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HomeMy WebLinkAboutELDON BLK 1 LT 13 I)evelnprreent- Services bepartrnent Buildfnq safety Ojvsjon On -Site Water Stc:water---- ' 4700 Furore; load r A,Iaf'c segich F.O. Box 196550 Mayo, A.'chorage, Ak 99507 ' c -r_ :• . C --�—' ,'907) 34.379 �'r Pti Installation Log Well Drili�gperartit �'uanber; SIV Parcel Identification Number: Date of Issue., ..�...01Co-X02-3"1 Legax Description�� I L�4..-elz t3,ner Name Name Address:: T 3 POR) Installation Date; Pump Intake Depth below Tf)p of Well Casing:feet Pump ivianufsactIlrer'sNa.Zie: Pump Model:` Pu P -Size r -L - by l''ittess Adapter-u:rial Depth: feet �PitteSs AdapteritiTanufacturer's Name:k2AVlta� Witless Adapter ivataller- Welt Disinfectcd Upon C ornpletic•n'> Lees J Method of Disinfection: NO Comments: �Uev� -V,t' mmp Installer -Name: lie i ce r C; lttentiOn: Theurr, ; p p _nstaller si,a!(prov;de a ourn� itastallflzion:og to tiaeSD w,*,hir 30 day; ofp• +n, insta}lafian. l'd Zi�LO t�7L05 ieS dwnrd'S 1I?&M1 (;6e3oyouy d,�Z:70 6 9Z urf GR, -"ER ANCHORAGE AREA BC-' 'UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAl DESCRIPTION SEPTIC TANK: DISTANCE t,~O."~ FROM WELL ~'~'~[t'0-~ MANUFACTURER '~-~'1~'~)'~_r.,~ NUMBER OF MATERIAL ~. © u,¢//e ~ ~ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY t(D~5(3 GALLONS. NUMBER OF PITS I DIAMETER OR WIDTH LINING MATERIAL ~Pc~be ! J BUILDING FOUNDATION CRIB SIZE: DIAMETER NEARESt LOT line ADDITIONAL ABSORPTION LENGTH DEPTH i ~,.I DEPTH___~L DISTANCE FROM: WELL ~.0'1~ ~.;~t~¢~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,~c(~ SQ. FT. WELL: TYPE kf)4 ~ ¢"1 \l (~ ~ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAL: DATE DIAGRAM Of SYSTEM - G.A.A.B. GReATeR ANChORAGe AReA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE PIt DRAIN'r~EL~, TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS PERMIT NO. PHONE i OTHER NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TESI' COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. , DRAIN FIELD r~' ~ , DRAIN FIELD MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ~'~ SEPTIC TANK TO SEEPAGE PiT WALL BEPTIC TANK . SEEPAGE PIT TO NEAREST LOT LINE. WELL TO S~PT,C TANK /nd> DRAIN FIELD . ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK /~J ~ SEEPAGE PIT ~'~' DRAIN FIELD ~/~ ~' SEPT,C TANK. SEEPAGE P,T /~ , DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL OR LICENSED DESIGNER ] CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, ~ GREATER ANCttORAGE AREA BORO'~. Department of Environmental Q~..ity 3330 "C" Street Anchorage, A1 aska 99503 SOILS LOG - PEROLATION TEST Performed for ~ Legal Description: This form reports: .... ~oils log . Date Per fo rme d__b~.~//~/~ -l- Depth Feet i- 3- 4- 5- 6- 7- 8- Percolation test 10- 11 - 12- 13- 14- Was ground water encountered? ~/¢] If yes, at what depth? .................. Reading Da te Gross Time Percol ati on rate ..... ~-n-u~e-J Net Time Net Drop --*--- ........... brain Field .Proposed installation: Seepage Pit ....................... Dept~--t-O'~'o-~-t~-'-o-f-i~i t or trench [)el)th of Inlet ................ · COi,IMENTS: ~F~7 -a)x -~ ' .... ~Tfl¢i-~Y? Date: ........ EQ--O40 (~/74) unicipality of Anchorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 G£ORGE M, SULLIVAN, MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31', 1980 Floyd Epperson Post Office Box 10-617 Anchorage, Alaska 99511 Permit ~ 800025 Subject: Lot 13 Block 1 Eldon Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the aS-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, / / /~ Senior Environmental ~cialist LNB/ljw enc: Copy of Permit SWP/057 PERMIT NO. MUN I C I ~A! . I TV Or R~CKORAGE ~DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ' L '~ STREET~ ANCHORAGE.. AK. _~50i WELL PER~ I T 800025 ) APPLICANT LOCATION LEGAL FLOYD EPPERSON BILLS STREET LOT l~ BLOCK i ELDON S?D~ PO BOX 10-617 ~5tl LOT SIZE 344-8253 12000 SQUARE FEET MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES DECEMBER ~1, 1980 I CERTIFY THAT i~ I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS 8S SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. APPLICANT FLOYD EPPERSON V4. 0 8K808 · MUNtCIPALITY 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 1, GENERAL INFORMATION L'0t 1 3, B Complete legal description HAA # RECEIVED AUG 1 1991 Municipality of Anchorage Dept, Health & Human Services ock 1, Eldon Subdivision Location (site address or directions) 701 Bill Street Anchorage, AK Property owner Mailing address Floyd Epperson P.O. Box 110617, Anchorage, (907) Day phone AK 99511 0617 344-8253 Lending agency Day phone Mailing address HRT Real Estate Agent (Lori Hackenberger ) Day phone 907) 56~2220 Address Unless otherwise requested, HAA will be held for pickup. 3 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: X Individual well Public water NOTE: If community well s, ystem, 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 '){JOM speeu!Bue leUO!SSe~oJd eql u! suo!ss!~uo Jo sJoJJe Jo~ elq!suodseJ ),ou s! e§eJoqouv ;o ~j!l~d!o!Unl~ eq.L 'penss! s! e1~o!i!peo e eJo;eq ~l~p eZ/,leU~ Jo suo!ioedsu! jonpuoo lou op SHH(3 ;o see~oldU~ 'sjueuJeJ!n beJ eleis pu~ i~Jepe,t u!e~eo/~s!l~s ol JepJo u! suo!im,!lsu! §u!puel J!eql pu~ se~uoq ,[o sJes~qoJnd ol ~se~ noo e se s!q), seop SHHa eq.L 'e~lSelV ~o m,m,S eq), u! peJm, s!§eJ Jeeu!§ue i~uo!sse~oJd luepuedepu! u~ ~q e^oq~ g qdeJ§eJ~d u! ue^!§ suo!l~iueseJdeJ eql uodn ~lUO peseq se),~o!J!~JeO le^oJdd¥ /qpoqlnv qileeH senss! (SHHa) seoFues ue[unH pue qll~eH ,~o ~ue~upedea e~eJoqouv ~o X1!l~d!o!un~ eq.L s~ue~u~uoo leUO!~!ppv suo!ielndqs §U!MOIIOJ eq), LI:~!M 's~uooJpeq 'suJooJpeq Joj leAoJdde I'eUO!~.!puoo .pe^ojddesla ~o~ peAoJddv ~ =II:InJ.~N91S SHHa '9 Lot Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 13, Block 1, Eldon Subdivision Parcel I.D. A. WELL DATA Private Well type Log present (Y/N) Total depth 95 f t. If A, B, or C, attach ADEC letter. ADEC water system number t,//'A No Unknown Unknow~ Date completed Driller even wi th driveway grade Sanitary seal (Y/N) Yes .Cased to Unknown Casing height Date of test Unknown Static water level Unknown Well flow Pump level Unkn ov, n FROM WELL LOG Unknown Wires properly protected (Y/N) AT INSPECTION 7/23/91 32 ' 2.5 approximate 90 ft. approximate SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 110 f t. Absorption field on lot 130 f t. Public sewer main Unknov~ g.p.m. Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout No g.p.m. ,~ (~ Over* 100 f t. Over 100 ft. Unknown Petroleum tank Unkno~"~ none visible within 100 ft. on subject site WATER SAMPLE RESULTS: 0 Coliform Date of sample: 7/23/91 Nitrate Collected by: 0 Other bacteria Kent Sheets / Gilfilian Engineering Date installed 6/3/75 Cleanouts (Y/N) Yes High water alarm (Y/N) Date of pumping B. SEPTIC/HOLDING TANK DATA Tank size 1000 9a I I ors Compartments 1 No Foundation cleanout (Y/N) Yes Depression (Y/N) Not Applicable Not Applicable' Alarm tested (Y/N) To be punT)ed 7¢~/- ~'/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Norie apparent Well(s) on lot 110 ft. On adjaoent lots within 20, ft. 25 ft. To property line Absorption field None apparent Surface water/drainage 100 ft. Foundation 30 ft. Unknown Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON' BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Not Applicable "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 6/10/75 Length 12 ft. Width 12 ft. Total absorption area 288 sq, f t. No Depression over field (Y/N) Results (pass/fail) Pass Peroxide treatment (past 12 months) (Y/N) Soil rating 1.5 9.p.d./sq. ftSystemtypeSeepage pit Gravelthickness 6 ft. Totaldepth 14 ft. Cleanouts present (Y/N) Yes Date of adequacy test ?/23/91 for 3 No If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELI~, TO: None Apparent Wellonlot 130 ft. On adjacent lots within 100 ft. Propertyline To building foundation On adjacent lots Unknow Surface water 100+ f t. Curtain drain 50 f t. To existing or abandoned system on lot Cutbank Over- 50 ft. Water main/service line Driveway, parking/vehicle storage area None knov~ to exi st 25+ ft. None None apparent 5O ft. E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date HAA Fee $ //'~0' ~0 Waiver Fee: $ Date of Payment ~""~/"- ? / Date of Payment Receipt Number ..~,, ?.~. od ( ) Receipt Number 72-023 (Rev. 3/91) Back MOA 21 3ENALI SEWER & DRAIN SERVIC[. 2900 BONIFACE PWK NO. 537 ANCHORAGE, ALASKA 99504 PHONE 333-5794 43OO CUSTOMER'S ORDER NO. DEPT. 7 8 13 ra~n:~q. KEFP IHI$ SUP §L320/01320 FOR REFERENCE Gilfilian Engineering, Inc. Professional Environmental Consultants July 29, 1991 Main Office: 255 E. Fireweed Lane, Suite 102, Anchorage, Alaska 99503 (907) 277-2021 · Fax (907) 274-8683 Mat-Su Office: 5751 Mayflower Court, Wasilla, Alaska 99654-7880 (907) 376-3005 · Fax (907) 373-5686 Mr. Floyd Epperson P.O. Box 110617 Anchorage, Alaska 99511-0617 RE: Lot 13, Block 1, Eldon Subdivision 701 Bill Street, Anchorage, Alaska RECEIVED AUG 1 1991 Municipality of Anchorage Dept. Health & Human Services GEI Project No. 191101 (Doc. #191101.REG) Dear Mr. Epperson: This letter is to provide you with a report on the results of a sewage system adequacy test and well flow test that was recently completed on the above referenced property. In response to a request made on your behalf by Ms. Lori Hackenberger of HRT Real Estate, a field representative from Gilfilian Engineering, Inc. visited your property on July 23, 1991. During our July 23 site visit, we conducted an adequacy test on the septic tank system and a 4 hour flow test on the water well pumping system. We also collected a representative sample from the water supply system and analyzed the sample for total coliform bacteria and nitrate. Upon completion of the work, we prepared the Municipality of Anchorage application forms (2 pages) for "Health Authority Approval" that are enclosed with this letter. The following section describes our site visit field findings: SEPTIC TANK & SOIL ABSORPTION SYSTEM Based on the measurements obtained during the adequacy test that was conducted on the existing septic tank and soil absorption system, it appears the sewage system is operating properly and absorbed the entire wastewater load that was applied to it. The soil absorption system consists of a deep seepage pit. The absorption rate was found to be sufficient and satisfied the Municipality's minimum requirement of accepting 450 gallons per day per bedroom. In addition, the septic tank needs to be pumped and a receipt provided to the Municipality since it has been over a year the last time the tank was pumped. RECEIVED Floyd Epperson Lot 13, Block 1, Eldon Subd. Page 2, July 29, 1991 AUG 1 1991 Municipality of Anchorage Dept, Health & Human Senclce~ WATER SUPPLY WELL SYSTEM It should be noted that the rate of flow provided by the existing water supply well was found to be sufficient to satisfy the Municipality of Anchorage minimum requirements of 0.104 gallons per minute (gpm) per bedroom. However, during the well flow test we observed the well had a limited flow rate under sustained flow conditions. Under long term pumping conditions exceeding 4 gpm for over an hour, the water level in the well dropped below the pump level which necessitated shutting down the pump for several minutes to allow the well to recover. Upon recovery, the well was placed back in operation at a flow rate of 3 gpm for approximately 15 minutes before it became necessary to shut the pump off to allow the well to recover again. Hence, this procedure was followed for the duration of the 4 hour flow test. If desired, this condition could be corrected by the installation of a supplemental storage tank and auxiliary pumping system. The well was found inside a well pit located beneath the center of the paved driveway. It is our understanding that several years ago you received an acceptance of the well pit from the Municipality. Since there is no documentation on this acceptance, we have prepared a record drawing of the well casing in the well pit. Based on our site inspection, it appeared the well pit construction was adequate with a means to drain water through the sandy base soils. Also, there were no indication of inundation from surface waters during the past several years of use. Lastly, the water samples collected from the well pumping system were tested for total coliform bacteria and nitrate by our affiliated firm, Mat-Su Test Lab, Inc. The attached test results indicated the water quality for these parameters is acceptable and satisfies the Municipality's minimum requirements. Sincerely, . . Robert E. Gilfil~n, P.E. President ~ A copy of this letter with the attachments and your septic tank pumping receipt should be submitted to the Municipality for health authority approval. If you have any questions concerning this letter please do not hesitate to call me at 277-2021. ' Attachments cc: Lori Hackenberger HRT Real Estate w/ attachments RECEIVED AUG 1 1991 Municipality of Anchorage Dept. Health & Human Services G/Ifil/an Engineering, Inc, O[llc~: 5701 M~*~Iowor Coul'r, W~.~lll~, Alas~ 8~654 gel PROJECT NO, I~II~mI ' iMAT-SU.'TEST LAB. · Soils %= Concrete ,--Water- Field and Lnboratory Testing SmMces 'P.O. Box 8718~8 · H/ad/la, Alaska 89687: (907) 376.3005:" ' DRINKING WATER ANALYSIS FOR TOTAL COLIFORN BACTERIA ~pp[,ICA NT' INFORMATION: S~mple Inf~mation: " Legal Desc=iptio.: ~7" ¢3 "i~'aC~' .-/ Date Col'letted: ?7,CZ~-' Time' Cone=ted:')~; Sample Type: ~'Routine E] F'lTreated I"' Stole LD. Collected B r'] Unt reft'ed THIS SECTION TO BE COMPLETED BY LAB;, ANALYSIS .RESULTS  Satisfactory Unsatisfaccory F-] Sample Rejected:l~-]Over '50 Hours In TronsitF~TNTC;Cdonle$ Too N0merous To Count -- [--'-] Confluent Growlh RECOMMEND RESAMPLE Final Membrane Filter Results: 'f~3 Colonies .'. of Positive Tubes fr.om, fiv¢ 10 ml Pdrtions4 No. Analysis Completed: 7/2~q Reported B'y: Date . . MICROBIOLOGY LABORATORY RECORD-COLIFORM ANALYSIS ' · Date Received: ~/g ~//~/''~[';~J/zfl/~! Time:Received: t '~f /~ 'Y~-/f~ ~,) Lab . Number: , .~/~ ~// . TEST METHOD TEST jRESULTS . 6ATE/~IME/ANALYST tilter~r~-Cou~, O Cclon~es/lOO'ml Membrane (MF) Verification:.LTB ,BGB/' ."',.,'' .' Presumptive Tube # (LTB) 24 Hr. · ' '~ " "¢ 48 Hr. ,i~ ' Confirmatory Tube # (BCB) 24 Hr. 48 Hr. '.' Completed Plate # r ' Tested EMB 24 lit. , .. , , ,r "~ Tube # :' I,T~ 48 tlr. REFER TO BACK SIDE FOR INSTRUCTIONS MAT-SU TEST LAB Soils ~ Concrete -- Water -- Asphalt Field and Laboratory Testing Services P.O. Box 871868 · Wasil/a, Alaska 99687 · (907) 376-3005 FAX 373-5686 CLIENT: Gilfilian Engineerinq, Inc. ADDRESS: PHONE # ACCOUNT #: 5751 Mayflower Ct. Wasilla, AK 99654-7880 376-3005 DATE: July 24, 1991 COST OF TEST(s): $22.00 PAYMENT BY: CHECK #.__ CASH REFERENCE NO: 391075 !911091 TESTING REQUESTED: Nitrate LEGAL/PROJECT NAME:Lot 13, Block I Eldon Subdivision PRIVATE: X DATE RECEIVED: DATE SAMPLED: 7/23/91 GEl 191101 PUBLIC (LIST STATE ID NO.): 7/24/91 TIME RECEIVED: 10:45 AM TIME SAMPLED: 4:30 PM SAMPLED BY GEl Analysis Performed: Nitrate Level Detected MCL 0.0 (ND) 10 mg/I mg/I = miligrams per liter ND = none detected MCL = maximum contaminant level NOTE: This analysis was performed by: If you have any questions concerning the above results, please call me at 376-3005. ~...~~ <, ~.j~ 7/24/91 Bill Qu~eitzsch, Lab Manager Date APPLICANT FILLS OUT UPPER HAI 'ONLY Property Owner , ' ' ': /../.~1 ./ '/ Phone .' ? /..j,~ ,. Zip Code / Buyer ' ;~ " -- ..... Zip Code Address Phone Lending Institution "' J " '' ~i ;.:: .'/~ ''1: '/' / ''~ /' ' ., , . .... Address Zip Code Phone Realty Co. & Agent Address / ~ , r : -¢/' Zip Code Legal Description ~._ ~ ] / [~, ¢~. ~(¢J~ 11 ~¢( (2 ye . Street Locati~ ,/ Z:,; / '? .' % ,::: ~ { Type of Resi~nce ~ Single Family : ~ ,  Multiple Family No. of Bedrooms ,~ Other ¢.s~>:Z.~: '¢ Individual A~ACH WELL LOG. A w~l Icg 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 ~ ~ ':~ Year Individual Installed: ~ ' ,' ' .:' ~ Individual ¢ ~/ ~ ~ ¢ ~ When Connected to Public Utility:  Public Utility Holding Tank ~ .. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time ' Time Date Date Date.~_ \ 2b--~ ~L~*~ Date -~ '~ ~/¢~' '-'~/ Inspector Inspector Inspector Inspect~t~,~0 ~k~6,,. .~?'~_ Field Notes: ~"~'~3, MUNICIPALITY OF ANCHORAGE DEP~', OF HEALTH RECEIVED ( ) APPROVED BEDROOMS .~ · *CONDITIONS OF/~I{I~O~VAL~ ~ ( ) CONDITIONAL APPBOVAL' Soils Bating Dale ~wer Installed Well To Absorption Area Well Log Reseived Well to Tank Septic Tank Size 72-023 (3182)