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Home My WebLink AboutBENITO BLK 1 LT 4 G"~.TER ANCHORAGE AREA BORO~'GH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 663 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MAILING ADDRESS DISTANCE FROM WELL LIQUID CAPACITY J GALLONS. MATERIAL INSIDE LENGTH NUMBER OF COMPARTMENTS ~ LIQUID INSIDE WIDTH / DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: / NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH LINING MATERIAL ~ ~ ~"~ ~:;"~/~J' ~"/~'~"~,~' . DISTANCE FROM WELL _~:~.~' / NEAREST LOT LINE /~) TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA , LENGTH DEPTH BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: ./4/~ DISTANCE FROM WELL ~ ,FOUNDATION. NEAREST LOT LINE. I~PTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE W ELL :/~'"'~"'~"~-/~'"~-~ ~"~"-"~/~'~'~"~/'~" ~D~A'~'~ FROM TYPE4"~.,,~/~--.4-.~'~ , DEPTH .7~''~/ ,BUILDING FOUNDATION '-..-4'~J · NEAREST SEPTIC / SEEPAGE LOT LINE ~'~ , SEWER LINE./'~ ~ , TANK ~ SYSTEM TOTAL LENGTH OF LINES I N. 'TI~T~ L EFFECTIVE IN. ABOVE TILE WATER SAMPLE ../x~ NEAREST OTHER , CESSPOOL /j,/~,,,~x~_~, SOURCE~,~j,/,~/~/~.~ DISTANCES: /~'7'2~ c~ = S/~ ' DIAGRAM OF SYSTEM DATE HEALTH AUTHORITY GAAB-HD~2 GREATE ANCHORAGE AREA '?~ROUGH Case N o. ~/~ HEALTH DEPARTMENT 327 Eagle St. ~L~/~n/~q~ag~a 97~ 279-2511 ' SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT TO SERVE THE FOLLOWING FACILITY FIN.~.,N..CED THROUGH . .~[. ~EST R ESU LTS NAME OF APPLICAN _ ~~~ ~AILING ADDRES . PHONE NO. ..... ~ES~DEUC~ A9DRESS ~~~ ~0OAT~OU 0, ~STA~AT~0~ ¢~ ~~ ~~ APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ ,DRAIN FIELD ,0THER O I STA N C E S: ~/~/?) ~ff/~,f~) BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT ~ ) , PERMIT TO INSTALL A ~'~~ ~.,s ,s ~o s~w ~s ~ ~~' r ~' DIAGRAM OF SYSTEM HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Great~ Anchorage Area Borough Ordinance No, 28-68 apd that the above described sy~(em isv4n accordance with said code./'. / DATE APPLICANTS SIGNATURE~ (~AAB-HD-2 GREATE 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 )ROUGH 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION &.PERMIT NAME OF APPLICANT _/~,C4)~//~ ~7'~' ~" / RESIDENCE ADDRESS ?/2 ~, ~/~ ~ ~/~'~ ~ LEGAL DESCRIPTION ~ APPLICATION TO INSTALL: SEPTIC TANK ~,, SEEPAGE PIT. ~, DRAIN FIELD TO SERVE THE FOLLOWING FACILITY ~ .~-~ /~ ~/~ ~ ~ ~ ":- FINANCED THROUGH ,~'~ ~ ~ T0 BE INSTALLED BY PERCOLATION TEST RESULTS /~ ~ ~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT MAILING ADDRESS ??d 5',,. P/.~'~ '~' ~ . PHONE LOCATION OF INSTALLATION ~ ~--2~'0 x~ ,~'~. , OTHER THIS IS T0 SERVE AS /-i-~A/v/~ ~-~/ PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE /~ TYPE ,~'~ ~ SEEPAGE AREA DISTANCES: Health Authority DIAGRAM OF SYSTEM I certify that I 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. DATE APPLICANTS SIGNATURE ,/ ,. v - '~ P.O. tt hso beau b~ to oqu~ 8ttentiou that ImbUe s~wo~ is svolhble to Lot 4, Moek 1, ~mito Subdlvtelon, Ir we do not he~ ft~om you within m~Mn (?) deys. we will ~ooumo thor ~r roeoz~o aa the a~bJeM p~ to. pubb mm, er by the cud or the lOVV eeummM~a ~. RECEIPT FOR CERTIFIED MAIL--30c ST,EE'r...~ .o. (plus postage) POSTMARK OR DATE P.O. STATE AND ZIP CODE OPTIONAL SERVICES~0 ~07.? ~'~-0~4~'~/'~, ~__~.- __ ¢See other side) GPO: Mm,..}mm~ ~,44lI P~O. Boz~ Dea~ Mr'. Coin: m41fy us tmmdimd~ ifyou~ ~ ~ ~ m-~ tim pemtt dlteff mt rtl~.8888, esteudou SSt, ~ the Dopm. tmut or Bttvl~ 4/reality et sv4-4itl, eztesmimm 141, RECEIPT FOR CERTIFIED MAIL--30<~ (plus postage) SENT TO POSTMARK OR DATE STREET AND NO. P.O., STATE AND ZIP CODE OPTIONAL SERVICES FOR ADDITIONAL FEES RETURN ~k~ 1. Shows to whom and date delivered ........... 