The URL can be used to link to this page

Home My WebLink AboutDAWN VILLAGE BLK 2 LT 3hewn Village Block 2 Lot 3 #014-061-41 Mark Begich Mayor beve]opm,¢nT S~rvices Department Bui!cii~g 5~fety Division On-5i¢¢ W~"rer & W~sCew~ter Progrem 4700 ~r~gow 5¢reet P.O, Box ~96650 Ar~chot*~gc, Al< 995Z9-6650 www.muni.orq/onsf?~ (907) 343-7904 Well Drilling Pe~'mit Number: SW Pump Installation Log Date of Issue: Parcel Identification Number: Legal Description Property Owner Na,~e & At}dress: Pump Installation Date: q,,~%.-7-/, I Pump Intake Depth Below Top of Well Casing: ~'(~ feet Pump Manufacturer's Name: /~C~ ~O~X(~ l<~ Pump Size /~.. hp Pitless Adapter Burial Depth: [' 0 i'eet Pitless Adapter Manufacturer's Name: ~)/~ Pitless Adapter :Installer: ~)//~ Well Disinfected Upon Completion?~ Yes [] No Method of Disinfection: Comments: Pump Installer Name: Anchorage Pump & Well Service 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. PERHIT NO. APPLICANT LOCATION LEGAL PETER~SON CONSTRUCTION TESHCAR ST L3 B2 DRI.IN VILLAGE SRR BOX 171AX LOT SIZE i0000 SQUARE FEET HINIHUH DISTANCE BETWEEN 8 WELL. AND ANY ON-SITE SEWAGE DISPOSAL SYSTEH IS leo FEET FOR A PRIVATE WELL OR 2C40 FEET FOR R PUBLIC HELL NELL LOGS ARE REQUIRED AND 1-11JST BE RETURNED TO THE DEPRRTIIENT i. IITHIN 3e DRYS OF THE HELL COHPLETION. SPECIFICATIONS 8ND' CONSTRUCTION DIRGRRHS ARE AVAILABLE TO INSURE ~ROPER I NSTRLLRT I 0N. PERI,11 1' ~/RL I D FOR Ot~E VERR FROt,1 I S5~JFZ I CERTIFY THAT I: I AH FRHILIRR WITH THE REQUIREHENTS FOR ON-SITE SEWERS AND WELI_S RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE, 2: I WILL INSTALL THE SYSTEH IN ACCORDANCE HITH THE CODES. SI GtED ........................ , 'RPPL ~NT PETE?~0N CONSTRUCTION . Municipality. of,Anchorage Development Services Department Buitding Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 O CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal DesCription: DAWN VILLAGE BLOCK 2, LOT 3 Parcel ID: O I~ OG ~ L~ ~ A. WELL DATA Well type pRIVAT~ Date completed Total depth 102 Date of test Static water level Well production · BASED UPON SURROUNDING WELL LOGS. If A, B, or C provide PWSID# N/A 4/21/77 ft* Sanitai'y seal (Y/N) YES Cased to *40+ ft. FROM WELL LOG 4/21/77 30 ff. 7 g.p.m. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 10/12/09 24 .ff. 7 .g.p.m. YES YES 12+ in. C= WATER SAMPLE RESULTS: Colifom~ ~ colonies/100 ml. Arsenic: [I. ~ ug.lL. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Foundation cleanout (Y/N) Nitrate ~ ) ("') mg./L. Date of sample: 10/12/09 PUBLIC SEWER Number of Compartments Depression over tank (Y/N) Other bacteria ~ coloniesll00 mi. Collected by: GEG Ltd. Date installed Cleanouts (Y/N) High wat~J D~te of p{~mping ABSORPTION FIELD DATA Date installed Pumper S°'l ratinjdi~'P'd'/ff'°r~~ ':~w pipe Length . ft. ft. Totalde~t'h ft. Eff. abso~ ft2 Monitoring tube Depressionoverfleld Date of a~equacy test f Results (Pass/Fail) ~ For bedrooms · Fluid dopih i~ ~ before test in. Water added gal. New depth in. Elap~ rain... Final fluid depth in. AbsOrption rate >= g.p.d. ,,J~'~u,~ .enation treatment (past 12 mo.) (YiN & type) If yes, give date D. LIFT STATION Dateinstalled. Size in gallons ~ ~-~ 'Pump on" level a~ High water alarm level at in.' Da_~.J_utum ~ C~ alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankJlift station on lot N,/A Absorption field on lot N/A Public sewer main *45+ Sewer/septic service line . *23'4- Animal containment areas. 50'+ On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank 100'+ 100'+ '96+ Manure/animal excrete storage area~ 100'+ SEI~ARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water service line Surface water ~'~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORP~ TO"~ Property line ~undation. Water main. Water service line ~ Surface water Driveway, parking/vehicle storage ~ Wells on adjacent lots, F. cOMMENTS *ADEC TEMPORARY WAIVER APPROVED 4'//3'/85. MOA INDICATED THEY WOULD HONOR THIS WAIVER. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this data. Engineer's Printed Name JEFFREY A. GARNESS Date I ~ ~ C0$A Fee $ Dat,e of Payment Receipt Number (Re~t.~ll/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On-Site Systems Approval # 090396 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 3 of Dawn Village Subdivision. This inspection revealed an arsenic concentration of 11.4 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On-Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. SGS Ref.# 109553700 I Client ,Name Gat'Ross Engineering Group, Ltd Printed Datefrime 10/26/2009 8:31 Project Name/# Dawn Village B2 L3 Collected Date/Time 10/12/2009 14:30 Cllent Sample ID Dawn Village B2 L3 Received Date~Time 10/12/2009 14:55 Matrix Drinking Water Teehnlcal Director Stephen C. ['.de PWSID 0 Sample Remarks: Allowable prtp Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Hera:La by ZCP/~ Arsenic 11.4 * $.00 ug/L EP200.8 C (<10) 10/19/09 10/20/09 NRB Waters Department Total Nitrat eJNitrit e-N ND 0.100 mg/L SM204500NO3-F B (<10) 10/13/09 LCE l, ti. crobioloi~/ Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 col/100mL SM20 9222B A (~200) coFI00mL SM20 9222B A (<1) col/100mL SM20 9222B A (<1) 10112/09 DLC 10/12/09 DLC 10/12/09 DLC ............... 8~"0 2..'7 ~ 5P~ 7 8 0 E-//'//- o~_o~ ANCHOR,ACE OlSTRlOl' lOT 4 4g~ wn Anchorage Recording DlsfrlctTAlaska ~.OT SURVEY C~RTIFIC~TION Ret 2034 '" ~'B. No. ~U]'r.~ SAI,~;~-~ Drv]~O~] ,LEGEND 0 .'.-~.~ pipe am~ r~b~-'-d~ ~ 2 x 2 hMb & t~ r~x~r~ 5/8"x30#rtbor Imf INI I~ ' · - ' 0~'~ ~") 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) /' Location1 (address or dire(~ti0ns) (c) Applicant is (check one): Lending Institution []: Owner_/builder"J~': Buyer []: Other [] (explain): (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address ~,~/ Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL. Onsite [] Public'k~,, Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72.025 ENGINEERING FIRM PROVIE ~ INSPECTIONS, TESTS, FILE SEARCH, t.,../'A 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 coml~liance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address /~'~' Date DHEP APPROVAL Approved for . .Y Approved ~,,., Disapproved Conditional Date Terms of Conditional Approval CA UTI O N 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 this 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAI~LTH AUTHORITY APPROVAL (HAA) " DEPT. OF HEALTH & EI',IVIRONMENTAL PROTECTION JAN 1 $1987 A. WELLDATA RECEIVED CHECKLIST - FEBRUARY 1984 2644720 Legal Description: .-7-f2,,,/ Well Classification Well Log Present{~ Total Depth /~t,~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Condui[~N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C., D.E.C. Approved (Y/N) . Date Completed Z//-~/- ~'7 Yield Depth of Grouting Pump Set At Sanitary Seal on Casing t~_.~N) Depression Around Wellhead (Y~) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Li.0p~~' ,~5' / Cleanout/Manhole ~ ?~, Water Sample Collected by Water Sample Test Results Commented') ~:~'(~ ~-~-- ; On Adjoining Lots //.~ ; On Adjoining Lots - To Nearest Public Sewer To Nearest Sawer Service Line on Lot ; Date /- B. SEPTIC/HOLDING TANK DATA . /' , Depression over Tank {W~~ Pumping/Maintenance C~t ~ _ Holding Tank High-Water Alarm (Y/N) ~ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments undation To Disposal ~ To Stre~Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA s Rating in Absorption Strata Date ed Width of Square Feet of Absorption Depression over Field (Y/N) .~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course ~ To Driveway. Parking Area. or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (WN) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining To Cutbank ,t) LIFT STATION ~'--~"'///'~7 Manhole/Access (Y/N, "Pump On" Level at ~...z~ 'Pump Off" Level at Water Alarm Level at ~'"'~'"~~Vent (Y/N) High Tested for ~ ~ ~Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that l h av~e~d,~er~j~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~-'~'~(- '- '~'~"'"'"-'~ Date MOA NO. Company Receipt No. ~/'~dbO / Date of Payment Amount: $ DEPT- Of: HEAL'[ ~2-0~ {11~84} RECEIVED Lelal Description (include lot, block, ~ubdivision, section, township, range) ~o~s~on (~dress or direa~io~) (1)) (d) (e) Applicants Address ~, ?z// ~ cA [o~ ~, ~-'.. Applicant is (check one) Lendina Institution Buyer~-~; Other~(explain); Telephone - tto~e Business j J Real Estate CO. & Agent (f) ~ail the HAA to the following address: 2. Type of Residence Single-Family.~U. Number of Bedrooms 3. Water Supply Individual Multi-Fam!!y~ Other (describe) Community~ Public~-~ Note: I~ c,o~munity well system, must have written confirmation fro= the State Department of Envirom~ental Conservation attestin$ to the legality and status. 4. Serape Disposal 0nsite ~-~ Public ~ Co=unity ! i Eolding Tank ~-U Note: If community well system, must have written co~izmation ~rom the State Department o~ Environmental Conservation attesting to the legality and status. [Page 1 of 2] .,~ 5- En$ineerin$ Firm Providin~ Inspectious~ Testst File Seareh~ Data and Information As certified by my seal affixed hereto ~d as of the validation date sbow~ below, 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 adequa=e for the number of bedrooms amd ~ype of structure indicated herein.. I further verify =hau, based on the information obtained from the Manicipality of Anchorage files and from ny investigation and inspection, the o~-si~e water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regu!a- tions in effect on the date of this inspection. Date ~/q/~ S ' · -- · . ~z ........ A roval Approved for ~l~.',-a-,---bedrooms By /~,*~-- [~'~'~,t.t~,._.%~.t(~ Date / .... " Approved , Disapproved Coeditional THE MUNICIPALITY OF ANCEORAGE DEPAR."2IENT OF HFALTE AND ENVIRONMENTAL PROTECTION (DEEP) ISSUES ~vALTE A~THORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONE GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTEF~.~, IN T~E STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF EOMES TEEIR LENDING INSTITL~IONS IN ORDER TO SATISFY CERTAIN FEDERAL 321D STATE REQULKE- MENTS. EMPLOYEES OF EHEP DO NOT CONDUCT LNSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORACE IS NOT RESPONSIBLE FOR ERRORS 0R OMISSIONS IN TEE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eI/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE ,.~ DEPT. OF HEALTH & ..._~ ENVIRONMENTAL PROTECTIONi (MOA) {m~i APR 1 ? 1985~ welt ~og ~esent ~) Total Depth /jp.~" Cased Stati~ Watsr revel ~.),R7/ Casing He ight Abov~ Ground /, ~ / Separation Distances f~cm Well: To Septic/~olding Tank cn LOt TO Neaz~st Edge of Absomption Field ~ Lot To Nearest Public Se~ Line c~ean~t.v~nt,ole ~ 9~ ~at~ Sample Collectsd B~ Z~b~ ~ ~ts ~a~ 8~mple Test To Nea=est Public Sewer B$ To Wats=Supply W~L1 To Prc~er~y Lira To Water ~ain/Service ~ine To Building Foundation ~J/~ To Dis[x~al Field ~/A To St=earn, Pond, Lake, ~ Major D=ainage [Page 1 of 2] Receipt t Date Paid.- 2-15-84 Soils Paring in Abso~tio~ Strata ~/~ Width of Field Square Feet of Abs~mticn'A~ea Dep=ession ~= Field (Y~) ~ ~ ~ ~st ~ ~st ~ati~ Dis~ Type of System Design ~ength of Field ~/~- Depth of Field Gravel Bed Thickness To Buildin~ Foundation To Ware= Main/Be~vice Line ,~t~/,4 To Cutbank(if To Stream/Pond/r2~.e/(= Majo= ~ainage Course ~/t. To D=iveway, Parkir~ A=ea, c= Vehicle Stc~age A~ea ~t/{~4- To Existing c=' Abanckmed System cn 'Pum~ Off' level at vsnt Pum~in~ Cycles ~u=ir~ A~eguacy Test. 2-15-84 ALASK/ IIUIROIlm ilTAL COI1TROL S RUIC S, IilC. ~nqineerincI G ~nuironmental Studies MARCH 20, 1985 ED ZEHRUNG 6741 TESHLAR DRIVE ANCHORAGE, AK 99507 SUBDIVISION - DAWN VILLAGE BLOCK - 2 LOT - 3 WELL FLOW TEST A FLOW TEST WAS PERFORMED ON THE WELL. 306 GALLONS OF WATER WAS PUMPED AT A RATE OF 1.7 GPH OVER A DURATION OF 2.25 HOURS. THE DRAWDOWN .WAS 69.06' WITH A RECOVERY TIHE OF 30 HINUTES AND THE STATIC WATER LEVEL WAS 42.87 PEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOH HOHE. 1200 LUesI 33rd Auenue, Suite B · Ane~oracle, Alaska 99503 · [907) 276-1361 o DEPT. OF' £N%'IRONMENTAL CONSERVATION ANCHORAGE/~ESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 203 ANCHORAGE, ALASKA 99501 274-2533 April 3, 1985 Alaska Environmental Control · Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 SUBJECT: .Waiver Horizontal Separation between t,!ell and Sewer Line !Lot 3, Block 2, Da~.~n Village,~ Anchorage ( 521- A-125) Dear Sir: The Department has revietied the subject waiver request and hereby tempo- rarily ~aives the horizontal separation between the well and se~er man- hRe, sewer line, and private sevler line to 96, 45, and 23 feet respec- tively on the subject property for a single family residence only. The temporary waiver is contingent upon a [.IID being applied for. If the IJID is not constructed within 3 years, the system will be upgraded to code. Sincerely, SUE/msm DEPT. OF £N%'IRONMENTAi, CONSERVATION ANCHORAGE/~ESTERrt DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 9950! BILL SHEFFIELD, GOVER,'~IOR 274-2533 April 3, 1985 Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Separation between Well and Sewer Line Lot 3, Block 2, Dawn Village, Anchorage (8521-WA-125) Dear Sir: The Department has reviewed the subject waiver request and hereby tempo- rarily waives the horizontal separation between the well and sewer man- hole, sewer line, and private sewer line to 96, 45, and 23 feet respec- tively on the subject property for a single family residence only. The temporary waiver is contingent upon a WID being applied for. If the WID is not constructed within 3 years, the system will be upgraded to code. Sincerely, S$1E/msm · ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Aven~. Suite B .ANCHORAGE, Al. ASK,c` 99503 Phone 561-5040 SHEET NO. OF CALCULATED BY OATE CHECKED BY DATE ~"* DATE RECEIVED INSPECTION APPOINTMENTS ITIME TIME TIME iDA DATE DATE INSPECTOR INSPECTOR (~ .. INSPECTOR ~, p. 4~...~. O4~ ~' MU.ICIPA L'TY OF ANCHORAGE ~NICIPALI~ OF AN~O~GE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPt. OF HEAltH & ~5 L Str~ - A~or~, Al~ka ~501 ~IRONMEN FAL PSOTECTION ENVIRONMENTAL SANITATION DIVISION APR 7 1981 Telephone 2~7~ DIRECTIONS: Complete all pa~s on page 1. I~omplete r~u~ will not ~ pr~. ~ease allow ten (10) days for proc~slng. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PRONE 2. BUYER PHONE I[IH~E~ MAILING ADDRESS 3. LENDING IN~ITUTION ~ PHONE I MAILING ADDRESS 1. REAlTOR/AGENT J PHONE MAI ~NG ADDR~S B. LEGAL DESCRIPTION L_-~ - T~ ~ STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY I--I MULTIPLE FAMILY 7. WATER SxUPPLY ~ INDIVIDUAL* i-'l COMMUNITY I--~ PUBLIC UTILITY NUMBER OF~BEDROOM$ [] One I~1 Four [] Other r-I Two [] Five Three [] Six · ATTACH WELL LOG. A well log is required for all wells drilled since Jur!e 1975. For wells drilled prior to that d~te. give well depth (attach log if available., ~?/j~C~77 8. SEWAGE DISFO~AL SYSTEM ... [] INDIVIDUAL/ON-SITE" PUBLIC UTILITY .YEAR ON-SITE SYSTEM WAS INSTALLED. 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 D SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX ! PERMIT NUMBER 2. WATER SUPPLY I--I' INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED [] PUBLIC UTI LITY Connection Verified INSTALLER r--lSeptic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4, DISTANCES WELL TO: Septic/H°lding Tank IAbs°rpti°n Area ISewer Line INearest L°t Line Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) #1: Time MUNICIPALITY OF ANCHORAGE, DEPARTME,r~OF HEALTH AND ENVIRONMEN"~'; PROTECTION 8~5 "L Street, Anchorage, Alaska 99501 Date © 2:30 p.m' 5-4-77 Tues Insp Pratt 279-2511, ext. 224 or 225 Date Received: May 4, 1977 #2: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Mutual Savings Bank Mailing Address: Post Office Box 1120 99510 2. Property Owner: Pederson Construction Phone: 344-8638 Mailing Address: Star Route Box 1718X 99507 Phone: 274-3561 3. Legal Description: Lot 3 Block 2 Dawn Village Subdivision 4: Single Family Residence: (z~ Number of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms: Se e e Well System: Individual we~l (x) Community/Public System ( ) Permit # 77014 Depth of Well 102' Well Log on File ( ) Construction Bacterial Analysis Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-site System ( ) Public Utility Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area 1. Type of Inspection: CMRO VA FHA Mailing Address: ! 3. Name of Buyer: MUNICIPALITY OF ANCHORAGE 2510 Ea~ Tudor R~d, Anchora~, Alaska 995~ 276-2221H'<t"~' REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES ~ ~/7/~ ~~_DayPhone: Mailing Address: Day Phone: / __ 4. Name of Lending Institution: _~'~.~4~_.~ ~'~j'~4~ _...~/_z~,'/ L-'~..-~-~-,~-~') Mailing Address: S. Nameof Realtoror A~ent: o Mailing Address: Phone: Location: ~/?_t/ .~---/~ _,_~--~-~ c~7 ,~-~Zw /'~'~-.-' ,,'-~r,,.J ~8~ -- Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served No. Bdrms. ~ Individual / If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site} If Individual, date of installation 72-003(3/76} . ~.age Two , .... Department of Health and Environmental Protection Request for Approval of'Individual Sewer 'and Water Facilities Legal Description: Lot 3 Block'2 Dawn Village .Subdivision Co~,m,ents: Affadavit Attached: ' ('.) Letter Attached: ( ) Approved: Disapproved: Department Worksheet: Date: