No preview available
HomeMy WebLinkAboutSAND LAKE #2 BLK 6 LT 12  ~i... ~' MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME.__._ ~ , IPHONE ~;~NEW MAI LING ADDRESS LEGAL DESCRIPTION ~ DISTANCE TO: Well /~'~ Absorption areao~ Dwelling/~/[ ~ / PERMIT NO._~ff~/~5 D ~ Manufacturer ~ Material ~] 1 No. of compartments -~ ~ Liq'7~gall°ns IF HOME.DE: Insidel~ Width ~ Liquiddepth.~ ~ ~ DISTANCE TO: Well Dwelling ~ PERMIT NO. O z ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundat,o~ ~ .e~rest lot I,ne ~ .~MIT ~0 --~ Nc. of lines / Length ofe~ch line~7~. Total length oflines.¢~.._. Trench w,dth../Z,nches Distancebet~enlines/~ ~ ~ ~ Top of tile to finish grade Material beneath til$ .... Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ / M Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank / Absorption area(s) ~ DISTANCE TO: ,/ / ' OTHER PIPE MATERIALS : it' '7 //' /z; i/ APPROVED DATE LEGAL 72-013 (Rev. 3/78} F':'ER!"i ! T FiF'PL :i CF!HT i"IFIR.k: T[3L~S[-:'.'i'-4 E;:[~d.',).:: 'T'ERR'T' PLF~C:E [,_OCFiT :[ ON L..EGRL. L &2 E: 6 SFIBIE:, LFIKE S,-.-'D '.S~;2 L. OT SIZE T'¢F'E OF SOJiL RDS[)RPT]:OI'-,! Sb'S'TEH :ES: TRENCH HRX:[P!UH F,iL!HE~ER OF:' BEE:,ROOHS :~: SO:iL. F:RTiNG (SQ F"i",--"E~i~:):-;; THE F?E~UIF;E:[:, SZ2:E OF:' THE SOiL RBSORF'T:i:Oi'.4 S'.?STEH ~S: FIND THE E:[:)TT[)H OF "r"4-' [.. F:'E:RH]:T RPF:'I T'":Ri'-T ~-~'::I': THE !'~.~:..::,r U 4:,.'.-E .... t~ ):i"J'Z;'T'F:: Fi"']'" "~ T '.,?:7, F'F'i":TTi'"ti'-,I':; i-![::' F:l~'.,!~,' t r: I :: Fl[' NLII"!BF:F;i OF RES I2[i:JNCES THF!T TFiE I'.I[:i'_L. HiLL i"'I~Jf'4Zi'"ILi!"i DISTFtf',IE:E BE'TI,iE:EN F! HFLL. [aN[;:' RN'T' ON-SZ'TE SE!.'.tRGE [:'IE;POSF~I... :i..EHZ, FEET FO[? ~ F'RiE'v'FTFE HELL OR J..E::.i6 TO 2E"Z~ F'E:ET F~'.OH Fi F:'L!E~LIC i4E::LL LiF'ON THE T"?PE OF F't...IBL:[C HELL. PIZN!FILIH E:'ZSTFti",ICE: F'I:~'.[:tH F! F'R]:VFI'i"E !.'.!EL.L TO R PF?.Z"/FITE SEi.,.iE:F: LINE TO R E:Cff'!Ht_fN]:T'¢ SEI.'.IE!:;;: L.:[NE: IS 7~ FEET. HELL LOGS ¢~[~:E RE~;¢.J:iI:~:ED Fff',!D HUST BE F~iE"f'LtF:!",IEb TO THE [:'EF'F~RTHiENT !,.!ZTH:[N :]N:E~ E:'i::i?S OF THE !4ELL. CCIHF'LET]:ON. OTHER REQLI I FiiEi"'tENTS I"!Fi? FIF'F:'L.'?'. SPEC ! F' i C:F!T :[ ONS FiND CONSTFiLiE:T ): Oh! [::,1[ F:iGF~:FIP1S RRE FI',,,'F~ ]: LRE~LE: TO Z !'.,!SIJ[~'.E PROPER i NSTFiL. LFFi' Z ON. i C:EF. tTZ F':" THRT :L: i Fill FF:IHZL_]:F!F: H'i'TH THE F;:Ei;:!LtIRE:!"IEI"4TS FOF.: ON--SITE SEHERS RND HELLS RS SE'T' FOF-::TH B'T' THE: !'dt,,.li'.,! :[ C :! F'FIL .ii Tk' OF FiNC:t'!OFb:I,(:ii!E. ;::': Z H:[LL ZNL:;T,RLL THE S'¢STEH iN FiE:C:OF:[:-'i"4.?'~CE HZTH THF.~: C:O[:'E'..:.;. Z: I I,.iNE:,EJF?STFii'-,ID THF!"F 'T'HE': Oh,!--.S:[TE :':T, EIqEF: :5'?'S'f'E:hl P!Fi',? RE[;¢JZF'.E: '-2:NLRF::(L:;EHE:HT :iF' TFIE RESIDENCE IS.:; F:Ei','iOE:,ELE:E:, TO INCL[JDE i"10~:E 'THFI!'.J 3: E~EDF.:O(]HS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14- 15- 16- 17 18 19 2O WAS GROUND WATER' ENCOUNTERED? IF YES, AT WHAT DEPTH? ;/ Reading Date Gross Net Depth to Net Time Time Water Drop Jr. PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIED BY: DATE:~7Z',--'- ~.0 ~ 7-~ 72-008 (6/79) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of. ,public water system located in Alaska, submitted in accordance with 18 AAC 80.100 by have been reviewed and are [] approved. [] conditionally approved (see attached conditions). BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Date or descriptive reference) Approved by The "APPROVAL T° OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on : (date). The system is hereby granted interim approval to operate for 90 dayS following the c.omp et on date. BY TITLE DATE As-built plans submitted during the interim appr~)val period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE DATE Municipality of Anchorage Development Services Department' . Building Safety Division ,. ~ On-Site Water and Wastewater Program .. !4700South BragawSt. ' P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us : (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. :011-133-25 1. GENERAL INFORMATION C0mP!ete legal.deScription LoC Location (site/addre§s or directions) HAA# 0 Expiration Date: .(~'~i 12; Block 6; .Sandlake Subdivision #2 8349 Seaview Current Property owner(s) Ted Whip Mailing address Len'ding agency Mailing address Day phone 360-303-8998' Day phone Real EstateAgent I(~[m p.~s]e¥ / JKP Day phone Mailing Address 11~ W_ Nnrth.rn T,'lEht-n Unless otherwise requested, HAA will be held by •SD for pickup. 2. NUMBEROF BEDROOMS: -~ TYPE OF WATER SUPPLY: ' Individual Well [] Individual Water Storage [] Community Class A Well ~] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual Omsite [~ Individual Holding tank I'-'1 Community On-site F'] Public Sewer Fi l The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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 pdvate or Class C well and may be reissued with new water, sample results. (Certificates may be reissued for a pedod 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 errors or omissions in the professional engineer's work: STATEMENT OF INSPECTION'BY*ENGINEER As certified by my seal affixed hereto and as Of the validati~)n 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. NameofFirm S &'S Engineering phOne 694-2979 Address 17034 N. Ea~le River Loom Ste. 204 Ea~le River, AK 99577 Engineer's Printed Name Robert C. cowan Date ,~"-/3-p/'O~ bedrogms. DSD SIGNATURE Approved for Disapproved. Conditionai approval for bedrooms, with the following stipulatio'ns:' Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev, 01/02} X Maintenance Agreements SupPlemental Engineer's Report Othe~ Original Certificate Date: ~, .. '~- 0/-~ '~ Municipality of'Anchorage Development SerVices Department · Building Safety Division OmSite Water & Wastewater Program 4700 South Bragaw St. :P.O. Box 196650 Anch6rage, AK 99519-6650 : ,,,,w,,v.ci.anchorage.ak.us (907) 343-7904 ' ' HEALTH AUTHORITY'APPROVAL CHECKLIST Leg~,l'De$cription: /~-; //~LOC..I,('~'=,," ,.,~l;;~/-z,zzo ~._,,q-.~t'.~'r" Parcel ID: A. WELL DATA : '71~'2 Well. type .,/1~. If A, B, or C provide PWSID # gl5 ~,~. Well Log (Y/N) , D~te Completed ' Sa~ seal (Y/N) Wires properly protec~ (Y/N) T?~ Idepth. ft. ' to--ft.' Casing height (a round)- , ~tiC water level ' ~ fL ': / ft. ~',~ / , / We I, producbon / : g.p.m. / g.p.m. WATER SAMPLE ~SULTS: / . Cohfqrm ~olonies/100 mi. · N~trate rog.II. / Other bacteria., coonies/1 Arsenic: Img.ll. ~ Date of sample: ~ Collected by: B. SEpTICI~ TANK DATA ' ~',~, . . . , Tanksize .~ OOO gal.. Numbe?ofCompadments ~ Cleanouts (Y/N). · , : , ,. ~'~:: (YIN). Y D~pressionovertank(Y/N) ~ Foundation cleanout . High water alarm (Y/N) D~ ~ O~'~ Pumper ~~.