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HomeMy WebLinkAboutDELUCIA LT 20 MUNICIPALITY OF ANCHORAGE DEr TMENT OF HEALTH AND HUMAN SE.V Environmental Health Division 825 'L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT _ / X SEPTIC .r/ANKS~ I] HOLDING ICapa(:lty in g TYPE OF SYSTEM TRENCH X BED [ ] W. DRAIN F_-'] OTHER ;,i ;,pc b.. re.n, trun. ~o~al d~plh trom o,,gH]S grado 0.~ eT 0,~ FT FT F' F1 L X PRIVATE ~ OTHER (Identifv) jd';~ t,,,, ,, ,i' <A3 U; ....... ~ ou, [;or_,:u J case,~ to FT REMARKS: WELL DISTANCES SEPTIC TANK ABSOBPTION FIELD WELL LOTLINE /D ~- /O '../- /'J//~ FOUNDATION ~" AS-BUILT DIAGRAM iYnow I©catlorl ol well. sop, tic system property ,u/es Iour,datlorL dn,t'way watel bodies, otc ) Inspections Performed by ~,~,o 3-17- z~ "'7 ENGINEERING ,.u~w,"~'' r..~,,~'" '- ~.,.,,.,"" .... -'C..~ ~.,~,.,,,,,~- ' ~u.- ,,~,,,.-.-. cedily thai lhis inspection was pedormed according to all r~ix~r~Ip~ lill~l,: ._7 ~./~'--~ 7 Heallh Department Approval:'~~'~'~ ~ '~'~' ~'~)'~7'''-'~'~-'~'~'' Date: ~"~""'" / -- ~ ~- ,:.) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE~._.~zZ-~'~I~/j~ -// 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~D 3~C/[h Township, Range, Section: ~ ~ O~ s~o~ 2 3 4 5 7 8 WAS GROUND WATER 10 I,~t ~ ~, ~[~o ENCOUNTERED? 11 S L IF YES, AT WHAT O 12 DEPTH? p E Depth to Water lP~/.4 13 Monitorino7 /._.A/'-"7 Date: 2-2,,~"'Y? I Reading Date Gross Net Depth to Net Time Time Water Drop 15 17 18 19 PERCOLATION RATE ~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~FFECT ON THIS DATE. DATE: ~"-'""'"~ ~ 72-008 (Rev. 4/85) SCALE .4 E '0 '0 .( ~ ~ ~ ~ ~ r '-' 'k~) O~~ 0 t $ & S ENGINEERING 17034 Eagle River Loop Roed No. 204 Eigle River, Alaska 99577 GRAIN SIZE DiSTRibUTiON TEST REPORT W 90 50 40 ~0 ~0 10 o ~ I; I Iii I .01 N SILT I · I I GRAVEL I % ~AN~ I I USCS l 1 I MATERIAL ~ESCRIPTZON TYPE OF TEST © ~H~Y GRAVEL ASTM ~ 422-65(?2) No.: 8RR Z N 81ZE I~ Z STR ;[ ~UT ! ON TE:~T REPORT RO])NEY P. KINNEY ASSOCIATES Plate No. 1 GRAIN SIZE DISTRIBUTION TEST DATA Project Data P',.-,:, j e c :t N :',. : Samp i ~:~ D~.~sc)r z I]'~ ic, r~: ~Bi:~i~OY Gt'~AV[[L USCS [}lass: i::H:~SH]' 0 ~2 i ass: ~:'La~sS ~¢2 Zt"~d¢~x ~ ixii~' Fig. No. : J. Mechar~ical Ar, alysis Data ir, it iai [)ry ~:~.amp i~:- a'r~(:l -U ar~e=: :L 326. ~B Dry tsample we~gh~ .= 10~[5. ~) '1 ar¢~, f'c,r c:-uniu I a~ :i. ve w~s, l ght r~,~ a i r~ed=. 301. e-; % + 3 ir',. = 0. 0 ;< F:'iNEiS --= 0. 8 Fractional Compor~er, ts % GRAVEL ~:.: 4i~. G % SANi} =-' 56. 5 D6~=; 5. 158 1)30= 1. ~885 D10='. ~i. 634(-]1Z, Cc: -= 0. 8710 Cu = 8. 1;.z_'i~3 EASEMENT AGREEMENTS The undersigned, in consideration of the mutual agreements set forth below, grant, convey and affirm the following easements, effective this ~/~ day of ~.r~-~ ~ as follows: EASEMENT A 1. We, Richard Kimmel and Addie Kimmel, husband and wife, hereinafter in Easement A referred to as Grantors, owners of certain real property hereinafter referred to as "Lot 24" and more fully described as: Lot Twenty Four (24), Delucia Subdivision, according to the official plat thereof filed in the records of ANCHORAGE RECORDING DISTRICT, Third Judicial District, State of Alaska, do hereby grant to Geoffrey W. Decter and Madeline N. Decter, husband and wife, hereinafter in Easement A referred to as grantees, as owners of certain real property hereinafter referred to as "Lot 20" and more fully described as follows: Lot Twenty (20), Delucia Subdivision, according to the original plat thereof filed in the records of ANCHORAGE RECORDING DISTRICT, Third Judicial District, State of Alaska, an easement