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Home My WebLink AboutTHUNDERBIRD HEIGHTS #1 BLK 7 LT 3lAut4o�.28�� LoT -goo MUNICIPALITY OF ANCHORAGE w \ 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 NAME PHONE EW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION ,r L 14 W S LOCATION N0. OF BEDROOMS 3 v Y DISTANCE TO: Well r U / Absorption area / Dwellingt// / 7 PERMIT NO Pad 0..2 U4 ~ Manufacturer Materia tjj £ No. No. of compartments rn Liq. capacity in gallons 11011) 0 IF HOMEMADE: Inside length Width Liquid depth 6 Y JU2 DISTANCE TO: Well Dwelling PERMIT NO. Sanufacturer M Material Liquid capacity in gallons O W0: TO: Well �� / Foundation Nearest lot line PERMIT N � tL Z F 2 w No. of lines Length of each line Total length of lines Trench width inches Distance between lines -- Q H p Top of tile to finish grade / / "',3/s Material beneath tile S 1 Inches Total effective absorp 'on area 3�� W Length Width Depth PERMIT NO. QF CL W Type of crib Crib diameter Crib depth Total effective absorption area W to DISTANCE TO: Well Building foundation Nearest lot line J J ss Depth Driller _... Distance to lot line PERMIT NO. W DISTANCE T s Building foundation i Sewer line / t ?Ori Septic tank / .2Gc� Absorption area(s) OTHER N PIPE MATERIALS D r)341 SOIL TEST RATING , U /-l+J� INSTALLER S s REMARKS Q r P g APPROVED DATE / LEGAL �0 (el, f 2 72.013 (Rev. 3/78) V U PI L_1 r -d a 17-: T^ T• F=, L_ = T 'T ID F f=� r -a r_ a -"73 F: F=l 1:3 E=— DEPARTMENT DEPARTMENT _r HEALTH AND ENVIRONMENTAL .ROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 2r,a-a r 20 wu I PERMIT NO. C 820459 > APPLICANT STEVE 9-OAGGS CONST. PO SOX D CH! IGIA K 99557 688-2531 LOCATION LEGAL L3 67 THUNDERBIRD HEIGHTS LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NU NBER OF BEDROOMS = 3 SOIL RATING CSG! FT/BF'>= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S : CE:F'-r t-Aw�TH= ='�-y ��F:F=e':� Et G•EF'TH= THE LENGTH DIMENSION IS THE LENGTH CIN 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 E::CAVATION CIN FEET). THERE IS NO SET WIDTH FOR TF:ENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). R E��!�J = ELS =•EF'T 3 �� THtaf= _• �E_ �ryfr�nL_I •! PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL 14ILL SERVE. --- TG•.li=i ■= �' `■ I t-•!_•F'E��T I r=ir-.!_• RF:E F:E�-!�_� I R:EGti --- BRa'F I LL I NG OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY Ota -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEFENDING UPON THE TYPE OF PUBLIC: kIELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMSNITY SEWER LINE IS 75 FEET. OTHER REG!IIREME14TS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER, INSTALLATION. F'EF:r'7 I T E:=,F' 2 6= E GtiEl_ ErlE:EF: -=1: 1_=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. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. : I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLAR EMEtIT IF THE RESIDENCE IS F:EPb=iGE _C' TO MORE THAN 3 BEDROOMS. SIGNED: ------ -------------- APPLICANT ,-------- ----------------------- APPLICANT STEVE SK.AGGS CONST. C� ISSUED BY y/%=G - - --------- DATE_/Y/_g— =----- V4. [+ r0"111 ^I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST SOILS Loc ❑ PERCOLATION TEST PERFORMED FOR: Sk lam' KJ�/N� DATEPERFORMED: LEGAL DESCRIPTION: SLOPE SITE PLAN elm- Sill Cmrav t 2 COMMENTS Date 3 Net Time �• r,.4 . 5 6- 7" 7 8 10-- 12 .