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Home My WebLink AboutEVENSON #3 BLK 5 LT 1 oGRE:- R ANCHORAGE AREA BOP ' GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM W~ACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL ~/~/ COMPARTMENTsNUMBER OF . LIQUID DEPTH LIQUID CAPACITY'/~ GALLONS. SEEPAGE Pit: NUMBER OF PITS / DIAMETER OR WIDTH /~, LINING MATERIAL~/~ /4l/~' CRIB SIZE: DIAMETER BUILDING FOUNDATION ~Z~2'~ NEAREST LOT LINE ADDITIONAL ABSORPTION LENGTH DEPTH ~ DEPTH ¢ DISTANCE FROM: WE~. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~'""('~ SQ. FT. /,.c/cc/,'o a BUILDING NEAREST NEAREST FOUNDATION ~ LOT LINE SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL:A// LOT SLOPE: REMARKS: Form No. ED-031 GREATEr ANCHORAGE ArEA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 ~ TELEPHONE 274-4561 ))'/':~ PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION J~-//~/~-~ ~/~-- ~~ ~~'~z:~ LEGAL DESCRIPTION ~//~/~/J~//J~J-~'~/~-'~ ~%~ ~' J' ~' ~/-~' ~' ~ ~ ~ ~ J~ INSTALLATION OF: SEPTIC TANK ~' SEEPAGE Pit ~ . DRAIN FIELD , OTHER TYPE AND SIZE OF FACILITY TO BE SERVED ~ ~~ ~J~/~~~~ ~~ SOIL TEST results ~) /~ /~/~~-~/~7' NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COM"LETION DATg 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. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO sePtiC TANK FOUNDATION TO SEEPAGE PIT ~'~ , DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK ~ / ., SEEPAGE PIt ~ /, DRAIN FIELD WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAin FIELD --~ ALSO CONSIDER AREA WELLS. ~ SEEPAGE PIT //'~ SEEPAGE AREA SIZE SEPTIC TANK. /~2/',.~ SEEPAGE PIT .~-~/-~ 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, DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. [ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2/3-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE W'TH SA'D CODE. 327 ~^~,,~g ~2TREET. ~J~'C.~O~.(~E~, ~,1~ 99501 soil The Sp was fairly con- sistant with some Sp erratic Sw and Gw bodie: The sediments had a moderate to low water content and were fairly compact. Was a~Oumd Water Zncounte~d? No If Yes, At What Depth Reading 9ate G~oss . . Location Sketch SE A SHEET Net Net Drop ., at~ l,, ~-- ~r~ e~- Proposed I~tal~Seepage Pit XX Drain not e~eed '1 0" '~'et ~ ---7 the ~" 'the f'i'n~r "sed~__~'~~T~~ Test Perforvmd By: Percco GJ ER A~iCHORA~£ ARLA BOROdu,. DEPARTMENT OF ENVIRONMENTAL QUALi[TY 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For Robert Evenson Dated Performed 10/4/73 Legal Descript.ion: Lot 1 Block Subdivision Evenson This Form Reports Soils Log xx Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage SysTem - De.oth Fee: Soil Characteristics Tan Silty ~Sand (SM) Gray and Brown Sand (SP) with clean sand seams (SW) with gravel seams and pockets 5' - 11' 8 -- '10 -- 12 -- 14-- 16-- Was Ground Water Encountered? If Yes, At What Depth? No Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit ×× Drain Field Depth of Inlet Depth' %o Bottom"of--Pit ,or Trench COMMENTS: 140' square feet of drainage area is required per bedroom below 4 foot depth. Test Performed BY R.E. Carlisle ALASKA MINERAL & ~4ATERLALS LAB Date Certified BY: Date: PRELIMINARY I hereby certify that I have s,u. rveyed the following . Anchorage Recording Precinct, Alaska, and that the pro- posed improvements, as planned thereon by the builder, will be wtthin the property lines and will not overlap or encroach on the property lying O. djaeent thereto, that no improvements on property lying adjacent thereto encroach onthe premises in question m~d that there are no roadways, transmission lines or other visible ease- qnents on said property except as ~ndieated hereon, Dated at Eagle River, Alaska this _~-~_~/~-.____day of_ ~g_r~ ~'~r.y' _ .... IgV~_ . ROBERT C. JOHNSON . . -~. SCALE: Regi:,tered Land Surveyor No. 8Rg~LS 1"----~r-t9' Box 456. Ea~le River. A[askv Phone 694-2543 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 GENERAL INFORMATION Complete legal description Location (site address or directions) PropertQ owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone ~G~-~"~*.