HomeMy WebLinkAboutEAGLE RIVER HEIGHTS BLK 2 LT 28
" HEALTH DEPARTMENT ~ ' 1~'.O 8~.G
~'~ ' '~ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION,
MAILING
SEPTIC TANK:
LIQUID CAPACITY / t~O GALLONS. INSIDE LENGTH, ~ t}
NUMBER OF
COMPARTMENTS
/'7 7/
.1NSIDE WIDTH ~DEPIH
SEEPAGE SYSTEM: SEEPAGE PiT:
NUMBER OF PITS
UN,NO M^TER~A~ ~o~-/~7~'~
NEAREST LOT LINE
OUTSIDE DIAMETER ~~.~ENG TH /~C.. DEPTH '~/
, DISTANCE FROM W~~O' f~4iL'/~L"~
, IOTAL EFFECTIVE ABSORPTION AREA ~ALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
· FOUNDATION .. NEAREST LOT LINE.
,~"~'STANCF~WEEN LINES ~NCH WIDTH~'"'"~'~"~
SQ. FT. LENGTH OF EACH LINE
TOTAL LENGTH
., OF LINES
DEPTH: TOP OF TILE 10 FINISH GRADE
NEAREST
LOT LINE SEWER LINE,
.DEPTH OF FILTER A&ATERIAL BENEATH TILE
DISTANCE FROM WATER
. BUILDING FOUNDATION, SAMPLE
SEPTIC "4A'~ r /..~.~ /?~.n SEEPAGE...~, / - .~ ,!
, TANK ~'~ , SYSTEM/~/u ,TT~" ~[~,/,¢.~CESSPOOL
IN. ABOVE TILE
· NEAREST
OTHER
· SOURCES__
DISTANCES:
DIAGRAM OF SYSTEM
DA,E 7/¢'7Y ,PPROVEI
/
GrEalhJR ANCHORAGE AREA BORuUgH
SEWAGE DISPOSAL SYSTEM ~. APPLICATION AND PERMIT
NA.E oF APPL,CA.T ~ c~ ,,~,, MAIL'NG .~,,, ~ qx~
INSTALLATION OF= SEPTIC TANK I~"~'O
TYPE AND SIZE OF FACILITY TO I~E SERVED
50IL TEST RESULTS O~l
DRAIN FIELD OTHER
PHONE
NOTE: THIS PERMIT IS HOT VALID WITHOUT ~OIL. TEST
FINAL INSPECTIONz 24 HOUR flOTICI~ REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION DY THE
HEALTH DEPARTMENT AUTHORITY WILl., SE SUBJECT TO PROSECUTION°
DRAIN FIELD
SEEPAGE PiT
ALSO CONSIDER AREA WELLS,
SEEPAGE PIT
GRAVEL DACKFILL
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA I~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
/ / '
MUNICIPALITY OF ANCEOKAGE
DIVISION OF ENVIR0~NTAL t~ALTH
DEP~N~ 0F ~H ~ E~IKO~AL ~OTECTION
~PLICATION ~OK ~TH A~HOKI~Y ~PKOV~
General Info~atlon Application Date
(a) Legal D~scrtption (include lot, block, subdivision, section, to~s~ip, ra~e)
. ~-,-f 7-~~..~, z ~ ~ ~ ~, ~/~.
(~)
Applicants
Applicants ~dress
(c)Applicant ~s (check one) Le~l~ Iust~=ution ~ ~
Buyer ~ ; Other ~ (~pla~n);
(d) Lendiu~ Institution Telephone
Address
(e) Real Estate Co. & Agent
(f) ~he ~ to the follo~ng fldress:
Ty~e of ~sidence
Single-Family~
Hulti-Family ~--~ Other (describe)
Number of Bedrooms
Water Supply'
Xadivid~l Well p:~ Comm~i~
Note: If com~nunity well system, must have ~rrittea con~irmation from the State
Department of Enviro~en=al Co~e~aClon a~=es~i~ ~o =he legality a~ s~acus.
