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LOT SIZE
u3,O.
J_g?42 SC..!URRE FEET
rl't. N ll,ll N.i r,ISI'F¢iCIS F:I-'I'I.IFFN
~ FEE1 FC:P. fl f"I;'TVFITK IdITI_L
~,,., FmPrl CJfFglltF'.UD AND HI_I:gT
t4;'1 I I '":' ' '
I-IF TllrE [lUl.[ CAblK'I[TTION
,%I,I:'IFIC:FITIF~N< AND ~CNSTP 2TION DIKIGRgI'IS ARE R'v'FlILFIgl-E TO IflSI..IRE PROPER
1 ~lf;'J- f II .I .FIT I
I :'lrli~l'l ~ -i- '...'I--II ._ I O FCII[: CIRCE ','EIhR: F~C~l'q I 5SI_lE
J' T f'll't FF¢4[I Tlqf;' I,IITII TIlE REtqI_IIF..:EHENTS FOF,,' ON-SITE SEblERS AND WELLS RS SET
FOf:'TII [:',' TIN" HIJNTCIPRI ITY OF ANCHORAGE.
c ~' · RCCgRDRNCE WITH THE CODES.
2: I I.lltJ. IN'STAll Tile .,,.,rrll IN
[ '.. '~ u "~ l:V,'_~~--.'.:-~=~-~- - ........ ' ................
( er ifieil Drilling
by
A & L DRILLING COMPANY
BOX97, EAGLE RIVER, ALASKA99577 · TELEPHONE694-2588
OWNER OF LAND
ADDRESS
DEPTII OF WELL
STATIC LEVEL OF WATER
DRAW OOWN
GA~. PER IlR
LEGAL DESCRIPTIOk
PERMIT NUMBER
KIND OF FORMATI(JN:
From [ Ft.'tO
From YO Ft. to Y~ Ft.~L~K~
From ~o Ft. to~Ft. '
From~Ft. to ,
From ffO~ Fi. lot
From__Ft. to
From Fi. to' Ft.
From Ft. to Ft.
From__Ft. to Ft..
From__Ft. lo
From Ft. lo FI.
From__FI. to Ft.
From ' Ft. to Ft.
Ft. to Ft.
· Fi. to Ft.
Ft.t~' ' Ft.
Fi. to Ft
Fi. to" Ft.
Fi. to · Ft.
From Ft. to__Ft.
From Fi. to Ft.
From__Ft. to Ft.
From__Ft, to Fi.
Ft. ' From
From Ft. to Ft,
From Ft. to Ft.
From Ft. to Ft
From
From
Frdm
From Ft. to Ft
From____Ft. to Ft.
From Ft. to Ft..
From Ft. to Ft.
MISCL. INFORMATION:
DRILLER'S NAME
Address ~ ~< ~ ~ ~,[,._, ~ ~ ~ (~ /~ Zlp~e
Address ~ ~ Zip ~e
~ Othe¢
Water S ply
ldl A~ACH ~LL L~. A w~l I~ Is r~uir~ for all wells drll~ slncelJune 1975.
~ ~mm~lty ~ ~ For wells ~111~ prior to tha date. give well depth (attach ~ If avallab e}.
~bllc ~illty When ~ect~ to Public Utility:
NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Oate Date
Inspector Inapt:lot Inspector Inspector
( ~APPROVED~DR~MS ~ .CONDITIONSOFAPPROVAL
( [ } DISAP~OVED
( ) CONDIT~NAL~O~*
O
5oils Rating Date ~wer Install~ Well TO ~sorpUon Area Well Log R~elv~
Well to Tank Septic T~k SIze
CHEMICAL & GI"~,OGICAL LABORATORIES/~ALASKA, INC.
TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
274-3364 5633 B Street
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTEM:
I.D. NO.
Watar Syitam Name L~/J~..o (~' ' ~.~. y~4 ~, Pho~e N~'
Mailing A~dr®iI
City State
MO, Day Year
Zip Code
SAMPLE TYPE:
ri Routine
[] Check Sample (for routine sample
with lab ref. no.
ri Special Purpose
SAMPLE
NO.
I
I
4 I
LOCATION
[] Treated Water
ri Untreated Water
Time CoIlectid
Collected By
TO BE COMPLETED BY LABORATORY
Analysi~ shows this Water SAMPLE to be:
~'~atisfactory
[] Unsatisfactory
[] Sample too long in transit; sample should
f~ot be over 48 hours old at examination
to indicate reliable results. Please send
new sample·
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
.~ Membrane Filter
Lab Ref. No. Result' Analyst
I.II~/'~; ;~ ' ,.:~ l .' l'-F'l
.READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
~-1220 (ti)
Rev. lg78
BACTERIOLOGICAL WATER A~IALY$1$ RECORD
[~ ' /'~'INICIPALITY OF ANCHORAGE r'"X N
· ,~ ~.DEPARTMENT_ . HEALTH AND ENVlR~ONMENTAL ROTECTIO
· ~k~,,~.;} ' 825 L Street, Anchora-.. Alaska-' 99501
October 25, 1977
264-4720
Date Received:
Time ~ '. ~A~ ~ 02: Time ~3: Time
Data ,~-,5;- 77 ~03d. Date Date
Insp f ~ ~/ IJ,~.. Insp Insp
2e
e
Se
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: First National Bank of Anchorage
Post office Box 4-2090 Phone: 274-1521
Steven Whaley Phone: 694-3382
Box 1025 99577 ~_~,% C~c~
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Lot 41 Block 2 Eagle River Heights Subdivision
Single Family Residence: (~ Number of Bedrooms:
Multiple'Family Residence: ( ) Number of Bedrooms:
~wo
Well System:
Permit ~
Construction
Individual Well (x) Community/Public System ( )
Depth of Well ~ Well Log on File (
Bacterial Analysis
e
Sewage
Permit ~
Septic Tank Size
Absorption Area
Disposal System: On-site System ( ) Public Utility
Installed ~ ~ ~ ~ Installer
Manufacturer
Soils Rate Material
(x)
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
~ Municipaliw of Anchora~ ;---%
DEPARTM. . OF HEALTH&ENVIRONMENTALPRO. , ;ION
POUCH 6-6~ ANCHORAGE, ALASKA 99~2
279-~11
OCT P, 5 1977
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES D .
I. TYPE OF LOAN . J 2. ASSESSORS PARCEL ]~BI~,RI,, I ¥ I. I,/.
[~:VA r'l F.H.A. [] CONV []
I
3. LENDING INSTITUTION 4. REALTOR OR AGENT
.... ',* First National Bank of Anchorage r. Ar.:[: Star Realty
.,~,u .... P. O. Box 4-2090
~,~,l .... 640 ~. 36th
Anchorage, Ak 99509 Anchorage
Al T:I: Florence i~H0~l~: 274-1521 A77;~ Max Bevins P~0;',:: 279-2491
5. SELLER B. BUYER
;~ .~ Steven Whaley r;,',r~t~ Peter S. Goldberg
AIJ!)~-~3~ Box 1025 ;,tu,~FS;: 412 A Beluga
Ea~le River, Ak 99577 Ft. Ri~son, Ak 99505
D;¥ ?t~0;::-:694-3392 I~^¢ ~HU~F: 862-1132
7. LEGAL DSSCRIPTION B. LOCATION/STREETADDRESS
LOt 41r Block 2r Eagle River Heights
9. TYPE OF DWELLING 10. WATER SUPPLY 11. SEWAGE DISPOSAL SYSTEM
[~SINOLE FAMILY RESIDENCE 2 BDRMS [~PUBLIC UTILITY I~ PUBLIC UTILITY
I-I MULTI-FAMILY RESIDENCE DDRMS [1~ PRIVATE ON-SITE E~ ON.SITE
YEA. ~STA,LBD
INSTRUCTIONS TO REQUSSTOR
~. Complete ~tem$ ~ to 1~ above 3. Send to address ebove 5. Response wiR ~e relurned to lendino
2. Remove the Carbon 4. Please allow 10 days for prooessin§ institution ·
DATE RECEIVED DATE OF INSPECTION TIME OF INSPECTION INSPECTOR
TYPE DEPTH YEAR DRILLED PERMIT REFERENCE
'~ FT.
~: CONSTRUCTION BACTERIAL ANALYSIS LAB REFERENCE NO.
YEAR INSTALLED INSTALLER TANK SIZE MANUFACTURER
m DIMENSIONS CRIB CONSTRUCTION
~- [] PIT
o TOTAL LINE LENGTH TRENCH DEPTH GRAVEL DEPTH
~- [] DISPOSAL
~ FIELD
~ FT. FT. FT.
TOTAL ABSORPTION AREA PERMIT REFERENCE
SO. FT.
72 010 (I 1/76)
S EPTI 9.;,T.,A,N K~
..13ZTO,~I ............ ".', .JSORPTION AREA ".', SEWER LINES : LOT LI~S - OTHER~
" - "* SEPTIC TANK ABSORPTION AREA WELL
ABSORPTION .... LOT. LINE
~og~o~ C ~- ~::~' '"~ ' ; '" ' "' SYSTEMTO:_
,-. · ~ ·
APPROVED ' ~CONDITIONALAPPROVAL .-, - J
DISAPPROVED ~ UNABLE TO INSPECT
DATE INSPECTOR ·
'lAG RAM OF
.... ~ .... D SYSTEM " "
....... ~ ...................... ~ ..... L L
F ,
I ce~ify Ihat Ihe information contained in lhil requesl for approval to be a Irue and ~curate repres~ntatio~ of lh~ iubj~ct sewer and water facilities
and lhe~ lacililie~ are op~raling ~tJ~factorily,
DATE SIGNATURE
.Pag6 Two~
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 41 Block 2 Eagle River Heights Subdivision
Comments:
Affadavit Attached:
Approved: ~
Disapproved:
(') Letter Attached: ( )
~ ~' Date: , I/'~h/'~
Date:
Department Worksheet:
STATE OF ALASKA
DF'"-'RTMENT OF HEALTH AND WELr'"~
' DIVISION OF. PUBLIC HEALTH
'BACTERIOLOGICAL WATER ANALYSIS
~LNITARIAN' S REMARICS
-- I BACTERIOLOGICAL WATER ANALYSIS RECORD
READ INSTRUCTIONS ;. -., o~
REVERSE SIDE
BEFORE
COLLECTING SAMPLE