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HomeMy WebLinkAboutPROSPECT HEIGHTS #1 BLK 3 LT 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALT]'I AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~"~" ~ { ~l~ ~ 0~'~ SEPTIC ABSORPTION ~ddress EROM~ TANK FIELD WELL Lot~ l Block ~ I Subdivision I)i~0~ ~ ~~ ;OWnShip, Range, Section I ] t~bq~ 'FOUNDATION 3~ ~O ~ i % '% J Z ¢ ~ ~ '~'d AS-BUlLT DIAGRAM (Show iocation of well. septic system, propedylines, foundation. ] ~ driveway, water bodies, etc.) TANKS Material ~ ~ N°' of Compa~ments TYPE OF SYSTEM ~ /_ ~ od~inalDepth to~ra~epipe ~ottom from , ~ ~ ~ ~ ~'~ ~ Total depth frgm original grad~ . Fill added above original grade Gravel depth beneath p~pe Nu~bor o,,i.** J Soi,,..ne Pipomatorial . 4~ X Installer Date Installed '~ PRIVATE ~ OTHER Ildentifv) ~ % Inspections Pedormed by: ~¢ ,t ~ Municipal and Stale guidelin~ in ellect on Ihis date: ~ / ~} ~ %" ~, 4149. E ,MUNICIPALITY OF ANCY,-JOI~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIC~ ~, 2 8 199,0 KE KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 · Fax (907) 338-1874 Narrative Description -- The lot slopes down to the west and down to the south, This upgrade will not impact upon the existing system to the west do to the separation of greater than 125 feet. The upgrade area does not influence area drainage patterns,The system upgrade move s the field farther from the existing well. ~ ~.///,~ I4~..,, ~ / ,, 1. New Bed = 125 sf/bed x 5 bedrooms = 575 sf x 150.%.. =":~38 sf 15' x 63' = 945 sf 2. New tank to be 1,500 gal with pump compartment (appmox~ 2,000 gal) 1 1/4" piping with 3/16" holes on 6 foot spacing (171 If perf. ) / System Upgrade to a presssume absorption bed.- ~ SEPTIC SYSTEM DESIGN 50/0~/~0 ACREAGE SYSTEHS ~GALE PREPARED BY: ~" : so, Kniefel Engineering MOA CE ~0-030 1. New system is a pressurized absorption bed using a 1,500 gal tank and STEP system pump operation, Anchorage Tank or approved equal. Hole diameter as per Anchorage Tank pump. Other pumps will need new hole spacing and sizing. 2. Ail materials, oons~ruction methods and inspections to follow MOA rules and regulations. Contractor to provide proper~noffication. ~~--~ ~,~"~ MOA CE 90-030 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:~~~~=~ LEGAL DESCRIPTION: ~'.O'~" '~,. ~"~,OC~.,, ~ Township, Range, Section: 5 ~?~r T%'Z.~'~,,~., ~'~.~J 8 9 10 11 13 14 15 16 17 18- 19 20 _ I COMMENTS WAS GROUND WATER ENCOUNTERED? ~,) '~ S L IF YES, AT WHAT ~ O DEPTH? p E Oeplh Io Water After Monitoring? '" Date: .'¢~ '~'~' "~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND ~ FT, PERFORMED BY; K ~,t % i..~"'~¢"f... I J~,, ~ I1~ % ~,..~'¥~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THiS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION= L~'~'~ ~'~" ("~,,OC~,,. "~ 2 3 4 5 6 7 8 9 10 11 12 14- 15 16 17 18- 19- 20- COMMENTS DATE Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? SITE PLAN /£ L IF YES, AT WHAT ~ O DEPTH? P E - Depth to Water After ~ .d?..~,,.~0 Monitoring? ~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop O~&'~'''~ ~, PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND __.FT PERFORMED BY; ~"' ~"/t ~"~'~'~ I ~"'' ~... ~l ~[.-~'f,~ CERTIFY THAT THIS ~'EST WAS PERFORMED tN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (~"~ ~'''''*''' fO 72-008 (Rev. 4/85) ~~/f ''-'~\\ NIUNICIPALITY 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 NAME ;11 PHONE LOCATION ~ ~ Manufact~er Materia~ ~ ~ H < ~ ~ ~ &' '¢'~ / No. of compartments Liq, capacity in gallons Inside length Width Liquid depth ~-~ IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. · --~O Z ~ Manufacturer Material Liquid capacity in gallons O Well .~ Foundation Near~st lot line PERMIT NO. ~ DISTANCE TO: /~ .~¢~ ~ ~ ~ ~ ~ No, of lines I Length of each Pine Total lep~th of lines Trench width Distance between lines ~ Top of tile to finish grade ~ Material bene~ tile inches Tota absorption area Length Width Depth PERMIT NO. ~ N Type of crib Crib diameter Crib depth Total effective absorption area a Well Building foundation Nearest lot line ~ DISTANCE TO: j Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation ..2., Sewer line Septic tank Absorption area(s) OTHER ~r- PIPE MATERIALS ~ _~.~ :~ _~ .... ~ /' SOl L TEST RATING INSTALLER REMARKS APPROVED ~-~::,: ....... - -- · DATE LEGAE~ '~ THE I_EN(TFFH DiHEhi:.:i;iON iS THE; LENGTH (fbi FEET) OF THE TRENCH OF: DF:F~ZNF':[ELD. 'T'HE C,i~EF::"H-'i OF i:a "FRENCH OF: P]:'f' IS T'HE E:,!S-f'RNE:E EiETWEE:N Ti'{E: Si...iF;:FF~CE ()F THE GF:OUND i~h,!D THE: BOTT(IH OF' THE E'?,CRVi:T'i"'iON (iN F:EET::,. THERE ];S iq(] SET HZE:,"!"H F'(]R TRENCHES. T'HE (;~;'.F!',,,'IEL DEPTH IS THE i"!iN!HUhl DEPTH OF GF:R',,,'EL. BETHE(EN THiE OI..ITF'F:!!J_. F';(F'E FiND THE' E',OTTOH OF THE E;XCF:iVRTZON (IN F:'EET'). ?iINiHUH D.'i.'STF~NCE; B!E'T'WE;i'!:-i",! !:"i I.,!EI.L. t::iND FIN"? ON-'_:_':!"i~E ::T--E:i4R(]i!.:7 F'EE!;T F!3R R F'R~',,,'FYi"E .,'-,!EL.I...; 'TO ?E'iEi FEET l:::'F'.Cd"! R Pi...tBL:i:C i.,.!ELL !')EF:'END;[NG iJF'OF-': THE; T'"¢F'E' E!F P!..iE&. !C kl.r:FELJ !,.!E41..L.L.OGE; ir.:iF;:E f;i:E):;:!!..!iF.'E!) 'FI?-~i?, i','i,'..i'.iE:;"f' E~E F:ET'UF:NE:;D '!",.'.".) THE C, EFff:iI:;~:THENT THE !4EL. L L':OHF'LEETION. OTHE,'q: REQLIZI::.-:E:]fiEi'.,F!":Ei; i"iF:l"r' FiF:'F'E."r'. SF:'E:C!F:(CRT:.i;.ONS Fi?'.!D C:()N::~;TRUC'f'ZON :i: LFiE&.E T'O ),: NE;UIE:IiE F'F;.'.OPEI:;.': Z Nr.:.';'r'FIt. L.Fi'T .T. .'.-( CEF:T!F'-¢ 'i"Hi:TT :.t: i Fii-'! F'FiH!i_IFIR kiir'TH THE F.':EQLiiF:EMENTS FOR O?',i'""SZTE SE!,iEF.':S F::!ND F'()RTH ?,'¢ T!'.IE .r'IUN ]; C Z i:'f:iL. Z TY (';iF RNCi..iOF.':F:IG:E. Z:: Z H:i_'i..L Z!'.,!:EFTi-';IL.L THE S'-?E;'rf~;Pi ~?.~ RCCC~E:DF:,:NE:E l.,.l:.('rH 'f'HE; CODES. ;:~:: ~ Lii'.,E)EF:STFff.4D THFiT T,HE ON-E;E'TE %EEF.!EF'. S'¢S"i'EH !"iFiY REQUIRE ENLFiF.:GEHE]'-,IT Z F TH'E( RESZDENCE: :(fi; F:E?IODE:L. ED 'FO !NCLUE:,E HOF.-:E 'FHRN PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG- PERCOLATION TEST DATE PERFORMED: ~'""~O ILS LOG [] PERCOLATION TEST 3...Z?'- ?~, 1 3 ~-~ 4, 5 6 7 8 9 10 11 12 14 15 ~ 17- 20 COMMENTS SLOPE ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN ?: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE {minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIED BY: DATE: 72-008 (7/76} t slx INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 4~05 DRILLED AT THE RATE OF ~1C~o00 PER FOOT. PROPERTY OWNER ~. ~ ~~ ~00 ~ ~. ~o~ 99~0~ LOCATION OF WELL SITE ~o2 ~.3 ~: ~o~ /-~ WELL LQG: 391~05' S~ 39O ~. COST INCLUDES ALL 'LABOR AND MATERIAL FOR GOMPL~ION OF SAID DRILL. INC. WRITE CHEC~ ~AYABLE TO RAMPA~T DRILLING WORKS FOR THE SUM OF ~5~00.00 THANK YOU VERY MUCH, BERNIE CLAUS OF RAMPART DRILLING WORKS SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 250 DRILLED AT THE RATE. Of $18.00 PEr FOOT. PROPERTY oWNER LOCATION OF WELL SITE. DRILLER B~ WELL LO'G: 250 ~: ~)~ ~ c;~ ~pc~ ~4~. 250 ~¢~ X S78.00:~4500o00 ~a~: Ap~i2. 14,tk, 1978 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 ~_.~1~0~2_- 0'2._ NAA# GENERAL INFORMATION Complete legal description Location (site address or directions) Property :owner Mailing address F:~.o ~--[-' Dayphone ~./',,3-~? Lending agency Day phone Mailing address Agent Day phone Address Unles§ otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION 'BY ENGINEER As certified by my seal afflXed'h'ereto 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 .~f"5~._~f__ ~C_._ Phone Engineer s signatu re {~ Date S,G.