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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 7 LT 5Mountain Park Estates Lot 5 Block 7 #017-391-14 MUNICIPALITY OF ANCHORAGE It 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 L��']/f ' "/}v -e/� PHONE NEW ❑ GRADE MAI LIN DDR ESS 6:7 LEGAL DESCRIPTION C,V L�— 57 J /V LOCATION NOF BEDROOMS V Y DISTANCE TO: W I Cw, Absorption yrea Dwelling P IT NOC) F Z w ManufacturerMateri ar^_!� _ / dd T P-� No.of�pmpartments Liq. apadty in gallons IF HOMEMADE: Inside length Width Liquidddepth 0 x J Z DISTANCE TO: Well Dwelling PER0� _ F Manufacturer Material Liquid capacity in gallons w W DISTANCE TO: Wel l� U� Foundation r1 c-� Nearest lot l PER _ O� ��� �- � u Z Z w H -x No. of lines L ngth f ch line a Total length rya I" s 1-5 Trench inches n e Distab t can lines H Top of tile t Irish grade I Material beneath tile inches Total effective absorption area w [7 Length Width Depth PERMIT NO. a F W° Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Buildu ing foundation Nearest lot line J J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER PIPE MATERIALS SOI L TEST RATING INSTALLER REMARKS A ED DATE LEGAL (x� �/ 72-013 (Rev. 3/78) PERMIT I.'r_i. APPLICANT '-Lii—A (•IO1.4 LEGAL AL a . F:.FI t i ,i.ttiF.i. I.. -� tt rNVI I'kfii..F��fi lITE1-?.. _tf lr'J c.'25 *STREET, ANCHORAGE, AK. 91091 264-4720 =$ EE € 4 E:: Era F=' �-._ E�_ t k 1 1- 820700 - _0.0F it rrt;'t. D TH13 J. FE7F':: PO BOX 10-2247 99511 TYPE OF SOILk�_ ....aTFPI IS: TRENCH MAXIMUM NUMBER OF BEDROOMS.c_ 245-387.m. LOT '=IZE 999999 SQUARE FEE[Y SOIL RATING '.'-;t 1 FT/BR)- !-Y , ,,.... REQUIRED SIZE OF 7;-(E SOIL Af=;=a."iF.''F`Tiiik,I S'r':=.TEp+; I_-=: 9... #/`P _E_G !ff F1'_^'E_L_ i.z EE F --'-i THF: LENGTH INE IS I'!-!r'd IS THE, LENGTH H ': I ¢.d FEE T O f -HE. TRENCH OR. DRA I! 1 �dF : E'i .I': THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BE WEEN THE SURFACE OF THE GROUND I'll_lND Hp,D THE. BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO _.ET WIDTH i l R TRENCHES. THE GRAVEL DEPTH 15 THE MINIMUM DEPTH OF GRH'•,.E'L BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM liFF. THE EX:-LlVH.'..TI_EN (.IN FEET:;. PERMIT APPLICANT HAS ..1..HE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION ill t EI r iNS OF ANY HELLS : A A 'ENT TO THIS r-`PI_IF'ERTY AND THE NUMBER F';=: i -,E- RESIDENCES THAT THE WELL. WILL SERVE. — —'— --- s.- :'._ "�, �'-� - � "=_" �� F _- ._@__ �; e=s $'-'E'== €-a Vii_ E _ �,=' F„ 6_ a �_€ 'R- �^-' � �"-� — —— BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THTHIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM {DI IHNI E BETI.IEEN H. WELL i'iP+ID c, 1Y 011 -_,ITE SEWAGE DISPOSAL B'I'"-TEM IS JtI}_t FEET FOR H PRIVATE HTE ti.EL L OR 150 TO 20 FEET FROM UPON THE TYPE, � F H PUBLICWELLDEPENDING MINIMUM t; .I'_,-IP.0-J_E FROM A PR.IVN1!- WELL TO H PRIVATE '_;E!•d.r-R LINE IS '.__, FEET AND TO H COMMUNITY SEWED- LINE IS 75 FEET NEL..(EiGS ARE REOUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN DRYS OF THE I, ELi_COMPLETION. r _ r-�_ OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION iIAGRRMS ARE AVAILABLE L..E TO lNSURE PROPER !N'=T.11 r HTION. 004005:101-1- : -= �'-` T' �.:P:-- _ ,_ E> EEl C -' E=_ Pl =E3 Ez ate=_ 2:1: <-_s T CERTIFY THAT 1: I AN FAMILIAR WITH THE REQUIRE'ME,`(1''S FOR ON—SITE SEWERS AND !