Sewage Disposal
Note: If community well system, must have written co~i~mation from the State
Department of Environmental Conservation attestin~ to the legality and status.
[Page 1 of 2]
En~ineerin~ Firm Providin~ Inspections? Test% File Search~ Data and Information
As certified by my seal affixed hereto and'as of the validation date showu below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wsstewater disposal system is safes 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 ~chorage files and from my
investigation and inspection, the o~-site ~ater supply and/or %rastewater disposal
system is in compliance with all Municipal and State codes, ordinances, ami regula-
tions in effect on the date of this inspection.
Name of Firm
Telephone
Address
Date
DHEP Approval
Approved for
Approved .~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTI~NT OF HF~TH P~D ENVIRONMENTAL PROTECTION
(DEEP) ISSUES ~_.%LTH AUTHO~ITY P3P~OVAL CERTIFICATES BASED SOLELY UPON TI~ REPrESENT-
ATIONS GIVEN IN PARAGRAtS1 5 ABOVE BY AN INDEPENDENT PROFESSIO:~L ENGINEER REGISTERED
IN TEE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF EO}~S
T~IK LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL. ~ND STATE RZQUIXE-
I~NTS. ~'iPLOYEES OF DHEP DO NOT CONDUCT INSPECTI05~ OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
O~ OMISSIO}~ LN THE PROFESSIONAL ENGINEEr'S WORK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19-84
A. ~LL D~TA
Bo
Well Log Present (Y/~
Total Dspth ~ /~-. Cased to
Static Water [e~l ~'~' ! ~"
Casing Height Abo~ Ground
Electrical WirinG in Ccnduit
Separatio~ Distancss f~c~ Well:
To Septic/Holdim~ Ta~k on Lot
To Near~st Edge of Absorption F~Lot.
To Nearest Public Se~r Line ~ ~--~ '~y .~-
Cle anout/Mam]~ole Z~D
Water Sample Collected By ~ ~.~/¢f- ; Date
Water Sample Test Results
SEFI'IC/H~LDING T331K ~T~
~ Installed
size
Air-tic
t On Adjoining Lots
t On Adjoining Lots
To Nearest Public Sewer
Sswsr Service Line on Lot
Standpipes (Y/N)
Depression (me= Tank (Y/N) ~
Pumpimg/Ma intemmnce Contract
Holding Tank High-water Alarm (Y/~
No. cf Oa,~arta~nts
Caps (Y/N) Foundation Cleam~Dut (Y/N)
Last Pu~d
Y/N) ; fo~
Temporary Holding Tank Permit (Y/N)
To water-Supply Well
To Property Line
To water Maim/Service Line
Course
Separation Distances from Septic/Holding TarR:
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, (r Major Drainage
~L~ ' Date Paid:
pa~ ~.~ Amount: ,-~
[ 1 of 2]
2-15-84
Ce
ABSORPTION FIELD ~TA
Soils Rating in Absorption Strata
Date I r.-~ta lled
Width of Field
Square Feet of Absorption A~/~
Results of fast Adequacy Test --
Separation Distance f~cm Absorption Field:
To Water-Supply Wall
To Building Fou~.dation
Lot
To Water Main/Service Line
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Sta~.dpipee Present (Y/N)
Date of fast Adequacy Test
To Property Line
To Existing c~ Abandoned System cn
; On Adjoining Lots
To Cutbank(if present)
To Stream/Pond/Lake/c~ Majo~ Drainage Course
To Driveway~ParkinG Arena, c~ Vehicle Stc~rage A~ea
D. LIFT STATION
Date Installed
Size in Gallc~
"PUmp On" I~vel at ' j
High Water Alarm Level at
Tested for
Electrical Codes(Y/N) ~
Ma r-hole/Access (Y/N)
Off" Level at
Vent (Y/N)
ycles du~inG Adequacy Test.
