMGTH (IN FEET) OF THE TREHCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS HO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MIHIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AHD THE BOTTOI'I OF THE EXCAVATION (IH FEET),
REI~U I RED SEPT I C TAt~.-. S I ::~'E= '4 000 GALLON5
BRCKFILLIHG OF ANY SYSTEM WITHOUT FINAL IM~PECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUH DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I~
i00 FEET-FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPRRTMEHT WITHIW ~ DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIRGRRHS ARE AVAILABLE TO INSURE PROPER
I NSTRLLRT I ON.
PERM I T VRL I D FOR Ot,~E ~r'ERR FROM
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
RESIDEHCE~S/R~MODE~DE MORE THAN ~ BEDROObIS.
G I GNED: ~ ~ _ ~~-~- ~~ ....... /APPLIT~OHN E THOMPSON
~5 - m.: (~5) .
ground water cncou:lLured? .~'_o ........ If yes, aL %~ilaL des, Ch?
Roadinq DaLe Gross Time I.IeL Time OcpLh to W,Ie,. Not Urop
::::':..::: ::-::::.: !!!!!~:_~'!i:!!:._:.:..' !'-.'.'.!!!!!:.!!'i':-: i~!!~:-~57, i'!,i!'!::::' ·
~i!51~i-i!!_ii:_iii.'- i'iii'ii'ii?_-'_Si:Sii' : · '-:
~,;;ec'oT.,'~-r~W ¼-~'~ ................................... J ..... - ......... 7]: -:'.': :.. :~ 2:.17. '
· Ini till LC.
I'roi,o~ ed.. i,,s La I laiTY'n:' '".'>~i'i)7!lC I'i t lira i,, fie 1 d ' '
' ' dF'ti i i'(dJi~i~¥ .................
· 'J~:JJ~,Jl I) f hdeL ";el)
................ · ), pit. or Lr(,m:i. ""
f(".J~ ,,L,""'rr'i.). - .........................
,.;.~,:,-o.~,,:...,, ,;~'.-'~~,X..~.',.:,:~.,','~',;..:,' ',:~':~ZU. ~~',;..'~'z,,,:~:~:
I~(~ II,HI (~;/7.1) P~ichar. A. Drahn, P.E. . ' Oichard I. Drahn, P.E. ·
SHEET NO, OF
CALCULATED BY .DATE
CHECKED BY .DATE
SCALE
As certified by my seal affixed hereto and oanfthe validation date shown below, |verify that myinvestigation,
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.
Name ofFirm Douglas 7.Kenley, P.E.
Address 9800ENorthmaCircle, Palmer, Alaska �
Engineer's Printed Name Douglas TKenley
5. DSD SIGNATURE
Disapproved.
Conditional approval for
bedrooms.
Phone (907) 746-1073
with the following stipulations:
xKi'l'^.
Attachments:
CO8AChecist
ArsenicAdvisory^
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date
(Rev. 11105)
WATER AND
WASTEVAI ER 'F
PROGRAM
Attachments:
CO8AChecist
ArsenicAdvisory^
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date
(Rev. 11105)
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. If
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~/) 7 ~ ~ ~ ? HAA # ~-IO~, -f-~ ~ ~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
407' ~ ~cl~ Z. EA~I~/.~,~/e/~ ~u~zP. $ /'1;
Location (address or directions)
(b) Property owner m~,~A ,~ ~o~ t~.~kA~ Telephone: (home) ~Business ~'?/'" ~"~?
MailingAddress ~,o~. ~'rA~t~A~ ~A~I~IV~ ~ ~
(c) Lending Institution ~mm~e~J~k ~ ~. Telephone 278-~ Z~?
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
~;Ck--_ lie-.. (~ C,o ,,, ,,,o,, ~//~ ~/.~
2. TYPE OF RESIDENCE
~ Number of bedrooms ,~
Single-Family
3, WATER SUPPLY
Well ~ Community cI Public []
Individual
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site'~ Public [] Community [] Holding Tank [3
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
Page I of 2
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 o.f this inspection.