15¢ With delivery to addressee only ............ 656 RECEIPT p 2. Shows to whom date and where delivered .. 35¢ SERVICES With del very to addressee only ............ 85¢ DELIVER TO ADDRESSEE ONLY ...................................................... 50-~-- SPECIAL DELIVERY (extra fee required) .................................... 'NO INSURANCE COVERAGE PROVIDED-- PS Form Apr. 1971 3800 NOT FOR INTERNATIONAL MAIL (See other side) GPO: 1972 O - 460-?43 August 25, 1971 VA Administration Federa! Building Box 1399 Anchorage, Alaska Subject: Lot 4, Block 1, Bentto Subdivision, Frank Iskt, Owner. Dear Sirs: Nei)i)er public sanitary sewers nor public water is available to the subject lot. It is also not economically feasible to bring these services to this tot. Water needs to be provided by individual wells. Sewer facilities need to be provided wy an on-site sewer system. Si ncere ly, Lynn S. Coad Envi ronr, ental Special cc: Frank Iski st February lg, lg71 Fede re1 Hous lva~ Ad~tnt s trail on P.O. ~ox 480 Anci~orage, Alaska 99601 SU~d£CT: Lot 4, t~locK 1, ~entto Subdivision Uear St rs: A gS' drllled ~ell has been placecl en the subject lot. The well log indicates very dense sot1 conditions and w~tle we could not take a bacterial sample from t~e well, it ts likely that the well wi11 provide potable water. The ~ell vas able to produce at a rate of 39 ~allons per minute. Sincerely, dorm l~. Lee, Sent tart an rn MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (M~st be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Lot 4: Block 1: Benito Subdivision Location (address or directions) 10107 Genora, Eagle River, Alaska (b) Property owner AHFC ~23818 Telephone: (home) BuSiness - Mailing Address (c) Lending Institution Mailing Address CITY MORTGAGE Telephone (d) RealEstate Company and Agent JACK WHITE COMPANY/Lori Crowder Address 10928 Eagle River Road, Eagle River~ Alaska. Telephone 694-5500 (e) Mailthe HAAtothefollowing address:(orcheck here [],ifholdforpick up.) Listcontactperson and day phone numberbelow: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [] 3. WATER SUPPLY Individual Well [~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] 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. 72-025 (Rev. 7/88) Page 1 of 2 5. 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, 1 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 Address Date S & S ENGINEERING Eagle River, Alaska 99577 Telephone 6. OHHS APPROVAL ~.~./~.~,,~/c.~'~// Approved for ',~ bedrooms by .... Date Approved ~ Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 RECE EO A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Z-~'/ Well Classification If A, B, C, D.E.C. Approved (Y/N) ~/~ Yield ? p Well Log Present (Y/N) i,/~ Date Completed ""- I '¢/ "}' ~-_ ~ .,'! , ' Total Depth k)'l~' Cased to /--JO 'f' Depth of Grouting Pump Set At C) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots · On Adjoining Lots ^)/~ ' t Static Water Level ~ O Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~5- To Nearest Public Sewer Cleanout/Manhole ! To Nearest Sewer Service Line on Lot ~. %- '~' WaterSampleCollected by ~ ~ ~ ~lg~ l k)~¢ l tg~ ;Date ~'~ Water Sample Test Results ~"~'~.f~rC..'~'~/ -- ~::)~C-.