HomeMy WebLinkAboutCONTOUR ACRES #4 BLK 2 LT 10CON
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JU I 10 ' � 11.42a
Anoho!-age loVeil,"K Pump Sei
K724K742
C)e"'Vment Services bepartmen-t
Bui,"ding Safety bivisi.,
On -,Site Water 4 Wastewater Program
700 Elm..Or,p
, fZoa,-j
clerk Eeyticrt
P.O. Box t96650
Anch.crwe, AK 99507
PU (5'07) 343-7K4
imp Installation Lon
%Ve11 r.
r"11119 rertilit Nujijj:Or: SW
P2rcej .1dendricatior, _N
umber:
L=9211)==Cxjp—da��
a4Ur V-41 P, -) I I
III PUMP
Q
Pump luwie
D-Pth Edow Top oj' weB Casing.. Vta.eer
Pump 'N'a-P uf"I Urer's Name: 4q M, C
PQMP Mode):
PUMP Giza 31
hp
feet
Pitless Adapter M2)1'1faCCUrvr),,: Narac:
-Pitless Adipter rnstallr:
WOR Disinfeetcd Upon CO,..(1pjet,Grj?
"I'lethodof Disji3tecllon: E No
Comments: 1912 lqe6-
Pump 111staller Nam ra:
Date of Issue:
P10
t3' Owne. � Me Addres,
F4L
The purlp irzt�
cjjje,,S7 all provide ..p= rr,� ittstallsti t- lag to rhe.
-D-qD Wit,"lin I'days
� OrptU11r; jn,;.Oatjon,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAM LP"ONE
LE~ DESCRIPTION
NO. OF BEDROOMS
'' I
DISTANCE TO: ~. ~ ( '
~ Z ~nufacturerF~i,t~~.. ~. ~~C .o. o~p~tm~nts
Liq IF HOmEmADE: Inside length Width Liquid depth
~ ~ST~,C~To: ~, ~,i.~ ,~,o.
-~~-- ~ ~anufacturer ~aterial Liquid capacit~ in gallons
Nearest I? I~bn~ ~ PERMIT~r ~ 7/
~Q, DISTANCE TO: Well Z~O ~ TotaIF°undati°nl~,th 7of lines7 / Trenc~iO~. . Dista,ce~7~i,~[
~ ~ ~ ~ ~o. of lines/ ~en,th ~ I~ ~' ,nch.s ~ti~ion
~ ~ lop of tile to finish ~rade Material beneath tile lotal area
Length Width Depth PERMIT NO.
( ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
P~MATERIALS
SOIL TEST RATING
DATE LEGAL
72-01 lev. 3~78)
-~.~. :DEF'ARTMENT L HEALTH AND ENV'rRONMENTAL
:=:2.=, '" L'" STREE:T ANCHORAGE.. RK. 5~'95E~L
/~'~.~ - '" '-, .....
· -'- ~, 4 -4 ,'
~ E L_ L ~ ~-~ [:, C, ~-4 ~. ".='-'] I T E '_.-"] E l.-.l E ~." F' E R F'I I -r
FFLI_.RNF c:A'T'rIC!ND HAN'~nN ?.tE.~ WEIMER ~-..':9 '-'~'-" ~-;':'~-'~
LOCRT I ON BADGER _
LEGRL L :1. Et B 2 CONTOUR FICRES ~4 LOT '.-';IZE :I.L~E~E4E~EI SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MR2<IMUM NUMBER OF BEDROOMS = 4
SOIL RRTING (SQ FT/BR)= iDS':
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:, E F' 'T H = 1 ~.Z~ L E !%1 m._~ T' H = ~ mi F~.' R '-..' E L
[:. E F" ]- H = -~_';.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF 7'HE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE E×CAVRTION (IN FEET).
Fl:E[:, "_---;EF' T' I: C: TR['-.II<: '_=. I ZE= -125~-Z", ~3FIIL_ L C, 1"-.15
PERMIT APPLICANT HAS; THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING 'THE
INSTALLRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE HELL HILL SERVE.
.......... -rp~o ,:: 2 ) I I'-~SF'EC:'I- I C,~-~S FI~:E RE,S.!LI I Fi:E[:.
BRCKFILI. ING OF AN'¢ SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF' PUBLIC: WELL.
MINIMUM [:,ISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET FIN[:,
TO R COMMUNITY SEWER LINE IS 75 FEET.