NameofFirm ~/Ob~.-I'Z$o..J -~'~O,O(~-"~t.d/. Telephone ..~£7- ~-~,7
Address
Date
Engineer's Seal
6. DHHS APPROVAL
Approved for~,'~'?~edrooms by
Approved -~ Disapproved
Terms of Conditional Approvai
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval
cerificated 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 cf 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
A. WELL DATA
Well Classification
Well Log Present (Y/N) }/ . Date Completed
Total Depth?S'~" Cased to
Static Water Level 5"J'
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
To Nearest Sewer Service Line or~ Lot
Water Sample Collected by A.
Water Sample Test Results SA-;'t'~
Comments tx) Ell
~ MUNICIPALITY OF ANCHORAGE (MOA)
~qr,,;~L;~ OF ANO~ Authority Approval (HAA)
~,~:"~l~P HEAL1H ~:HECKLIST - FEBRUARY 1984
ENW~NTN. PRO~C'~O~r . 343-4744 . -
DFC ,5 1~8B Legal Description: ./_~7"
RECEIVED
If A, B, C, D.E.C. Approved (Y/N)
Il'/~/- ?& ' Yield ~
Depth of Grouting NO ~ou~'~
Pump Set At ~'
· Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots '1
~ ~G' ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole ,.~, ~.:.
/~'E'
; Date
SEPTIC/HOLDING TANK DATA
Date Installed //-/o- ~(, Size
Standpipes (Y/N) ' Y Air-tight Caps (Y/N)
Depression over Tank (Y/N) FJ
Pumpir!g/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) _
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:'
To Water-Supply Well /~,~ / To Building Foundation
To Property Line 4~O' .' To Disposal Field
To Water Main/Service Line
No. of Compartments
' ~' FOU n d at io n..~.u ! ('~).,~
Date Last Pumped C2. -./_~)
; for ~--/-'/~,
Temporary Holding Tank Permit (Y/N)
F
/6'
To Stream, Pond, Lake or Major Drainage Course
Comments ,,V*ax/,~"- /,v -~W'~',,g '
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Datelnstalled //-/~-?~ c,,','~
Width of Field ~'
5"o,~/ u'.~r~,O,r Length of Field
Square Feet of Absortion Area 7.~
Depression over Field (Y/N)
Results of Last Adequacy Test
Type of System Design
Depth of Field -. Iz.'
Gravel Bed Thickness .5' '
Statndp'ipe~ Present (Y/N)
Date of Last AdequacY. Test
Y
SEPARATION DISTANCE FRoM ABSORPTION FIELD:
To Water-Supply Well ' '~ O'
TO Building Foundation ,.~?'
Lot ,vo ¢'r'~g ¢..~ LoT'
ToWater Main/Se~ice Line ' /~e ~
To Property Line ~/
To Existing or Abandoned System on
; On Adjoining Lots /~,o' f
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ,,~,,~ e. /,,~ ~ ~-------------------~
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~?,~-~,h'e,~, =;,u,sle~ uo~-~ R~c'/e~'n~
Size In Gallons-'""'"'"'~ ~
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
.... Pump Off" Level at
Vent (Y/N)
~ ~,,~umping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection·
Signed ?9~,~,t t~
Company ~J ~0~
Date / '/~/~ ~ ff. ~j~ ~ ~ ~' ~ Engineer's Seal
MOA NO.
Receipt Nc
Receipt No.
Date of Payment
Amount: $
(Rev. ?/88) Back
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92~040440
AEALY3I$ [[~O[T BY SAMPLE for #ork O~der ! 10604
Date Report P:tnted: ROV 29 83 I 17:30
Client sample IC:[9. 12, 115[I PAiR $/U
Collected ROV 22 88 ~ 17:00 h~e.
Received ROV 23 ~3 ~ 0~:$9
P:.ee~v.d vtth :ROI~
Client RaM : [O~[IO[C CO~.
Client Acct:
~eq I
Analysts Completed :ROV 23 B8 sand [oporto to:
Spect&l RO[C POI HC[
I~t~uct:
Cho~ab lei !: 3539 Lab Sap1 lC: I htzix: WATER
Allowable
~ezeMter Tested Result/Units NoShed Limits
RITIATI-¥ 1.9 m~/l EPA 353.2 10
Sample ROUTIEE SAMPLE
BeMzks= SAMPLE COLLECTED BY AH
Tests Performed * See $psctal IMtzucttona Above UA-Unavailable
Rona Cetectod ** See Sample leMzks Above'
9-22-88
ANDERSON
ENGINEERING
P.O. Bbx 240773
Anchorage Alaska '99524
90'/ 337-8367
Commonwealth Mortgage Co.