� 13- 314151617181920 14- 15- 16- 17- 18- 19- 20- COMMENTS - 9 re-►veI N IOv o'/13P Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY:I . Pto [i I CERTIFIED B 72.008 (6/79) DATE:�_?=r_zl GLS �►� Irl-�-�. �U -c::> C4 L,.—U L ri� ozz� y ° 01000 U I 3o W'tA r1 �, 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 3�)q-UL 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) or 3 B<K 7 ,„e 8 Mrl Location (address or directions) (b) Applicant Name 7174c.45 Ptii4AX Telephone: Home Business fP y`l yy / / r Applicant Address ``��.a bJT �r G-D��M�� ST/�y'E f�+•4Lts�D t16 W (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ;Buyer ❑ ;Other (explain); �.4_ft .c (d) Lending InstitutionS&!:eN Telephone Address 'e 'J (e) Real Estate Company and Agent ]`�dr+r� ei4 1 DM..ES Address Telephone (f) Mail the HAA to the following address: Engineering •�;RB 19A: Eagle River; Alaska 99577 . ♦ �, • • • r' ` 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Number of Bedrooms 3 Other 3. 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. 4. SEWAGE DISPOSAL Onsite 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) ro� it Iirn,nrhhlrllnl rlflr,11'11111t1{n1III �n'�'1111III I��"r��`1f a t. r1voTa 11m p �4{i� �Im1r11rIn 1l�il I Asi 1=afllilad NY IiIY aaa atllxvll info{Rall 04 A 1 till AW11 N� §Ilpwll p WI I Jgfl Y Itll ny IflyH1,111 N II Al IIIIt; (luhllll Authority Approval shows that the on-site water supplyy and/or Wastewater disposal system Is sate, functional and adequate , for the ntZer of pedroorna and type of structure Inulcaled heroin, I further varllY.1hat paned ran the Informafian tapt4Ingo Iron Ilio Muni cipaUly,of Anchoraga files and frommy'Invnatlgatlon and Inspootlon, Ilia on -alta watar,suppiy'and/or.. wastewater disposal system Is In compliance with all Municipal and State codes, ordinances, and regulations In effect on t the date of this inspection.� ! Name of Firm i tl STeieptione' ` '...-. '.).' I .r 1 J ..;-+ re). r ;!'• 1 ,.t li `rJ l t. .1 ! '. ., Addresst' X a "' Eagle River, Plaska 99 �r Date • ; ' e ,l'- 1.., �_. /� �, " ':'t { r', 1, i.t � r �L• 1 1 .t r +.., v l 1 r 11 t , r Lr• , fs ,In i t i ! , !t - J r t'. - ' ,.' 1 , •f t � f J r 7 J 1 ♦r 11 r r/, lJ }.:' e i r ) ..: .��\�7�� 1, `-.i ♦ e `' , r d.l 1 1.'r T ` S r..'•,n i. Vii( la�'1.�C �` i t rr ^ r 111+ r r r I Jr l J t r 1 Zf V ♦" `y \�•w•H•..�.'�w•�1 . t 'I;e d r �1 � 11 t T � � �' hQ• •• j r b� J• t ' , , , � r 1 ,. � j r , ! . 1 1 t 1 A n a l f 1 .; F ', .� `' •• -, :, r, -q .•� 4e t C t r• ) `J I ..'1 I ✓ , I 4 „l l • f 000 RR •t 1 lip 4•• ••• i• •.• t al r' I t l' G I r i, y r 1 r r ` _ �) r t e ) a .j r" • •. dtMri A.Ilk lh�f�r i c 1 .Y,rJ 1 d t r .-, s, t 1., r..'r �. • • w :i 4 / i s l r 1 r r r, 3.. 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V � =l ♦ '1 r 'if 11 ql t,r , 1 i _ I00 f .., 1 p r ..... > r. 1 • r a r' ) f q w} r t, i t •�.. �. .� 6' DHEP APPROVA 1 k 000 'Approved for I�Gedrooms b Datee / 'Approved ' S ` Conditionals Disapproved rI, Terms of Conditional Approval � �d J - n. .i r d 1..1 it + 1 1 f ,'J t .1 • t 1 7y , , - r ... 1 y ( 1 11 1, r' 1 1 asl 1 d{ ') �r j J I�.) 1 r wh �� r ��il r r t♦ � f 11 >, I'... rr 1' �•.J,, l`t i r ., ; i l i t x♦ i, I♦ i ,�{ r � )i l 1 e '`i ril 41. ,Li♦, r e♦N.�.,' i',. ♦' " l,.l 1i r;r •"1 t r .. f , .r Grt + ,:. II � �f , r � J��f ) r, •,�} e i qr"j dl � e .r Tp 1 r r i tt nl ` YJF 1 1 ♦.. t J )H♦1ft '• t +'I.t, i1' i t✓ (':1 11r r -II'lik " r� 1'1 GJ �✓, / .'11 (e tl.: Ifl Irl It f I Sr t ♦p ♦'l "'t lyt q )J;t ) 1•.Z g1t_1 VL 11 i 1: ' ,J .' 