-"~¢'l'~t' 1 Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ No. of Compartments Standpipes (Y/N) '~r-tight Caps (Y/N) __ Foundation Cleanout (Y/N) Depression over Tank (Y/N) '~ Date Last Pumped _ Pumping/Maintenance Contact on File (Y,/,,? IA_ ; for Holding Tank High-Water Alarm (Y/r~ %~/"[ Temporary Holding Tank Permit (Y/N) sEpARATION DISTANCES FROM SEPTIC/HOEiNG TANK: To Water-Supply Well ',,~To Building Foundation To prOperty Line '~ Disposal Field To Water Main/Service Line '" ToStream. Pond. Lake or Major Drainage Course 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field nA ea' , Square Feet of Absortio Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM A : To Water-Supply Well To Building Foundation Lot ;OnAdJ~' ~ngLots To Water Main/Service Line To"C,,utback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments .[.)o J~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on D. LIFT STATION ~~ Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/ Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Date MOA No. Receipt No. ¢-~ Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 56,93 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I,D. #92..0040440 Date Client Sample ID:L~ Collected ~¥ 4 90 Receive8 MI~ 4 90 ! i6:00 f~e. ~reeetye~ with :AS Client Namo: Clien~ Acer ~ ~N~ENGP ~.0.! ~0~ geq J Ordered By : R. 3R~F~R irmlysi~ Complete~ :l~l 8 90 3er, c! Report, to: Special Iratruct: Chemlab ~ef %: 901126 Lab Smpl ID: I Matrix: Allowable NITRATE-N O.S? I~/! EPA 353,2 ~ample IOUTINE ~AMPLE. b~- ~cne Detecte~ "See ~ample ~emerke Above ~l- ~ot lr~l~zed LT-[o~e Than, C~=~teatet Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO'I~ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~ --' I ~ - ~ GENERAL INFORMATION (a)~ Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) .(b). Applicant Name I~'--~. ["~'~ ~/)~¢t~! Telephone: Home Applicant Address ! '~.r7 ~¢::~-/Z-~ ~/'~ L.~ (c) Applicant is (check one): Lending Institution []; Owner/builder J~, Buyer [] · Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone [_~'~'1 (f) ~ HAA tO the following address: TYPE OF RESIDENCE Single-Family. J~ Multi-Family [] Number of Bedrooms '_'~ Other WATER SUPPLY Individual Well,J~ Community [] Public r-'l 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 I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING .,dSPECTIONS, TESTS, FILE SEARCH, DA'I,-, AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heal~; 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/ wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on Ihe date of this inspection. E ', ~. N E~r,t N (~ Telephone DHEP APPR~.~. ^ _ y~,~ Approved for ~,.~_.k~g._~bedrooms b Approved ~.~ Disapproved 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 Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification ~ ~ ~ Well Log Present (Y/~) Total Depth t.), ~ Cased to Static Water Level '~, C::)/ If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ IQ ~7.- Yield · ~/~ Depth of Grouting - Casing Height Above Ground Electrical Wiring in Conduit ~:;)N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole /~ Pump Set At Sanitary Seal on Casing ~¢¢~N) Depression Around Wellhead (Y/I~ · On Adjoining Lots /'~' ~ /'~ 'On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot .~ Water Sample Collected by ~ ~1 ~ ~::::~(~,~~,~,.1~. Date Water Sam pie Test Results Comments ~' \~'~"~" ~/I B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Compartments Standpipes (Y/N) Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) ! Date Last Pumped Pumping/Maintenance Contract on File (Y/N,)~/j~ ; for Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank permit (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 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 (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 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 Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Manhole/Access (Y/N) ///~ "PumpOff" Levelatvent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection; Signed $ & ~-ELNG.I~I-E--ERING! Date ~' -, ?..,Z, -' ~ ~ Compan~-~ ,~LE RI..V,.ERz~A.I~_~S..