M~OtS ~
** O~eck Permitted Bedroom Rating AGainst HAA Request **
certify that I have checked, verified, <~ o0nfo~,,~d to all MOA HAA Guidelines in effect
on the date of this ir~pection.
Signed
C~,~any
KB1/d5/s
[Pa~e 2 of 2]
2-15-84
HEMICAL & Ge:OLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL C'I~NTER
5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPUER
WATER SYSTEM:
(') See h on back
I.D. NO.
Sm,*
Zko C*_
SAMPLE TYPE:
~,~/-Routlne
Chock Sample (for routine sample
with lab rof. no.
D Special Purpose
r~ Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
, I
Time ColIoCIKI
Colioctod By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
,~['Satisfactory
D Unsatisfactory
I-1 Sample too long In transit; sample shoulc
not be over 30 hours old at examination t¢
indicate fellable results· Please send new
sample via special delive~ mall·
Time'Received /'-~ ''~ 0
Analytical Method:
O Fermentation Tube
I~Membrane Filter
Lab Ref. No. Result* Anelyat
L~ ~ ~'/~*/I ~' ~-~
I I-i-]
I ~
I I-~
BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Fillet Direct Count
Verification: LTB
Final Membrane Filter Results
Collformll00ml
TNTC = Too Numerous To Count
BGB
CollformllOOml
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL ,,~HE, FFIELD, GOI,~RNOR
Telephone: (907)
Address:
274-2533
January 18, 1985
Mr. Robert sharer
S&S Engineering
SRB 196X
Eagle River, Alaska 99577
SUBJECT: Waiver Horizontal Separation between Well and Municipal
Sewer Line, Lot 28, Block 2,.Eagle River Heights Subdivision
(8521-WA-092)
Dear Mr. sharer:
The Department has reviewed the subject waiver request and hereby waives
the horizontal separation between the well and sewer line to SO feet
on the subject property for a single famtly'restdence--o'n-l~.-- -- --- f
The waiver requet has shown that special construction of the sewer line
will preclude the possibility of contamination in this instance.
Sincerely,
Bruce ,(~Erickson
District Engineer
BEE/msm
· t INSPECTION APPOINTMENTS
TIME TIME TIME
INSPECTOR INSPECTOR INSPECTOR^
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHOflA~E DEPt. OF H~ALTH &
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION E~IRO~ENTAL I ~OT[~ION825 L S~r.t · Anchor.~, AI.k. ~,
) ENVIRONMENTAL SANITATION DIVISION rl0V 4 1980
REQUEST-FOR APPROVAL OF INDIVIDUAL WATER AND SEWER
~ BUYER PHONE
MA~G~D~SS (
3. LENDI~ INSTITUTION
4. REALTOR/AGENT _~ ~ li PHONE
MAILING ~DDR~SS ' - ~ - ~ '
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One .~ Four
~' SINGLE FAMILY
[] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
.~ INDIVIDUAL* * ATTACH WELL LOG, A well log is required for all wells drilled
I--] COMMUNITY since June 1975. For wells drilled prior to that date, give well.
I--i PUBLIC UTILITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON-SITE*' .YEAR ON-SITE SYSTEM WAS INSTALLED.
PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
· -.. THIS SIDE FOR OFFICIAL USE ONLY .
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE r-I OTHER
[] MULTIPLE FAMILY [] TWO [-I FOUR [] SlX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL · · .
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
r--IPU BLIC UTILITY
Connection Verified INSTALLER
C-ISeptic Tank or r-'iHold[ng Tank
Size: If Tank is homemade SOILS RATING · ·
give dimensions: . _
TYPE OF TANK MANUFACTURER ' '-
TOTAL ABSORPTION AREA MATERIAL
S. COMMENTS
[]~"~APPROVED FOR" ~ BEDROOMS ~
I'-1 CONDITIONAL APPROVAL (lette~r must accompany certificate)
[] DISAPPROVED ' ~
DATE BY
72-010 (Rev. 6/79)
E, HEMIC,4L & GL.,LOGIC,4L L,4BOR.4TORIES ,..F ,'tL.4SK,4, INC.
TELEPHONE lg07)-279a10t4 ANCHORAGE INDUSTRIAL CENTER
~ 274.3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
Water System Name
Mailing Address
. ', I.D. NO.
Phone No.
City
Zip Code
Mo. Day Year
SAMPLE TYPE:
r~ Routine
[3 Check Sample (for routine sample
with lab ref. no.
D Special Purpose
El Treated Water
[3 Untreated Water
SAMPLE
NO.
I
I
, I
LOCATION
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
A~al¥sis shows this Water SAMPLE to be:
[] Satisfactory
D I~n~satisfactor,/
[] Sample too long in transit; sample should
not be over 48 hours old at examination
· to indicate reliable results. Please send
new sample·
"D~te Received
Time Received
Ar~alytlcal' Method:
Fermentation Tube
Membrane Filter
Lab Ref. No. Reeult* Analyst
I
I ['t-]
I
I rtl
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
o~-]22o (~) BACTERIOLOGICAL WATER ANALYSIS RECORD
,~,.~--~_~! DEPARTME, ~ 'F HEALTH AND Et~VIRON~E~7~, >ROTECTiO~I ·
I ~T3Y', 825 L Street, Anchorao~. Alaska 99501
264
-,1720
~i:
Time ~/LI~ __ ""2: Time
Date L~-_~ -~ ~t ~ Date
Insp ,~~ Insp
Dar, December 13, 1977
~.~¢'."3: Time
6~%. ~"0 Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Security Pacific Mortgage Corporation
Mailing Address: 1011 East Tudor Road, Suite 190 Phone: 276-1933
Property Owner: Orin L. Moses
Mailing Address: % Dan K. Coffey
Phone:
276-4335
3. Legal Description: Lot 28 Block 2 Eagle River Heights Subdivision
4: Single Family Residence: (x) ~;umber of Bedrooms: Four
5~ultiple Family Residence: ( ) ~[umber of Bedrooms:
5. well System: Individual well (x) Co~:m~unity/Public System ( )
Permit "" ~__ Depth of Well
Construction _~
Bacterial Analysis
6. Sewage Disposal System: On-site System ( )
Permit # Installed Installer
Septic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
· Page Two
Request for Approval of
Department of Health and Environmental Protection
Individual Sewer and Water Facilities
Legal Description: Lot 28 Block 2 Eagle River Heights Subdivision
Comments:
Affadavit Attached: · (') Letter Attached: ( )
'Approved- . .--- DateI ~
Disapproved: ~ Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE ~..,~.. ~....
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION .*, , ,'~ . .
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA XX FHA
~.':L,. ..- o ~L'I2LI2-77
CONV
2. Property Owner: 0tin L. Hoses
C/0 Dan K, Coffey-Attorney
Mailing Address: 2600 Oqnall Street DayPhon~:
Name of Buyer:. Berkeley Jo Ide(now Iivlng in house)
276-4335
Mailing Address: Box 70 Eagle River, Ak 99577 DayPhone:
Nameof Lending Institution: SECURITY PACIFIC HORTAGE CORPORATION
Mailing Address: 10Il
Name of Realtor or Agent:
Mailing Address:
East Tudor Raod Suite 190
none
Phone: 276-1933
Phone:
278-361q
No. Bdrms, h hedroorn~
Individual XX
6. Legal Deseription:' imf 9~: Rlt~ ~; ItARIF I~IVFR
Location: NH~I t~.~e.vF, nn ~;~-~,~,~-. ~agle River
7. Type of Facility to be Inspected: sinqle fatal Iye
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System Community syseern
Type of System: Public UtiliW
If Individual, date of installation.
