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HomeMy WebLinkAboutCONIFER HEIGHTS BLK 1 LT 14  MUNICIPALITY 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 MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~O~T DISTANCE TO: [Well kO~ [ AbsorPti~aroa Dwolli~ I PERM I~O~  ~anuf~c~u~e~ ¢ O~eE~ Materia~g~66~ No. of compa~nts Liq, capacity in gallons Inside length Width &iquid depth t~¢O IF HOME.DE:  ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ¢ Manufacturer Material Liquid capacity in gallons O ~ ~ DISTANCE TO: ~ ~o, ofl,nes ~ kon~o,e~chl,ne~ ~-0 Totall~ofl,nes Trench~th~ i nch~s Distanco~o~nlines ~-- Top of tileto finish Length ~id~h Depth PER~IT NO. ~ ~ Type of crib CHb diameter Crib depth To~al effective absorption area ~ ,~eH Building ~oundafion Neares~ Io~ Hne ~ DISTANCE ~ Class Depth Driller Distance ~o Io~ line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic ~ank Absorption area<s> OTHER PIPE MATERIALS SOIL TEST RATING REMARKS 72-013 (Rev. 3/78) x.~ MLINICIPRLIT¥ OF ANCHORAGE' DEPARTMENT r~ HEALTH AND ENVIRONMENTAL PROTECTION 825 'k STREET, ANCHORAGE, AK. 95 I .~,~-~'~,~/l/ ~/' 264-4720 WELL AND ON--SITE SEWER PERMIT PERMIT NO. ( ?8037? ) APPLICANT LOCATION LEGAL ALASKA BUILDING & DESIO 276i RUBY DRIVE PORT OXFORD DRIVE Li4 Bi CONIFER HEIGHTS SUAD LOT SIZE 24~-t810 ~0968 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS' DEPTH= i0 LENGTH= 5i GRAVEL E.,EPTH= 5 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 BOTTOM OF THE EXCAVATION (IN FEET). THERE iS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQUIRED SEPTIC TANK SIZE= i250 GRLLEIt~S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2 ) INSPECT IONS ARE REQU I RED BACKFILLINO OF ANY SYSTEM WITHOUT FINAL INSPECT I ON AND APPROVAL BY TH I S DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 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 DRYS 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 ~l., 1978 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. ~: I UNDERSTA~AT THE ON-SITE SEW~~M MAY REQUIRE ENLARGEMENT $IGNED:_L~,~._.,=--~"~__~ ................ - LICANT ALASKA BUILDING &DESION I F THE V_?... 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 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) 77/-/F Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address (e) Telephone: Home Telephone .~Lo [ - Telephone ~- ?~5~ Mail the HAA to the followine address: or: Check here ~, if hold for pick up. List contact person and d~~mB~ Business TYPE OF RESIDENCE Single-Family J~ 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: If community 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 fRev 8/86~ Front 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 "t~'~~/.,~ Telephone ,~, Address ~"" ?' '~ -- ~ P/ ~ Engineer's Seal 'i:~":'.. · DHHS APPROVAL Approved for ~ Approved :~ bedrooms by -/~4~, ~J~- Disapproved Terms of Conditional Approval Conditional 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 fRev 8/86) Back WELL DATA MUNICIPALITY OF ^N~nORA~E ........ ~.., ,i~ES Div~ICIPALITY OF ANCHORAGE (MOA) ENVI,OI'~4~Nm^' ~c,v ~. '~.~LTH AUTHORITY APPROVAL (NAA) CHECKLIST- FEBRUARY 19~ 2 1987 RECEIVED Legal Description: I..~'/" I~t;~,~ I, Well Classification ~--~ If A, B, C, D.E.C. Approved (Y/N) J~'/,~r Well Log Present (Y/N) Y Date Completed ~'//~,/~ ~ Yield Total Depth ~f'~O Cased to ~- ~- Static Water Level Casing Height Above Ground ,/t_{~ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~)/O'-~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot '~/O-f..') ; On Adjoining Lots To Nearest Public Sewer Line J~O f~:~ To Nearest Public Sewer Cleanout/Manhole 1~ O~,,/~ To Nearest Sewer Service Line on Lot Water Sample Collected by "~-~ ; Date Water Sample Test Results Comments '~' ~'4.~.~ /~_~J/~-~. ~"-~'~/j ~ ~ Depth of Grouting .