~KA ~9~ MOA No. ~~ ~ Receipt No. ~5~ 3 ~ Date of Payment %' ~5-~ * oun : Page 2 of 2 72-026 (11/84) - '~ - '- ? ' '- ..... ~ - D~rE RE~EI~ED _ ' /~.. - /NS{~ECT].ON~ApPOtNTMENTS - -. : - _ :ELMS - '' ~'- -'- Ti'M-E ' · .~JMEr ' ' · DAntE DATE ~ ~ ~,~ _~ DATE NSPECTOR INSPE~- , - , - INSPECT~ ~[ - '-' "' ~ . A" ~UNI~L TY OF AN~HO,A~E ' MU~C~ALITY OF ANCI ,OR G ' 'T. OF H~ALTH & ~ DEPARTMENTOF HEALTH &ENVIRONMENTAL ~ROTECTIO~Vi~ONMENTAL ~;OT~CT ON ' ' _ '~ ' Telephone 2~4'0 - REQUEST FOR-APPROVAL OF INDIVIDUALWATER ANDSEWERFACI-------' ' ---LITI'ED - . DI REC~ONS~ Complete all parts o, page 1, Ineomple~ requ~ will not be proc~d. Pleaseallow ten (i0) days for processing, 5 MAILINGADDRE~S ' - ' ~ ' " ~ ~ ' "- ' ~os~ O~f~ce ~ox 279 99567 '- ~ROPERTY RESIDENT (If different from above) ........ ' _ I PH. ONE 2. BUYER ........ - -. _ ".PHONE - Mi-nor_u/Margaret Hayashi- . ' , 272-7674 -- ~1~ N Street 99501 ~ ~ ' _. Spokane Mortgage Company . . _ ~ 277-0543 MAI LI NGA'DO RESS' ' ' .... ' ' ' ~ ~ - - ' 3201 C Street S~ite 250 99503 4. REALTOR/AGENT ' '~ ' ' ' " ' ' I PHONE' Marianna Koehler %-Greatland Real~y ~ . ~ 695-9125 MAi LihGADERESs ~ , . , - . . . . Post 9ffice Box 633 99577 - E. LEGAL DESCRIPTION ' Lot 4 Block 1 Benito Subdivision STREET LOCATION ' ' ~ SUPPLY I [~X INDIVIDUAL* ~ * ATTACHWELL-LOG. A Well I°g is required for all wells drilled ! I--I COMMUNITY since June 1975, For wellsd~itled prior {o that date, give well [] PUBLIC UTILITY depth (attach log if. available.)/ . 8. SEWAGEDISPOSALSYSTEM ~.-' - - " [] INDIVIDUAL/ON,SITE'* - yEAR' ON-SITE SYSTEM WAS INSTALLED, ~ PUBLIC UTILITY .... - NOTE: THE INSPECTION'FEEMUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) t 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: THIS SIDE FOR OFFICIAL USE ONLY NUMBER OFBEDROOMS [] ONE [] THREE [] TWO [] FOUR PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER [] FIVE [] SiX DATE INSTALLED INSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line MATERIAL Septic/Holding Tank Absorption Area Sewer Line [] OTHER Nearest Lot Line 5. COMMENTS DATE [~~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner' CMRO VA_ × FHA CONV. JAMES and JUNE COAN Mailing Address: P.O. BOX 279, Chugiak,AKDayPhone: 694-9125 Name of Buyer' MINORU and MARGARET HAYASHI Mailing Address: 1210 N. 4. Name of Lending Institution: Mailing Address: 3201 C. 5. Name of Realtor or Agent: Mailing Address: P' 6. Legal Description:T'°t 4, St., Anchoraqe SPOKANE MORTGAGE CO. St Suite 250, Anc.Phone: GREAT LAND REALTY- Marianna Day Phone: 272-7674 277-0543 Koehler O. BOX 633m Eagle River Phone: 694-9125 Block 1, BENITO SUB. Location: 4th house in on right side on Genora St. Eagle River Natural Color Ranch Style 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Single Family Res. No. Bdrms. 3 Bedrm. Public Utility drilled well Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility. If Individual, date of installation X Individual (on-site) one 72-003(3/76) FHA Form 2573 Form Approved Rev. July 19.f6 U. S, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FEDERAL HOUSING ADMINISTRATION Budget Bureau No, 63-R0296 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. Alaska 8tare Bank 111-012708-203 MORTGAGOR OR SPONSOR PROPERTY ADDRESS James V. Coan Genora Street, Eagle River, Alaska SUBDIVISION NAME --- J BLBCK NO. [ LOT NO. Benito Subdtvtston I 4 [] Can attic or other area be made Into TOTAL NUMBER: BASEMENT New installation addltJonol bedrooms? LIVING UNITS BEDROOMS BATHS (If Yes, how manyf) I---IWATERpublicSUPPLY BY:r--I I SYSTEM DESIGNED FOR 3.,.J system I I Community system [~] Individual NO. Of SDRMS. GARBAGE DISPOSAL SEWAGE DISPOSAL BY~ I,.lPublic system ['-] Community system [~] Individual [---] Yes [-'] No PART fl.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH ---- L..._ ~. ..~ -' _ It is the opinion of the ['~ State ['--] County ~l Local Department of Health that this individual water-supply system [-Xq is ~ is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [~1 State l--1 County [~ Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [~] Can be expected to function satisfactorily, and [~] Cannot be expected to function satisfactorily is not likely to create an insanitary condition -~'A T E/ / I S'GNATURE [ TITLE r'' 8 7:,, I Envtr0nment~l Specialist NOTE: The health 'authority should, complete the appropriate opinion statement above and af~x date, signature and title in the spaces provided. Uso of the above grid for Health Department Inspector's sketch as well os uso of the back of this form Is at the option of the l . health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the Individual water-supply system be considered [--] Acceptable r-'] Not Acceptable Sewage disposal be considered r-] Acceptable [--1 Not Acceptable. DATE SIGNATURE [~] CHIEF A~C,~r~Cr ~ DE~'ur¥' FO. c,~. ^uC,~TECT HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FHA Form 2S73 Rev. July 1958 9~ Oo 6~$ Od9 '61 'ainu!u/ Jad sUOlle~ · a~nu!tu Jad SUOll~' '~u!s~ jo uopnllOd alq!ssod jo sa).mos Jaq~o play lesods!p :~aa~' ~tu~ )Ddas 'J~a~ [] 'ap!s [] '~uoJj [] ~e ami ~o 'lla~ paaog [] 'lla~ ~n(l [] 'Ila~ ua^!J(l [] .lla~ Pall!JCl [] :tuoa. i ,qddns aa~,~ lenp!^!pul · ~aaj 'ami ,(:lJ;~doJd ]UOJ.,I UlO,I.:[ ~eq ~os ~U!lla,~Cl 'daap ~aaj- ap!,'a laa] :az~s 3<rI · stua3s,(s [~sods!p-a~as pu~ ,~Iddns-~a3~ I~np!^!Du! qloq tll!~ pado[a^ap ~'u!aq 3ou a~. [] a~¢ [] p(x)q~oqq~!au u! sap~ado~d Jaleta jo .~lddns a~nbop~ qs!uJnj o:~ ,(l~u!:)!^ a~e!pauauJ! u! Sllam jo aan[!ej Jo pJ())a~ lua:~J ]sou~ 'satl~u! metu jo az!S '~aaj-- u~v. cu Ja~e~ .')!lqnd ~saJeaU o~ a.~uv.~s!CI WIISAS AlddflS?IIt/V~R lVflQIAIONI--NOIL:)tdSNI :10 61 -,(q pa~x,xlsu1 '~!Joq{nv q31eaH le~O'l [] './v,a~ [] 'ap!s [] '3uoJJ [] ~e aml 3oI ~saJ~au :3aaj i%~a~e, ua l~u!u!l ']aaj 'q~dac. j 'saq~u! 'saq~u! · laaJ aJenbs 'saq~u! aaq)O 'auo)s ua~l(ug [] --'ape~ qs!uy o3 aip y) do3 'q~dacI '~aaj 'saqguaa~ jo tuo]~oq u~ v,a~e uopdaosqe a^9~a~Ua 183o1 'saq3u! saU!l uaat~3aq a3ums!(] 'saU!l )o aaqtunN 'JeaJ [] 'ap!s [] 'Juo.lJ [] ]e aU!l :~o1 :lsaJeaU ',]aaj' 'uogepunoJ l~!aal~.tu ~/u!u!'l 'SUOlle~ ',(~pedv,) p!nb!'l uo!Dadsu! Jo s~uaual.~duao) jo JaquJnN 'q~dap pmb!"l '~aat 'luatu~Jedcuo9 ~alU! ,4:q'~edv,D 'suolle~ M/SAS IYSOdSICI-Ig¥/~RIS I¥11QIAI(3NI--NOI/:)IdSNI :JO ltlOd:ltl GREATER ANCHOi:t/~GE AREA BOROUGH Owner: Ma/ling Address: User / Tenant: Property Address.* Subd/v/s/on~ TES ~: Positive Negativ~ ADDITIONAl. Office: Field.* Administered By.. ~ PW-062 (7-74) UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS t Print your name, address, and ZiP Code in the space below. · Complete items i 2, and 3 on reverse side. · Moisten gummed ends and attach to back of art c e. RETURN TO PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAAJ~E,,~ .$300 ocr .