1 ♦ Jt lI` ♦ '(1 41 I f N Ot , r r, r t r 31 � r I �♦ iy ♦/ A -F {. r+ t J ip, � r r } 'i , t i 1 • It ✓ ' i I IJ J r 1 t. ,♦ 1 �.� ♦ 1 1,r rr l 3 , $ It i- r i •♦ '+ 4 1 ` - j r v Si. + 11 f r `, f 1 51 f S 1 R 1, ' , a ,I" • i,, "1 f fl r,r t } 1: t +- C i� t r 7 If ¢ I l ', r 14 b, I ��1 [ , i 2 r ,• 7■■��.%� 1 r ,- ,' r ,) .. 1 4 t •� , � 1, I 1 I � r t� , 4 l i- ✓ li. �/} If.' 1 1 l MC� ,. J '' " { • � r 1, r �, r l ..I 1 e' ,", i , C_Ir,,, ' i• 1 a•M1 t (.�,i "- e! it.l 1f♦ 1r• 1, t 1•c j. .:l 1 It t t + �1 /' .i r hr� ♦ 1 ��r �Jy � '7 ', iI }+t r,l �r I f''; i'r r� 1 L ♦ If 1' l it �' I l+ } VT J!4 i • l 1 Qtr+die ' hf l't+`/t 1 , J,le 1 t1 a , wJt, r{ ♦^o ,f , t 1 l Ili 1 ti , t, t r {i .. d 1 r 4 ♦ w i ,1 r Il ?'�Mi i•. ; I..• li ', �. �♦ �V.1f I ° .N� ft -.� I ti r. J -!f, �i ,r �'F �'J, b 1 �,M1 gg♦N`i 1l'l`j)Y xFnr lig .i r r V 1 I f i t I I 4 , tl .i 1 1, ) I't a "Y' i 1 tr ♦- i! r 'r ♦ 1 I Q r , r't r J, r , .+r CAUTIONja , .y '': I. f. ., AI '':.n+,..+,-'�{., ),.J; ` +IT r".•i�r rj• v ' /r�71?.lJ n' ;. The Muncipafity;of Anchorage Department of.Health and Environmental Protection' (DH EP) issues Health 'Authority-.' :; < Approval certificates based solely, upon the representations given In,paragraph .5 above by an,independent professional ? ;1,. '':engineer♦re'gistered In the State of Alaska. The DHEP,does this as a courtesy to purchasers ofthomes and their lending s l ; r 1;: institutions'lin order'to satisfy certain federal and state requirements: Employees,of DHEF,do not conduct inspections or, r analyze data before a certificate is issued The Municipality of Anchorage is not responsible for errors or omissions in the \ i1 r .t',11 ......•. ... I il `r t .I ✓ �'1 'll �'S� 1 t iYt ir� `I'. ). f 1 � �i If `r � M1 )f. _f yeti ...,1/ �rI'Y• I ` 1 i A�'. lr 1 1., i + i professional engineers work , l' r .�li +, , y , }I:f " k r .. 11 y: I r � 1/ tr •.y ' S `r 1 I : ""1 n< •� '} ; t ,} } l I rf t )ef r( r .III t ��rtl '1 lfy r It. Jrl , %ire r• 1.' .1 r 1♦ r`lr r sI. II r1 ,.i.. }I -fr; �;} I� .I el ti i tt 4 f.,, Jrr1r t 'i iytt', 1a 1•. 11 '.♦ , 1. n rw l;r l4,N -♦ '. Page 2 of 2 0 �t 7 a r ? ,. �" it ; a • ' 72-025 (11/84) MUNICIPALITY OF ANCHORAGc r,.y DEPT. OF HEALTH & NmENT MUNICIPALITY OF ANCHORAGE (MO�E�I�� PROTECTION HEALTH AUTHORITY APPROVAL (HAA) MAR 17 CHECKLIST - FEBRUARY 1984 264-4720 2 E 1 E D Legal Description: L)!r L A. WELL DATA ---� Well Classification ,��i�L t L If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth — Static Water Level Cased to peb of Grouting N Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Zoo t F Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _� t tr ; On Adjoining Lots To Nearest Public Sewer Line: Cleanout/Manhole Water Sample Collected by _ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Test Results Comments P VklS 10 sk: Z B. SEPTICfHAt-EiFNfi TANK DATA ; Date Date Installed 4 1-8a Size "a 00 No. of Compartments —Z Standpipes/P) Air -tight CapsOHT7 Foundation CleanoutAmr Depression over Tank Otl*z Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for '— Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well A-MY0 I+– To Building Foundation To Property Line %S To Disposal Field To Water Main/Gem4e Line 24 To Stream, Pond, Lake, or Major Drainage Course Comments — Pagel of 2 72.026(11/84) fir`^ r_• I C. ABSORPTION FIELD DATA zoo °ftp`- Soils