14ELL LOGS ARE REQUIRE[:, FIN[:, MUST BE RETURNED TO THE DEPARTMENT HITHIN 30 [:,AYS
OF THE WELL COMPLETION.
OTHER REQUIREMEN'rs MAY APPLY. SPECIFICATIONS RN[:, CONSTRUCTION DIAGRAMS ARE
RVAILFtBLE TO INSURE PROPER INSTALLATION
F' E F.,: f,1 I T E :.'.-:." F' I F: E '5 [:, E C: E W B E R 2-::. -1., :1_ Lr~.. :--_-: :IL
I CERTIFY TFIRT
t.: I AM FAMILII::IR HITH THE REQUIREMENTS FOR ON-SI'TE SEHERS AND HELLS RS SET
FORTH BY TFIE MUNICIPFILITY OF' ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE 14ITH THE CODE_Cl.
]~: I UNDERSTFIND THAT THE ON-SITE SEHER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS; REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
SIGNED:
RPPLICBNT RRYMOND HANSON
~OH ! C [PAt. I 1'¥ OF ANCitORAC-~
D~pa~me~t off l!ealt~ and EnvLronn~mtal.
261-4720
' ~ ~' HAHOWRITTEN P~2~IIT * ' ~
a.g o.-Sl se .
~e R~ir~ Size of ~he ~Lt ~rpt~on SFs~
,
-
~e length 4~nsion La ~ l.~gth(ie f~) of ~he tre~h or ~-~inete~a.
d~th of a teeth or ~t L~ the dishanoe be~eeB the s~e O[
~ ~t~ o~ the ~ava~on(~n ~oet). ~ora Ls no ~t width
· ~ REQUIRED S~TIC(~I~) TANK SIZE ' / L~ ~LL~S
Pe~t~ applicant ha~ ~he re~oLbili~y tO Ln:o~ ~hLs ~ac~n~
installation ins~tEons of a~ weE%~ adj~e~t ko ~his Dro~=~Y
Ba~i[l~ O~ any sySt~ qLthouk 'f~a% tB~ion' a~ approval
~n~ disease ~~ a ~ll an4 ~ on-s~te ~wage d~saL
of public ~LL. Min~ 4i~e [r~ a pci~he ~% bo a privake
is ~$ ~ ~d ko a co~,~Lty s~ec Line L~ 75 f~t. WeL~ togs are
and must ~ e~t~n~ to thL~ dopar~nt ~thLn 30 days o~ the well
Ok~r ~Lr~t~ ~y apply, 8p~ifi~atione and uons~n~tLOn 4iaqr~
avail~e tO Lnsur~ pro~
[ c~ei~y that:
(L) [ ~ f~/~La~ with ehs r~ir~n~ ~oc on-line ~wec~ a~d
so~ forth by t~ R~Le~a/fty o~ ~hoeage.
{2) ~ will fns~.all t~ ~St~ in a~ordan~ With
(3) ~ ~rstan4 that t~ on-~ite se~ syst~ m~y ce~L=e
~LL D/OR O~
~ ~ '~ '['WO(~) INSPECTIONS
~: c~o.t:'ti~y t'hat:
se~ forth by t~ g~te~ali~y o~
s¢*'./7
Dat~
JNICIPALITY OF ANCHORAGE
Department o~ .Health and Environmental ~rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
~ - WELL-A~D/OR ON-SITE SEWER'PERMIT
Legal Description: ~ <Q~'~"CT'~'~J~J<~f~3~ d_//~/~, .LOt Size: /~q~,,~
Type o.f Soil Absorption System Is:
Trench: ~'Drainfield: Seepage Bed: Holding Tank:
Maximum Number of,Bedrooms: ,~. Soil Rating(sq.ft/br) .... / ~. ; ~ ·
The Required Size of the Soil Absorption System Is:
DEPTH / ~ LENGTH GRAVEL DEPTH ~"'~' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. ' The
depth of a 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 gravel between the outfall pipe and
the bottom of the excavation(in feet).
*' * REQUIRED SEPTIC(HOLDING) TANK SIZE =. m/ ~ ~ GALLONS * *
Permit applicant-has the.responsibilitY to inform this department-during the
installation inspections of any wells adjacen~ to-this property and the n~mber
of residences that the well will serve.
~ * * TWO(2) INSPECTIONS ARE REQUIRED * * *
B~ckfilling of any system without .final inspection and approval by this department
will be,subject to prosecution.