•JELLSH.. - SET FORTH BY THE MIftaiC:iFHLIT4' OF iHtdCylrFra-3%=:. a. I WILL INSTALL THE SYSTEM _T...I'1 1::. H' ILIF..'t7Hi•.ItE WITH THE I':(iDE<= UNDERSTAND THAT THE: ON-SITE '_EWER SYSTEM MAY REQUIRE ENLARGEMENT . y r U^I."c THE RESIDENCE 15 REMODELED TO INCLUDE MORE THRN 3 BEDROOMS. _ owf teT- wt 1 I APPLICANT ALL'Ll..IP'D INC ?. FEJa / � SOILS LOG 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99507 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Paw I PaIi� oer- DATE PERFORMED: -9'1 • 12 LEGAL DESCRIPTION: kar`; 1' �r '�S sok UIX �A t M S 1_R_0 ')-GI`�.i11iC 2 Date Grass Time (Mi.)'Slii 3 Net Drop N LC) i• I SZ 4 le I .S'S -6. 5 - 6 4- "20 7 —40- vim' 8 ?tit Stn Ea 9 t 10- 11 13Lilla 9 rave I'S 12 E� r064;}s ov 13- 3 1a 14- 3�,ts1g c,��a�Ional L '.14 I lei truap eS 15 16 16 4C T91 No. 2P51 -E x7 F WAS GROUND WATER ENCOUNTERED? no IF YES, AT WHAT DEPTH? Oil Reading Date Grass Time Net Time Depth to Water Net Drop N LC) i• I SZ 3: 15 le I .S'S -6. - C 4- "20 3�Ztd —40- vim' N•Z L; ?tit Stn Ea i , yt� t 2 HZO 13Lilla 1 ayg E� tN a 3�,ts1g � L '.14 I lei :U PERCOLATION RATE 7 TEST RUN BETWEEN h:'G�AND'F: y •.� PERFORMED BY: 91fY1+9Agji. /V Q�' CERTIF: ED BY: 72-006 (6/79) \ 7 - 4AWIPA,MAT :umaillml Tfom:.z $OX 13009 .STAR I:OtiTE A ANCHOMAGE* ALASKA 00502 844-7714 )'v� SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 226 Tee,', DRILLED AT THE RATE OF 23' 00 PER FOOT. PROPERTY OWNER r �';a 7c.y� 345-3821 'btaomd 9nc. ,` 10-2247 99511 LOCATION OF WELL SITE 5 `,L�,. 7 Stb. P701k1146ij,1 Park DRILLER f3e,lm,ie CAo a-' Ro tna�t 0h i LUn.n, <<'ah.h. WELL LOG: 0-----17' 05.0tu- aho.vrt. 40" 17----58' Sandi. ;Dine aAavet. 20;' r..!rtj- 58 --- 124' Caa�rAe r�,v7.veA.. Sevehn{_ �ca�fL GauLd . 724--182' !f v dnan. cer�en ted (Y"mire l.. 182--223' Sd,1.&.1 w -CA zandl.s rtat.l. 223--226' Coad clean, catv7Ae ah2veJ.. '7oteA BevilAr, jhmylnn d pAodtut,;an a,P 10 SPP ord ih. 55 ?.eek a° armte,,?..a ton.ddncr dri co-�)-in a- One i lahAe jh otAd be 5 .to 10 lr ect mfg J attarsi.. Co, . a,". ;,1.23.00 pew not Y. 27� "5198.00 `l� COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF , 5198. 00 THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS Sept 1,5t, 1989 f-, SERVICE CHARGE OF 11/2% PER MONTH WILL BE SESSED ON P ST DUEACCOUNTS. -M F -o - 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. # 017-391-1 4 HAA #/�3 DDDD� 1. GENERAL INFORMATION Complete legal description Lot 5, Block 7, Mountain Park Estates Location (site address or directions) 13030 Ri t7gavi am nt 9j u8 AnChorago, AX 99516 Property owner naxter and .Tarly mases Dayphone 245-4030 Mailing address 13020 Ridgeview Drive Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Day phone Address — Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3 ) 3. TYPE OF WATER SUPPLY: NOTE: Individual well XXX Community well 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: 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(Rec1/91) Front MOAe21 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 forthe 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 Anderson Engineering Phone 522-7773 Address P.O. Engineer's signature 6. DHHS SIGNATURE 2 Approved for ✓ bedrooms. Disapproved. Conditional approval for Additional Comments L-0 M ITIC Date 1 /24/00 bedrooms, with the following stipulations: Date/ - 25 -0o 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 thei r lendi ng 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 engineer's work. 72-025 (Pa .1/911 Back MOA #21 RECEIVED Municipality of Anchorage JAN 24 2NO DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANCH 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907YW Mft SERVICES Health Authority Approval Checklist Legal Description: Lot 5, Block 7, Mountain Parcel I.D.: 017-391-14 Park Estates A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 9/1/82 Total depth 226Cased to 226' Casing height (above ground) >21 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 9/1/82 10/24/98 Static water level 55' From Bottom 59' From Bottom Well production 10 g,p,m, 4.8 g,p,m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 2.43 mg/T. Other bacteria 1 Date of sample: 1 / 17 / 00 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Date installed 8/82 Tank size 1 . 