~ ~ c. A~SORPT~O~ F~ELD D~"i&stalled 'S/~ Soil rating (g.p.d.lft'or~ I~ Systemtype ~, ; i i,i , ; LenCh ~ ~. ' Widm ~ n ~r~v~ be~o,~ p T~tl ~epthqft. Eft. absorpt! onitoringtube. V Depression over fi~,, Flu ~ depth in absorption ~ield before:test ~ in. Water added~gal. New depth~z~ iht E~ap~ed Time: 30 min. F~n,, fluid depth ~. Absorption rate >: ~ ',~ ~;: . r,ejuvenation treatment (past 12 mo.) (YIN & type) ,~,/--~ ,/-f"/,~¢~ ~ ,J If yes, give date --'-"- Date installed , · '"C'J J'~ ,Size in gallons i .,:' Manhole/Acc'es~ (Y/N) '· ~,. "Pump on" level ai ' : in. "Pump off" level at __ in. ', High water a arm lev"e'l'at Datum ~ ' Cycles tested i Meets alarm & circuit requ rements? E. SEPARATION DISTANCES i - ' ..... SEPARAT ON DISTANCES FROM WELL ON LOT TO' ~ ~..r ,,,f- .'Absorption field on lot i ; / ~' ,,,F ;..: i On adjacent lots · Publcsewermain~,~' ;'' ' /SJ//'~-_ ' : .Pubhcsewermanhole/cleanout ,Sewer /sept c service l ne ' ,//01(2 4-, .:~ - Uold,ngtank . SEPARATION DISTANCES FROI~I ~EP~ICf~~ TANK ONLOTTO: . .,,Buidngfoundation', i ~,~-2 ~- · Property line ~ ) Absorpdon[~e~a?, ~...~ Water main ~'I;C) ~ -')- Waterserwce hne I I~'.-)- Surface water ! SEPARATION.D:I'STANcE:FROM ABSORPTION FIELD ON LOT TO: i". Pr°~ert¥1ine ';: i iO-l~-~v~!:Bu dingfouhdatioh i lt~ ~'+: Watermaifi '! !:~ Curtain drain NtTto'E ~ t,4.,0 WellsonadjacenLIots,-~c~..:~ +' ~:' ' 'i il: . ,G. ENGINEER S CERTIFICATION. · :; , I' . . -~'/~ ,.i ",~'~' · I ce~ify that l have determined through field Inspect o ,' , ,~~"--; review of Municipal records that the above systems.are in ;~ ; . . ; conformance with IMOA 'H~ guidelines in effect o~ this daler, : , ~,~. ROBER :En ~ eersPn e ,N .... Date of Payment ~:L~ ~1 ~r ' ,. Date of Payment. Sent By: JKP; ..... 9072764309; May-26-04 4:56PM; ~uu~ E JOHNS JR Page 2/2 PAGE ~2 30' I SURVZy C-,ER~lr-iCA ,'iON L[----3.%='~. ."_'=.. , -'.. .,,,. . '=. ,m' .'u~,~' SURVEy TYPE PLOT PLANS & LOT SURVEYS C ~s~'~,- ' UILDF..R OR OWNER PRIOR TO "~ t'CI1ONo tO vERIr"Y PROP0~ BtJIU~INC ~R,,~D~ ~0 .~/q~E~.ED O~xO£ AND UTIuTy CONNE:CTION~ AND TO D£T--r..~MI~IE Robert' Prepared by - E. Johns, Jr. & Profess;onul Lond Surveyors' AN ~2 r_ ~2 ~v~. "' -~ 0 ' Lot 4,2004 ~ P. EJ 24, 2004 ~.224 I, OI' !2, BLOCK 6, ADDII'ION NO. 2 ASSOC. S~3..'.D LAKE SUBDIVISIC 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 Parcel I,D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~)//-- //.~'.~ '-'~-5'~ HAA# Jc[iC~r 1. GENERAL INFORMATION Complete legal description Lot 12~' Block 6; Sand Lake Subdivision #2 Location (site address or directions) 8349 Seaview ~ Property owner Mailing address Mark Tovsan 6943 T&rry Place Anchorage, AK Anchorage, Day phone AK 99502 ~43-55~4 Lending agency Mailing address Agent Address Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup.. NOTE: Individual well Community well ×XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: XXX Individual on-site 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. 1/91) Front MOA~2! 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. Name of Firm Ad dress Engineer's signature DHHS SIGNATURE ~'~ Approved for ~ / Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date /././ 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. 72~25 (Rev. 1/91) Back MOA fY21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-o?-/7-) ~L/< (~; ~%~,D L~.~ Parcel I.D. A. WellData !~'d_- (_E.7-c~--'v~ of~ ~r--~/~/~c_/z/-/,~.jc~'- /.~ /~cc_~c..~.~o L..~-/-/ Well type G~_~..E'.5 //~ Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Septic/holding tank on lot Absorption field on lot Public sewer main _ .Casing height Wires properly pro~ ~ PECTION Static water level Well flow ~~ Pum__.~l SEPARATION DISTANCES FROM WELL TO: ~-/__~ 5'.5' ~ ii0[ X g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Sewer service line WATER SAMPLE RESULTS: ~E~T ~/C ~ ~ ~- ] O - ~. Nitrate Tanksize //(.