^'rURE Approved' for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stiPulations: Additional Comments 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#21 C. LIFT STATION Date installed ' : ~ Manufacturer __ ~z;t Pum~ at Manhole/Accel_s.~ t High water alarm level '"'"---. ~ ~es tested Meets MOA e,ectrica, codes (y/N~./.. ~ SEPARATION DISTANCE F~)M LIFT STATION TOi.~'"' - -- Well on lot ~--~/ On adjacent lots _ Surface water D. ABSORPTION FIELD DATA Date installed i'z./ ~/~5/~ 4) Soil rating ~.-~' System type ~"~ Length ~ ~ ' Width ~ ~ Gravel thickness ~ o ~ Total depth Total absorption area ~ ~ :~ Cleanouts present (Y/N) · Depression over field (Y/N) ~ Date of adequacy test Results (pass/fail) J~,'~ ~-~ for .~' Peroxide treatment (past 12 months) (Y/N) /~ If yes. give date - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: · Wellon lot .J/~ ~) '~ On adjacent lots / ~) ~:~ '/" Property line To building foundation ~_~ E;) +' To existing or abandoned system on lot '/ Onadjacent lots !~ ~ '~ Cutbank ! (~ C) d" Water main/serviceline Surface water J ~ ~ '/'' Driveway, parking/vehicle storage area i ~ Curtain drain ] ~ ~ bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect of this inspection. Signature Engineer's Name Date HAA Fee $ Date of Payment ReceiPt Number Waiver Fee: $ Date of Payment Receipt Number ARCTIC SLOPE CONSULTING GROUP, INC. --~ OF ~ WELL LOG '-~ .-....? LOCATION: ~ i'~ ~ ~....{ Subdivision: Client's Name: Address: hitial R~ding on Meter: DRAW TIME GPM GALLONS GALLONS FIELD MONITOR METER DOWN VOLUME TOTAL LEVEL READING 1'7.3 151 11:~o Z ~0 $ot~ ~ 370 Iq7 I: o~ Z . I. -; F ou , Production Rate: /. ~ GPM 24-Hour Capacity Gallons 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) / / Location (address or directions) .Applicant Na me/¢:~//r%-: .~po/~ / Telephone: Home Business .Applicant Address' 'Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (b) (c) (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Singfe-Fam[ly~ Multi-Family [] Number of Bedrooms . ~"~ .,~ Other WATER SUPPLY Well~l~" Community [] Public [] individual 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: If commuaity 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) 5. ' ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA,,4 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 ad~quate 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 th~tion, t Name of Firm'~ "~-'/;-' z'~-_%~-~.. ~/~--~/~--~',~. ~ ~-?¢W-~7--~ Telephone _~ ¢',¢ f .~. d-<~f// Address Z.,~,,~ ~ ~...¢.~;..'¢- ~¢ ~'~/ ~=.. ..~.¢,~_//¢.~¢,¢~ .~,.z~ ¢:~;-~.,? Date ,,'/'~" -~ ~'-~'~'~ / DHEP APPROVAL Approved for /~'~¢/ Approved )y bedrooms by/ DisapprovC_.d' Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of A~aska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and ~tate requirements. Employees of DHEP 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 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALiTy OF ANCHORAGE DEW, OF HEALTH & ENVIRONMENTAL PROTECTION .... ' © 1985 Well Classification - ~ /~'~f¢5'~k~ If A, B. C, D.E.C. Approved (Y/N) Well Log Preset) Date Completed ,,,/,¢~/ry //~/~ Yield Total Depth ~/",~"~- ? Cased to Static Water Level ~-~F, ~--.~ Casing Height Above Ground ~ .-~ Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic/H01ding Tank on Lot ~ /. ; On Adjoining Lots To Nearest Edge of Absorption Field on ; On Adjoining Lots Depth of Grouting Pump Set At .~"~7~~c'~ /' Sanitary Seal on CasingS}4) Depression Around Wellhead To Nearest Public Sewer Line .-¢."/.~/ To Nearest Public Sewer Cleanout/Manhole /'., To Ne~rbst Sewer Service Line on Lot Water Sample Collected by //¢/~ //~?,4'/,~-'4~V// ;Date Water Sample Test Results Co m m ants /~-~ ~'~ r'~W%'/~¢' ~;;~ ~/'~' ~-% ~'~ ~¢ -~'~" B. SEPTIC/HOLDING TANK DATA Date Installed .~.¢.¢.'~' /¢/~2¢ Size Standpipe (~) Air-tight Cap~) Depression over Tank (Y ~¢) Pumping/Maintenance Contract on File (Y/N) ~ Holding Tank High-Water Alarm (Y/N) No. of Compartments ~- Foundation Cleanout~q) Date Last Pumped .,/~' -~ J~ --c-~''''',~ ; for Temporary Holding Tank Permit (Y~ ¢~" Separation Distances from S~lCJng Tank: To Water-~upply Well To Building Foundation ,~,~ ~ To~r,.~pert; Line ~ '?' // / To Disposal Field ~ ,~ate~'Main~se~ice Line ~ To Stream, Pond, Lake. or Major Drainage 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~--~"~'~ Date Installed Width of Field -.~ Square Feet of Absorption Area Depression over Field (v(~)_ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,~----~- ')/ To Building Foundati°n/~/~:--- Lot-'+////~- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field 3 Depth of Field. /_~, Gravel Bed Thickness ¢~ / ~ff~- -~'~ Standpipes Present) Date of Last Adequacy Test To Property Line ~ To Existing or Abandoned System on ; On Adjoining Lots /~'~-'~ To Cutbank (if present) / To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that/~.¢~,~ec kd/C, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~.~--. ,/~, Company .Z~-~¢-'<~ ; ~/,¢'.-~7¢)7~ MOA No. Receipt.o. 35 Date of Payment Amount: $ Z./'.~ ~ ~) Page 2 of 2 72-026 (11/84) Client's Name: Address: BESSE, EPPS & POTTS 2220 EAST 88 AVENUE ANCHOeAGE, AK 99507 (907) 349-6451 WATER ~.L TEST Initial Reading on Meter: Producti. on Rate: //~/ GPM 24-Hour Capacity ~----C~].lo~s '~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF }!'~ALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P~OT~CTION ENVIRONMENTAL ENGINEERING DIVISION JUL, ? i979 Telephone 264-4720 FOR APPROVAL OF INDIVIDUAL WATER AND REQUEST DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER ~ PHONE MAI LInG ~DR~SS PROPERTY RESIDENT {If differendfrom above) J x l l/l 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION /I PHONE MAILING ADDRES~ 4. REALTOR/AGENT 5, LEGAL DESCRIPTION 6. TYPE OF RESIDENCE ~ J NUMBER OF BEDROOMS ~ SINGLE FAMILY ~ One ~Four ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six 7. WATER SUPPLY [] Other [5~"/'1N DI VI DUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM *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.) []~"1 N DI VI D UA L/O N-SI TE** [] PUBLIC UTILITY I nd v dual/on-s,te, g,ve installation date ~.~/7~_~ If system is over two (2) years (~ld an adequac~ test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) ._ THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME ' TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE E] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 3ERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified _ INSTALLER []Septic Tank or [] Holding Tank *~" '~J~ .,?.~* _~ i-.~.}?~' ~ Size: I~"-/)~'7) If Tank is homemade SOILS RATING give dimensions: d"_7 ~I TYPE OF TANK MANUFACTURER ~] TOTAL ABSORPTION AREA MATERIAL ~' 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS I~PPROV ED FOR ¢ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED .~~ DATE BY (Title) LEGAL DESCRIPTION 825 -L' S'FREE'I- ANCt!OR/\GE, ALASKA 99501 (907) 2(Pi 411 'i GEORGE M. SULLIVAN, MAYOR PROTECTION July 18, 1979 Guy G./Tammy L. Bellville 'Star Route A Box 68-M Anchorage, Alaska 99507 Subject: Lot 2 Block 3 Prospect Heights Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: (1) A well log submitted to this department. (2) The water analysis report be delivered to this office from Chem Lab, 5633 B Street, for our review. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Security National Bank Mortgage Loan Department 800 H Street 99501