0 0 0 Number of Compartments ? Cleanouts (Y/N)_y Foundation cleanout (Y/N) Y Depression (Y/N) m High water alarm (Y/N) Date of Pumping 1 /11 /00 Pumper Isaac's Pumpi�cr C. ABSORPTION FIELD DATA Date installed 8/82 Soilrating (g.p.d./ft2orft2/bdrm) 280 sF Systemtype DC -Pp Trench Length 6 3 ' Width 31 Gravel thickness below pipe 8 ' Total depth 14 ' Effective absorption area 1 , 008 SF Monitoring Tube present (Y/N)y_ Depression over field (YM) m Date of adequacy test 10 / 2 4 / 9 8 Results (Pass(Fail) Pass For 3 bedrooms From Top From Top Fluid depth in absorption field before test (in.); 9 ' 10 " Immediately after48 0 gal. water added (in.): 8 ' 6 6 3 " From Top Fluid depth 8' 7" (ins) Minutes later: 30 Absorption rate = > 450 c.p.d. Peroxide treatment (past 12 months) (Y/N) N If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION - None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot >100' Absorption field on lot Public sewer main >100' N/A Sewer /septic service line >25' "Pump off" level at* On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation >51 Property line >5' Absorption field >5' Water main/service line >10' Surface water/drainage > 10 0 ' Wells on adjacent lots > 10 0 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 ' Building foundation > 1 n ' Water main/service line I n 1 Surface water >100' Driveway, parking/vehicle storage area , ,3 n 1 Curtain drain None Noted on Lot Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rt in conformance /with MOA HAA guidelines in effect on this date.1.0w Signature s r Engineer's Name Michael F_ Andorann, P P.. e% Date 1124/00 1, HAA Fee Waiver Fee $ Date of Payment / Z � Date of Payment Receipt Number s -7,0 0/ % Receipt Number 72-026 (Rev. 3186)* 0 systems are ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524" 522-7773 522-6779 (FAX) January 24, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0260 Attention: Onsite Services Engineer Subject: Lot 5, Block 7, Mountain Park Estates Subdivision Certificate of Health Authority Approval Dear Onsite Services Engineer: We were recently contacted to complete a Certificate of Health Authority for the well and septic system on Lot 5, Block 7, Mountain Park Estates Subdivision. A review of the Municipal files indicated a certificate had been issued in November of 1998 based on information submitted by Brent P. Eaton, P.E. It is my understanding the testing completed for his certification is acceptable for a minimum of two years. For that reason we have chosen to utilize his information for the new Certificate of Health Authority. A brief test of the absorption trench was completed on January 23, 2000. The water level in the trench was measured at 69" from the bottom or 72% of the 96" effective depth of the trench. We then added 100 gallons of water into the monitor tube of the trench over the next 25 minutes and noted the water elevation rose to 73". The water level was then checked 2 hours later and found to be 71 ". We therefore conclude the trench absorbed a minimum of 50 gallons of water over a 2 hour period indicating the trench is probably capable of absorbing at least 450 gallons over a 24 hour period. It therefore meets