HomeMy WebLinkAboutWILD BERRY ESTATES LT 2AWild Berry
Estates
Lot 2A
#017-091-82
12!05!2012 03:43 9072430742 AIAPS, INC. PAGE 05/06
� .r:Kesa3cx •rb `..
a°h
Mark Seglch
Mayor
P
Well Drilling Permit I umber: SW_.____
Parcel Identification Number:
Leg/gal De, 'ption
2
1/V 11 d7 U 2/vv y rc�� y
L �}
Pump Installation f)'nec
Pump Intake Depth Below Top or Well Cas!
Pump Manufacturer's Name:
Pump .tidodel: -7-'5F- -31( '? %r f l s
Pump Size %y hp
Pitless Adapter Burial Aepth: f y feet
Pitless Adapter Manufacturer's Name.
Pitless '�)'fhl orer Iastailer;
i kll Disinfects ➢ Ui,ar, Ca rJ;: e.timn '
method o4-Dta9e:fe•_tiu ta:
Comments:
Pump Installer Name: 1 I {
/ AA 4a
Attention: The partp installer shall provide a p
•%;2Yy'r Se.r`�'iCe�. CBlhoi"fititPrtr
>%C'G gra^:cao Street
ip Installation Log,
Date of issue:
No
vY YS
I
ten- o9l-ga
roperty Owner Name & Address`:
.,7ln t r y t 40 y. t o Y
installation log to the DSD within 3G days ofpump installation.
72-013 (Rev. 9/91) MOA 25
Municipality of Anchorage Page of ;t-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DEPARTMENT
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: �\A/ (.d/93 PID Number: DI 07182—
Name: _
Wastewater System: rj New Xupgrade
pi Iso Jj
Address:
ABSORPTION FIELD
Phone: J�D _AC)
No. of Bed{ooms:
Deep Trench ❑Shallow Trench El Bed EI Mound 7) Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
IV
r GPD/S . FL
Lot:o,A Block: Sub bision:
Depth to pipe bottom from original grade:
Gravel depth beneath p/pe
/
Ft.
Ft.
Township:
Range:
Section:
Fill added above original grarrde:
Gravel length: /
Q,J Ft.
Ft.
WELL: El New Upgrade
Gravel width: r
Numberoflines:
Distance between lines:
Ft.
Ft.
Classifiction (Private, A,B,C):
Total Depth:
`
Cased To:
Total absorption area:
Pipe material: i}SZM
F
aC0 Ft.
IS?,' FL
�56 SD. FL
3 uD
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
3-ag-93
a' Ft.
c1quCKS
Yield:Pump
a GPM
Set at: i 7
a?c Fl
Casing Height Above Ground:
16 Ft.
TANK
SEPARATION
DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
TO
Septic
Absorption
Lill
Holding
Public/Private
Man Ufaeter
[
Capacity in gall
From
Tank
Field
Station
Tank
Sewer Lines
I
Well
W
L rA
�"
6,14
S
Material: �L-
Number of Compartments:
.2
WateSurface r
(W'f-
(O6�
—
pJ LIFT STATION
Lot'
*r�
_
Size in gallons:
a cturer:
Line
Foundation
'',,\\ /
r,
"Pump on" level at:
"Pum lev
High water alarm at:
Curtain
Drain
ON
KNOWN
,_
Pump Make a
Electrical Inspections performed by:
Remarks: Am NSuL±LLZ/S7/A)6-BENCH
MARK
(L S TWd
Location and Description:
U G . Roop- Sttrg �'
T "'/u SEj9716 7ftNK
N• W. CUt2l�S
Assumed Elevation: d
/VQFt
C 'Jr OF�` t,
SQOBA iCl� figg
�^nt 1
��G 9p
e_�41n tl
coy
a r
n
Dates: 1st
� ._�� oeoccva ees .vee eas �oa a
Inspections performed by:
17034 Eagle River LoOpRQal` nd —/�—%�
R
4i, e ER9 FEo
R ;GJ. 'HA
�
Eagle River Alaska 99.577
Department of Health and Human Services approval
c n
Reviewed and approved by: Date: -/-ig-9U3
72-013 (Rev. 9/91) MOA 25
. Permit No. Sao ll3 Page Iz of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Leqal Description: / n7 WILD &m Ec7 PID No.: D6 -40W821
R
Co .s b'1" MZ ,
14 /as'
1
H3' `\ a 4 ✓
Cos 53' Ia
mb
BO" cos pc.
M ?'' Ids'
N-71, No W�ra
72013 A (Rev. 9/91( MOA 25
From AK/NOW-WELL
I nestlnn Of Well
PHONE No. 907 345 4417 Mar.30 1993 9:26AM P01
Well Log
Alaska Now-Well/Vern's -Drlllling
12241 Avlon
Anchorage, Alaska 99516
(907)345-4417
AA3327
PERMIT w SW926in
`rq3
Borough C_ubdivislon Lot Bluck 3ecLlun Nv Tuwnshlp N Rai, e m _ E 11crdian
Anchors e Wildberr 2A ��_ �: v Wy
Well Log
Estates
rt. Dolow Surface
Material Tvua Too Bottom
brn gravely,cobhles 0 2 V
0
48
silty gravel_
4e
50
silty sand, little
FO
70
liar_d pun__--_--_ _—_—Y--
gravely hardpan. seep ea 100'
-_---70
100
100
140
-^
brown till, seepage & 140'
140
150
rustx brown bedrock, H2O about i /3 gprn�
redish-brn rock,
---1,50
152175
152
_^ mm
gray brn rock, tracesfr reen rock
175
�V 200
_
black rock, wittgreen rncly white streaks^
20G_
260
�-
190' Seepage Storting to corne In
220' to 260'/H20 getting stronger_
_
260'- 2 pny+ while binwin�t with Ma__
wile
- _e¢tt1!th
ignchoi
Human
age
rwce
Well Depth (ft)
Dato of completion
—� 261j)
---3/29/43
Drilling MAhod
USE,
rot.ar
dornestic
Caning Type
welded
Diameter (in)
Depth (ft.) Weight (Ibs/ft)
152' 7 1/2 — 17
—�_
r_ 6 to
L to
_
Finish of
Well
TLpe
ll
1.open holo .__._J
_Diameter�
Static Water level
Level (ft.')
Date
This well was drilled undor my Jurisdiction and this report fs true t.o the b
Authorized Reprosentotive - Date
Vernop k,Nowell
C—"— —923i3G/93
Pumping level
Below T of C (ft.) After (hrs) purnping (g,p.m
Grouting
Yes Material
IJoHX
Pump
N.P. _ Copecfty Type
--- ---�
submersible
-
Sattino M.) (� -
Remarks
my knmele?1ge and bellef
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920193
DESIGN ENGINEERS & S ENGINEERING
OWNER NAME:JENNISON BRENT W
OWNER ADDRESS:P.O. BOX 92772
ANCHORAGE, AK 99509
PARCEL ID:01709182
LEGAL DESCRIPTION: WILD BERRY ESTATES LT
LOT SIZE: 49479 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
fo�1
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED: 7/23/92
EXPIRATION DATE: 7/23/93
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ENGINEER MUST NOTIFY DHHS AT LEAST TWO HOURS PRIOR TO EACH
INSPECTION. 7
DATE: C
RECEIVED BY:
ISSUED BY: Jd J Sm ('n4 DATE: -.34?
0
July 17, 1992
HEALTH AUTHORITY
APPROVALS
Mun ci.pae i ty ob Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
SEWER &WATER P.O. Box 1966n50
MAIN EXTENSIONS Anchorage, A.2.aska 99519-6650
ROBERT SHAFER, P.E.
ROGER SHAFER. P.E.
CIVIL ENGINEERS
(907)694-2979
FAX 694-1211
REFERENCE: Lot 2A; Witd Berry Estate -6
SEWER &WATER Request you issue a pewit to instatt a new wett and septic system .to
INSPECTION serve the existing house located on the u6mnced property.
A new weft .is proposed bo,% the bottowCng reasons:
ENGINEERING STUDIES 1. The existing wept repo,%ted2y produces tess than required 4or
AND REPORTS Municipat Approvat.
2. The existing well .is within the driveway.
WELL INSPECTION 3. The existing wept 2.oeatton prahi,bits the .in,stattati.on o6 a
&FLOW TEST septic tank outside .the 100 bt. wePt %adiels and stitt aPtow
reasonabte pumping access due .to tot slope.
The existing septic system .its undocumented with an unknown location.
SITE PLANS Thi6 system .is to be excavated and abandoned during .the septic upgrade.
16 you require add i bona, ln6ormation bar your review, please contact
us.
ROAD DESIGN
S.incerezy,
SOIL TEST
FR
OGER J. SHAFER, P.E. r
PERCOLATION JS/gm
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
8 f
Ir
A
® yo w�® rogue
OF
s S?:• o""KD Df u o,
e � Municipality of Anchorage
^ruetrccacenc�. av enaorv 'i
DEPARTMENT OF HEALTH & HUMAN SERVICES 8
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST �^'• zla
PERFORMED FOR.IE- �� ,�tt DATE PERFORMED:
p '2A
LEGAL DESCRIPTION: I W 11�i �I�. T ✓ Township, Range, Section:
1
n "
2-
3-
4
3
4
/r b
fpr
Depth to
Water
Net
Drop
t
5
�
6
p
7
r
8-
9
9
o
I
10
r p
!9
S
11
r
2
12
r� O
13
7b
f
14
dr( �
15ng�-
f8 e
16
17
m
19
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE
Depth to Water After �I I�,y
Monitoring? �_ _ Date:
SITE PLAN
Reading
Date Gross Net
Time Time
Depth to
Water
Net
Drop
�
-I�y1v 11 =?ova
3 2
�
11 •. y -o
s z
S
12=rA
'� 12t
2
\'L'• s D
20
PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND
^\-FT
COMMENTS4/-'�
PERFORMED BY: S & S ENGINEERING ,RiVerLap o I CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 En IE6g9�fvliire44�as�Ca �¢S7pp7 IIt1' �/
ACCORDANCE WITH U IG GUrdEYR4L"�I♦1! EFFECT ON THIS DATE. DATE:
J'-����
72-008 (Rev. 4/85)
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: 1�i��F-1T -��^ DATE PERF
LEGAL DESCRIPTION:
,.c ET)
7 � �L
N
2 _
3 `
4-
5
6
0 fir`
7
Q
8 i
-d r0
9
10-
11
0 11 -
Y
12
7 �
13 U -
0
14
15
16
17
18
19
-X
65T-1
Township, Range, Section:
SLOPE
WAS GROUND WATER r, I
ENCOUNTERED? C7
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? _- Date:
SITE PLAN
207
PERCOLATION RATE ' 6 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 15 FT AND FT( _���
COMMENTS � �y c5r— ���' — l��•
PERFORMED BY: S & S ENGINEERING I �L CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle River Loa Rood No. 114 1
ACCORDANCE WITH Ehbl�TI�1�aFA t�a��IUIDELINIS IN EFFECT ON THIS DATE. DATE: (' I
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
° DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # — Ci) I — 0AA
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
X67 &
ERRAUBDIVISIUN
14700 Pnaton
Property owner Bne.nt Je.nni6on Day phone 34:5 '
Mailing address P.U. Box 92772 Anchorage, AK 99509
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/911 Front MOA #21
5. 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 of this Health Authority Approval application 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.
S & S ENGINEERING Phone
Name Of Firm 17 s. .age Iver oop oa 0. Q4
c, —, R,vor A ,,sIca 44577
Address
Engineer's signature
6. DHHS SIGNATURE
Approved for �'2 `� bedrooms.
Disapproved.
Conditional approval for
Additional Comments
d2l_' -
Date
bedrooms, with the following stipulations:
Date /?Z- ff -1 '
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 courtesyto purchasers of homes
and their lending institutions in orderto 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 engineers work.
72-025 (Rev. 1/91) Back MOA V1
Municipality of Anchorage
Department of Health & Human Services MY+
/
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:f �Tar� kbLY� Parcel I.D.
A. WELL DATA /
Well type R?FL If / A, B, or C, attach ADEC letter. ADEC water system number u�tA4
Log present &N) lFS Date completed`� _,Y_73 Driller K /VUw'u �cc A6
Total depth � Cased to I Cl rCasing height 1 /
Sanitary seal O/N) Wires properly protected aym) y�
SEPARATION DISTANCES FROM WELL TO:
I�r ; On adjacent lots lDD d
Septic/holding tank on lot t
Absorption field on lot
r40, ; On adjacent lots 166,/
Public sewer main to/1 Public sewer manhole/cleanout N/A
r ��,,
Sewer service line 56 Petroleum tank Nosy t hwlj
WATER SAMPLE RESULTS: /
Coliform 0 Nitrate o r 6 Other bacteria
Date of sample: 4 -0 1 — i !� Collected by: �L �- S
B. SEPTIC/HOLDING TANK DATA
Date installed 1 t)-11-12 Tank size /aS6 GA -L- Compartments f'
Foundation cleanout &N) yam— Depression (Y/& A16
High water alarm (Y/@ A)//} YV II � /'T� Alarm tested (Y/N) n/J��
Date of pumping NIA- — WIS Pumper h/.- / ' / V6w � /✓�
U_]
Cleanouts O/N)
SEPARATION DISTANCES FROM SEPTIC/' TANK TO:
Well (s)onlot 110 t On adjacentlo.- 1�0 Foundation -0
To property line 4-0 Absorption field �6 L Water main/service line
rr
Surface water/drainage
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
FROM WELL LOG
AT INSPECTION
,�nn
UVEA WEIS
�
Date of test
Static water level
T
o
g.p.m.
®
01
Well flow
°2 9.p.m.
C
asd
R1
G'
Pump level
SEPARATION DISTANCES FROM WELL TO:
I�r ; On adjacent lots lDD d
Septic/holding tank on lot t
Absorption field on lot
r40, ; On adjacent lots 166,/
Public sewer main to/1 Public sewer manhole/cleanout N/A
r ��,,
Sewer service line 56 Petroleum tank Nosy t hwlj
WATER SAMPLE RESULTS: /
Coliform 0 Nitrate o r 6 Other bacteria
Date of sample: 4 -0 1 — i !� Collected by: �L �- S
B. SEPTIC/HOLDING TANK DATA
Date installed 1 t)-11-12 Tank size /aS6 GA -L- Compartments f'
Foundation cleanout &N) yam— Depression (Y/& A16
High water alarm (Y/@ A)//} YV II � /'T� Alarm tested (Y/N) n/J��
Date of pumping NIA- — WIS Pumper h/.- / ' / V6w � /✓�
U_]
Cleanouts O/N)
SEPARATION DISTANCES FROM SEPTIC/' TANK TO:
Well (s)onlot 110 t On adjacentlo.- 1�0 Foundation -0
To property line 4-0 Absorption field �6 L Water main/service line
rr
Surface water/drainage
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATIQN JN
Date installed\�
Size in gallons
Vent(Y/N)
High water alarm level
"Pump
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE
Well on lot
D. ABSORPTION FIELD DATA
Manufacturer
Manhole/Access (Y/N.)
on" el at _ "Pump off' level at
\ ycles tested
IFT STATION TO:
On adjacent lots Surface ater _
Date installed //—/? —%2 Soil rating n. R G10/2.1SF System type —FP liZEi,r/a
Length P Width 2, S Gravel thickness / Total depth M
Total absorption area �s41 _ Cleanouts present &N) YES � /
Depression over field (Y/9l f v0 Date of adequacy test A / /Vcw S% l -z %4 i
Results (pass/fail) for 4 bedrooms
Peroxide treatment (past 12 months) (Y/I0
If yes, give date N/
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot )
On adjacent lots fdd Property line
To building foundation To existing or abandoned system on lot
/
On adjacent lots 9 r. J_ Cutbank
Water main/service line
Surface water.00 la Driveway, parking/vehicle storage area
Curtain drain Y_11'I mx � Wv /
E. ENGINEER'S CERTIFICATION
I certify that / have checked, verified, or conformed to all MOA and HAA guidelines in
S & S L'NGINEERING
17034 Eagle River Loop Road No. 204
Signature E&W-'e Rkev, Alaska 99877
Engineer's Name
Date
4 -S' -►-t?
HAA Fee $ Waiver Fee: $
Date of Payment c7,'� _ Date of Payment
Receipt Number o2,Zt,5X3 Receipt Number
72-026 (Bev. 3/91) Back MOA 21
90'/
as'a
14
'iU01.R J. ill LU'Gh
this inspection.
r.n
Sc' & S ENGINEERING
FAX It 694-1211
fief: Well at Wild Merry Estates, LT 2A
owner: Brent W. Jer.,JS-On
Wel l VI
Original well was located within a well pit, under- the driveway. After
drilling the new well, the old well was Grout Sealed with bentonite
slurry, and dry bentonite chips, from bottom to top.
Benonite slurry was pumped in the well, and then top 5 feet was filled
with bentonite chips, in the slurry.
A steel plate way welded to the top to form an air tight seal.
Sincerely,
Vernon L. NOWPi1
5. LEGAL DESCRIPTION _ T
D -A -(E RECEIVED
INSPECTION APPOINTMENTS
_STREET LOCATION
TIME
TIME
TIME
SINGLE FAMILY
❑ Two Ell Five
V C�'.
DATE
DATE
DATE
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
L
INSPECTOR
INSPECTOR
INSPECTOR
- MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH& ENVIRONMENTAL PROT ECTIAI IRONMENTAL 1'I:OTECTION
825 L Street - Anchorage, Alaska 99501
APR 2 9 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RR ����
WATER AND SEWER�� (MILD
REQUEST FOR APPROVAL OF INDIVIDUAL
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
PHONE
1. PROPERTYOWNER
fly Thu
MAILING ADDRESS
�U/eLIO aJ� F3 6 J b ��G i9O2ftfi� /
PHONE
PROPERTY RESIDENT (lf different from above)
4) el—AZ 3
PHONE
2. BUYER
A) SL74L.'..'/Lln,/LTI�
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
PHONE
4. REALTOR/AGENT �
�l7zL/L c/jcli /j rCiv7 C T�LT't� -3To, !✓
MAILING ADDRESSif,g
5. LEGAL DESCRIPTION _ T
zs-
_STREET LOCATION
- -
6. TYPE OF RES DENCE
NUMBER OF,BEDROOMS
F__1 One F-1Four [__1 Other
SINGLE FAMILY
❑ Two Ell Five
❑ MULTIPLE FAMILY
D�Three - ❑ Six
7. WATER SUPPLY
INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled l5
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
-
8. SEWAG�EDD�SPOSALSYSTEM
IJ INDIVIDUAL/ON-SITE**
- YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLICUTILITY
FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
NOTE: THE INSPECTION
72-070 (Rev. 6/79)
l � V
.M
72-010 (Rev. 6/79) _
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE
❑ TWO ❑ FOUR
❑ FIVE ❑ OTHER
❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
ED PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
INSTALLER
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
n ��
S -Q� l uxn.-•
❑ APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
DATE
S` � b -- 9 `
BY
R-Q,Q
72-010 (Rev. 6/79) _
May 5, 19851.
Ben Shennum
825 "L" STREET
ANCHORAGE., ALASKA 99501
(907) 264-4111
GEORGE.. FA. SULLIVAN,
MAYOR
DEPAr.7MENY O;: !?r,`,-LY>s AND E NV'IRONNIFNTAL PROTF.OI lON
% Shennum Builders, Inc.
209 West: Dimond Boulevard
Anchorage, Alaska 99502
Subject: T12N R3W Section 35 SO SW; SW4 NEk
Approval for the individual sewer and water facilities
cannot be granted until the.foll.owing .items have been
completed:
l_) The water analysis report needs to be delivered to
(5) The septic tank pumped with a receipt submitted to
this office. The total number of gallons pumped
need to be on the receipt and verified, by a registered
engineer. This i, to verify the size of the septic
tank,
(6) An adequacy test needs to be performed on the existing
leaching area. This test will determine 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.
this office from the Chem Lab, 5633
B
Street, for
our review.
(2)
The pit around the well casing needs
to
be filled
in with Lmpervious type soil so that
it
slopes
away from the well casing.
(3)
The well casing needs to be extended
above ground
level twelve(K) inches and capped with
a sanitary
seal so that it is water tight.
(4)
Expose the septic tank to verify .its
existance.
(5) The septic tank pumped with a receipt submitted to
this office. The total number of gallons pumped
need to be on the receipt and verified, by a registered
engineer. This i, to verify the size of the septic
tank,
(6) An adequacy test needs to be performed on the existing
leaching area. This test will determine 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.
d
Ben Shennum
May 5, 1981
Page Two
if there are any further questions, please call this office
at 204--472.0.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: First Federal Savings and Login
Post office Box 4-2.090 99509