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Home My WebLink AboutHALO BLK 2 LT 21 · .~-~ 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 MAI LING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well - _l~sorption area DISTANCE TO: ] ~]~% Dwelling PERMIT NO. ~ ~ ~.~e,e. ~ ~ Material No. of compartments Liq. capacity in gallons O ~ ~ Manufacturer ~ ~ ~; ~~ :) Material Liquid capacity in gallons ~ DISTANCE TO: ~ ~*~ No z7~4 E ~ .:.t.~ Nearestlotline PERMITNO. ~ ~ ~ No. of lines Length of ~'.~. Total le~o~ines Trench width Distance between lines ~ ~ Top of tile to finish grade ~ ,uhc ~ia~neath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller , Distance to lot line PERMIT NO. ~ DISTANCE TO: Building~..Z foundation/ Sewer line~ ~ z Septic~tanko~ Absorptionf~/~area(s) PIPE MATERIALS OTHER SO~L TEST RATING INSTALLER REMARKS I?,E:F'F!F~'.THE:NT (,~ ~HEI:::IL.'I"H FIND EN',,,':[ RONHEi'-,tTFIL ,.3TECT :[ ON .,- ~ tE;R E:E:=-~ ~;;:::'::~9 - E:. F'.. ~,.. 4-. ........ LOE:RT ): ON (:::O~tE:Z N 51 OF'F: I:::, ]: HOhlD LEEiRL L.2:i.. E:;;?. HRL. E~ SI..IE:D HINIHUH D;[?f'F:INCE FROr,'I b.iEL. L. '1"()¢~.4~¢ ~;El-:"r'~C 'I'F1NK,.¢F'F~CKRGE F'LF:!NT OR SOIL I::IB%ORPTZON S'¢STIEH :ES :LEI(~ P'"i' F'OF: R i.::'R:[VFi'f'EP.IE:LL. RND ;?DE~ F"f' FOR f~ PLIE~L~C lqELJ .... t.,~E:LL LOEi2; f'llJ~:;'/ EUE ~'.E:TUI;;:NE:[)']'O "tHE [)I:::F'I::IF:'t"HENT P!~'f'HZ~.,t E~:E1 DR'CS OF' THE b~ELL COHF'L E't'~: ON. S;F'E:C :[ F' ]: CFI'I"): ONS Rt'.4t) CONS;'f'F;:LICT :[ ON t:::,;i: FIG~,;rFII',ItE; F:iI:;:'.E: F:!'¢R Z I..J::IE~L.E TO I N~;UI:~E PROPER :[ N~;;TRL. LFIT :[ ON. ]: CER'F :i: F:"~.' THFIT :i: F::IH FFIH :[ L. ]: Fd:~: Fl:t: TH THE: BtE(;IU ]: RE:HEN"I'S I::'OR ON--S Z TE ~;EF~ERS; RNE:, 14ELLS RS SE"i'F:'OR'TH EFt' THE I"~t.J[,l]:CZF'l:~L.]:'f'"r' Ell::' F!NCI"iOI;4:F:IGE: FIN[)b.tZL. L ZNE;TFILL. :[N RCCOF:DRNCE b.i:[TH 'THE: COi.)E':. ~ Well Log ~or ........... ~.~.~ ,/.~. ........ ,:~.~*/.~. ........................................................................ Location ....... .~-. .: :7. ~ . . ~. . .l ...... ~.. .~. . ..o. . . :. .~. , . . .~. . ....... ~t. .~.~. . i ~. ..... ~ ~.~. . ................. '?/~,~ Date completed .................................................................................................... Depth of well ....... ./...~..~..! ......................................................................................... Size of casing ....... ~.././. ................................................ , ........... , ..... i ................. · .......... Distance to water .... ..~.....~...J. ....... · ............................... , .............................................. Distance to water while pumping .......... .~/...!. .................................... at rate of ......... ~.o...~.. .......................... .....gallons per hour. Formation [ from %,,,./' <.;1¢,/_ :,~,¢/ .. I*,;--- ~ / . ' (XA~/er. . yo 1 I Aurora Drilling Co. 8521 GOLDEN ANCHORAGE, ALASKA 99502 PHONE 344-0651 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION . , , 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER I PHONE Donaid B. Combs MAILING ADDRESS 1680 ~.)~R~Sse~iI:Rd,; M~in,Oregon 97532 PROPERTY RESIDENT (If different from above) PHONE Robert H, Combs 344~3782 2. BUYER PHONE Robert H. Combs 344-3782 MAILING ADDRESS 8607 Corbin Dr. ~1 Anchorage,Ak. 99502 3. LENDING INSTITUTION I PHONE The Lomas & Nettleton Co.I 274-7661 MAILING ADDRESS 4449 Business Park Blvd. Anchorage,Ak.99503 4. REALTOR/AGENT I PHONE I no agent MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 21Blk. 2 Halo s/d STREET LOCATION 8607 Corbin Dr. Anchorage,Ak.99502 6. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY ¥.