Individual (on-site)
72-003(3/76}
Rev. 1973
DATE
ALA ..... [PARTMENT OF HEALTH AND SOCIAL S
DIVISION OF PUBUC HEALTH
IHDI¥1DUAL AND SEMI-PUBLiC ..
' BACTERIOLOGICAL WATER AHA[YSIS
INDIVIDUAL r"l~'' SEMI-PUBLIC [] CHLORINE RESIDUAL PPM
Lab No
OFFICE
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WATER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY ~' '
DATE COLLECTED" '"~" / '' 7 . TiME COLLECTED · '/~"' ' /
Well -- ~ D~ ~ Cistern n OlherD'illed
O
n
n
GENERAL~ Does Water Become Muddy or DiscoLored? [] Yes [] .No
PURPOSE Of EXAMINATZON: 1liners Suspected? [] Yes
06.1220 {bt B
~*v. 19;3 A~CTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
Ilepo,ted by ~'~ ~/
FHA Foam 2573
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Budget Bureau No. 63.R0296
PART L--TO BE COMPLETED BY FHA
MORTGAGEE I SEWAL NO.
O~nk of Alaska
Caribou st..
r~New installation
[] Public system
1
[] Community system ~ Individual
PART II.-~TO BE COMPLETED BY HEALTH DEPARTMENT
lc is the opinion of the [] State [] County [] Local Department of Health that this individual water, supply system
~ is [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage.disposal sys-
tem with proper maintenance:
[] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
~ is not likely to create an insanitary condition ,- ~ ,.,...~
,. I$,G.A.:. //, //
:a.lec.._l.7,_197.t,:,.; ' , / __ ~ ?[~ ,
, '- -~,:/ '- ~-~--- ....~ - Envtron~ental-Sreclalts't--
Distance Imm: Well. fro; fuundad,~n, I'eet~ nc~'c~ Io~ line m~ ~ ~mnr. ~ si~, ~ ~c~. f~.
~ng~h of e~ch llne, f~. ~h. mpo[ 6lc ~o finish g~de, inch..
Ty~ ~ filler mmlerial: ~ Gravel. ~ Brok~ st~e. ~h~.
Numar of pits .... ~tslde d~a~ter, ~e~. ~h,, f~t. Lining m~tcfial
Disuse from: ~cll, f~: building fuundnf~m. F~; nearer I~ line at ~ fron~ ~ side. ~ renr..~.f~.
Ins~t~ by.
REPORT OF INSPECTION--INDIVIDUAL WATER-SUPPLY SYSTEM
Distante to nearest public water main, fe~. Siz~ ~l' main. inches.
Individual wells n art. n are n(~ cust(xnary in neighh~rho~l.
Give most retent rocord of failure of v/ells in immediate v~cin,y to furnish adequate supply of water
Properties in neighh~l.x>d n are f-I are nm bei.g developed with both individual water, supply and sewage.disposal systems.
la,t size' feet wide, feet deep. Dwelling set back /rom front property line. £eet.
Indivklual water supply Ii'om: n Drdled well. n Driven well. I-I Dug well. n Bored well.
Building fi~undation,
seepage pit.. feet; cesspool
Diameter, inches. To~l depth,
Approximate depth to pumping level of water in well
Sealed watertight to depth of feet.
feet; nearesl h~ line at n front. I"] side. [] rear, fee~.
feet: septic tank fees; disposal fleld~ feet;
feet; ocher sources m' possible pollution, J'eet.
fe~. Type ~' casing, Depth of casing, feet.
fe~. Approximate yield, .gallu~s per minute.
Fattefoe spa~e around casing sealed with: I-1 Cement grout, f-I Puddled clay. n Ordinary backfill.
Well cover: n Concrete. [] Wood. I-I Metal. Openings in well cover watertight: [] Yes. I-I No.
I~ml~ I-1 Shallow ~ell. I-I ~eep well. Len.~h of drop pipe, feet. Pump capacity,
located in: D Basement. 1-1 Pumpmom off basement. [] Pumphouse abe, ye ground, n Pump pit.