Rating in Absorption Strata Type of System Design Date Installed jo/' Length of Field N G' � o S Width of Field -3 Depth of Field • S� Gravel Bed Thickness FW Square Feet of Absorption Area Standpipes Present ; Depression over Field Date of Last Adequacy Test 3�/0 Results of Last Adequacy Test 5,4--r, S oso- :-mle Separation Distance from Absorption Field: To Water -Supply Well i + To Property Line J i To Building Foundation ZZ To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Serriee Line To Cutbank (if present) 4 �A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pit/nn Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• Check Permitted Bedroom Rating Against HAA Request •• certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date Company E. 196x r-Aiasicr94S77— MOA No. O0 3 Q� SQL rot E Receipt No. ::J -G -7c1 \ rtQ ,.,''•► f Date of Payment Amount: $ ��' y • •,.• rs• at•'t•^ . •• " >f M� A.•SfiaSec J�� N.• 1131.6 Page 2 of 2 72-026 (1vea) 6 EOF8USN a SILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: �5 114�e PWS I.n.# 2!// To Whom it May Concern: /.' &According to records on file in this office the i5k4tC`ael'� ,1t/ --i Water System is in compliance with the State Drinking Water RegUulatio''ns Sincerely, MUNICIPALITY OF ANCHORAGE DIVISION OF HEALTH DEPARTME[JT OF HEALTH AND ENVIRONMENT TAL PROTECTION APPLICATION FOR HEALTH A[MIORITY APPROVAL CERTIFICATE 1. General Information (a) Legal, cription (in ude t, Application Date , subdivision, section, township, range) (b) Applicants Name 2b lephore Applicants Address (c) Applicant is (check ore) Lending Insti�,utior Owner/builder ; Buyer Other � (explain); ,�'•/ (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone 2. Type of Residence Single -Family M Number of Bedrooms 3. Water Supply Multi -Family iC11 ll,I 00 N 7/7 e Other (describe) Individual Wbll �__f Community F=1 Public, Note: If ccmwnity roll system, must have written confirmation from the State Departzrent of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this (/N) 4. SewageSewage Dismal Onsite ~� Public Community Holding Tank Is the wastewater disposal system adequate fcr the number of bedrooms ( /N)� [Page 1 of 21 2-15-84 5. Engineerirq Firm Providing Inspections, Tests, Data and Information I certify thattA ve checked, verified, or conformed to all MOA HAA Guidelines ir. effect on the date i rspection. Signed DateZ`O Name i Telephone Address ..Sao L':xINEERIINI 5*--" : �� RNE�. ALASZr� •IS?i �� Signed by PH. GOI') 7Z Date (ENGINEER SEAL) 6.DHEP Aooroval App_ot.ed for -3 bedrocc3 By Apowd`-, Disappro�.ed Terms of Conditional Approval Conditional .D..t A. al.�i.• : i The Municipality of Anchorage Cepartnent of Health and Envircrnrental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bed: -corm and type of structure indicated. (DHEP SEAL) 7. Mail the/o t followingdress: l Zt KB2/d5/s (Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE (MCA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL LATA Well ClassificationIf Well Log Present (Y/9N,-./ Y/N Date Total Depth Cased to a3A'13J3d NW01 lona oawa O 1430 A, B, or C, D.E.C. Approve (Y ) Ccmpleted Yield Depth of Grouting Static Water Level Pump Sat At Casing Height Above Ground Electrical Wiring in Conduit 0 Separation Distances from Well: Sanitary Seal on Casing (YM) impression Around Wellhead (YM) To Septic/Holding Tank on Lot !