--'~AT-A~-S-O~L~'V- [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OF BEDROOMS 8 [] One [] Four [] Other [~ Two [] Five [] Three [] Six *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010{3/78) MUNIcIPALiTY OF ANCHo DEPT. OF HEALTH & ENVIRONMENTAl_ PROTECTioN 8 RECEIVED THIS SIDE FOR OFFICIAL USE ONL, DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE --- CATE CATE I NSP ECTOR INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX · PEI~MIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~)NDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tanker []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. D'STA[~'ESv~,, E L L TO: Septic/Holding Tank IAbsorption Area jlSewer Line ti ~earest Lot Line Absorption Area to nearest Lot Line 5. COMMEN~S ..... ~].--~APP R 0 V E D FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) / / LF~_GA L DESCRIPTION 72-010 (Rev. 3/78) Date ALASg 'tRTMENT OF HEALTH AND SOCIAL STM '-~ES DIVISION OF P~BLIC'HEALTH ~ Lab. No, BACTERIOLOGICAL WATER-ANALYSIS: Office PLEASE MAIL RESULTS TO: NAME /-.-:-, ",'"i,:-: ..., ,-., 'i,), ;i i-~' t- ADDRESS ',~';'¥- .i-~; , , ~- ? :.~ ~ . CITY kL'-'h.~"~..~ ,.. .... ZIP CODE Phone No. ~-, / i ~" Date Collected (~" Sampling Address .~,t~. /~n~ysis shows this WATER SAMPLE to be: Satisfactory [] Unsatisfactory [] Questionable- [] submit other sample ~ [] Sample too long in transit to indicate reliable results. Sample should not be over 48 hours old at time of examination. [] Bottle broken or leaked in transit. [] Other SANITARIAN'S REMARKS Specific place of collection REASON FOR SAMPLE SUBMISSION: [] Illness suspected [] Health-Regulated Establishment ~ Other L?.'~ , WATER SAMPLE SOURCE [] Well Type 6f casing [-]" Improved (Enclosed, Covered) Spring [] Siirface (Reservoir, stream, lake) [] Holding Tank [] Other '.Sanitariar~'s Signature: BEAD INSTRUCTIONS BEFORE COLLECTING SAMPLE 0s-~220 (bi B~CTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 ,-:~ ~ ~.~', l~ TimeR, ) Lab. No. Presumptive t lOml =-3, 0 m I%~, 10mi 10mi 1.Omi 0.1mi 24 Hours 48 Hours : 24 Hours '\~' .... 48 rs ,- ' - ,'--,~ H~urs ~I~4B '~'~ ~ , ~ ourz: , Broth 48 hours: MultipleVTube. R/~port: ~-.-. .... ~2 ~/~_, ,/ L'-~. 10mi Tubes Positive/Total [0mi Portions Membrane Filter: Dir~t Count Coliform/lOOml verification: LTB BGB Final Membrane Filter Results ~ Coliform/100ml Reported By ~ -' Date ~/:' ~ Time: /~ ( -~0_:~ > Date ALASI~ ' / ~ARTMENT OF HEALTH AND 5OGIAL 5u'~ ":ES '~-~J'-~' DIVISION OF PUBLIC HEALTH "-.~" '~ Lab. No. BACTERIOLOGICAL WATER ANALYSIS Office PLEASE MAIL RESULTS TO: NAME l- e, r,'q c, .~ CITY ~,~.Y~X'C-~'- ZIP CODE Sample collected by ~1~ ¥ PC~ ~ ~ ~ c~ n~r ~ · L~ ~-'-.%1~~ ' ff e:~C£ '~Sk-- Phone No. '~")~ Date Collected ~ - Sampling Address Specific place of collection ¢3',~ ~, k.~ REASON FOR SAMPLE SUBMISSION: [-~ Illness suspected [] Health Regulated Establishment ~' Other WATER SAMPLE SOURCE a Well Type of casing [] Improved (Enclosed, Covered) Spring [] Surface (Reservoir, stream, lake) [] Holding Tank [] Other Analysis shows this WATER SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Questionable [] submit other s~mple [] Sample too long in transit to indicate reliable results. Sample should not be OVer 48 hours old at time of examination. [] Bottle broken or leaked in transit. [] Other SANITARIAN'S REMARKS Sanitarian's Signature: _.READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected-- Oate Received .. Source a.m. Time Received p,m. Lab. No. Presumptive 24 Hours 48 Hours Confirmatory 24 Hours Multiple Tube Report:--~w-~-- Membrane Filter: Direct Count~ Final Membrane Filter IResults~ Reported By Broth 24 hours: Broth 48 hours: .10mi Tubes Positive/Total 10mi Portions ColJform/100ml Date Time: a.m. ~??