~ Pump Set At /~oT"7"e~f Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~,~ B. SEPT!C/I~I~IMII~ TANK DATA Date Installed ~' ~' '~ Size /~-,~'~ No. of Compartments ~-/.~"C~ Standpipes (Y/N) 7'~'O Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped ~/E,/~? Pumping/Maintenance Contract on File (Y/N) I~///',~¥ ; for Holding Tank High-Water Alarm (Y/N) J%//,~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding To Water-Supply Well )/~ To Property Line ~ ~C) To Water Main/Service Line ,~/~ Course Comments Tank: To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ]~-.~ Date Installed i~, · q' 7~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~> To Building Foundation Lot l~Ot~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on · On Adjoining Lots .~ ,~--~ To Cutbank (if present) D. LIFT STATION Date Instal led 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 ** Signedl certify that~.v~r conformedDate to alI.~/~/~MO~ and HAA..~ guidelines in effect on the date of this inspection. Company MOA No. Receipt No. Date of Payment ,,~c:~ ,3-- g 7 Amount: $ d" O O cC) Page 2 of 2 72-026 (11/84) Engineer's Seal 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 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Apphcant Name %~ ¢~¢~ Telephone: Home ~-~ Business Apphcant Address 7 7~' ~ ~ ~ ~ ~'~ Apphcant ~s (check one): Lending Institution ~; Owner/builder ~: Buyer ~; Other ~ (explain); ..... (d) Lending Institution Address Telephone Telephone ................................ J~-'~ ~ - / -~-~-~-~--- ......... (f) Mad the HAA to the fotlowmg address: TYPE OF RESIDENCE Singte-Fam~lyJ~ Multi-Farmly [] Othe~ Number of E~3drooms 3. WATER SUPPLY Well ~1~ Commumty D Public Individual attesting to ~he legality and slatus. Note: It commumty well system, must have wr~ttetl cof~t~mstiow f~'o~!~ It1~ ~Itt onsite,t~ Public E] Community [] Holding Tank Note: if community well system, must have written confin attesting to the legality and status. Page l of 2 mental Conservation 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 _..~_.~/¢b~_~ ~p_f,¢ f'l~o~ . .~_ ~ F---__ Telephone J~' ;~ Address ¢~"~ -~ ['~ / ¢'~ ~'~ Date ,,l. 9, /gr,' Engineer's Seal TA:rPrmOsV::con dit, o na~l A p p rova!i~_- '~Conditiona CAUTION The IVILJncipahty of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Appfova~ certificates based solely upon the representations given in paragraph 5 above by an independent professional in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending order certain federal and state requirements. Employees of DHEP do not conduct inspections or a ~rtificate The Municipality Anchorage ~s not res errors or omissions in the work. A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAG~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AU( $.0 Total Depth /'~DrO Cased to ~ Depth of GrOuting Static Water Level ..~O Pump Set At Casing Height Above Ground J'{~" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) ~'~ Separation Distances from Well: To Septic/Holding Tank on Lot ~, I0~ ~ On Adjoining Lots To Nearest Edge of Absorption Field on Lot 7 t ~ ~ · On Adjoining Lots ~' I 0-~ To Nearest Public Sewer Line N o N~ To Nearest Public Sewer Cleanout/Manhole No hi ~ To Nearest Sewer Service Line on Lot Water Sample Collected by '~ ~ , Date ~'//~..t~ Water Sample Test Resul ts ~ .~, ~' Comments ~' ~¢'.~,~ 1,1~,,~_~ ~..~ '~d..4,~w~, Well Classification '['~,~ .~3 If A, B, C, D.E.C, Approved (Y/N) Well Log Present (Y/N) Y Date Completed ~/~ 1 '7~ Yield B. SEPTIC/HOLDING TANK DATA Date Installed ~o'~,'7~ . Size I~¢~ No. of Compartments Standpipes (Y/N) -r'~ o Air-tight Caps (Y/N) .~' Foundation Clear)out (Y/N) Depression over Tank (Y/N) N Date LaSt Pumped ~'/3/~'J-~ '"" Pumping/Maintenance Contract on File (Y/N) t~ ' for Temporary Holding Tank Permit (Y/N) N/'~ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 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 ~-0 ~'~,v~ _,~ ~u~'~'~ Page 1 of 2 72-026(11/841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~, · ~' 7~' Width of Field Z/'<~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/N) Results of .Last'Adequacy Test Separation Distance-from Absorption Field: To Water-Supply Wel To Building Foundation Lot (~/O To Water Main/Service Line :~ I O To Stream/Pond/Lake/or Major Drainage Course To Driveway, parking Area, or Vehicle Storage Area Comments ~" ~-~,~,~ To Property Line To Existing or Abandoned System on · On Adjoining Lots '~ '~' £ To Cutbank (if present) ~k/O/~' ~' D. LIFT STATION N C) ~ L~'" 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 alIJVtOA ~nd HAA guidelines in effect on the date of this inspection. Signed _~- ~ Date ~r"~Z ~/'~'""-~ Company T~~ MOA No. ~ ~-~ // / Receipt No. Date of Payment Amount: $ ~ ~ ~ ~,, ~ .,~ f~ Engineer's Seal Page 2 of 2 ¥~:., JUN[ 25, 1971 .'~ 72-026 (11/84) 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM' AD'EQUACY TEST LEGAL: LOCATION: OWNER: LOT 14, BLOCK 1, CONOFER HEIGHTS 7745 PORT ORFORD THOMAS STARRETT RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: ON SITE WELL SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: GREER STEEL, 1250 GAL, COMP. ABSORPTION SYSTEM: TWO TRENCHES ABSORPTION AREA: 700 SQ. FT. SOIL RATING: 125 INSTALLATION DATE: JUNE 1978 TWO DATE OF PUMPING: AUGUST 3, 1985, MIDNIGHT PUMPING DATE OF TEST: AUGUST 28, 1985 ,_T~EST PROCEDURE: ~ /% WATER WAS ADDED TO THE SUMP OF ONE OF THE ~'~' z~v~ c~c~J/' TRENCHES. SUMP WAS DRY PRIOR TO TESTING AND ~6~0~ ~ ~ , ~ ' ' ~-~t'~'-'~-L'~-~:%~ %-' ~ %~ 'GALLONS: OF'WATER.-:' WATER D2D NOT BACK UP I'N~ ~ ~ ~ ~. ~ TU~' ~A~-~,~ ~ TEST RESULT: '~HIS SYSTEM IS OVER DESIGNED BY A FACTOR OF _~ .~ _~50 %. BY iNSP~IO~-CLfARLY MEETS; THE ~t. f ' -*~ the year, and the ~ater usa e of the famil . ...~. · · ~e,,,~ ·  bezng served by the system. These conditions ~..~~....~.~ are outside the control of the evaluator of can ~ ~ any estimate of how long the s stem ~ili ~m :. .' ~ . . Y ~t-~" ..... ..'~%~ continue to meet the operational requirements ~t~f<~D~t ~ o~ the .unic~aZ~ty an'8 State. 203 W, 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 14, BLOCK 1, CONIFER HEIGHTS LOCATION: 7745 PORT ORFORD OWNER: THOMAS STERRETT TYPE OF WELL: RESIDENTIAL WELL LOG AVAILABLE: YES ---/ INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 3 GPM, FROM PUMP TEST 6 GPM PUMP YIELD: 6GPM PLUS DATE OF INSPECTION: AUGUST 29, 1985 TEST PROCEDURE: WATER WAS DRAWN FROM WELL AT A CONSTANT RATE WHILE DRAWDOWN WAS MONITORED. 'RECHARGE OF WELL WAS MONITORED AFTER PUMP SHUT DOWN. TEST FOR COLIFORMS: NEGATIVE TEST RESULT: THIS WELL MEETS THE MUNICIPAL REQUIREMENTS. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 _,~t_~%~. hours. This well surpasses this requirement. ~ .O..F._~%~. The assessment of the condition of this well :.' ~. ~ .;,~,~. applies only to the conditions as of this -, ~ '--'~ date. The flow rate of the well may change ~..,~.-,.-,,,~*,F~~*~49~ '~ %*~ dt~e to subsurface conditions that may not be ~~~ observed from the surface, and changes in ~~. ~.~._~..~ land use and other factors that may impact .~ %~ ..~ the conditions of the aquifer feeding the ~. · ~ ~ well. ~/~-... ..-I~ ~- ~.. .' ~-~ MUN,C, AL T' oF A.C"O A , D sT. ,. · ' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~NVJRONMEHT/~L ['F,©TECT ~ ~ ~ 825 L Street- Anchorage. Alaska 99501 ~" ' N O ~O APR ~ 1980 ~ ~)) ENVIRONMENTALENGINEERI G IIV!SI" ~~ Telephone 264-4720 ' Ol RECTI ONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (I0) days forprocessing. ~ N ' PROPERTY RESIDENT (tf d[{f~rent fr~ above) ~ PHONE 2~~ , ' PHONE · . 3. L~DING INSTITUTION~ ' - , - _ i I PHONE /~/ ~ -. 4f~ALTORIA~E~T z-- / ~ ~ . .~ . ~ I PHONE' ~ ' , , ~'~ -. '~JThE-'.T LOC TId~ 16''T EO RES ENCE NUMBER'OF BEDROOMS ' I '~' 8tNGLE FAMILY [] One [] Four [] Other ' [] Two [] F ve [] MULT PLE FAMILY .~ Three [] Six /. ~ INDIVIDUAL* ~ATTACH WELL LOG. Awell log is re~uir~ foFall wells dr lied ~ COMMUNITY Vsince June 1975, For wells drilled prior to that date, give well ~ PUBL C UT LITY depth (attach log if ava ab e,) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** If ,ndw,dual/on-s te, g ye insta at on date ~fl~ , , ~ If system is over two (2) years old an. adequacy test is required ~ PUBLIC UTILITY by this De partment. -' NOTE~ THE INSPECTION FEE MUST ACCOMpANy EACH REQUEST BEFORE PROCE~IN~ CAN BE INITIATED. 72~10(3/78) '_~"~. ' THIS SIDE FOR OFFICIAL USE ONLY rIME I NSPECTI ON APPOI NTM ENTS TIME DATE RECEIVED TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified r--iSeptic Tank or [] Holding Tank Size: /c-~-~3 If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER ~ MATERIAL Septic/Holding Tan k~Abs~1~-~ ~''- / /~ ISewer Line [] OTHER Nearest Lot Line 5. COMM'ENTSr ' " DATE ILEGAL DESCRIPTION ~ APPROVED FOR _~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ BY (Title) 72-010 (Rev. 3/78) ~ ' MuNICIpALITY OF ANCHORAGE ,' ' r ' . ._ ' ' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI~CTIO~I, ~,~ ~.~ ' 825 L Str.t - Anchorage, Alaska 99501 - ~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~R'FA~'I~I~I~ DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proceed, Please allow ten (10) days for processing. I PROPERTY OWNER ~ - PHONE ' ' ' ~, ~ ~e~ ' "~ ~-~ MAI LI~DDR~ ~. ~SNmNOmS~TUTmN - I ~ON~ MAIEING ADDRESS ' 4. REALTOR/AGENT ] PHONE MAiLiNG ' [~"~INGLE FAMILY FAMI LY [] One [] Four [] Other TWO [] Five hree [] 'Six 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 O.F.-RESIDENCE NUMBER OF BEDROOMS [i~ SINGLE FAMILY [] ONE [~E~THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WAT~RSUPPLY PERMIT NUMBER ~d' INDIVIDUAL 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 Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4' DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area jSewer Line INearest LOt Line Absorption Area to nearest Lot Line 5. COMMENTS E~~APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE (Title) LEGAL DESCRIPTION ~ 72-010 (Rev, 3/78) C~--~.~'~ICAI. i3 (~OLOGIP.,AL L~;~TO~ v,: AI.A~;C~, I;;C. }, f P.O. BOX 4-1276 4649 BUSINESS PARK BLVD, ANCHORAGE, ALASKA 99509 TELEPHONE (907) 279-4014 ANALYTICAL REPORT Water Analysis(Facility) William Coker Date Collected: 8-18-78 Time Collected: 1:50 PM By: .... Source of Sample: Lot 14 Block 1 (Conifer Heights), Anchoraqe, Alaska Physical Observations, Remarks: [] mq//~Aluminum [] 240 mmhos Conductivity [] mg/1 Arsenic [] 7.7 units pH [] mg/1 Barium m9/1 Ammonia Nitrogen-N [] mg/1- Boron m§/1 Kjedahl Nitrogen-N [] mg/1 Cadmium mg/1 Organic Nitrogen-N [] 22 mg/.~Calcium mg/1 Nitrate(N) [] mg/1 Copper mg/1. Nitrite(N) [] mg/~ Chromium-Total mg/1 Phosphorus (Ortho)-P [] m.g~]_Chromium-Tri . mg/1 Phosphorus (Total)-P [] mg/! Chromium-Hex ~-2 mg/1 Chloride []. mg/1. Iron-Total mg/1 Fluoride [] mg/1. Iron-Dissolved m~/1. Cyanide [] m~/1 Lead 9 mg/1 Sulfate [] 4,5 mg/1 Magnesium m§/1 Phenol [] mg/1 Manganese m§/1MBSA [] mg/1 Mercury mg/l BOD [] mg/1 Nickel mg/1 COD []. 2 mg/.~ Potassium 129 mg/l TD Solids [] mg/1 Selenium mg/1 TV Solids [] 28 mg/1 Sodium mg/1 Suspended Solids [] mg/1 Silver mg/1SV Solids F1 mg/1 Zinc JTU Turbidity [] [] [] [] [] [] [] [] [] [] 72 mg/1 Hardness as CaCO3 106 mg/1 Alkalinity as CaCO~ m§/1Acid~ty-T as CaCO3 mg/1 Acidity Free as CaCO3 0 /lOOml Coliform-T /lOOml Coliform-F /lOOml Strep-F units Color 0.02 mg/1 gl & Grease Transported by: Received by: Transported by: Received by: FOR LAB USE ONLY Lab# 8528 Rec'd by: SE Date sample rec'd: 8-18-78 Date analysis completed:8-21-78 Date results reported: 8-21-78 Date: August 21, 1978