Pumproom properly d~aine~: I-I Yes. [] No. Pump mounting watertight: I-1 Yes, n No.
Type ~' sto~age: n P~essure. [] GravitT. Capacity, .gallons.
Has bacteriological examination o/water been made.> [] yes. I-1 No. If answer is "yes," give date
Quali~T c4' water f-I is f-I is not saris.factory for human consumption.
Installation [] does n does not comply with approved exhibits, if any.
Inspectiofl made by: I-~ S~ate. f-I County. [] L~xal Health Audm~ity.
Inspected by.
Date o1' inspe~'tioe , 19
.gallons per minute.
(Tm.l)
19
GRE~ER ANCHORAGE AREA
BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
/ ,~'"'~, f F~ "'~'" -- --
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED BY:
ADDRESS: ~"~' ,~.~,m...4ff
PHONE: ~
PROPERTY OWNER:
PHONE:
LEGAL DESCRIPTION:
TYPE FACILITY TO BE
NUMBER OF BEDROOMS:
STREET:
WELL DATA:
A. TYPE
B. DEPTH
C. SIZE ~'"'/
D. CONSIRUCTION_._~,~::a~'~.J~
E. ~^CTERIAL ANALCSIS Oqr/ /~-&?-7/
6. SEWAGE DISPOSAL SYSTEM:
SEPTIC TANK {IF HOMEMADE,
1. SIZE /.~z'~
2. AGE /??/
3. MA,UFACTUR~ ~Z
SHOW DIAGRAM ON BACK)
4. INSTALLER
APPROVAL
PAGE TWO
REQUEST FOR
SEWER
& WATER FACILITIES
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
REQUIRED MEASUREMENTS
A.
B.
C.
D.
E.
F.
G.
H.
WELL TO SEPTIC TANK
WELL TO SEEPAGE PIT
WELL TO SEWER LINE
WELL TO PROPERTY LINE
WELL TO OTHER POSSIBLE CONTAMINATION
FOUNDATION TO SEPTIC TANK ~
FOUNDATION TO SEEPAGE PIT ~
SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
DATE: /~ ~7--'7~' DATE.
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL
QUALITY
March 25. 1975
File No.: 4-1
ANCHO"AG£ A"E:A ""hUG"
Mr. OrinMoses
P.O. Box 70
Eagle River. Alaska 99577
Dear Mr. M({ses:
It has been brougl~t to our attention that public sewer is available to
Block 2. Lot 28, Eagle River Heights Subdivision.
According to Greater Anchorage Area Borough Ordinance, Chapter 16,
Article 16.45, Section 16.45.050:
"Septic tank-seepage system sewage disposal facilities shall not
be installed or used on any premises where sanitary sewers are
available within seventy (70) feet of the nearest 'lot line of
said premises ·..'
The Greater Anchorage Area Borough Public Works Department has
checked their records and they indicate that your structure(s) is
not connected to the sanitary sewer. Would you please check your
records to verify that the structure(s) is or is not connected and
notify us immediately if your records indicate that a connection
has been made.
If we do not hear from you within seven (7) days, we will assume that
our records are correct. We, therefore, request you connect any and
all structures located on the subject property to public sewer during
the 1975 construction season.
You must apply for a connection permit from the permit officer for the
Greater Anchorage Area Borough, 3500 East Tudor Road. If you have
any questions regarding the above, please do not hesitate to contact
the permit officer at 279-8686, extension 259. or the Department of
Environmental Quality at 274-4561, extension 141.
~/ Eaglr River District Sanitarian
JL/lw
RECEIPT FOR CERTIFIED MAIL.O<' (plus postage)
METURN L ~ *$hi~'~m~d di~e 4lllv~ed .......... ~5~
P
NO INSURANCE COV[RAG£ PROVIDED-- (S.. of~., ,d.)
NOT FOR INTERNATIONAt, MAtt. *G~:X~ OoU0-743