for a water well now in place on Lot 24, together with the right to lay and ~intain water lines from said well to a residence on Lot 20, and with the right of reasonable ingress and egress for installation and maintenance of such lines. The easement is further described as follows: The northerly 20.00 ft. of the easterly 20.00 ft. of Lot 24 of Delucia Subdivision, located within the SE¼ of Section 9, T15N, R1W, SM, Alaska, and with said right to be effective upon the signing of this agreement by the parties thereto. , 1987, and agree to conditions and restrictions 2. It is understood and agreed that water service to Lot 20 from Lot 24 is to be provided by a connection beginning at the Grantors well on Lot 24. It is further agreed that the costs of installation and maintenance of service line to Lot 20 from said well shall be borne by the Grantees. 3. There shall be no charge for the use of water from the well on Lot 24 so long as this easement agreement is in effect unless a charge is arranged between the parties of their heirs or assigns or successors in interest by separate written agreement. 4. Grantors make no warranty as to the quantity or the quality of the water to be provided and shall not be ~iable for any damages caused by nondelivery of water for any reason. 5. The Grantors further covenant and agree that the Grantees shall have full, free and uninterrupted use of said easement and water for reasonable domestic use so long as such use does not create an unreasonable adverse impact upon the Grantors water supply. 6. Failure to make use of the water and well herein described shall not be deemed abandonment of said easement. 7. Grantees further agree to bear costs, if any, of abandonment of the easement, including but not necessarily limited to abandonment of well. 8. This easement from Grantors to Grantees shall be binding upon and inure to the benefit of the parties hereto, their heirs, legal representatives, successors and assigns, and shall run with the land. Page 2 EASEMENT B 9. We, Dan Franks and Gale Franks, husband and wife, hereinafter in Easement B referred to as Grantors, owners of real property hereinafter referred to as "Lot 25" and more fully described as: Lot Twenty Five (25), Delucia Subdivision, according to the official plat thereof filed in the records of ANCHORAGE RECORDING DISTRICT, Third Judicial District, State of Alaska, do hereby grant to Geoffrey W. Decter and Madeline N. Decter, husband and wife, hereinafter in Easement B referred to as Grantees, owners of "Lot 20" and more fully described in paragraph number one (1), an easement on Lot 25 for the construction and maintenance of a water line from Lot 24 beginning at the property line between Lot 24 and Lot 25 and running east to the property line between Lot 25 and Lot 20 and further described as follows: The southerly 10.00 ft. of the easterly 115.00 ft. of Lot 25, Delucia Subdivision, located within the SE¼ of Section 9, T15N, R1W, SM, Alaska, utilizing as small a portion of land on Lot 25 as possible and which allows installation to be in compliance with Municipality of Anchorage standards. 