Minimum,distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well .logs are required
and .must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specificat£ons and construction diagrams ar.e
available to. insure proper installation.
* * * PERMIT'EXPIRES DECEMBER 31,'1 9 8 1 * * *
I certify that:
(1) I am familiar with the requirements for on'site sewers and wells as
set forth by the Municipality of Anchorage,
(2) I will install the system in accordance with codes.
(3) .-I understand that the on'si~e sewer system may require enlargement if
the r'esidence is remodeled to include more that 3 bedrooms.
S igne~: Issued by~-~, ~~~'~
Applicant Date:. ~ ~/~ -/~ '~/
SWP/024 (1/81)
e:e~r~if~" that 1 have Surveyed
~he. ~emi'ses; ~n ~Uea~,~o~, and' ~Ha't there are no
e;~'emen~a~: on~ a=ai~'. pr'op,ert~' except ,as' sho~ here. on~. ~gu,~t: 20, ~9'8~
Contra...rig Engineers & Associates
212 East International Airport Rd,
Suite 204
ANCHORAGE, ALASKA 99502
(907) 278-3773
SOILS LOG - PERCOLATION TEST
XSOILS LOG
PERCOLATION
TEST
PERFORMED FOR; ~'~,~'~0t~'~t-~ I~,~ ~O~f DATEPERFORMED: "~f"~-!
~:~ ' ' - ' SLOPE ' SITE PLAN
~6
i~.,~ 9
Ralph IS.
NO. 1995oE
WAS GROUND WATER
ENCOUNTERED?
g___J
tF YES~ AT WHAT : ~:~. - E
DEPTH?
Gross Net Depth to 'Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
, ~ TEST RUN BETWEEN FT AND FT,
P~FORMEDBY: ~, ~O~,_ ~ CERTIFIED;Y: ~ ~~-DATE~~ '
RETURN TO: Division of Geological and wslcal Surveys (DGGS)
)OO1 Porcupine Or~ve (Telep,~ne: 277-6615) ~:
Anc~rage, Alaska 99501
WATER WELL RECORD
Drilling Company Nam V'~:, ~ ~ ~ ~' : ; ' ' , ,, ' '
.~ Orllllng Permit No.
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
.0CATION OF WELL I Please complete either la, lb, or lc. A.u.m.
la. Borough Subdivlsionl Lot Block lb. Fraction Section No. Township Range Merldlan
, ~r-, , i / / N/S E/W
'..! ,.~ ~ . [ .~-. ..~~
lc. Dlstance and Direction from Road Intersections 3, OWNER OF WELL:.'.'/i ,.' ! [4, / ~ . .
Add tess:
Street Address and Area of Welt Location
2. WELL LOG Feet Below l+. WELL DEPTH: (completed) Surface Elevation Date of
Su r face Comp1 et i on
Mater~al Type Top Bottom ~ i_r'F ft.
,...,:;; :. · ' i . ;~ . r " ,
:-~ -;L . : .~ 7..: ' '.'..~,;~.
; , L.~r in. tO ~ ~ ~ ft. O~pth Weight lbs/ft.
~n. to ft. Depth
~ ' , '"- ,i ~- ,, -~ ~"" . ,:.
-~' ~ ' ~ i ~; . "" '~ 8. FINISH OF WELL: %:...-.}' .. _ ' -
' ' ' / I ' Type: ,';!':"' '. ' "~''' ~-'
'+ .:.- /~:V'-~ ~ Slot/Mesh Slz~: Length:
. ~ /..' ,t - , / '. ~ , i . ~ ,
/ . (C",'~ z. ~ .... Set bet~en f~? ~. ft. and .'
Fittings:
D. STATIC ~ATER LEVEL: '' "'
~A~ve ~.eelow land surface
Type of Heasur~nt: '
10. PUMPING LEVEL below land surface
ft. after hrs. pumping g.p.m.
ft. after hrs. pumping g.p.m.