3333 Denali Street
Anchorage Ak. 99503
Attn: Michelle
Re: L9 B2 Eagle Park Subd. - 6032 Ptarmigan
Dear Michelle,
The on site water and wastewater systems for the subject property were inspected
and tested on Sept, 21, 1988. Both systems are in compliance with regulations of
the Municipality of Anchorage.
The absorption characteristics of the sewer system have improved slightly since
testing last occurred in February which makes the system adequate for the three
bedroom dwelling. The volume of water in the well also is adequate.
It was noted, and brought to the owners attention, that a leak in the well piping
was causing the pump to operate more than required and should be corrected. This
could be causing air in the water system which the owner had recently noticed.
A copy of this letter is being sent to the Municipality of Anchorage for their
records, If you have any further questions regarding the systems please contact
me at 561-5829.
Yours.Truly,
L. Wayne McFadden
cc: MOA/DHH$
MUN C PAUTY OF ANC,O.^GE O 5'0 '1
DEPARTMENT OF HEALTII AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~..~(~ - ~____~""[ ,~
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lo'r ~ 1~4.oc~ z. ,~Ar=~ r~AJ~ 5d~. .5' /7/ /"/',/.'~'
Location (address or directions)
Applicant Name _.~TJ~ ~, I1~. Telephone: Home ~o7.) 337-/-.,/$7 Business
Applicant Address ~_~-,~t'
Applicant is (check one): Lending Institution []; Owner/builder [~i~; Buyer I-I; Other [] (explain);
(b)
(c)
(d) Lending Institution (~ommo~ i.,JE'AI..TI4 mor~"r-~44-------------------~. Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone G~q' q~O0
(f) Mail the HAA Io the following address:
TYPE OF RESIDENCE
Single-Familyl~ Multi-Family[]
Number of Bedrooms ,~
Other
WATER SUPPLY
Individual Well ~ Community [] Public []
Note; If community well system, must have written confirmation lrom the State Department el Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite{~ Public[] Community[] Holding Tank[]
Note: II community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 ?2-025 {ll.84)
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 Item 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.
Name of Firm
Address
Date
Telephone
Engineer's Seal
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does Ihis as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
E'A~Z _~ P.4 ~'~'
Well Classification
Well Log Present (Y/N) * /~/
Total Depth ?-~'~'" Cased to
Static Water Level .5"$'
Casing Height Above Ground /~
Electrical Wiring in Conduit (Y/N) y
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A, B, C, D.F-C. Approved (Y/N)
Date Completed //- ~- ?'& Yield
Depth of Grouting W'o~''~'
Pump Set At G ,~ '
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
/~g'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole /'~! l.~'$
; On Adjoining Lots lOO'~
I~.0~ ; On Adjoining Lots /OO'./-
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot /~ ~"
Water Sample Collected by ~)A,d.g ,~'~F'A~c,£,d ; Date ~-/¢'
Water Sample Test Results .~,-f~.~". ~ .~/_~),.~--.,'~)~',(~}..--/~//~.~
Comments ~ v4'r"~
B. SEPTIC/HOLDING TANK DATA
Date Installed //'/o - 7&
Standpipes (Y/N) Y
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 ,.,5'*~~
Course ~,~'~'~'~' /,~'
Comments ~ ~:~.~:~ t"/¢ 7-,'~ "~
Size /o~o No. of Compartments
Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N)
Date Last Pumped
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond. Lake, or Major Drainage
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~. '
Square Feet of Absorption Area '7 ~)O
Depression over Field (Y/N) /4
Results of Last Adequacy Test /=,4 5 SE: D,
Separation Distance from Absorption Field:
To Water-Supply Well ~ /~,.~ ·
To Building Foundation
L o t ~ o
To Water Main/Service Line /~'
To Stream/Pond/Lake/or Major Drainage Course
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Y
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots w~ ',~
To Cutbank (if present)
To Driveway, Parking Area, or Vehicle Storage Area
Comments
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 Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request
Signed ~1 certify ~~ecked.~ (~"~ ~ateVerified' or conformed~to all MOA and HAA guidelines in effect on .the date of this inspection.
Company MOA No.
Rece,pt o.
Amount: $
Page 2 of 2
Engineer's Seal
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date July 2~ 1985
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 9r Blk 2r Eagle Park subdivision alT, T14N
Location (address or directions)
6~ ~e~-m~gan Blvd. · Eaqle River. Alaska 99577
(b) Applicant Name Jim l{illier Telephone: Home 694-3371
ApplJcantAddress 6032 p~at-m~qan Ea~le River, AK 99577
(c)
Business
Applicant is (check one): Lending Institution D; Owner/builder I~; Buyer D; Other [] (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
Mailthe HAAtothefollowing address:
Jim Hillier '
6032 Ptarmigan
~aql. Rtv. r. A~ 99577 ' '
(f)
TYPE OF RESIDENCE
Single-Family I~: Multi-Family[]
Number of Bedrooms '~
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status·
4. SEWAGE DISPOSAL
Onsite~ Public [] CommunityD Holding Tank[]
' Note: If community well system..must have written confirmation from the State Department of Envir°nmental C°nservati°n
attesting to the legality and status.
Page 1 of 2 7~-o~ {~,~4)
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.
Name of Firm OU/U:)RA £ncztneerin<3. Inc. Telephone 276-3770
Address 401 E. Fireweed Lane Anchorager Alaska 99503
Date July 2, 1985
Engineer's Seal
6. D, HEPAPPROV~.~.. '., .. ~
Approved fo~- Jlf/.~.,~' ,bedroomeq~
Approved / '" ::Disapprove'c
Terms of Conditional ~Approval
Date
Cond t ona,
· CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based aolely upon the representations given in paragraph S above by an independent professional
engineer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their Fending
Institutions in order to satisfy certain federal end state requirements. Employees of DHEP 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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
WELL DATA
Legal Description: Lot 9,
Eagle Park Subdivision
Well Classification ~nd%vidual If A. B. C. D.E.C. Approved (Y/N)
Well Log Present (WN) ¥ Date Completed 11/4/76 Yield 6.5 qal/min.~'"--
Total Depth 74' Cased to 72 ' Depth of Grouting None
Static Water Level 52.7' PumpSetAt E.4, {mm ~'np O~ ~"n~'~nq ~
Casing Height Above Ground ' ~" Sanitary Seal on Casing (Y/N) ¥
Electrical Wiring in Conduit (Y/N) ¥ Depression Around Wellhead (Y/N) N
Separation Distances from WeIl:~.~
To Septic/Holding Tank on Lot~'' 182' ~ ; On Adjoining Lots 1OO'+
To Nearest Edge of Absorption Fie~n L~ 120' ) ; On Adjoining Lots 3.00'+
To Nearest Public Sewer Line 50n ,4- "'"'--'"'""To Nearest Public Sewer
Cleanout/Manhole 500 '+ To Nearest Sewer Service Line on Lot N/A
Water Sample Collected by Alan Hara] ;'Date 7/1/85 11:30 p,]~, ~
Water Sample Test ResuIts .'~A-r,;~ ~-Aw~, /
Comments Water system is ade( ~ate.
B. SEPTIC/HOLDING TANK DATA
Date Installed 6/76 Size 1000
Standpipes (Y/N) y Air-t ,t Caps (Y/N)
Depression over Tank (Y/N) __
Pumping/Maintenance Contract on ~ (Y/N) --N
Holding Tank High-Water Alarm N
To Water-Su
To Property Line 45'
To Water Main/Service Line
Course
Tank:
y Foundation Cleanout (Y/N) Y
Date Last Pumped 6/29/85 '""
; for
Temporary Holding Tank Permit (Y/N) N
To
Foundation 18'
12'
To Stream. Pond. Lake, or Major Drainage
Comments
Page I of 2
72-026(11,84)
ABSORPTION FIELD DA~ ~
Soils Rating in Absorption ~
Date Installed 11/10/76
Width of Field
Square Feet of Absorption
Depression over Field (Y/N',
Results of Last Adequacy T
rata 1 '),[ ¢~- _ , Br_ i,// Type of System Design
orig. 5/81 updated Length of Field 73'
Depth of Field 12'
Gravel Bed Thickness 5 '
trench
rea ?3O f~..2 Standpipes Present (Y/N) Y
t~ Date of Last Adequacy Test 7/1/85
st Passed /
Separation Distance from~ ~tion Field:
TO Water-Supply Wel,('~)
To Building Foundation'''-''74'
Lot None
To Water Main/Service Line ] 00'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway. Parking Area. or Vehicle Storage Area
Comments
To Property Line 45'
To Existing or Abandoned System on
; On Adjoining Lots .
To Cutbank (if present) None
Nor~e
30' to driveway
Absorption field is adequate for structure.
D. LIFT STATION
Date Installed None
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
*' Check Permitted Bedroom Rating Against HAA Request **
I certify that I have c_hecke~, verified, or conformed to all NIO.~. and HAA guideIines in effect on the date of this inspection.
Signed ~ ~,i~ Date
Corn pany ~¥~I'~ ~'
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
Engineer's Seal
HUNI¢IPALI~ OF
DIVISION OF F~I~O~'H~,~FF. AL I~.ALTH
DEPAR'L~NT OF f~..~LTH AI~ ENVLRO~I~.AL I~0TECTTON
APPLICATION F0K K~ALTH AUTHORITY APPROVAL CERTIFICATE
~. C, eneral Information. Application Date 1-25-85
(a) Legal Description (include loc, block, subdivision, section, township, range)
L - 9~ B - 2 Colonial Pk.
Location (address or directions)
(b) Applicants Name 9hondv M.rtin
694-5354
Telephone - Home
Applicants Address. ~SC ~2 Bo× pll} Elmendorf AFB 99506
(c) Applicant is (check one) Eendin~ Institution ~--~; Owner/builder~;
Buyer~--~; Other~(explain);
(d) Lending Institution
Telephone
Address
Real Estate Co. & Agent C. 1]~ry Of ~o~as ~35~.~%
Address 60~ W. Tudors' ~cbora~, ~
Telephone 563-3655
(f) Mail the HAA to the following address:
603 W. Tudor
Anchora~et AK
2. Type of Residence
$ingle-Fam!!y.~X--~.
Hulti-Fa~ly~
Other (describe)
Number of Bedrooms
3. ~ater Supply
Note: If community well systen, mus= have written comflz'aaCion from the State
Department of Enviromzental Conservation attestica =o the legality and status.
[Page 1 of 2]
1!;. ~- lagtneertn~ Firm Provtdin~ Inspecttous~ Tests~ File Seareh~ Data and Information .
~i'i- '., .As ceri:ified by my seal affixed hereto and as of the validation date shown below, I [
~;'.: :.. verily thai: ~y investigation of this Eealth Authority Approval shows i:Mi: the om-sii:e [
~'. ' way:er supply nna/or was=ewe=er disposal system is safe, ftmci:ional and adequate for [
[:-' =he number of bedrooms aM type of st~uci:ure indicated herein.. I fury:her verify i:ha=,[
:;' based on i:he idot~nai:ion obi:aimed from =he ,V~nicipality of Auchorage files and from my []
invesi:igation and i~speci:ion, i:he ow-si=e wa=er supply and/or wastewater disposal
. syste~ is In c~pliance ~=h ~1 ~nictpal ~ S~a~e codes, ordinances, nM re~a-
tio~ in dfec= on the ~ce oi =his i~pec~ion.
Name oi Fi~ Ocean Tec~olo~, Ltd.
2502 W. Northern Lights Blvd.
"Address
Date 1/29/85
Approved for ~ bedrooms
.Texas of Conditional Approval
Telephone 248-3888
~_~. · . .
-
v~<~,, ... .."
7-19-8~
t4T~C~ 0~ A~(:2DI:U~G~ (HOA)
1984
Well C l~sificatio~ Private
Well Eog E~ese~t (¥/4~) Yes ~"
To ~pti~ ~ ~ ~ 100'+ ~''
To ~st ~ ~ ~tion ~ld ~ ~t 100'+
Wa~ ~e ~le~d ~ M. Hagan
C~
~pth of G~tl~;) n/a
unkno~ ·
Sanits~y Seal on Casir~ (Y/N) Yes
Depmessic~ Around Wellhead (Y/N) No
Da~e lns~l~ed ~-20-82 Size ~ No. of Cauga=tmmnts 2 ~--
S~i~s (Y~) Yes ~t ~ (Y~)Yes F~ti~ C~a~t (Y~) No
~i~ ~= ~ (Y~) No ~ ~-t ~d 1-25-85~?:'
~i~in~ ~a~ ~ Fi~ {Y~)n/a ; f~ n/a
~ld~ T~ ~~ ~ (Y~) n/a ~ ~ Ta~ ~t (Y~) n/a
~ ~u~ly ~11 1~'+~-' ~ ~ildi~ F~ti~., 10'+~'
TO Property Li~e 10
TO Wa~er Main/Se~vics Line 20,+ ~
To Disposal Field 5 ' +
TO S~mesm, Pond, Lmke, cg Raj,::= ~ainage
Receipt #
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
146 sq. ft.
Soi]~ Rat~ fit ~:~-v~,ic~t Strata bedroom
Date Xnse~!~d 8-20-82 '
[
Width C~ Field 30" j'
Det~*essic~ ove~ FieXd (Y/N) No
Ty~e c~ System Design' trek'ch
~ Field ~,+~
Field 12' /
s~i~s ~nt (~) ~
~t ~ ~st 1/25/85
Results c~ Last Adequac~ ~sst Adequate //
Separattc~ Distance f~au A~sorptic~ Field:
To ~te~Supply I~11 120,+ ~ To l~ol:e~ Mrs 1~,+
To Building Foundation 23, /' To Existing c~
COl; none loceted ! 0[1 AdJoll~ng COts ~0'% ....
To ~te= l~in/Se~'vice Line 20'+ To C~t~ar~(if F~esent)
To St~e~/c~ ~t~jc~ ~air~e Cc~rse
To [~iveway, Pe~king ~ea, c~ Vehicle Stc0~a~e ~-ea 10,+
Date Xnstalled
Size fit 6allc~s
'P~ 0~' Level at
~s~ ~
** ~hec~ Permitted 8edrccm Reting ~afitst 8AA Pequest **
I certi£¥ that ! have abecked, ~ri£ied, c~ ~,.~c~d to all ~0~ ~A Gg.~l~.s in effect
Si~d ~~ 1/29/85
~ Oce~ Tec~olo ~d. ~ ~ ~, ST~-O~4
~/~/s
2-15-84
. ' DAT~: RECEIVED
INSPECTOR INSPECTOR INSP~CTO~
{~ ENVIRONMENTALSANITATION DlVlSlONteleph~e ~47~ O~C 1 9
~ohn Thompson~ 694-2852
MAILING ADDRESS
6032 Ptarmigan Blvd, Eagle River, AK 99577
PROPERTY RESIDENT (if different from ebon) PHONE
2. BUYER PHONE
~[m 6 Rebecca tl[[[~eT 694-357[
MAILING ADDRESS
7 Bearpaw C~Tc[e, Ea~[e RiveT, AK 99577
Na~oaa[ Ba~k o~ AlaskaJ 265-2883
MAILING ADDRESS
Pouch 7-025, AnchoTa~e, AK 995[0
4. ~eAutO~/A~ENt I PHONE
A~A, Z~C, ~ea[to~s/A[ EomaszewsL[I 694:-9555
MAILING ADDRESS
P, O, ~ox Z49, Ea~[e E~vc~, AK 99577
5. LEGAL DESCRIPTION
Lot 9 Blk 2 Eagle Park Sub.
STREET LOCATION
Ptarmigan Blvd
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
i--I One [] Four [] Other
[] SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
7. WATER SUPPLY
[] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ,j.,,~ ~ ~.,..,
~ INDIVIDUAL/ON-SITE** ]976 YEAR ON-SITE SYSTEM WAS INSTALLED.
I--I PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
· . THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[~SINGLE FAMILY r--I ONE [] THREE [] FIVE [] OTHER
[] - MULTIPLE FAMILY ~/' TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBEF~,7~i.?~ ~7 /
J~ INDIVIDUAL DEPTH OFWELL
[] COMMUNITY
[] PUBLIC UTILITY DATEDRILLEDI~/q ['"] U
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~DIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY ) J - ~_] _ -~ /
Connection Verified
INSTALLER
I-ciSeptic Tank or []HoldingTankL- rll'i,',n
Size: /tOO0 IfTankishomemade SOILSRATING
give dimensions: j ~.. ~
TYPE ~)F TANK MANUFACTURER
TOTAlS'ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/HoldingS. ~' ~1 ~Tank Absorptionf AreagIJSewer LineIJ Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
{~"APPROV ED FOR '~ BEDROOMS
d~}~CONDITIONAL APPROVAL (letter must accompany certificate)
[] D SAPPROVED
72.010 (Rev. 6/79)
DAVID A. SLENKAMP
ROSERT A. SHAFE~
MECHANICAL ENGINEER
694-9055
January 11, 1981
John Thompson
6032 Ptarmigan
Ea~le River, Alaska
Deer F~. T~omp~on,
99~
Reference~ Lot 9; Block 2; Eagle Perk Subdivision
An adequacy test wns performed on the se~,£e system located on
the referenced property, as requested by Area Realty. The sentic
tank was pumped and verified to l%~ve a capacity o£ at least 1000
gallons. The absorption trench w~s tested by a continuous flow of
%mter over a period of 72 hours. The flow rate tms adjusted in
24 hour increments in an effort to determine the absorption c,pacity
of the trench.
It can be concluded from this test th, t the septic tank is adequate
for your three bedroom residence, however, ! regret to inform you
that the absorption trench appears to be currently edequ, te for
approximately one bedroom.
If we may be of further service to you in obtaining a permit and
srrsnging for the upgrading of your system, please do not hesitate
to contact us.
National Bank of Alaska
ATTE~IONt Rebecca
Municipality of Anchorage.
Department of Health and Enviorumant~l Protection
ClVILENGINEER
694.2979
SR8 196X EAGLE RIVER. ALASKA
//,~!/ - 825 ~ Street, Anchorage, Alaska'-99501
~m~' t 279-2511, ext. 224 or 225
-- ~ .~ ~ · 14,.1977
~//. ,~ ,~ Date Received. April
~1: Time ~ '.~f-) m~ ~2: Time ~3: Time
Date ~/-;~-~7 ~$ Date Date
Insp ~ Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Peoples Bank & Trust
Mailing Address: Pouch 7-007 99510 Phone:
279-7511
694-2852
752-2065
Property Owner: John E/Waltraut B.L. Thomson
Mailing Address: Box 6032 Eagle River, 99577
Phone:
3. Legal Description:
4: Single Family Residence: k~
Multiple Family Residence: ( )
Lot 9 Block 2 Eagle River Park Subdivision
Number of Bedrooms:
Number of Bedrooms:
Well System: Public/Community System: ( ) Individual Well: (x)
· 7& well ,.og ile
Permit ~ ~ Depth of/~l ~ ~ on
/~_/-~.-~.-~._~-~/ Bacterial Analysis ~, ~/~'~'
Construction
6. Sewage Disposal System: On-site System (Xk Public Utility ( )
Permit ~ 7~7/ Installed //~/~ Installer ..e~/
Septic Tank Size / 0~O£~----~Manufacturer
Absorption Area ,~/.~,?a~oils Rate /2~ Material
7. Distances: Well to Septic Tank /~'-~ to Absorption Area
to Sewer Line 0< ~ Nearest Lot line /~ )
· Absorption Area
to Nearest Lot Line ~ '
Page
~_ · ~- Departme~ of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 9 Block 2 Eagle River Park Subdivision
'Comments:
Affadavit Attached: '(') Letter Attached: ( )
Disapproved: Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
rlO,¥
1. Type of Inspection: VA FHA
2. Property Owner: JCJ~T
Mailing Address:
3. Name of Buyer: JO!~. E. 5 ~y.sJ~r'-~Ij~ THO,),~N
Mailing Address:
4. Name of Lending Institution: ]~OPLES BA~N~ ~ '1~[~
TO~! ?OO? Phone:
Mailing Address:
Name of Realtor or Agent:
Mailing Address:
Legal Description: 7JDT 9, BLK. 2, F.A~ RIVER PAR](
Location: Nt~T ~C~'~
Day Phone:
Day Phone:
Phone:__
CONV ~
694-2852
759-~5
279-7511
7. Type of Facility to be Inspected:
8. ' Water Supply
Type of Supply:
Public Utility
No. Bdrms. ,3
PRIVATE ~,~'3,T, & S~'rZC
Individual
o
If Individual, number of dwellings presently served
If Individual, depth o'f well.
Sewage Disposal System
Type of System: Public Utility.
If Individual, date of installation
PRIVATE i~-~T.l'. & ~:~'J.'[C
Individual (on-site)
72-003(3/'/6)