/ V f t/; On Adjoining Lots To Nearest Edge of Absorption Field onLo On Adjoining,Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ; Date Water Sample Test Results Comments B. SEPTIC/tkMWW4G-TANK DATA Date Install ( 7i Size No. of Ccrpartments 2 Standpipes (Y it -tight Caps (Y Foundation lean. (Y ) Depression over Tank ( ) Date Las d 'oe 2 Pumping/Maintenance Contract on File (Y j/� ; for Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (Y Separation Distances frcrq Septic//H ding Tank: To Water -Supply Wall 01,119 r / To Building Foundation / To Property Line d �� To Disposal Field To Water .b Service Line To Stream, Pond, Ld-.e, or Major Drainage Course L Comments (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorp ion trata �� Type of System Design Date Installed Z Length of Field Width of Field ,� Depth of Field e-?' V2, Gravel Bed Thickness 66 Square Feet of Absorptionlea �O �din(Standpipes Present O) Depression over Field (X Date of Last Adequacy Test Results of Last Adequacy Tbst 6(f �/� 1Y 9Z Separation Distance from Absorption Field: To Water -Supply Well X2,4- .4 To Property Line To Building Foundation Z 2 1 To Existing or Abandoned System on Lot /✓ / /r' ; On Adjoining Lots '570 T To 44atA�r Main/Service Line /D To Cutbank(if_present) To Stream/Pond/Lake/cr Major Drainage Course O^J //'g - To Driveway, Parking Area, or Vehicle Storage Area l0 74 Ccmrents D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/4) "Pump On" Leval at "Pump off" Level at High Water Alarm Level at Vent (YIN) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Co mnents ** Check Permitte Bedroom Rating Against HAA Request ** I certify thh I h checked, verified, or conformed to all 'MOA+H�, lzde4i s in effect on the dat f ion. ' ae Ol'i T'.. e.i as Signed Date Copan - MOA No. I � !r "4`. ►� t. h lVtLly LV:3 air+... ! a. 't QRS 1S^c•X 4 KB1/d5/s fi : bLt RIVER. AU="A'i.717" . �' A. a►os., + • a PH.1b. 1Q7 j A, [Page 2 of 21 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION April 27, 1984 PWS I.D. #211156 To Whom It May Concern: BILL SHEFFIELD, GOVERNOR Telephone: (907) 274-2533 Address: 437 E Street Suite 200 Anchorage, AK 99501 According to records on file in this office the Thunderbird Heights Subdivision Water System is in compliance with the State Drinking Water Regulations. Sincerely, mes F. Hayden Environmental F Id Officer JFH/msm cc: Mr. Robert Shafer APPLI( .VT FILLS OUT UPPER HX" 'ONLY Time Property Owner`^ f �� es Phone Mailing Address 15t1P..a_... /Q3 n' - y /o [ 7 ,r. Zip Code 6-7 .3QG Buyer �G M 05 ga-/et ' Inspector Address _ at , u.t1 Zip Code •y qj .SO Inspector Lending Institution�j G ln/:/-�Y<:P /� s��/p Phone �K [k Address Y s `j 5I. Au, (x6 c4e Zip Code ( ) DISAPPROVED Realty Co. & Agent ( ) CONDITIONAL APPROVAL - Phone Address / Zip Code BY: Legal Description �C 3 B X 2 '7`&.(;1 , 1- rY I o i 1 r S Date Sewer Installed Street Location t C. rt * / -- o 1 r Type of Residence Well to Tank Ingle Family ❑ Multiple Family No. of Bedrooms_ ❑ Other Water Supply ❑ Indiviqual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. mmunity For wells drilled prior to that date. give well depth (attach log if available). ❑ Public Utility Sewer Disposal L7.tndTq',dual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time DatZZ c� Date Date Date Inspector Inspector Inspector Inspector Field Notes: (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received tp Well to Tank Septic Tank Size 12,023 Of=