11. ~ELL H~D COMPLETION: ~ In Approved Pit
~Pltless Adapter Inches above grade
12. GROUTING: Welt Grouted: ~ Yes
~aterial: ~Neat Ce~nt ~ Other:
1~. PUHP: (i¢ available) HP
Length of Drop Pipe __ ft. ca,city ~ g.P.~
Type: ~ Sub~rslble ~ Rec iProcat ing
I~. REMARKS:
m
15. ~ATER ~ELL CONTRACTOR'S CERTIFICATION:
This we~l was drilled under my jurlsdlction and this report Is true to the b~st of my knowledge and belief:
~ '' ' L'~cense Number
Jstered Busln~ss Name
IAddress: '¥~/.;--", ,.'.." ."':':~, ~' ." ~ ':: '-' ','~'~ ~ m ..,'
, ~: ~" - .F. ?,
' ' ?' ' ):' - ," ~:x" Date:
51gned: /.",~,~ ,i. . -.% .,'
Authorized Representative
Form 02-~R Copy Olstrlbutlon: ~HITE - State DGGS, PINK - Driller, CANARY - Customer
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~-~ .,.~_z.C~ ..
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a)
(b)
(c)
Legal Description (include lot, block, subdivision,~sec[ion, township, range) .~r
....-'
Location (address or di~
Aoplicant Name,~ ~-,,,~ /Z~',¢ . Telephone: Home-.~ ~ -~ / V7 Business
Applicant Address /'-~ /~ ~>-~-'~ ~ '~
Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~;
Other
(explain);
/
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address L_~f~ _/b / "~
Telephone ~'/~ ~ -
(f) Mail the HAA to the following address:
6DHITT_ (~.
TYPE OF RESIDENCE
Single-Family~ Multi-Family//[]
Number of Bedrooms 7
Other
WATER SUPPLY
Individual Well'~ Community Fl 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
Onsit~~ Public[] Communityl-I H°lding'Ta,~,kl-I'
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 (11/84)
J
ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA, 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 compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of th.t~is.~inspec~ion.
Name of Firm /~~ ~'~:~ ~ / ~+
-'-~--~ Telephone
Address ~ ~ ~' ~ ~ ~:~' ~'~' .-
Date _z~ --- ~/--. z~' ~J
Approved for J~(.-~,~- bedroom -.~
Approved ~ Disapproved Conditional
Terms of Conditional Approval
Date
cAuTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations giv,en 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)
--- Or: ~,NO,~RM~UNICIPALITY OF ANCHORAGE (MO,~l
'~ON~E~O~' O~ p~]~T~ALTH AUTHORITY APPROVAL (HAA)
E~Vt CHECKLIST - FEBRUARY 1984
WELL DATA
Well Classificat~~/~ 7' ~
264-4720
L gal DescripJ, k)n'
If A, B, C, D.E.C. Approved (Y/N)
Log Preset) r
Total Depth ~~ Cased to ~,j. I
Static Water Level / 7
/
Casing Height Above Ground ~ ,~, ~
Electrical Wiring in Conduit~)
Separation Distances from Well:
Date Completed
Yield
Depth of Grouting "
Pump Set At
Sanitary Seal on Casin~j)
Depression AroUnd Wellhead
To Septic/Holding Tank on Lot ,/~'~-~ ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field pn~ot ' //~ ~On Adjoining Lots
To Nearest Public Sewer Line ~/~ To Nearest Public Sewer
Cleanout/Manhole ~/ / To Nearest Sewer Service Line on
Water Sample Collected by ~/~~/~ ;Date ~
Water Sample~ Results. 5~[~~ ~, ~,
Comments-~~ ~/~/"~/;~ ~/~ ./~~
B, SEPTIC/I,NM=Billf~TANK DATA
Date Installed~ ;~ ~' -'~// Size /,~-,.5'""~ No. of Compartments
Standpipes~ Air-tight Caps ~N) Foundation Cleanou~)
Depression over Tank (Y.~ / Date Last Pumped ~,/~.'7/~'"'"'~
Pumping/Maintenance ContraCt on File (Y/.N~//./,~ ~/,,4-. ;for ' . //~ .
Holding Tank High-Water Alarm (Y/N) ,,~./-'~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /'~:~ ~ .... To Building Foundation ~ /
TO Property Line ~' , 7,,'~, To Disposal Field
To Water Main/Service Line ,/V/',-~ . To Stream, Pond, Lake, or M~jor Drainage
Course _
Comments~ _~~-~'~,~- /~,~-~~ /~~,~-s.- ~-~
/
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date InstalleC
Width of Field
Length of Field
Depth of Field
Gravel Bed Thickness '--~""
~ '7~ ~ Standpipes Preset)
Date of Last Adequacy Test
!
Square Feet of Absorption Area
Depression over Field (Y~)
Results of Last Adequacy Test
Separation Distan ce from Absorption Field:
To Water-Supply Well /,/¢¢¢ ~~'
Lot /~/~,~= ~//
TO Water Main/Service Line /~'///~
Type of System Design
To Property Line
/
To Stream/Pond/Lake/or Major Drainage Course _,,/~¢ /"'-/"--'~"
To Driveway, Parking Area, or Vehicl,~,~Storage Area
D, LIFT STATION
To Existing or Abandoned System on
; On Adjoining Lots ~ '/'-/~----
To Cutbank (if present) .-c/~~
Date Installed Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
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 MOA and HAA guidelines in effect on the date of this inspection.
S ig n ed/._~/~ ,~'~ Date '~///
Company~,~-~-~-.,~ ~ ~"~'~-7'--~'~-/ . MOA No.
Receipt No. ~-((~O
Date of Payment
Amount: $ ~ ~.~
Page 2 of 2
72-026 [11/84)
BF_.S,SE~ EPP$ & ~S
222.0 EAST 8B AV~'NUE
b~lCX~.C~.~ AK 99507
(907) 349-645].
W~ ~LT~
Lot: /~
Block: ~_~
Te~r:
Initial Reading c~ Meter:
Prr~ l~,c:tj on Ra t'n: ,~/~ GPM 2'l-flour' Carx~ci ty Cai]cnn
"~_~ -~; - - ......... DATE RECEIVED ' '
i~'" :':' ~ I~T!ONAPPOINTMENTs . ' ~:~L_,L~
'"~'~-" - ..... ' ~ TIME - TIME
DATE · 'DATE DATE
' ~EGUEST FO~ APPROVAL OF INDIVIDUAL WATE~ ANDSEWE~ FACILiTIEs '
DI~CTION~J Complete all p~rt~ on page ~, Incomplete rlqu~l~ will not b~ prod, Please allow *eh (10) days for processing.
~. ,~OP~ow~ ~ / ', . .UO~E' "
P~OP~TY ~ESID~NT (~diff~r~n~ from 8bov~) ~ ' PHON~
'2. 'BUYER , ' ~/ , ' ' PHONE
MAILINQ ADDRESS
, .. I '
MAILING ADORE~" ~ ~ ' J
lB. LEGAL DE&CR T O - /F / J~ ''
IS'mEET LOC%T, ON ,~',~. '
6. TYPE OF REBIDENCE NUMBER OF~BEDROOMS
I--1 One [] FoUr. [] Other
[] Two [] Five
~ Three I-'1' Six
[[~INGLE FAMILY
[] MULTIPLE FAMILY
7'. WATER SUPPLY '
~ INDIVIDUAL' ' ATTACHWELL LOG. A well tog is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, ~i~e well
[] PUBLIC UTI LITY depth (attach ICg if available,) {"~t~ ~ ~ .
8. SEWAGE DIBPOSAL SYSTEM
J]~J/ INDIVIDUAL/ON-SITE'* ,/~',~ / YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY ' ~'~' ~-o,~b~- ~ ~..~A.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
1. TYPE OF R;ESIDENCE
[] SINGLE FAMILY ' -
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] NDIVlDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size; If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot. Line
5, COMMENTS
THIS SIDE FOR OFFICIAL USE ONLY ..
NUMBER OF BEDROOMS ' ~
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED .
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
[Sewer Line ] Nearest L0t Line
Septic/Holding Tank
IAbsorpti~n Are~
DATE
~"~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
Anchorage
825 "L" S'FREET
ANCHORAGE, ALASI<A 99501
(907) 264..4111
GI::()fl(;L bi. SULLIVAN,
MAYOR
DEPARTMENTOE HEALTH AND EN\/II~OIXIMEN'I'AL PROTECTION
November 17, 1981
Carl E. Luchsinger
Post Office Box 10-374
Anchorage,- Alaska 99511
Subject: Lot 10 Block 2 Contour Acres Subdivision #4
Information submitted to this office on November 16, 1981
is satisfactory regarding the water well serving the above
subject property. However, we will need the following
additional information:
(1)
After final grading, were the standpipes to the sewer
system in place and above ground level?
(2)
Was there any depression over the sewer system; leaching
area and septic tank?
(3)
Does the construction of the water well meet with
Municipal of Anchorage regulations?
The additional information submitted to this office will need
to be stamped by an engineer on a original copy.
If there are any further questions, please call this offfice
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw