HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 4 LT 7GRE/,, :R ANCHORAGE AREA BOR,.JGH
Department of Environmental Oualitv
3330 C Street
Anchorage, Alaska ggs03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
INSIDE WIDTH LIOUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID C APAC ,TYL~I- LON S.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDAT'ON ~ /NEAREST LOT LINE ,~---'O [ OF TOTAL LINES LENGTH~ 7 /~
NUMBER OFL'NES / D,STANCE BETWEEN LINES /-'~/A~, TRENCHWIDTI~:~ ,N, TOTAL EFFECTIVE
¢' DEPTH OF FILTER ~ ¢~;:~ '/
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN.
WELL:
TYPE
BUILDING
FOUNDATION__
CESSPOOL _
APPROVED
CONSTRUCTION
DEPTH
NEAREST
SEWER LINE__
__REMARKS
SEPTIC SEEPAGE
TANK__ SYSTEM
NEAREST
LOT LINE_
OTHER SOURCES
DISAPPROVED
DISTANCE FROM:
DISTANCES:
SEWER LINE DEPTH:
PIPE MATERIAL:_Ef' /~
LOT SLOPE:
REMARKS:
..s,,; L
DATE /I'/ /2APPROVED /-'~~
APPLICANT
LOCATION
LEGAL
J A MODULAR
RIDOEVIEW RD
L? 84 MT PARK ESTATES
3488 MT VIEW DR
LOT SIZE
2?9-2589
3G000 SQUARE FEE]"
TYPE OF SOII~ ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING <SG FT/BR>= 140
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
D e P l- H ?-- l~ L. Er~GT~= 2 I~ {~RA"¢EL. r~EPth= 8
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 80TTOM OF THE EXCAVATION (IN FEET>.
'THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF ORbVEL BETWEEN THE OUTFAL. L PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>,
RE~ltJ I RED sePt' I C 'rANK S I ZE= ieee
Tb,i£3 (2) I [~PECTION--~$ ARE REQLJ IRED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL 8E SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
PERF11 "T' ",,.."FILI D F'OR ONE "-r'ERR FROH I$$UE
I CERTIFY THAT
i: I AM FAMILIAR WITH 'THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH 8Y THE MUNICIPALITY OF" ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3;: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY RE(~UIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO I NCLLJDE MORE THAN ~ BEDROOMS,
~...---. ;~ , /~, ,, ~/ ~ .
........ --./~:--~',--~ ....... ~. L ~-~...-, ,--~' ~' 70 -d~ ~ S
BePLZCbNT J 8 MOD~R-' ~
/.~L~,~ "~ GREA1ER
Anchorage, Alaska ggb~'J3
, '-. (,~. ~:
.- S()II,S hO(; - I'I':R()I,ATION 'FI':ST
Legal De~cri
This form reports: Soils log ....
Dep ~h
Feet
Was ground water encountered? ,~0 If yes, at wi~at deptl~? .................
Itcading Date Gross Ti me Net 'fi me
Percolation rate minute.
Depth to Water
Net Drop
-Proposed installatio'n-:- Seepa'ge Pit . _~____ _ Drain Field
l)et)th of Inlet . Dept~-t~n--o~ pit o.r.__trencil ', ................
WATER WELL LOG
FOSS DRILLING
1336 Ingra Street
Anchorage, Alaska 99501
FT.
J~DI
DATE COMPLETED~PUMP TO BE SET AT~
to
to__
__to
tO ......
tO ........
to ,,
to__
to__
__t 0 ....
to
__to
to
,, to
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner
Mailing Address
(c) Lending Institution
Telephone: (home)
//~,-/-,~ ~u /'-'-f~,,
Telephone
Business
,+~ ¢'¢~
Mailing Address
(d) Real Estate Company and Agent
Address ~(0~ J~r' ~ ~_ e (/
Telephone ~ ~¢- O~ /
(e) Mail the HAA to the following address: (or check here [], if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family [] Number of bedrooms '~
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 th legality and status.
4. SEWAGE DISPOSAL
On-site [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev 7/88) Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 flies 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 /:'(~/-/.~ '-f'c'cA~fc~J _¢¢~"v/~ Telephone
Address / ',/5..,7d ~::¢_.A~ 5'''~/../ /~¢4¢,~-~¢¢~, /~-~'~ c~9,.¢. /~,-
Date ,A-/¢,," , I
~~ ~ ~ Engineer's Seal
DHHS APPROVAL
ApprovoO for ~rooms ~~/~~ ~ Date
lerms of ConOitioaal Approval
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated 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 DHHSdo not conduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev, 7/88) Back Page 2 of 2
~°~or~UNICIPALITY OF ANCHORAGE (MOA) N\~~
'v~'~'( (-~. ~"~ Health Authority Approval (HAA)
~,,c~,ar,,: ~t.,~.~;~_~ CHECKLIST- FEBRUARY 1984
,~%~ '" ~nA 343-4744
~" ,~O ~ ~ Legal Description:
x.
Well Classification Pr t',/,~/-¢ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) T' Date Completed 5'/~.$/ 7 7 Yield I,? ~/¢~ ~e~z.r
Total Depth ~0,~- Cased to ~o$
Static Water Level "~ 3E' '
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) V
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 105"
Depth of Grouting N,,4.
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots --~ t~o '
ToNearestEdgeofAbsorptionFieldonLot Ilo' ./-~¢.~'. ;OnAdjoiningLots tl~'
To Nearest Public Sewer Line N,/k To Nearest Public Sewer Cleanout/Manhole At,/L
To Nearest Sewer Service Line on Lot ~ ~''
Water Sample Collected by F"/,~/-/-~ 7"~c~, ~s ; Date ~/~'/~q~
Water Sample Test Results ,('~.~-~r_.,/-o~,,// - ~'~,lt,/o,'.~/foo~'./ ~:~,~Z,~,~,/..~
Comments~ (~'~.~ ~e~cm~ G~/~.,,,~,.q '~79/ ~ ~1'
B. SEPTIC/HOLDING TANK DATA
Date Installed 5'/[7/-/7 Size (OOd2~[ No. of Compartments
Standpipes (Y/N) ~' Air-tight Caps (Y/N)
Foundation Cleanout (Y/N) N
Date Last Pumped ~/
;for
Temporary Holding Tank Permit (Y/N) N,
To Building Foundation
To Disposal Field
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) /~,~.,
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line ~'-~ '
To Water Main/Service Line ~' '~'-r
To Stream, Pond, Lake or Major Drainage Course ~ too '
Comments¢ '7-',~,~ ~
72-026 (Rev 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/1"/
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N) hl
Results of Last Adequacy Test ,4-¢/~¢~/-¢' ~ r
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /I ~' Jctr,,',, c-,
To Building Foundation '~ '/'
Lot
To Water Main/Service Line ~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments /='~¢(~ ~,,¢-/ ,~ ,~,,~¢,,~ ~ ~,,4
/6'"¢:~,',"~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line -~' '
To Existing or Abandoned System on
; On Adjoining Lots ~ ,~¢ '
To Cutback (if present) ITM.
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**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.
Signed
Company
Date
MOA No.
Receipt No. c~/ 7 O~ ,/~ ~//~ ~ ~'''~
Date of Payment Z--¢'/ - ~ ~ (~
Amount:$ / 2C~"~_r ~---~'")
72-026 (Rev. 7/88) Back
~ w, ,'-~-- /' ~ : ~ ~ Engineers Seal
} * ' ~r:O'O~ ~ "DORE ·
;;'.,'. CE- 358? .,/
Waiver Fee: $
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
SEWER AND WATER FACILITY
OF
ON-SITE
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
1'-5 ~yO fl~d-~,~ u~ Dr-~be
(b) Property Owner ,A
Mailing Address "~/'c~
(c) Lending Institution /"/'
Telephone: Home 3 Yq -O5-(-,' f Business
Telephone
Mailing Address
(d)
Real Estate Company and Agent
Address ~ ¢/E;E,' [.-/-~r'Gz-d
Telephone ~ ¥ ~ - c~5'--g)
(e)
Mail the HAA to the followina address: or: Check here [~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family []
Number of Bedrooms
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.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: tf community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
72-025 (Rev 81861 Front
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 this inspection.
Name of Firm /'~/a .~/~,~0 7"ec~ ~n ~'(:~[ ~'~ Telephone
Address Jy~O ~C~o ~/. ~C~ ~
Date ~"J/ ~ t~
DHHS APPROVAL
Approved for
Approved ~"
___ Disapproved Conditional
Terms of Cortditional Approval
CAUTION
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.
Page 2 of 2
72-025 (Rev 8/86/ Back
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description: /-77
A. WELL DATA
j~r't V~ ~'~ If A, B, C, D.E.C. Approved (Y/N)
¥ Date Completed ,5"/P_<C/' ~' 7 Yield
Cased to ~'O,5"' --X Depth of Grouting N'~L,
~ .7 ..~'- Pump Set At
Iq' '¢ Sanitary Seal on Casing (Y/N)
T
Well Classification
Well Log Present (Y/N)
Total Depth .'7 O,.¢'
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot I 0,$' t
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line t4~.
Cleanout/Manhole ~h/~,
beA-o eeo
Water Sample Collected by
Water Sample Test Results
Comments Co~' ~ n39'
SEPTIC/HOLDING TANK DATA
Depression Around Wellhead (Y/N) ~
~ E.o. ; On Adjoining Lots
II~' ,~,c.o. ; On Adjoining Lots t~' ~,$,,,,,/, ~.c~,~ ~.
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~,
;Date __
Date Installed ,.,~'/ l?[ '17
Standpipes (Y/N) Y (' [ }
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line _
Course
Comments ¢' -'r"'~ ¢,~ o,~ fy
Size [001~ No. of Compartments
Air-tight Caps (Y/N) ?' Foundation Cleanout (Y/N)
/~ Date Last Pumped ~/81/,¢~
/~ 0/'~r. ; for
/~f'/¢', Temporary Holding Tank Permit (Y/N) ~,
To Building Foundation ~, t
t
To Disposal Field ~¢'
To Stream. Pond, Lake, or Major Drainage
Page 1 of 2
72-026 /Rev 8/86/ Fronl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
¢"/ 17 f 77
Square Feet of Absorption Area ¥ ~
Depression over Field (Y/N) ~
Results of Last Adequacy Test ,A (_.,(¢¢c4¢x~-¢'
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot t~ ~.
To Water Main/Service Line
~f~C(r~,'~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~'O '
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
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.
Signed ¢..~-~ ~. ~ Date
Company /¢(~L.,./¢,/¢ 7~c//. -.('¢o' M,OANo.
ReceiptNo. _,~-,/__~ ~¢::~/
Date of Payment
Amount: $
Page 2 of 2
72 026 fRev 8/86/ Back
Engineer's Seal
APPLI' NT FILLS OUT UPPER HA. ONLY
Propert Owner //7/:/~./.~/~/,~,~' Phone
Mai~ingAddress %1~..~ ~,'/3X '% ~ ¢, ~, ~. ~ ~ ~ ~) ~ ZlpCode ~ y~ ~ ~
Buyer
Address Zip Code
Lending Institution ~hone
Address ~'~yc.~r~';.g~ [ t~l;lJ// ~/11~/1 ~C~,~ /~'~ Zip Code 2~<~3 ~. ~ ~
Realty Co. & A~nt (~ ~ ~ Phone
Address ~ ~ /~,:.~ /~ ~/(. ~ ~ ~ ~ ~ .~ ~. ~- Zip Code ~ ,/~//~ ~ ~
Street Looati~ i' ~'~ ~ '/':/~
Type of Resi~nce ~ ~ ' ' ~
~ Single Family
~ Multiple Family No. of Bedroo~ ~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l.log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual , ,.,' : .:,,'"' ,t 7 /:' . Year Individual Installed: )~ '
~ Public Utility ~¢ i / ..... When Connected to Public Utility:
~ Holding Tank /L::]
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OOESSING CAN BE INITIATED.
~ Time ~/ ¢..~
Date Date Date Date .V -
Insp~tor Insp~tor Insp~tor Insp~t~ ~
Field Notes: MUNICIPALITY OF ANCHORAGE
PF~T C~ vZ'~"~ ~
RECEIVED
( ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
DATE ~'~ ~
Soils Rating Date ~wer Installed Well To Absorption Area WeU Log Received ~)~:
Well to Tank Septic T~k Size / ~ t~ E~
72.023 (3t82)
~teinr ' - ~'~
AncO, AL 99r~07
Subject.- Lot 7 Block
August 31, 19B2
Mt. Park Estates
Ap~roval for the individual sewer and water facilities cannot
be granted until the following items have been cori~plete~:
The water analysis report needs t,o., be submitted to this
off./ce from the Chem Lab, 5633 B Street, for our revie~¢.
The septic tank ~umped with a receipt submitted to this
~ epartraent.
A four (4) inch cast iron cleanout need, s to be installed to
the septic tank and/or leaching area.
Please notify -this Department for a reinspection v~en the
noted discrepancies }]ave been corrected. If th~re are any
further questions, please call this office at 264-4720.
Sincerely,
/[lim Roberts
ALASKA 6[1UIRO[lm6RTAL CORTROL $6RUIC6$, IRC.
~n§ineerinq ~ ~nuironmcnlal Studies
I~UNJCIPAL~TY OF ANCHORAGE
DFPT OF !~'17 ~ ,e,
RECEIVED
HOME FEDERAL
535 D STREET
ANCHORAGE AK 99501
SELLER - HEINCHRCH BUYER-RENZ
SUBDIVISION-MOUNTAIN PARK ESTATES
BLOCK-4 LOT-7
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 432 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 200 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF
THIS 3 BEDROOM HOUSE.
1000 IS ADEQUATE FOR
1220 LUest 25th Auenue · Anchort~qe, Alaska 99503 · [907) 276-1361
91: Time
Date
In sp
MUNICIPALITY OF ANCHORAGr
DEPARTM~,~~LTH AND ENVIRONMEN ·
A8~~~ Anchorage, Alaska
Date Received:
~2: Time ~3:
Date
Insp
PROTECTION
99501
May 26, 1977
Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request:
Mailing Address:
State Veteran's Administration
Phone:
2. Property Owner: James A. Heinrick
Mailing Address: % Jonas
Phone: 279-2589
3. Legal Description:
Lot 7 Block 4 Mountain Park Estates
4:
Single Family Residence: (
Multiple Family Residence:
Number of Bedrooms: 3
5. Well System: Individual well
Permit # ~~__ Depth of Well
Construction ~
6. Sewage Disposal System: On-site System
Permit # ~
Inst~lled
1977
Number of Bedrooms:
Community/Public System ()
300 Well Log on File
Bacterial Analysis
Public Utility ( )
Installer
Septic Tank Size /~ Manufacturer ~
Absorption Area ~~.~_ Soils Rate . /~ Material
Distances: Well to Septic Tank
!
to Sewer Line /~ Nearest Lot line
to Nearest Lot Line /~
tO Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 7 Block 4 Mountain Park Estates
Co~nents: ~~
Affadavit Attached: ( ) Letter Attached:
Approved:
Disapproved:
Date:
Department Worksheet:
-~~equest for Approval of Individual Sewer and Wat~.~9~%~s
MUNICIPALITY OF ANCHORAG,.
Department of Health and Environmental ~rotectlon
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225 ''
e
Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
Lending Institution:
Mailing Address:
Phone:
e
Realtor/Agent:
Mailing Address:
Phone: ~ 2 ~,} ',TL %'~- <~
e
Legal Description:
Street Location:
Single Family Residence:
Number of Bedrooms
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: *Individual Well (')
if individual Well, well depth [~ ~
If Community System, name of system
Sewage Disposal System: On-site System
If On-site System, date of installation:
Public/Community System ( )
(I) Public System ( )
*NOTE: A well log is required on ALL wells drilled since 6/75°
3/77
D + m
zo z
Si m
M� z
1
cc)m m
N
DZ
r 0
NZ V
a
y
z
2
W
m
p
N
N
C
m
• .rte
N
o
No3`c
:oma
i
o m A
>s°
+`
m
63�<
Z w g n
i
Ga em
c
��,• a,z
as. A"o
3" ''-
=s sa
�u:
a
00
r• 1
it 10
11 a
( j
Irl
1'.
lir h •.�
tl
1'
n7cr oc—m
zzhz°+'m
z
znce.a
oclm
mmr
zD DO
m
ynD
m
X110�y
c c
m
+q Illly®-!z
Co
{.
�1.
1 •c
`'`j• "�".�"'�,•-
$8946 JUL 16 1990
Y
S•
Ci
�uii
?�.ii•
•r' .�'
iii
-: ti
:t�;.•�.+�"1
•
• ��
�L- .
• .rte