-300 ~_¢¢4¢___ Foundation cleanout(~N) Other bacteria Compartments ~r'~' ~ Depression (Y~,~ Alarm tested (Y/N) Pumper ,z~ _~1.-. //~D/vl ~ Coliform /'~ ~:7~'7~Fo u nd at iD n ~'-E/ Water main/service line Date of sample: B. SEPTIC/,I,I~L--~I~TANK DATA Date installed ~"/[ °~/ Cleanouts ~/N) High water alarm (¥/~) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOL-DhN~ TANK TO: Well(s) on lot ,//O r On adjacent lots ¥' To property line Absorption field Surface water/drainage /00 ~u CONTINUED ON BACK PAGE 72-026 (3/93)° Front C, LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at J ..--"P'd~p off" Level at .~C~ycles tested Manufacturer Manhole/Access (Y/N) ~ High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATIO~ROM LIFT STATION TO: ~.?~ On adjacent lots D. ABSORPTION FIELD DATA Surface water O Z Date installed Length ~_~ r-~ / Width' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soilrating(GPD/Ft2) /~-.~T~"~ Systemtype ~ / Gravel thickness ,~", 5 / Total depth ~ / Oleanout present~N) "7'"E-S Depression over field (Y,~ Result,~ail) .~'~.~.-~',S for '~'-~.E-~-(3) Bedrooms ~ After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot //Y To building foundation On adjacent lots ~ ~ Surface water /~ Cu~ain drain ~( E. ENGINEER'S CERTIFICATION Signature / // Engineers N~ ~-~ ~, ~o~j~e ~ver Eoop Road Date Ea~River, Alaska On adjacent lots ,,~)~,xJ~ y'P/2a~S~z_Y--j Property line /-~ To existing or abandoned system on lot ~/-J Cutbank ~(_~ r ~ Water main/service line /O Driveway, parking/vehicle storage area ~ and HAA guidelines in inspection. ".;c ' :~',! HAAFee$ ~DO, Date of Payment Receipt Number waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back "~ ': WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 995'15 (907) 349-7755 July 26, 1994 Mark Tovsen 8349 Seaview Anchorage, AK 99502 SUBJECT: Lot 12, Block 6, Sand Lake #2 (8349 Seaview St.) Class "A" Public Water System, PWSlD #215469 Dear Mr. Tovsen: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on June 22, 1994. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on October 26, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on October 26, 1993. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted :o this Department on July 6, 1993. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is.valid for 30 days and is for the specified legal description noted above only. Mark Tovsen 2 July 26, 1994 If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II APPLI( iNT FILLS out UPPER HA[..~. ONLY Pr~gerty O'~i~r, ~'~ ~---- ~'~(~/? ,j~ '~, Phone Address ~ ~ '~/~ ,~ ~c'~ Zip Code Address ~.~/~/~ ~ ,~< ...... ~ Zip Code Realty Co. & A~nt Phone Address /~ Zip Code Street Locati~ . ~"~ ~ ~/~/ ~ / Type of Resi~nce SingleFamily Multiple Family No. of Bedroo~ ~ Other ~lndividual ~ ~ )~ ~ ~ ~]~ ~ . A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ ~ CommunitYPublic Utility For wells drilled prior to that date, give well depth (attach log if available)~ ~ ~,uivi~u~ q .~ ~ L~q ~- ] ~ ~3 Y~ ~nUiviaua~ ~,~ta,,d: / ~ ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time ~' Date Date Date Date Inspector Inspector Inspector Inspect~ Field Notes: q.~ ~ ~ cm~,.~ L.,..),~.~C2 ~ ~,~ ,j, aJ-~ ,~ MUNICIPALITY OF ANCHORAGE DFPT 0'- ','~'LT:~ 'q' ( ~,~ovE~ ~D~OO~S 3 ~ . '~O~D~T~O.S O~ ~OVAL Soils Rating Date ~wer Installed Well To Absorption Area ~ ~ ~ Well Log Received d--~ Well to Tank l~ Septic T~k Size IO0~ 72-023 (3182)