10. It is further understood that the water line will be installed in a manner which conforms to and meets Municipality of Anchorage standards and which includes reasonable restoration of the surface of the land after installation. In the event the water line requires excavation for repair in the future, the Grantee will insure that all surface areas disturbed through the repair effort are restored to their original condition, to include the removal and replacement of fences, shrubs, lawn, pavement, etc. Page 3 11. It is further understood that such easement includes the right to ingress and egress for pre-construction testing and engineering and subsequently for installing, maintaining and repairing said water line. 12. Parties agree and understand that the Grantees shall bear any and all costs associated with installation, maintenance and repair of the water line. 13. Grantees shall hold the Grantors harmless in the event of malfunction of said water line unless Grantors or their heirs or assigns or successors in interest negligently or intentionally and deliberately damage the water line or interfere with its operation. 14. There shall be no charge for the use of land on Lot 25 for said water line so long as this mutual easement agreement is in effect unless a charge is arranged between the parties or their assigns or successors in interest by separate written agreement. 15. Grantors make no warranty as to the suitability of land on Lot 25 for the installation and operation of said water line. 16. Grantors further covenant and agree that the Grantees shall have full, free and uninterrupted use of said easement and water line for reasonable domestic and other use so long as such use does not create an unreasonable adverse impact upon the property of Grantors. 17. Failure to use the easement and the water line herein described shall not be deemed abandonment of said easement. 18. This easement from Grantors to Grantees shall be binding upon and inure to the benefit of the parties hereto, their heirs, legal representatives, successors and assigns, and shall run with the land. Page 4 19. Agreement shall remain in effect until such time as city water becomes reasonably available to Needles Drive and hereafter for sixty (60) days. IN WITNESS WHEREOF, The foregoing has been signed and accepted by the parties hereto as follows: EASEMENT A Richard Kimmel, Grantor Addie Klmmel~ Mad~line N. Decter EASEMENT B Madeline N. Decter Page 5 STATE OF ALASKA ) : ss.: THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this ~7~-day of ~f~ , 1987, before me, the undersigned Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared RICHARD KIMMEL, known to me and to me known to be the individual named in the above Mutual and Reciprocal Easement Agreements; and he did acknowledge to me that the same was signed freely and voluntarily, with knowledge and understanding of the contents thereof, and for the uses and purposes therein mentioned. WITNESS my hand and notarial seal. Not~ry Pu61ic in ~nd for Alaska, My co.mmission expires: ?,~,/~ STATE OF ALASKA THIRD JUDICIAL DISTRICT i ss.: THIS IS TO CERTIFY that on this ,PT~- day of ~/f/~z~ , 1987, before me, the undersigned Notary Public in and for t~e State of Alaska, duly commissioned and sworn as such, personally appeared ADDIE KIMMEL, known to me and to me known to be the individual named in the above Mutual and Reciprocal Easement Agreements~ and she did acknowledge to me that the same was signed freely and voluntarily, with knowledge and understanding of the contents thereof, and for the uses and purposes therein mentioned. WITNESS my hand and notarial seal. ,~.~.