HomeMy WebLinkAboutTROLL KNOLL BLK 2 LT 9 ANCHORAGE AREA GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ~
FROM WELL~J~3~' ·
MANUFACTURER ~
NUMBER OF
MATERIAL COMPARTMENTS
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY/~;~0o GALLONS.
TILE DRAIN FIELD:~"~Z'I~
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE
NUMBER OF LINES [ DISTANCE BETWEEN LINES TRENCH WIDTH
ABSORPTION AREA ~'"'~ ~''' ' SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
MATERIAL BENEATH TILE ~:~ t IN. ABOVE TILE
IN.
WELL~
T YP E _k-- ~"Y~Yt/~t~ J CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION LOT LINE , SEWER LINE
DEPTH
SEPTIC SEEPAGE
TANK SYSTEM
DISTANCE FROM:
CESSPOOL
· OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BM:
SEWER LINE DEPTH:
PIPE MATERIAL=
LOT SLOPE=
REMARKS:
Form EQ-032
PERMIT NO.
APPLICA~IT
LOCATION
LEGAL
I"IUN I C I PI:IL I TV OF I-3~-.ICHORI~GE /~/_
Ot'.l--S I TE SEI.JER PERr~ I T II;~i g'~'J'__
76825
HILLCREST DR
B2 TROLLKNOLL SUBD LOT SIZE 18975 SQUARE FEET
TYPE OF SOIL ABSORATION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR>= 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= :1.2 LENGTH= 2-::' GRR'..-'EL DEPTH= 6
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 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 ORAYEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATIOH (IN FEET>.
RE(~I_I I RED SEPT I ¢ TRt~IK S I ZE= :1.~OO GRLLf-JhlS
THO ( 2 ::' I I'-ISPEC:T I Ot-.IS ARE REC!U I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTAtICE BETHEEN A WELL AND Rr'IY ON-SITE SEWAGE DISPOSAL SYSTEM IS
1£10 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
SPECIFICATIONS A~iD CONSTRUCTIOrl DIAGRAMS ARE AVAILABLE TO INSURE PROPER
I NSTALLAT I ON.
PERI"11 T VRL I D FOR OI'-.IE '-r'ERR FROt'I I SSL~E
I CERTIFY THAT
l: I A~l FAt'IILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND I.~ELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE,
2: I WILL INSTALL THE SYSTEM IN RCCORDRt'~CE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE I~ REMODELED TO INCLUDE ~ORE THAN 3 BEDROOMS
O Et E GEG.~"ECHNICAL Et DEVEL"~PMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
Russell Oyster
694-2774
Soils ~t Foundations
Performed for: N~me:
694-2774 or 688-2280
'SOil. LOG
Nalllng Address:
Legal Description::
Depth (feet)
EaH Eills
688-2280
Land Development
3
6
7
8
9
lo
11
$o~ll:C~l~actertsttcs' -. ~
12
15
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Co~ents: ~-~--~ c~~
No v/'/lf yes, whit depth
Drmin Field v//
Performed by:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P,O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak.us
(907) 343-79O4
CERTifiCATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-521-11
1. GENERAL INFORMATION
Complete legal description
Expiration Date: ~' - / ~"- O ~
Lot 9, Block 2, Troll Knoll Subdivision
Lo¢'~ticn (sit3 address or directions) 23846 Hilltop Ddve
Current Property owner(s) Kenneth D, Ivie
Day phone 688-0192
Mailing address
23846 Hilltop Drive Chuqiak. AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
Raney Hardman
Day phone 694-4200
Mailing Address t6600 Cente~eld Dr., No. 201 Eaqle River, AK
Unless otherwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
Three (3)
3. TYPE OF WATER SUPPLY:
Individual Well
Indiwdual Water Storage
Community Class A Well
Public Water System
[]
0
[]
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for eh'ors or omissions in the professional
engineer's work.
4. 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 Health Authority 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 of Firm Anderson Enclineerinq
Address P,O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson. P.E.
5. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Phone 522.7773
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Cedificate Date:
Legal Desc~ption:
A. WELL DATA
Well type ~lass A
Date completed __
Total depth
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box lg6650 Anchorage, AK 99519-6650
www.cLanchorage.ak.us
(907) 343-79O4
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 9, Block 2. Tmfl Knoll Subdivision
Parcel ID: 05t-521-tl
If A, B, or C provide PWSID # __
Sanita~/seal (Y/N)
Cased lo ft.
We, Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level ft. fl.
Well p~oduction g.p.m, g.p.m.