Municipal requirements. The well flow during our test was just slightly under 4 gallons per minute. Since our test did not last 4 hours we have used Mr. Eaton's results for the certification checklist. A water sample taken from the system revealed no coliform and only 1 other bacteria. The nitrate content was measured to be 2.43 milligrams per liter. The water quality is well within Municipal requirements. The attached Certificate of Health Authority is submitted with Mr. Eaton's test results for your review. We are hopeful the certification can be issued based on these results. Please let me know if you have any questions. Sincerely, Michael E. Anderson, P.E. 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. # O 1-7 — 39 t � 1. GENERAL INFORMATION HAA# 1�f,�'1K L-1''-lQii Complete legal description Location (site address or directions) X3030 �trn�aEV�� D2��1+✓ �t�tc�R��, � °Ia5i5 Property owner Day phone Mailing address A-IlWIRAIe7i A-�-- Ctcjc_2_18 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well 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_ 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 (Bev. 1/91) Ront 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. Name of Firm 131z t�l-F 1p� EATS Phone 2- .q-3_7_77 Address Engineer's signature 6. DHHS SIGNATURE - X Approved for bedrooms. Disapproved. Conditional approval for M Additional Comments Date bedrooms, with the following stipulations: Date // /l) —10 %UTIC 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 engineer's work. r2025(Re.1)91) Back MOAN Municipality of Anchorage iti0i99s� DEPARTMENT OF HEALTH & HUMAN SERVICj,U,� "'u r yr Environmental Services Division '41MFNTCf. sesvlces 0„ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: ljJ 137 MGl/F[TMIJ -i ko,� QST- Oo.Parcel I.D.: (711-7 — A. WELL DATA Well type T2(24 VG! -'TV: If A, B, or C, attach ADEC letter. ADEC water system number K !i<t Log present (Y/N) `{ Date completed Total depth 2210 Cased to 77-� Casing height (above ground) 3 Sanitary seal (Y/N) �k�s Wires properly protected (Y/N) \65FS FROM WELL LOG AT INSPECTION Date of test Static water level VI -O -OA ?e -TD -A.. f V__� ?10T -&AA - Well production g.p.m. 4. 8 g.p.m. WATER SAMPLE RESULTS: Coliform $ Nitrate 1109 Other bacteria -� Date of sample: �� (3 be, Collected by: a26t,1T B. SEPTIC/HOLDING TANK DATA Date installed /Tank size fo©x�' Number of Compartments Cleanouts (Y/N) Foundation cleanout (YIN) Depression (Y/N) v High water alarm (Y/N) Date of Pumping If% Pumper T��Yb(L a LIY� C. ABSORPTION FIELD DATA Date installed gZ Soil rating (g.p.d./ft2 o z/bdr 2� System type-TPe�Oci�_ Length &-3, Width 3/ Gravel thickness below pipe 0/ Total depth Effective absorption area 100eS 5-r. Monitoring Tube present (Y/N)_qj�F5 Depression over field (Y/N) Date of adequacy test Job44 Results (Pass/Fail) 121(55 For bedrooms Flow. T. o - P • ';=eonn. T. n . P. Fluid depth in absorption field before test (in.); cl / lo" Immediately after 400gal. water added (in.): 8' 6%" VR -ON^ T•o. Q. Fluid depth 8 ' p (ins) Minutes later. -30 Absorption rate = C55z- g.p.d Peroxide treatment (past 12 months) (Y/N) KIC) If yes, give date LLL A- 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adjacent lots "Pump off" level at* r On adjacent lots 17-0 Public sewer main NL Public sewer manhole/cleanout t-A1A r Sewer /septic service line 00 Lift station f /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Fw- Fvwp�5 Foundation Property line Absorption field Water main/service line �� r Surface water/drainage tILA �— Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1•D Building foundation Water main/service line 7 �r -/ Surface water N 1A Driveway, parking/vehicle storage area (J Curtain drain rl JA Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined th { field inspections and review of Municipal recor a A 019vtems are in conformance i n MOg6 lines in effect on this date. ��P� .• 0h I ➢ 4 •f a ° I Engineer's Name Q• EATU7� �J •. BMT 'EATON O Date [I 3 Igo-sizs HAA Fee $ 3 U-,�5 rp Date of Payment it /-/ I Receipt Number Al 3 2 7 66j�6) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Time APPLIMNT FILLS OUT UPPER HA NLY Property Owner -! �- p; ti(.( _ j� I ? 1 _ Phone Mailing "oress 1 - t_ Zip Code Date Buyer ,�, `: 'r�V L: L`;Ij fa //_i7 Inspector Address Zip Code Inspector Lending Institution ; „ _ q o , I 1� I AOfr Phone MUNICIPALITY Dc 'IT -OF HEALTH & PROTECTION _ - ENVIROPiMENTAL AddressSyZ- Zip Code Realty Co. & Agent I -1L; _,_� `r-1 i 1 NT€C, 1 G 9 46, 4 -£ Phone Address _ Gy, Zip Coda �• ^ � p Legal Description G - Street Location„.. ”- / BY: Type of Residence Date Sewer Installed Well To Absorption Area 0 Single Family .3 ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply j4 Individual ATTACH WELL LOG. A well 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 ir4C Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: I` OF A )C\, MUNICIPALITY Dc 'IT -OF HEALTH & PROTECTION _ - ENVIROPiMENTAL FEB 9 ? 'fogn RECEIVED ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE / BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72 023 (3162) ALASKA PIROMMAL COnTROL HAUS, InC. Cngineerinq & 6nuiromnental Studies February 24, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Robbie Robinson Dear Robbie: On February 20, 1984, I inspected the sewer system and well located on Lot 5, Block 7, Mountain Park Estates #1 Subdivision. At that time a water sample was taken and the results are attached. All standpipes were properly capped, above ground, and in good condition. The well is located 105' from the sewer system. The well has a sanitary seal and the wires are encased in conduit. The casing stands 2' above the ground surface. The ground is graded away from the well. JG/cad Sincerely, Sjimn LC Geotechnical Engineer Approved by: .e s®.eea g c oo+%1 o C. °Reid, +. o. 2251-E 1200 West 33rd Ruenue. Suite B • Anchorage. Alaska 99503 • (907) 561-5040 Time APPL19PT FILLS OUT UPPER HA Time Time _ONLY Date Propsrty Owner 41,wond Zhao l Phone Malling Address yQo, ®rrjx Zip Code ;j ' ewl Buyer ,E)-. Inspector Address Zip Code Lending Institution A la-sKa M i4 f tuari Phone�/ %j in r77a- EI760/9 li3 ra hCd rl]"7. `/ Address s f Zip Code /'` Realty Co. & AgentQ� nP r IQ eO- / In * N7 � Kr�7�z,'ng E r - Phone Address ' ( ) DISAPPROVED Zip Code Legal Description _ ij¢ BY: IJ/� Street Location Soils Rating Date Sewer Installed e— L- Type of Residence Well Log Received Septic Tank Size tb(t) b Single Family Multiple Family No. of Bedrooms ❑ Other Water Supply AIndividual - ATTACH WELL LOG. A well 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 K.l Individual Year Individual Installed: 7� El Public Utility When Connected to Public Ut li ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date ,� - ,E)-. Inspector Inspector Inspect h1 Inspector 1 Field Notes: MUNICIPALITY OF ANCHORAGE D°"T C' I, --I-,1 e. ENVIR ., V, 3 -. A....U. :.TION C -f 2 1982 RECEIVED (APPROVED BEDROOMS 1 --y - 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( I CONDITIONAL APPROVAL DATE BY: IJ/� Soils Rating Date Sewer Installed e— L- Well To Absorption Area Well to Tank Well Log Received Septic Tank Size tb(t) b 72023 (NU)