~ · Notary Public in ~nd for Alaska My commission expires: Page 6 STATE OF ALASKA ) : ss.: THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on thism~ day of~[~-~ , 1987, before me, the undersigned Notary Public in and for~--the State of Alaska, duly commissioned and sworn as such, personally appeared DAN FRANKS, known to me and to me known to be the individual named in the above Mutual and Reciprocal Easement Agreements; and he did acknowledge to me that the same was signed freely and voluntarily, with knowledge and understanding of the contents thereof, and for the uses and purposes therein mentioned. WITNESS my hand and notarial seal. Notary Pu61ic in ~nd for Alaska My commission expires: STATE OF ALASKA ) · - : SS.: THIRD JODICIAL DISTRICT ) THIS IS TO CERTIFY that on this ~7~ day of//~?~~' , 1987, before me, the undersigned Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally appeared GALE FRANKS, known to me and to me known to be the individual named in the above Mutual and Reciprocal Easement Agreements; and she did acknowledge to me that the same was signed freely and voluntarily, with knowledge and understanding of the contents thereof, and for the uses and purposes therein mentioned. WITNESS n~ hand and notarial seal. Notary Public in an~' for Alaska My commission expires: Page 7 QGREA' 'R ANCHORAGE AREA BORr Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 'GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS '7, ~,,,~ INSIDE WIDTH ,~1/~ ' LIQUID DEPTH ~" LIQUID CAPACITY /30~::~ GALLONS. SEEPAGE Pit: NUMBEROF PITS I . DIAMETER ¢t/~1 OR WIDTH /~" LENGTH I~-'i , , DEPTH LINING MATERIAL (..o} CRIB SIZE: DIAMETER ~' DEPTH ~' DISTANCE FROM: WELL BUILDING FOUNDATION ]~/I TOTAL EFFECTIVE NEAREST LOT LINE .~./I ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEPTIC , SEWER LINE TANK REMARKS DISTANCE FROM: SEEPAGE , SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-031 G.A.A.B. Department of Environmen:al (~uality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMF '}l~¢, I\IK~LI~b~r°~. ._ MAILING A~)DRESS ..................... PHONE SEPTIC TANK: L~ISrANCE NUMBER OF ~ " ' ~'~ ~.5 ~- ~ ~ e-~ COMPARTMENTS FROM WELL ........ ~IANtJFACT JRER ............ MATERIAL INGI[;L L[ NL;[tl ~' ~ _ INbI[)[ '>/t[)[t~ ~ _ LIQUID DEP]tl ..... LIQUID CAPACITY /~0~ GALLONS. SEEPAGE PIT: NUMi';ER OF PITS __L__ ©!,:\M£ ......... TER ~r"~¢' OR V"IDTH_L~_.', LENGTH I ~ I DEPTH /O ~' L. IriIINE, L.!;',.,FRIAL (~ ...... *~lh: SIZE: [)I~-*,MEI-ER r'DEPTH 6' DISTANCE FROM: WELL ¢ f-O1 AL EFFECTIVE bUIl_lPlr4~; !~JUNL),"l ION ....... , rJ, ,¢..F~L. b7 LO1 LiNE .&~__ . ABSORPTION AREA (WALL AREA) ,,.SQ. FT. WELL: l.z !~t I t_lpl ' ()LJN[)AT ION ,-, ~ ~ (~'v"i i~ _ CONSf RUCTION ') t~" 'I~ .... DEPTH N[./\I--~L% i Nf A ~FSi SEPTIC , LOI L!NE .... SEWER LINE _, TANK ()FILE !:R E-t)LJRCES DISTANCE FROM: SEEPAGE ~' ~'/ SYSTEM /~(~ ~ .'; bL',-JPL : DIAGRAM OF SYSTEM APPROVED )~ 4~ ~ G.A.A.B. January 4, 1982 Geoffrey W. Decter P.O. Box 1415 Eagle River, AK 99577 Permit ~ 810838 Subject: Lot 20 Delucia S/B A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit L':,E:LL!C ): ~:. :E:..".[, _EIT 2L-:.'~ DEL_lC'IR 9::,."E: MUNICIPALITY OF ANCHORAGE ~) ~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 H87-0176 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 20 Delucia Subdivision Location (address or directions) (b) Property Owner Jeff Dector Telephone: Home 688-2693 Business Mailing Address PO Box 1415 Eagle River, Alaska 99577 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) MailtheHAAtothefollowinaaddress:or:Checkhere[], ifholdforpickup. Listcontactpersonanddayphonenumberbelow. S & S Engineering 17034 Eagle River Loop Road, ~204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family [XIxx Number of Bedrooms Six(6) 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"l~: Public [] 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 (Rev 8/86~ Front 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 S & S Enqineerinq Telephone Address 17034 Eaqle River Loop Road #204 Date Eaqle River, Alaska 99577 Engineer's Seal This department has received written confirmation from the engineer regarding the Conditional Approval of April 1, 1987. The upgrade of the on-site disposal system has been completed and inspected by the above engineer. The subject property meets with Municipal standards and is now approved. DHHS APPROVAL Approved for Six(6) bedroomsby ./~_z~--~ .,<3. ~?