WATER SAMPLE RESULTS:
Caliform __celonies/100 mi. Nitrate rog JI. Othor bacteria __
Date of sample:
Collecti~l by:
B. SEPTIC/HOLDING TANK DATA
Tank Typa/Mate~al 6el~lC/Steel
Date installed 10/4/1976
Tank size t,000 gal. Number of Compartments_2 Cleanouta (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (y/N) N High water alarm (Y/N) N
Date of pumping 7/22/2002
Pumper JR'$ Pumpiml
C. ABSORPI'iON FIELD DATA
Date installed 10/4/1976 Soil rating (g.p.d./ff~ or ~rodrm) 85 SFIBDRM System type Deep Trench
Length 24 fl. Width Unknown fi.
Gravel below pipe 6
Total depth I~0 ft.
Eft. absorption area 28__J~.fl2 Monitming tube Y_ Depression over field
Date of adequacy test 7/18/2002
Res,alta (Pass/Fail) Pass
For _2 bedrooms
Fluid depth in absorption field before test 41 in.
Water added520 gal.
New depth48.5 in.
Elapsed Time: 1,380 min.
Final fluid depth 37 in.
Absorption rate >= 450
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D, UFT STATION
Date installed
'Pump o~' leval at __ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off level at
Cyctes tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/tiff station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
in.
Manhale/Aceess (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cteanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5. Property line >5.
Water main N/A Water service line >10.
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propen'y line >10'
Water Service line >10'
Curtain drain None Noted
COMMENTS
G. ENGINEER'S CERTIFICATION
Building foundation >10'
Surface water >100'
Walls on adjacent lots >200'
Absorption field >5'
Surface water >100'
Water main >10'
Dn'veway, pmtdng/vehlcle ~xage >10'
I certify that I have determined through field inspections and
mvlew of Municipal records that the above systems am/n
conformance with MOA HAA guidelines in effect on this date,
Engineer's Printed Name
Date 8/2/2002
Michael E. Anderson, P.F_
HAA Fee $ ~--
Date of Payment
Receipt Number
(R~. 1~)
in.
: ~ ' .:: ' ~ ANCHORAGE, AK 99524'~. :
.... 522-7773 :' :: · 522-6779 (FAX)
August 2, 2002
Re/Max of Eagle River, Inc.
16600 Centedield Drive
Eagle River, AK 99577
Attention: Raney Hardman
Subject:
Lot 9, Block 2, Troll Knoll Subdivision
Septic System Inspection and Test
Dear Ms. Hardman:
We recently completed the inspection and testing of the septic system on Lot 9,
Block 2, Troll Knoll Subdivision. Records indicate the tank was placed and the
absorption trench constructed in 1976 to serve a three-bedroom home. Soils
tests performed at the time estimated the absorption rate at 85 square feet per
bedroom. The trench was constructed to a length of 24' with an effective depth
of 6'. This computes to a total absorption area of 288 square feet.
The system was last tested in November of 1994. At that time the trench was
found to have 8" of standing water and was apparently working well. Our initial
probe of the trench indicated a standing water depth of 41". Water was then
injected into the septic tank to determine the absorption rate over a 24 hour
period. The water level rose to 48.5" after 500 gallons of water had been added.
The water level was then checked the following day and found to have receded
to the 36" depth. It appears therefore, the trench is capable of absorbing more
than 450 gallons of water per day.
The normal life of a septic system is from 8 to 12 years and can be less
depending on the type of system and quality of soils in which it is constructed.
This system is now more than 25 years old and showing signs of fatigue. It is
difficult to estimate the remaining useful life of the system, but at this time it
meets the minimum requirements for certification. No guarantees are expressed
or implied however concerning the future life of this septic system.
Sincerely,
Michael E. Anderson, P.E.
Attachment
· ' Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number:LOT 9, BLOCK 2, TROLL KNOLL SUBD.
Page 3 of 3
PID No.
THREE BEDROOM HOUSE
DECk
1.25'
7.7'
I
1.75'
t
Dr'c~inField
115'
PROFILE AS
Scole: NONE
BUILT
Senf;
· RE/UAX OF EAGLE R[VER~ ZNC.;
2 '2
9076960214;
!
Aug-13-02 2:09PM; Page 212
.ASBUILT-NO CiJE~ERS SET THIS DATE.
HEREBY CERTIFY.'.~I'HAT I HAVE SURVEYED THE
=O'_LOWING DESCRIBED PROPERTY=
;roll. Knoll Subd.:;Lo[ 9,Slk. 2
~.ND T'HAT NO ENCROACHMENTS EXIST ID(C£FT AS
INDICATED, IT IS.,'3'HE RESPONSIBILITY OF'
~NE~.TO DETERHI;~'E THE EXISTENCE; OF ANY
--AS?MENTS, COVENi~-NTS, OR RESTRICTIONS,
YHICH DO NOT APPEAR ON TIlE RECORDED SUSOI~'
/ISlO.N PLAT. UNDE, R NO CIRCU~4STANCE5 SHOULD
~J'~Y DATA HEREO~:'BE'USED FOR CONSTRUCTIb~
::)? F~£NCE lINES, OF{ FOR ESTA~L. ISHING BOUND-
%F~¥ LINES. .-.
.Re'ceived Time Aus.13. 12:58PM
.~ i ..'.'".:~':. '. : ..... .
SD~AI1D & ASSOCIAIES LAND SURVE~II~ 688-&566
SCat. E;
DATE:
3-23-90.
GRID~
1360
7'58
DRAWN;
'" /,'~"~ MUNICIPAUTY OF ANCHORAGE
~'r~ ,.' i' ~ ':-:, / '~' .~.~o~ ,, _ DEPARTMENT OF HEALTH & HUMAN $ ..I~.VICES · ,'
- ' - " ' ' "'. DI;/Islon'ofEnvin~nmentalS~r~lF.~"'" ' ':" · .
' '"'--..,...:. 3:.*..~...* ',-..-", · ~.; ,:.:~. .", -.,,.w,~- ~;':= On-Site ..... Servlce~ Section'-''?~,
..... ~ P.O. Box196650 "Anchorage, Alaska '995196650 ~:;' ":: · :. .'.
............ ,' :~' '~'..'.: 34,3-4744 '
· · . · '"..': :;t~' ..... ' 7 '":-
· ~ .!-..- ...... : ....... CERTIFICATE OF HEALTH AUTHORITY . '.:'. ~ . '
.................. APPROVAL FOR A SINGLE FAMILY DWELLING ' " ....
' ParcelI.D.# 0~"1--5'~1--11 HAA#
· ' GENERAL
..... ~. '~". 1. ~ INFORMATION
~: ,~ ' Complete'legal description ~,9 t~2 '~-o]] "~<no[] $/D · ':'.
:" Propei'ty owner ~-,~ ~,~a,,,-,.,,-,~-~ Day phone 688-1162
' MSiling addr~ :~3~6 ttilltop Potors Crook
Lending' egen~t D~¥ phone
- ~ ~-.~., ,.~. Addr~ .........
~, NUMSER OPBEDROOMS .......... . . .....
"3. ::.TYPE OF WATER SUPPLY: · . ' ' 'i . ' "". ' ' '
~! :. ::~_ . Individual well - · ' "
'; ,.,ommun,,~ we,, ~.~;
.... -" '" Publicwat~r , *' · ....
..... ' NOTE:,~' If community well _sy~__tem, 'provide written confirmation from State ADEC attest- y . .
7 '..,-.. 4. -'~:.TYPE OF. WASTEWATER DISPOSAl.:
.,.,. ~,.~..,, ........ ..~:~?~,-7-1ndivldual on,site,. ...... :,-;?,~-__ .., ~-..~..,., ::~. !,:~,,.,.~,,,,~.~[~,,,,~t .......... , . .
~," ~ ;~-..'NOT~ ,.If~mmunl~w~tawate~,s~tem provide w~ffen confi~ation'fmm State ADEC ;. ..'
1.. ' r~..'. ,,. ~ . .:..- .~ ,..~ a~lng to the and ~s of ,~em.~ ... ,.?: ~ -: , ~ ',,, * ~.. :.
' -.. ;.=-~ ~.- '..=...~,:, ~ ~. '.-~ :~.,., t~,.,.',- .-. -, ;~ ..... : . ......... · ..................... ~~.,.:, ,,. -..~..-
Day phone 694-5500: ',.:.' ..' :. .
5. STATEMEHT OF INSPECTION BY ENGINEER . ":'
· .. 'As car~ified *by'n~'y se~l affi~ h~r~to and ~'6f th~'valldation date shown below. I verify that my?.'~,-:~,
' investigatio'r{ ~f this Health Authority. Approval. application. . sh,,ws t~';;t'-t~'e on-site water supply. Y, '~: ':
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 Municipaliht of Anchorage files and from my inves.tgqati°n and ins;~'tion, the on-site water '. :.
supply and/or wastewaYer ais~:~aal s~tem i.s 16;c:bmPliance with all Municipal and State codes.
ordinances, and reguiafi6'ns In effect on the date of this Inspection.
Name of Firm ' S&S ~..n~{neer']ng Phone "~
17034 North Eagle River LOOp Suite~20~ Eagle Ri~6~ 'Alaska :' 9957~!"
..... Engineer's .-
..... . ' . . .,.~,t';.~-.-, ......... ~d~'~ · "'~ :.
................................................................ ,,.~, ,-' .....
_ . ~'. / ~-~:'_:. ·, ~ · ·
, ~ ,,...% ...~.-.,
.t-r:-. ':-'----'.',. ' - P' ~:"~'.,4~pproved for ~. ~'-/ bedrooms. ., ..., . . - . .
....... ~., ........... :~,: .....~-......4~,,...o~ '....,,~,..P~nr~%°, ,.:~-.,,.c,~....bedrooms,~.wtth the followng .stipulattons.~,'.'
...... . ...... ~ , . ..... ~ ..... , .. , .,~. -....~ ~,, - ,. - . ,',.~,?I~*~-'... ~ ,, ~ ,. ~, ~ , -,..
· ' · ....... " AdditionalComments ...... ~ ........ -,,.-'
.~ '? . .:. ~ ....,..,.,. _-.- ..... .~ .... . , ...~..
...... , ~,,.~.~,~;:~.~ . .., . ,.. . ,,. , . , . .... , . r ,.. r '
· .. ". 't ~. ~ Mun c ~1 w of Anc~mge ~t of H.Im and Hum~ ~ (DHHS) I~ H- · ~u~d~ 'r r. -
. . ~, ~,~ o~f~ona en~[~e~ n~SateofAl~k~DHHSd~ua~t°P~m°f~°~4/i '~
'~" ~ ';: ;;~i~lendna n~onsinoffierto~inf~~ui~'~Pl°~of.DH~d~,~':';,. -'
. ,. ,.. · . · . .-,...., :.., ·. . ~ , - . . :.~-_..-.:2_,-.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AuTHORiTY. ~ppRovAL CHECKLIST
LegalDescription:L-,~:~--°~ ~ ~-- '"T'~ot.~- I/-J.o~..~slP~rcell. D.
A. Well Data
Well type ~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Dale completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
. · ," FROM WELL LOG ATINSPECT1ON
Date of test
Static water level
Pump level1 ./
·
SEPARATION DISTANCES FROM W~LL TO:
SepticJheldi~ tank on lot '7.-o~, ~L ;~adjacent lots
Pul:dic sewer main
Sewer service line ~
WATER SAM PL~ ~ ~ ~ ~~'"'""~
Coliform ~ Nitrate
~ple:
Petroleum tank
Collected by:
Other bacteda
B. SEPTI .C/HC.~:.C.'~;C TANK DATA
Date installed :.: "'~t ~ C.'
Cleanouts ~N) ,,,/
High water alarm (Y~)
Tank size I c~o o Compartments '7__
Foundation cleanout {~N) ~/ Depressior{ (Y,~
Alarm tested (Y/N) ,'[J4
Date of purnping Pumper
SEPARATION DIS:TANCES FROM SEPTIC/HOL-Di~i~ TANK TO:
On adjacent lots
Absorption field
Well(s) on lot' ,~' /
TO property line '
Sudace water/drainage
Foundation
Water main/service line
CONTINUED ON BACK PAGE
C. UFT STATION
Date Installed
Size In gallons
Vent (Y/N)
'Pump on' level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
.
Surface water
· D. ABSORPTION FIELD DATA
Date installed ~. ~ '1 t~
'. :' Length ." "Z.~ ~ Width
Total absmption area '7--c~ ~ ~
. Date of adequacy test t b-l.-~-~t ~
· : Water level in abso~ion field before test
Soil'rating (GPD/FF)
OV-.- Gruel threes
Ciea~ pmsem
Re~s ~a~ ~5 for 3
~
~¢
- Peroxide treatment (past 12 months) (Y/~J'...))
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~/,~ On adjacent lets :r..~,. ' ~' Properfy line
To buiUing Ioundation 15' ' To existing or abandoned system on lot
On adjacent lots ..'5 o' ~'e Cutbank ~/,~ Water main/service line
Surface water / o o Driveway, parking/vehicle storage area
i
E. ENGINEER'S CERTIFICATION
I cer~y that I have checked, ye#fled, or conformed to all MOA and I-/AA guidelines in effe,c.t._~.~z.._t~?,te of ~is inspec~on.
: ·
Eng,neersName /~06'8a/~ C. C'~,4,,,. .,.~~,'[~
Date II
Waiver Fee $
Date of Payment
Receipt Number
o ~' ~' MUNICIPALITY OF ANCHORAGE ~."
- *. . Department of Healih & Human Services -. ·
' :*. DIVISION OF ENVIRONMENTAL SERVICES .: ·
· -... · ....... : :. . : .... 343-4744:.:-. .... : ': .... ....,: '... ~? ., '."
~:.~.~ ~' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF_. ~'/,:
ON-SITE S~tER AND WATER FACILI'D' FOR SINGLE FAMILY DWELLING ,..:: ?.
' !, GENERAL INFORMATION (Must be completed pre, or to submittal) .',:!:~.~ ~ ..~;, ~ :~.).., ~.'J [,'. 1
..:: (a) Legal Description (include 10t, block, subdivi ion', sectio, t ship, range]....~"'~....~ j:,J'.l.'.j~.¢_~ x~_; ,..; ~., :-
"" ' Lo~ 9, ~ock 2 T~oll Knoll Subdivision- ' ' '"':' ' '' ...... :~;'~'J" ""' ~:'"
(b) Prope~ owner "~ ...... Telephone: (home) Business
Mailing Address - -
'Lendin "' ;' ' "
_~c~ g Ihstitution Telephone ~"
~ ~ ''' 'L, ~ ~', -:
'. il r
(~:Ral Estlte'C~mp~fiyindAgent 'ASsociated Brokers, Inc.
Address 660'~. 36t , Suite ~1 Anchorage~ ~ 99503. '-'" ",'*
phone._:~563133332L~ ,,...~-.-- ~.:"- . . . ....~ ,-- - . - . . ,:.
List cqnt~ct person and day phone number below: :'_~..~-...~ ',-,". ..... ~,~,,,_... ~.: ....
~_ . · ......................... - ........ : ~. . . ~.~.~j · ,-~.~.,
ERD~ & ASSOCIATES Consultin~ ~n~tneers .....
151 East llerntng Avenue ........... 5. ~ { ;f{:¢~, -~..
2.
~PE
Single-Family~ Numberof bedrooms' ~ .... '
3. WATERSUPPLY' - ' ' . . '~..~ '
Individual Well D Community ffi Public ~ .. , ,-.. · .. ~. .....
' '~';?'-?= Note:~. f commun ~'we system:must have.written'confirmation from the State Depa~ment of Environmental: .' Conse~at on attest ng to th ega ~andstatus ' . . - . ' · , - ,.~ · : ....
. 4. SEWAGE DISPOSAL ..... · ~ -..~ ........ ~ ~' .... ~*--~-" .... d ~ ' ''~'.
-:--':: ;;'. Note:If commun ty we system, must have wr tten conf rmat on ~rom the State Depa~ment o~ cnvlronmental:~
Date :March 13. 1990 ............
' ' ' ' ~'~" ~' ~ FI'L-E SEARCHDA"-TAAND IN RMATFO'*ION ' ''~' "*
.... ~*~ 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, , ...... ~-
~'~. :As certified by my seal affixed hereto and as of the validation date shown below, I verify that my mvesbgation of this
~Health:A~thor tv. AoO?~;,l~sh-6~;th~,t;thb ~n':~ite-;~-ate~.;'sUpply-.and/oi~vastev~ater:'dis'posal system Is safe,'~:
';' i.' :i:: ~ ~Jn~t &ne ahd ~ea'u'aYe~f~the ~U~nber'of I~edro°~s*kn'd tyPe of Structure ndicat~d h'e?eln. I further verify that
· }i: '!':ilfi~ect ~r~ th~'On£site W?teF~fipplY'~nd/°r wastewater d $15~sal ~yste~ ls'in-cO'm,151iar~'~.ith all Municipal and "':' State codeS} Ordinances[ and regulations'in effect ~n the dat~ 6f this ins~e~ti'6h'.'.r
· Address' '151 Ease Re~[~ Avenue - : Vas(tla, Alaska 99687 .; *'' .... * .. -
. .............
.............. ~ · ~. e~ ~
. . 9~' .,~
................. ~ ..: :: ....... .- .. ~,..~,~
' . ................... ~ . ~ ~.~: ...... ~ ............. 2.-. . ' .........:~._.-4 ..
~Dato ~' ' ~'
6. DHHSAPPROVAL · -.~.~ , ~.,. :. '.~.~..,
' Approved for/ bedrooms by ~~ // , Da?.' .
Appr~v~'~ [.~/J', Disapproved Conditional .....
T~rms of ConUitional Approval
;~.~ .. ;.~] ;-~ ,-- } · :... : . , .... .;';.,~ ....... .
,,. ~~.~ ,~, ~
-.~). , .~, .I ~ ~ ... ..... . ~. · , · :-~ ..... .
' ,,,~/,.. A .,'~%~ ~.~ . .' . ......... - ,
,.~, , , ~%~ ............ ~ .r,-. .... ) .... ~ ....
The Municipality.of Anchorage Depa~ment of Health and Human Se~ices (DHHS) issues He~lt~ Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer '
registered In the State of Alaska. The DHHS does this as a couResy to purchasers of homes and their lending
institutions in order to satisfy ceRain federal and state requirements. Employees of DHHS do not conduct inspections
~r ~nal~ze data before a ceAificate is issued. The Municipality of Anchorage i.s not responsible for errors or omissions
in the professional engineers work.
Page 2 o! 2
~ MUNICIPALITY OF ANCHORAGE (MOA) .[~"~
,MUNiCIP^I~,~ORAGE Health Authority Approval (HAA)
ENVII~NMEN~$ DIVI$1OISHECKLIST - FEBRUARY 1984
~ · 343-4744
MAR 2 ]990 Legal Description:
RECEIVED
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to ___
Static Water Level
Casing Height Above Grour~d
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 on Lot
WaterSample Collected by
WaterSample Test Results
Comments
SERVED BY CoNHUNITY ~ATER SYSTEH
Lot g, Block 2
Troll Knoll Subdivision
Date Completed
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (WN)
If A, B, C, D.E.C. Approved (Y/N)
Yield
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
SEPTIC/HOLDING TANK DATA
Date Installed 10/76 * Size 1,000
Standpipes (WN) ¥ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (WN)
Holding Tank High:Water Alarm (Y/N)
No. of Compartments 2 *
Y Foundation Cleanout (Y/N) N
Date Last Pumped 7/1/~/89
N/A ; for
Temporary Holding Tank Permit (Y/N) N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well 2OO'+ to community wellTo Building Foundation 10'
To Property Ll*qe.. .5, + ........ : To Disposal Field J 5'
To Water Main/Se?x. ice Line ' lo'+
To Stream, Pond, I-~ke or Major Drainage Course 1oo '+
Comments * Information from HOA file
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 85: sq ft/BR *
Date Installed 10176 *
Width of Field NIA
Square Feet of Absortion Area.
Depression over Field (Y/N) N
Results of Last Adequacy Test PASS
SEPARATION DISTANCE FRoM ABSORPTION FIELD:
To Water-Supply Well 200'+
To Building Foundation 15'
Lot
ToWater Main/Service Line 10
To Stream. Pond, Lake, or Maior Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments * Information from MOA file.
NOTE: This home has been vacant since 7/9/89 adequacy test.
Type of System Design Trench
Length of Field 24' +
Depth of Field 10'
Gravel Bed Thickness 6' *
· " Statndpipes Present (Y/N) ' ~Y '
' Dat~ of Last Adequacy Test 7/9/89
To Property Line 10'+
To Existing or Abandoned System on
; On Adjoining Lots 30'+
To Cutback (if present)
100'+
10'+
N/A
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
NOT APPLICABLE
Dimensions
Manhole/Access (Y/N) '
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request;*
I certify that I have checked, verified, or conformed lo'all MOA and
inspection.
Company ERDNAN & ASSOCIATES Consulting Engineers ·
Date Hatch 13, 1990
MOA NO.
Receipt No. o91770
Date of Payment
Amount: $
.
Seal
Beceipt N~.
Waiver Fee: $
Date of Payment
Page 2 of 2
(Rev. 7/~8) Back
ANC}:ORAGE ~'IESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
A.~;CI~OPJ~GE, ALASXA 99503
March 20, 1990
STEVE COWPER, GOVERNOR
563-6775
FOR: ERD:~! & ASSOCIATES
Attn: ~ike Erdman
According to the
Subdivision Water
Drinking Water Regulations.
PWSID: ~210770 !
records On fil~ in this office, the T=oll Knoll
is in c~mpliance with the State of Alaska
System
Sinc.erely, ~
F.~E. CRAIG
Environmental Field Officer
VEC:bas
MUNICIPALITY Of ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 9, Block 2 Troll Knoll Subdivision
Location (address or directions)
llilltop Drive
(b) Property owner IlUD Telephone: (home)
Mailing Address
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent Associated Brokers, Inc.
Address 660 ~,'. 36th, Suite #1 Anchira~;e, AY. 99503
Telephone 563-3333
(e) Mail the HAA to the following address: (or check here r3, if hold for pick up.)
List contact person and day phone number below:
ERDMAN & ASSOCIATES Consultin~ EnRineers
151 East Ilerning Avenue
{~asilla, Alaska 99687
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Contact: Hike Erdman 376-6989
Business
2. TYPE OF RESIDENCE
Single-Family I~
3. WATER SUPPLY
Individual Well []
Number of bedrooms 3
Community ~ Public []
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 []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
Page 1 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 of this inspection.
Name of Firm ERDNAN & ASSOC'tATES
Telephone 376-6989
Address 151 East IlerntnR Avenue WasLJta, AK 99687
Date July 17, 1989
6. DHHS APPROVAL
Approved for. -~
Approved '~
Disapproved Conditional
Terms of Conditional Approval
Engineer's Seal
'-7-87
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 of 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
JUL 4 1B8
RF.C£1V£I)
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
. Static Water Level
.Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA)
Health Aulhorlty Approval (HAA)
CHECKLIST- FEBRUARY 1984
343.4744
Legal Description: Lot: 9, Block 2
Troll Knoll Subdivision
SERVED BY COI,~dNITY t/ELL
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (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 Sen/ice Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 10/76 * Size
Standpipes (Y/N) Y
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (WN)
Holding Tank High-Water Alarm (Y/N) N/A
1,000 *
Air-tight Caps (Y/N)
N
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout~Manhole
;Date
No. of Compartments 2 ~
Foundation Cleanout (WN)
Date Last Pumped 7/1~,/8g
N ; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well :~OO'+ to co--unity well To Building F0undation 10'
To Property Line 5' + To Disposal Field 15 '
To Water Main/Service Line 10 '+
To Stream. Pond, Lake or Major 'Drainage Course 100' +
Comments * Zn£ormation [rom HOA file.
Page I of 2
Co
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 3.0/76 *
Width of Field
85 ft2/BR'*
Square Feet of Absortion Area 288 *
Depression over Field (Y/N)
Results of Last Adequacy Test Pass
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well 200'+
To Building Foundation 15'
Lot
To Water Main/Service Line 3.O'+
100%
10%
Type of System Design
Length of Field 24' *
Depth of Field 6' Cover
Gravel Bed Thickness 6' *
Statndpipes Present (WN)
Date of Last Adequacy Test
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments * Information from NOA file.
Trench
Y
7/9189
To Property Line 10%
To Existing or Abandoned System on
;On Adjoining Lots 30%
To Cutback (if present)
N/A
D. LIFT STATION NOT APPLICABLE
Date Installed
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)
Pumping Cycles during Adequacy Test.
Company ERDi',~.N & ASSOCIATES Consulting Engineers
Date July 17, 1989
MOA NO.
"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.
Receipt No, ~/~ ~
Date of Payment ~'~'~ ~/-"'~2
Amount: $ / "~ - ~
Engineers Seal
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
3601 C STREET, SUITE 322
A}~CHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: July 17, 1989
~;SID: 21077~,
To Whom It May Concern:
According to the records on file in this office, the Troll Knoll
S/D Water System is in compliance with the State of Alaska Drinking
Water Regulations.
Sincerely,
~mCenP~taI~' Fiel~ Of ficer
VEC: gd
t,,-.- ERD 1AN & ASSOCI/TES
'CONSULTING ENGINEERS
SEPTIC SYSTEM ADEQUACY TEST
Location: L~/~ -r~o~.~_
Number of Bedrooms:
Septic Tank Size: ~0~ (gal.)
Soil Absorption System:
Required. Flo~: ~_ ~ ,~
~- ~b ,.-','
Date
Inspector
Project #
Cum. Tank Change SAS Change
Time Flor ¥ol. Vol. Level Tank Level SAS
(gpm) (gal.) (gal.) (ft.) (ft.) (ft.) (ft.)
Co~ent$
KECOVERY
TEST RESULTS
~ Passed Failed
Underground conditions are subject to change over the course of time.
t5t Eo~I Hernln~Avenue Waslllo. Alaska 99687
907-376-6~'o
~PPLIC"NT FILLS OUT UPPER HAI"~ONLY
8u~er
Address
Address
Realty CO. & Agent ~) ~//~/'"///~ ~ ¢
Address
Legal Description
Street Location
Type of Residence
(~' Single Family
[~] Multiple Family
ri Other
Water Supply
[] tr~dividual
~ COmmunity .
Public Utility
Sewer Disposal
Phone
Zip Code
;
" Zip Cod
ATTACH WELL LOG. A well log IS required for ell wells drilled since June 1975,
Fei wells ~illed prior to that date, give well depth (attach log i! available).
Year Individual Installed: // ~ 7 ~' /"'
When CO~ected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time TIm~
Date Date Date
Inspector Inspector Inspector
Field Notes:
.~) APPROVED BEDROOMS
(
( ) DISAPF~ROVED
( ) CONDITIONAL APPROVAL*
'CONDITIONS OF APPROVAL
Time
Da,.
Inspector
NOV 2 9 i~j3
RECEIV. FD
Soils Rating
Date ~ewer Installed
IWell To Absorption Area
Well ID Tank
December 5, 1983
Rainier Delaney property
Dynamic Realty Inc.,
Attn: Byre Bonfoey
P.O. Box 677
Eagle River, AK 99577
subject: Lot 2, Block 9, Troll Knoll Sub. Anchorage Record Dist.
Approval for the individual sewer and water facilities cannot
be Granted until the followinG items have been completed:
The septic tank pumped with a receipt submitted to this
department.
An adequacy test needs to be performed on the existing
leachinG area. This test will determino if the system is
adequate accordinG to National Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please come in and provide the correct lot and block, as it
appears the legal is reversed.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Enclosure
CW2/a/Env3
C o r;/~ Willis
Ac{~n,~ ~Sewe~ & %fat~_~_~~ ~.
Program ~ana~je r
TECH ENGINEERS, INC.
CIVIL · SA/VlFARY
January 1, 1984
Mr. Rainer Delaney
4580 Hilltop
Peters Creek, AK 99567
Re: Septic System Adequacy Test, Lot 9,
Block 2, Troll Knoll Subdivision
Dear Mr. Delaney,
On December 30 and 31, 1983, we performed a septic
system adequacy test on the above referenced property. 800
gallons of fresh water were discharged into the absorption
trench at a 10 gallon per minute flow rate. The water did
not accumulate in the trench and the absorption rate was
equal to the application rate.
As part of the test, the septic tank was pumped and the
volume was verified to be 1000 gallons. At this time, the
sewage septic system is adequate for a three bedroom
residence.
If you have any questions, do not hesitate to call.
ernon . o-ezzs,/~ -
13LE DOUX LANE · EAGLE RIVER. ALASKA 99577 ° TELEPHONE (907) 694-3574
TIME
DATE
INSPECTOR
INSPECTION APPOINTMENTS
TIME
DATE DATE
INSPECTOR INSPECTOR
DEPT. OF S:~ALTH
MUNICIPALITY OF ANCHORAGE r~l ,
·
825 L Slr.t. Anchor,.. Al.sk. 99501 APR 2 3 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone2~4720 RECEi~_
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all paris o. page 1. Incomplele requests will r~ol be processed. Please allow fen (10] days for processing.
t. PROPERTY OWNER I PHONE
RICHIE, LAI~RENCE ] NONE
MAILING ADDRESS
PROPERTY RESIDENT III dHlerenl from abowl
~HONE
2, ~UYEfl
SEXTON, HICHAEL,JUDITH
MAILING ADDRESS
PHONE
3, LENDING INSTITUTION
ALASKA FEDERAL FEDERAL SAVINGS AND LOAN
MAILING ADDRESS
PHONE
274-6565
4. REALTOR/AGENT
JOtIN PARKER
MAILING ADDRESS
P.O.BOX 911 EAGLE RIVER,
AK 99577
PHONE
694-9494
5. LEGAL DESCRIPTION
L9 BLK 2 TROLL :KNOLL
STREET LOCATION
NHN III LLTOP
6.TYPE OF RESIDENCE
SINGLE FAMILY
r-I MULTIPLE FAMILY
WATER SUPPLY
F-I INDIVIDUAL'
_ .~ COMMUNITY
· ' [] ' PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE"
[] PUBLIC UTILITY
SUB
NUMBER OF,BEDROOMS
[~] One I-"1 Four
[] Two I-'] Five
r~ Three [] Six
[] Other
· ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, g~ve well
depth lattach log if available.)
1 9 7 7 YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST A/CC~OMPANY
E~,CH REQUEST BEFORE PROCESSING CAN BE INITIATED.
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY ~
[] INDIVIDUAL
I--1 COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON *SITE
r--IPUBLIC UTILITY
Connection Verified
I--]Septic Tank or [--I Holding Tank
Size: ~ ~ If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
5. COMMENTS
'iTHIS SIDE~ FOR OFFICIAL USE ONL/~'.
[] ONE
[] TWO
PERMIT NUMBER
DEPTN OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR r--I SIX
SOILS RATING
MANUFACTURER
MATERIAL
[] OTHER
~,,~-~CISP R OV E D FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72.010 (Rev. 6/79)
~1: Time
Date
Insp
DEPART'"r~ ,' MUNICIPALITY OF ANCHORACuF.,
OF HEALTH AND ENVIRONME[ IL PROTECTION
825' L Street, Anchorao~, Alaska 99501
264-4720
Date Received: January 23, 1978
~2: Time ~3: Time
Date Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Lomas and Nettleton Company
Mailing Address: 4449 Business Park Boulevard Phone: 274-7661
2. Property Owner: Allan Zmuda
Mailing Address: Box 443 Eagle River 99577
Phone: 688-3436
3. Legal Description:
4: Single Family Residence: (x)
Multiple Family Residence: (
5. Well System: Individual well
Permit ~
Construction
Lot 9 Block 2 Troll Knoll subdivision
Number of Bedrooms: Three
) Number of Bedrooms:
( ~mm~nity/Public System (x)>
Depth of Well Nell Log on File ( )
Bacterial Analysis
e
Sewage Disposal System: On-site.~x.) Public Utility
Permit # Install~ 1976~/~Installe~
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~kwo
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 9 Block 2 Troll Knoll Subdivision
Comments:
Affadavit Attached: (') Letter Attached: ( )
Disapproved: %-/ Date:
Department Worksheet:
~'h MUNICIPALITY OF
ANCHORAG.'
~ Department of Health and Environmen~a~.'Protection
~,° ~~/ 825 L Street, Anchorage, Alaska 99501
" '~equest for Approval of Individual Sewer a~io~Facilities~.~
Property Owner:
Mailing Address:
~ t/~% ~,~ I: : Phone,
e
Name of Buyer:
e
Mailing Address:
Lending Institution:
Mailing Address:
Phone:
Phone:
Se
e
e
e
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Single Family Residence: (~Number of Bedrooms:
Multiple Family Residence:
Phone:
( ) Number of Bedrooms:
Public/Community System
Water Supply: *Individual Well ( )
If Individual Well, well depth
If Community System, name of system
Sewage Disposal System: *~Dn-site System (~Public System ( )
If On-site System, date of installation: /~/~
*NOTE: A well log is required on ALL wells ~rilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77