~ Day phone Unless 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 o 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 i'nvestigation 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. NameofFirm -I C~b~'¢~/ ~p~¢l/--lR~/7~::~ Address ~-.-0 ~ I~ / ~1--,/'~'1 /~ ~Z? 3 Engineer's signature '~- ~ Phone DHHS SIGNATURE Approved for J~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date//'-2 2 - ~'~ · I -The Municipality of.Ar~:horage 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. 72-025 (Rev, 1/91) Back MOA ~21 LIIqT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / '~O I ', On adjacent lots Absorption field on lot { {00' ; On adjacent lots Public sewer main > !/~ Public sewer manhole/cleanout Sewer/septic service line ~'i1~ ~ Lift station ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~/~//'/ Property line ~ / O' Absorption field _,~ ~" Water main/service line ~"0 f Surface water/drainage N O~ ~. Wells on adjacent lots ~}~ ! ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~'0 Water main/service line ~> ~--0 Surface water N ~ ~ Driveway, parking/vehicle storage area Curtain drain F. ENGINEER'S CERTIFICATION ! Wells on adjacent lots 0> /~9-~ Property line in Conforma HA~ guidelines in effect on this date. -'-~'~'**'**'*'*'"V~v~-?' '~' :. Si~amre '~*/49~ ~ ~ P/~ Date HAA Fee $ Waiver Fee $ .... Date of Payment. Date of Payment Receipt Number Receipt Number Rov. 8/95 OSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 1. GENERAL INFORMATION Complete legal description Location (site address or direCtions) Property owner Mailing address Lending agency Mailing address Agent ~ ~' 0,_/'~/~ Address VA Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~- TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- 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 #2~ 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 ""~ ~,,~ ~ ~7 Address c~-~ ~ ~ /~ ~ ~ , Engineer's signature DHHS SIGNATURE Approved for 2 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date //- 2/- ~¢ ,-The Municipality of Ar~'Shorage 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. 72-025{Rev, I/91) Back MOA#21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: Health Authority Approval Checklist ~3~ 5 EVe'~v~ Parcell.D.: A. WELL DATA Well type Log present (Y/N) ~x~ Date completed Total depth ( 412) Cased to / Sanitary seal (Y/N) FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well production g.p.m, l° ~ ~" g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate N D Other bacteria Collected by: ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed ~O/~//7q Tanksize /t~t~O Number of Compartments / Cleanouts(Y/N) Depression (Y/N) lX.~ High water alarm (Y/N) Pumper Al,4 ~t. Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed ! Length / ~' Widflt Soilrating (g.p.d./fi2orft2/bdrm)-~ii~ Systemtype ~;>o'WO'tg~Cv-~ ]5' Gravel thickness below pipe q' Total depth / t-//'~t~'tA~ Effective absorption area ~/-/tO Monitoring Tube present(Y/N)__~__ Depression over field (Y/N) N Date of adequacy test '1 ~,,9.~/q ~ Results(Pass/Fail)~ For _~ bedrooms Fluid depth in absorption field before test (in.); ~7~ It Fluiddepth 8t~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after2~/,y~al, water added (in.): Absorption rate = ~'~//~"~ g.p.d. If yes, give date Date installed Size in gallons Manhole/Access (Y/N) High water alarm level at* Cycles tested! "Pump on" level at* *Datum SEPARAT]~ON DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off' level at* Septic/holding tank on lot I ~"dO I : On adjacent lots Absorption fi~ld on lot I {O0 : On adjacent lots Public sewer main ~ ! ~ Public sewer manhole/cleanout Sewer/septic service line ~ 1-~! Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foufldation qq / Property line ~>/' O t Absorption field t~ ! Water main/,ervice line ~fJ'0 Surface water/drainage ~O~ Wells on adjacent lots ~>~ ! SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~.%~O Water main/service line Surface water N O ~ Curtain drain [XI. 0 VI ~- Driveway. parking/vehicle storage area '7 t Wells on adjacent lots ~>~ itttl-~ Property line F. ENGINEER'S CERTIFICATION I cert~ th~t ~ have determined thru ~eld i~specti~ns and review ~f Munlcipa~ rec~F~`~, a~e d~y~J~t~rn~ are tn conJbmnance wtth MOA ~ gutdehnes m effect on thts date. Signature I - ~. ................. . ................................................................................. HAA Fee $ Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc 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.# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent ~ ,P c~ ~7//~_ Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 #2~ 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 Address Engineer's signature DHHS SIGNATURE Approved for ,~- Disapproved. Conditional approval for bedrooms. Date bedrooms, with the following stipulations: Additional Comments Date //- 2/- ~ 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 satis~ 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 (Rev, 1/91) Back MOA ~21 Legal Description: A. WELL DATA Well type {~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4~4 t,-?~ "-~1~ //,. Health Authority Approval Checklist If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~, 0t '7 ~// Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Ib q. qb, Other bacteria t/ g.p.m. Log present (Y/N) Total depth //~ t bO[/~ ) Cased to ] t~,~/ Sanitary seal (Y/N) y FROM WELL LOG Date of test Static water level Well production g.p.m. WATER sAMPLE RESULTS: Coliform Nitrate Date of sample: Il I!.~_ q (~' Collected by: B. SEPTIC/HOLDING TANK DATA 6/12~t/Tg/ Tank size 10 0 o Date installed Number of Compartments i Cleanouts (Y/N) ~ Depression (Y/N) ~ High water alarm Foundation cleanout (Y/N). Date of Pumping ~j~,~ Pumper C. ABSOR~ION ~LD DATA Date installed C~ ~/7¢ ~t Len~h [ D Width Soil rating (g.p.d./ft2 or ft2/bdrm) N.4 System type Gravel thickness below pipe ?t Total depth Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth ~ ~]~ (ins.)Minutes later: Peroxide treatment (past 12 months) (Y/N) Monitoring Tube present(Y/N) 7 Depression over field (Y/N) /x/ Results (Pass/Fail) '~ For ,.~ bedrooms Immediately after [~;gal. water added (in.): q3 Absorption rate = ) ~> ~ g.p.dl If yes, give date ~'/ LIFY STATION N/~ Date iastalled Manhole/Access (YIN) Size in gallons High water alarm level at* "Pump on" level at* "Pump off" level at* Cycles tested *Datum E. SEPARATION DISTANCES Fo SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots "~ ; On adjacent lots Public sewer manhole/cleanout ~'~ Lift station SEPARATION DISTANCES FROM SEPTIC/FI~LDLNG TANK ON LOT TO: Building foundation /~//.//I Property line ~ / O t Absorption field Water main/service line ~ ,~0 Surface water/drainage ~t~ ~ e.. Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! Building foundation ~ .:5"0 Water main/service line ~ ~' O Surface water }N~ ~ tO ~- Driveway, parking/vehicle storage area Curtain drain ~'x] ~ ~l ~ Wells on adjacent lots ~.k./] ~ Property line ENGINEER'S CERTIFICATION ~_.~ I certify that I have determined thru field inspections and review of Municipal recprt~c~4tkJt the ~~,~ in conformance with MOA H~ guJdelines in effect on this date. HAA Fee $ ..~.~__7~ ~ Date of Payment Receipt Number~ Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa,wk.doc ZtiCT&E Environmental Services Inc. CT&E Ref.# Client Name Project Name/// Client Sample ID Matrix Ordered By PWSID 966059001 Tobben Spurkland P.E. Lot 5 Bk 1 Evanson Lot 5 Bk 1 Evanson Drinking Water Client PO# Printed Date/Time 11/15/96 11:26 Collected Date/Time 11/12/96 12:00 Received Date/Time 11/12/96 12:20 Technical Director: Stephen C. Ede Released By Sample Remarks: Smnpl¢ Collected by: T.S. Nitrate-N Total Coliform Results 0.100 U 0 PQL Units Method Allowable Prep Analysis Limits Date Date Init 0.100 mg/L SM18 4500-NO3F 10 max 0 col/lOOmL SM18 9222B 11/15/96 EMB 11/12/96 TAV · ~ DEPT. OF IF~ALTH MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~I~VIRONMENT/~'L 825 L Street - Anchorage, Alaska 99501 ~ MAR 2 8 L97§ t ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RE¢I:I FD 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 (i0} days for processing, 1. PROPERTY OWNER I PHONE MAI LIN{~ ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LE.D,NG,.ST.TUT.O. I PHONE I MAILING ADDRESS ' (~ ~. ~- ~ 4. REALTOR/AGENT '/ PHONE MAILING ADDRESS ~ 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~[~ Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975 For wells drilled prior to that date, g ve well · ~. depth (attach log if available.) '~. ~J~ ~ ~ ~ ~ ;~ 8. SEWAGE DISPOSAL SYSTEM '~ INDIVI DUAL/ON-SITE*~ [] PUBLIC UTILITY **if individual/on-site, give installation date ~,-~o-'~ ~ Iii' _,_L .... :_1___ ' '-' , ...... I I J I IJ ..... . ..... , ~, .... . . ,,t. I,'0 0%~, ~r~, ~x~.~-~,ql~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED :' INSPECTION APPOINTMENTS TItlE TIME ' ' ' ' 'b'll~ DkTE ..... DATE DA'TE 11~SPEGTO~ , ' ' / INSPEC"rofl ..... INSPEC¥OR Dil~ E¢'~ION~': ' ' II ~ I, I I ! i I Ii '1:~' .TYPEoF RESIliENcE NUMBE~ ~)F'BEDRoOMs - i r-'i SINGLE FAMILY' ' '; r"l (~NrE [] THREE' I'-I FIVE [] OTHER : []- MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2i 'WATER"SUPPEY ERMIT NUMBE'R ' i' ; [] INDIVIDUAL DEPTH OF WE'LL ' 'i [] COMMUNITY DATE DR I LLED ' '[] PUBLIC,UTI LITY · ConneCtion V~rlfi~d , LOG RECEIVED: . 3i:SEWAGE DISPOSAL~$YSTEM PERMIT NUMBER ~- ' · · . []INDIVIDUAL/ON -SITE DATE INSTALLED ' . [~3 PUBLIC UTI LITY ! Connect on Ver f ed , iii I NETALLER . I~ Septic Tank or [] Holding Tank Si2e: If Tank is homemade SOILSR~,TING · ' gl~e dimensions: T~PE OF TANK -. ~ -MANUFACTURER . _ ' . . T~TA LABSORPTION AREA MATERIAL 4i. . :DISTANCESwELL TOi Sept c/Ho d ng'l~enk . Absorpt on Area ]Sewer ~,n, ~ [ Nearest Lot Une A~orptl~n Area to nearest Eot Line G~ COMMENTS : . T I I I I [I I . rll · [~--APPROV ED FOR ~;;;~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) i [] DISAPPROVED DIATE , ~~:~ ' i~y.(Tit ~~~ ~~ , LEGAL DESCRIPTION :: . 72:~01'0 (Rev. 3/78) March 29, 1979 Richard A. Evenson 7260 Sand Lake Road Anchorage, Alaska 99502 Subject~ I~t 1 Block 5 Evenson Subdivision Approval for y~ur individual sewer and water facilities will not be granted until the following has been completed: (1) A percolation test be performed on the existing leac~kng area. This will determine if the system is adequate according to National Standards. A list of private .firms who perform the test is enclosed. This report, once completed~ must be turned into this office for our review before we may grant approval of the property. If there are any further questions, please contact this office at 264~4720. Sincerely~ Robert C. Pratt, R.S. Associate Specialist RCP/lJw cc: ~nfac Mortgage Corporation 401 East Northern Lights Boulevard Suite 212 99503 ~ MUNICIPALITY OF ANCHORAGE L~;., .:...~,..,,.~, ~ h".'. , ;.,.;'.: ~:I iON DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street-Anchorage, Alaska 99B01 i----,~'! .) i',:' (.~- ENVIRONMENTAL ENGINEERING DIVISION .... , 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. PROPERTY OWNER J PHONE MAILING ADDRESS PROPERTY RESIDENT(If different from above) ' ' PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE I MAILING ADDRESS MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY 1--I MULTIPLE FAMILY NUMBER OF BEDROOM,~ ~ [] One ~/' '~our [~Th~ •Five e [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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/~n~/f~/./ 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)