//~Date Approved XXXXXXXXX Disapproved Conditional Terms of Conditional Approval June 29, 1987 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates 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 72-025 fRev 8/86~ Back ROBERT A. SHAFER June 28, 1987 CIVIL ENGINEER 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality o f Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 20; Delucia Subdivision A conditional Health Authority Approval was granted for the referenced property on April I, 1987. The conditions of this approval required the water line and w~ll wires to be buried between the well head and the house on Lot 20. An inspection performed by us on June 28, 1987, revealed that all the work required under the terms of the conditional approval has been completed. Request you issue a final HAA at this time. RAS/ss SRB 196X EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL..J~(~-') OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Application Date ,~-- //¢-'" ~' ¢7 Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Namec--U~,¢'/'~ m~'c 7'o~ Telephone: Home g ~-'~ ~ ¢'-~ Business ApplicantAddress pO~;~OX: /Z~J~- ,~,~-/_, -IE' ~:~o/, RI,,[ (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) -Ma+l-the HAA to the following address: S & S ENGINEERING 17034 Eagle Ri:~er Loop Road No. 204 TYPE OF RESIDENCE Single-Family'. Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well/l~ 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 Onsitex Public [] 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 (11,84) ~ENGINEERING FIRM PROVIDli ,NSPECTIONS, TESTS, FILE SEARCH, D0 , 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 5. & S ~NG'.NEER!.NG Address 17034 Eagle Ri~ver Loop Road No. 204 Eagle River, Alaska 995~7 Date Telephone /)M..O ,564¢j'~' o ,,J ~__ o'Z' /u /_-z:. I J /... / ? ? J DHEP APPROVAL Approved for "~"'~"~'~')bedr°°msby/q~~x_ ~,~..~5 Approved ~B DisapproveO ConOitional Terms of Conditional Approval 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 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) WELL DATA MUNICIPALITY OF ~ N'-';Hc'.'~'~:~NICIPALITY OF ANCHORAGE (MOA) ENVIP. ONMEN'fAL S~_k¥ .... 5 :..~'~..E,~A~TH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 MAR 3 1 1987 Legal Description: L, .RECEIVED Well Classification p~::2{ Well Log Present~jN) Total Depth ~-/'~/ ' Cased to Static Water Level ]!"7 Casing Height Above Ground /'2, Electrical Wiring in Condui~ (Y/N) Separation Distances from Well: To Septic/h-P'm't~"~c..Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole If A, B, C, D.E.C.. Approved (Y/N) Date Completed ,,.,¢/]/~/~7 Yield Depth of Grouting /"'J Pump Set At Sanitary Seal on Casing ON) Depression Around Wellhead (Y{~) · On Adjoining Lots /~(--) '/- z/~¢)O t · On Adjoining Lots /'~::::)O tO- To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by ~ .,d ,_%' ~:',~jG..h~u/~¢',~'//u/__~ . Date Water Sample Test Results ~ ~ ~ ~ ~ ~ ~ ~ Comments ~//~ ~~ ~ ~ ~o~ ~. SEPTIo/~ TANK DATA Date Installed ~-~ -/~ -~ '7 Standpipes (~N) Depression over Tank (Y~N)j Size ~0~0 NO. of Compartments Air-tight Caps (~N) Foundation Cleanou (~N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) .,,,r,.j//c) 'for - Holding Tank High-Water Alarm (Y/N) P"///'~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Ide~Cfr~ Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata /2~'- Date Installed Width of Field ,.~(..~ Square Feet of Absorption Area Depression over Field (YN~ Results of Last Adequacy Test /2co Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To ~ M2uq/Service Line Type of System Design Length of Field Depth of Field Cravel Bed Thickness Standpipes Present N) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date of Last Adequacy Test To Property Line /0 ¢: To Existing or Abandoned System on · On Adjoining Lots , -J~O t~ To Cutbank (if present) ~ O ~ ~ 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 ** I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection. Signe~ & _~ EN6_Ikl;F-RIN6 Date ~ ~/~'~'~ Com R~934 ~gle R~ L~ R~d Receipt No. Date of Payment ~- ~ /--~ 7o o "~:':'~ ';;'..~' '; .':.~..'~ ~ Amount: $ / c~ ~ . ¢. '~; ..¢~ ,~ .,:. ~"' ~%~- Page 2 of 2 72-026 (11:84) F 17034 Eagle River Loop Road Eagle River, Alaska 99577 LOCATION OF WELL(Legal Description): ~ OZ" ~--~4-. WELL DEPTH: /~ FT. CASING: DATE DRILLING COMPLETED: ~/~ -- ~ STATIC WATER LEVEL (Top of Casing): //~ /- /~ ROBERT A. SHAFER CIVIL ENGINEER 694-2979 DATE Of TEST: FT. SCREEN: // FT. DATE: ~- ~/-- ELAPSED TIME SINCE DEPTH TO DRAWDOWN! PUMPING CLOCK PUMPING STARTED/ WATER, FT. RECOVERY RATE, GPM REMARKS TIME STOPPED, MIN. ! ~/~ o /,/~' -/'O (swl) o o Start 5 12~'- ~" ~' ~" ~,~ ~o~ ~ - ~o /Z ~ ~- 0 '' ~ ' ~ " /~ ~ ~¢~c ~ ~5 ///~" ~ ~ 25 Z ~ ~ 30 / RECOVERY t o /2~ - ~ ~ o 5 1l ¢ ' -/o~ ~ '- Z" ~z 4 10 15 20 25 30 35 MUNICIPALITY OF ANCHORAGE OF HEALTH AND ENVIRONHEN' _ L Street, Anchorage, Alab~.a 279-2511, ext. 224 or 225 '~a-te Received: PROTECTION 99501 May 6, 1977 #3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Lomas and Nettleton Mailing Address: 4449 Business Park Blvd. Phone: 274-7661 Property Owner: Mailing Address: James Kershner % Kenyon Pet Clinic 694-9544 Phone: 3. Legal Description: Lot 20 Block 1 Delucia Subdivision 4: Single Family Residence: (x) Number of Bedrooms: 3 Family Residence: ( ) Number of Bedrooms: 5 .~,~;ml System: indivJ.dual We]! (x) Communmtv/Pub!~_c System ( ) Permi t ~ Depth of Well 220' Well Log on File ( ) Con s'truc t ion Bacterial Analysis Sewage Di~-o-~,~- al~_,L_ ,..,o System: Permit ~ Septic Tank Size Absorption Area b,_zli~'v On-site System (x~ Public ='=' Installed Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to N=drest Lot Line MUNICIPALITY OF ANCHORAGE (~~~~. ~I DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION I) 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 Vd ~(~_,k'(~ v,~ REQUEST FOR APPROVAL OF C [C~?~ ~'\ g tNDIVlDUALSEWER andWAT, ER FACILITIES ~. Type of Inspect'o : ,/~ , / MailingAddress:]bS'~ ~~~d~TDavPhone: 3. Name of Buyer: ~J~ ~~ Mailing Address: ?d ~¢J() ~ '~ ~) ~~Y Phone: N~me of ~e~l,or or Agent' ~'~~ ~ ~0 - ~ 7. Type of Facility to be Inspected: 8. Water Supply ~ F ~-'~ No. Bdrms. E'~ Type of Supply' Public Utility If Individual, number of dwellings presently served If Individual, depth of well ,_~ ?~--~ I Individual Sewage Disposal System Type of System: Public Utility If Individual, date of installation [,~_,V~. ~_ 6_~ ,~ ~ Individual (on-site) 72-003(3/76) Pa~e~T%~o Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 20 Block 1 Delucia Subdivision Comments: Affadavit Attached: (' Approved:,~ Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: