HomeMy WebLinkAboutTALUS WEST #1 BLK 3 LT 21
Hea. Lj~.and Environmental Protec:.
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
FROM WELL __~.¢0
INSIDE LENGTH--~-'-'- INSIDE WIDTH
NUMBER OF
MATERIAL _ ~'~'~'~-~/~ COMPARTMENTS
LIQUID DEPTN .... LIQUID CAPACITY__ GALLONS.
DISTANCE FROM WELL 1~)~) / FOUNDATION [~_~NEAREST LOT LINE /~ OF LINE
ABSORPTION AREA ~--O SQ. FT. LENGTH OF EACH LINE 6--~ /
DCPl!h TOP OF TILE 10 FINISH GRADE___ MATERIAL BENEATH TILE_ % ABOVE TILE IN,
SEEPAGE PIT:
Log Crib Rings
BUILDING FOUNDATION--.
DIAMETER __OR WIDTH_--, LENG ]-H DEPTN
Crib Size:; DIAMETER__._DEPTH_ DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE_ _ . ABSORPTION AREA WALL AREA)
SQ. FT,
Class: ~ Depth:
Well Distance To: Lot Line
Bldg: Sewer /~ine:
Pipe Materials: ~,~' ~%'
~ of Bedrooms: / ~
Installer: ~?~_./~')(¢--~
Remarks: ~{3~ ~
PEITI'i Z T I'.,EI.
RPPL I CRIq'F
LOCRT I ON
L. EGF:IL.
BU _.1..
1.41 L.E:,ERNESS
L.2::L ECE: I [ ILL =, I.,.IEST
T'T'FiE L-iF ::_': II FIE::5ORBTION :,T-.,] LII I5: TREN(::H
MFI;:-::i[HI_I["I I'.~U[,'IBEF,: LqF BEE:,ROOhlS =
'SOIL RFI'I'INL~:~ ,:::51;! FT,.'E,R:.-= ;F:DE
, c :'"'" IS:
THE F.:EF_.:!U:[F,:E[) SIZE DF 'THE :,..IL RB':_:;ORPTION ......... 1Ell
]"FIE LENCiTH [)IHEI",ISION I:5 "FFtE LENGI:H (]:N FEET'::, OF THE TREI",E:H OR DI?FI 'J: I",IF ]: ['.:.L [).
THE DEF'TH OF R TF.'.D"~CH OR PIT I:5 THE I)ISTRNCE L:~ETI.qEEN THE F.,LIRFFH::E OF THE
GROUND RN[::' THE E:OTTOPI OF TI~IE F_:,.,:L-:Ft',,,'FFF Z O1",1 ':: I N FEET ).
THER.[-: I'5 IqO :5ET I.,.I:[DTH FOR TR[~NCHE'.:L
THE GRFI',,,'EL DE:PTI4 IS ']"HE PIINIHIJH D[-_-F'TH OF EiRF~',,,'EL BETP.IEEN THE OLITFFI[..L. PIF:'E
RND THE E:O"t"TOH OF THE E;,~:CF~',,,'FITIOI",I ,::.,I[:,1 FEET)..
EI1HEI.. I::1 L. LH ....... ]: 3R ]:I I'-,I~E;F I::IF'F'[(I(]',¢'E[:, FLHI',II I"IFI'¢ [:'~E ].Iq.:,II'L.LE..E.
FI E:OINTINI...IOU% 1'4FIINTENRNCE R(_'iREEI',IENT ];S RE(;!UtRE[:,. IF R I','IF~INTENRNE:E
I:IGF..'EEFtENI" I'5 NCIT KEF'T i::UIRRENT 'T'OIJ HFI'¢ BE F;'.E6:!IJZ[('.ED 'FO ENLFiRI3E THE 5OII.
FIEC.';OR. PT]:ON S~r'L:;TEH FIi*,ID,,'OF: "r'OU I"IR'T' F;E SI. JB.3EL-:T TO F'RCE, E(::UTION.
"-F ~-.--~ Ei~ < ;;i-i~ i:. ~1: ~'--~ :~:E: F" E C:: "F :J: C~ ~'-4t :'~; N:=D F-" EE F47 .tEE C;2 LjI :11:: IF;;~: ~E: E:.
E:FtCKF'ILLIN(~i OF RN'¢ S'-?STEH 1.4ITHOUT F:[NRL INSPECTIO[",I RI*,IE:, flPPRO',,,'RL B"/ "FH:['_5
I)EPRRTI'"IEI",IT I.,.IIL. L BE: SL.IBJECT TO PRO'.SECLITIC)i'.,L
i',IINIHLIh'i [:,I:STRi'.,IC:E E:E~f'L4EEN IR I.,.IE:LL I::¢',ID RN'.F OIq-'5.;:ETIE SEI.,.IRGE I::,I%POSFII... :E;"r':STEM
d.E~Z~ FEET FOR Fi F'F~'.IVRTE 1.4EL. L OIR ;?00 FEET FOR R PIjE:LIC 14ELL.
I.,.IELL LOGS RF..'.E R[D;!I_J~RED RND I"IljST BE RETLIF:'.NEE) 1"O THE [:,EF'RF;'.TP1ENT I.,.IITH.T.N
OF THE !4EL.L COHPL.E:TION
SPEC I F I CFIT t ON~.:, FINE:, C:CIN.?.;TRLIC:T Z ON E:,:[ RGRFIHS FIRE FI',,,'R ]: LFIDL. E 7'0 I N':-.;LIRE F'ROF'EI~:
I NSTRL. LFIT t ON.
I C:EtRTIFY THRT
::L: I FIN FRI"'IILIFIR t4:[TH THE: RE(;!UIREHENT'5 FOR ON-SITE SEI.,tER'-5 RI'.4D 14ELL5 RS SET
FOR'FH B'T' THE i'iUNICIPFILITY OF RNCHORRGE.
2: I [,.!:[I._1._ II",IS-f'RLL THE S'Y'STEf'I Ihl RCE:OF.:[>FINE:E [4:[TH THE
~:: I UNC',EI?STFIi'4[) THRI" .THE ON-SITE .'5EI.,]EiF~'. %"/E;TEI~I I"lFl"r' F:'.E(;!U]iFi:E EI'qL.FIF,~:(:'iE:I"IEI'qT IF THE
RESIDENCE: :['-=-; REI'"I()DE[..ED TO tI"~E:LIJ[:,E P1OF:'.E TI-'IFII",! 2:
S :1. Gi",IEI:': "----,FtF - ................................................
..............
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. Ct
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
(a) Legal Description (include 10t. block, subdivision, section, township, range)
/_.zit
Location (address or direct ons)
(b) Property owner ~~l~
...... ~e4,(~ome)
Mailing Address
'- ~:~¥" ~' , .-~,~hone
Business
Telephone
(e) Mail the HAA to the following address: (or check here ~,~if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family E~ Number of bedrooms
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State
Cohservation attesting to th legality and sta~u'~. :
Department of. Environmental
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.
5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed he reto and as of the validation date shown below, I verify that my investigation of th is
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
baaed 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.
N a me o f Fi tm ./~--(~' .~("' ,, (~'<~(- Telep, hone ~ ~z '~ _~ ~---~-S- '~- ~_~
Address ~--~, ~-~¢'~' ~(/'~)~'~(~ ,,~'~N--cfcL/'f'~7'~/"~-~"-~ ~'//-/~"--"~-~"~'% ~.(/
Date
6, DHHS APPROVAL
Approved for Y bedrooms by
Appro~Jed .~ Disapproved
Terms of Conditional Approval
Conditional
Engineer's Sear
¥,'JIIt'Ji
The Municipality of Anchorage Department of Health and Human Services (DH HS) 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
MuNicIP~,LITY 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 (Must be completed prior to submittal)
(a) Legal Description .(!nclude 10t, block, subdivision, section, township, range)
L ,2/..' 63. i.,r?j.~./,/,,.,'-/ ,.~,,,~/ '7"/~ ~ ~ ~ ..~ z~,
.... , ,-,: :,r/,.,
Locatfon (aSd r¥~s '6~.~icections)'
crt 0wrier''~'''T'h~E~B~¢2-' ~ P~-~rJ~-¢ Telephone: (home)
(b) Prop y . , .. ..... :'
Mailing Address
(c) Lending Institution Telephone
Business
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here,~if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family.I~ Number of bedrooms ,~'
3. WATER SUPPLY
Individual Well/~ Community [] Public []
Note: f community we system, must have written confirmation from the State Department of Environmental
Con§ervation attesting'to tl~ legality and stat'~Js. ' ' ' '
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, 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. ] 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 ail Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Telephone ~ 2 ~' '"'J"-J-J'--~-~
Name of Firm
Address //6
Date ~/~/¢O
6. DHHS APPROVAL
,-Al:rp-r~ e d ~
b¢d'rooms-by
Disapproved
Terms of Conditional Approval /Lh~'¢ ,'
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
A. WELL DATA
Well Classification
Well Log Present (Y/~[~) Date Completed
TotalDepth /./~ Casedto .,~f,,~t Depth of Grouting
{~A MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
LITY OF AtGJflE~--IST - FEBRUARY 1984
~NVI"~T~MENTAL SERVICES DIV~S~ON343-4744
AUG 9 ]990 Legal Description:
RECEIVED
Static Water Level ~ ~ ~
Casing Height Above Ground
Electrical Wiring in Conduit ~)N)
If A, B, C, D.E.C. Approved (Y/N)
Yield "/,~,~ '/J~'F//.,~ ,,~.~,~
· "~/z.,¢/.o
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by Z,
Water Sample Test Results ~'f'.'
Pump Set At
Sanitary Seal on Casing ~)/N)
Depression Around Wellhead (Y<~
; On Adjoining Lots .>'/"of
; On Adjoining Lots ..~/oo "'
To Nearest Public Sewer Cleanout/Manhole
; Date
Comments
B. SEPTIC/HOLDING TANK DATA . .
uate Installed 7//¥/79 Size /zJ'O No. of Compartments
StandPipes ~N) Air'tight Caps ~N) Foundation Cleanout ~N)
Depression over Tadk (Y~ Date Last Pumped ~/~o
Pumping/Maintenance Contact on File (Y/N) ~ ; for
Holding Tahk H~gh~t~.~arm (Y/N) ~ Temporary Holding Tank Permit (Y/N)
S..A.X?N ANK:
TO W~tet-Su?~.~]l ~';~dD To Building Foundation
To Property Line
To Water Ma~nT~,~efwc~e L~ne
To Stream,. ~ofld~Lake .~ I~laj6'r Drainage Course
· ~ ~ 2 '
Comments ',. ....
To Disposal Field ,~-~) '
!
..>/o o
72-026 (Rev. 7/88) Front Page 1 of 2 ~
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y~)
Results of Last Adequacy Test
Length of Field
Depth of Field /'~ /
Gravel Bed Thickness
Statndpipes Present ((~N)
Date of Last Adequacy Test
Type of System Design
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot /0/4-
To Water Main/Service Line
III
To Property Line ,~/o
To Existing or Abandoned System on
; On Adjoining Lots /~ ,;ZO ·
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
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
Meets MOA Electrical
Commen~.....~J
Dimensions
Ma n h ole/Access (~.¥.~
Pumping Cycles during Adequacy 'rest.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guideline.' '
inspection.
Signed
Company
Date
MOA No.
Receipt No
Date of Payment
Amount: $
72-028 (Rev 7/88) Back
the date of this
Receipt No
Waiver Fee: $
Date of Payment
's Seal
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907)562-2343
FEDERAL TAX I.D. #92-0040440
Date Repozt Pninted: AUG 2 90 ~ 13:08
Cliont Sample ID:L21 B3 TALD$~ST R~DI¥ISlON
PWSID :UA
Colleoted JUL 26 90 @ 10:30 h~e.
Received Jb~ 26 90 ~ ll:O0 hze,
Pzeee~ved ~ith :AS RE~gIR~D
A~lyeis Completed :~UL 27 90
Client Name : A E C S
P.O.! NO}~
Ozdezed 8y : L.
Send ~epozts to:
l)~ E c s
Laboratozy 3upezviso, z :~P~N C. EDE
ReleasedBy : ~~ ~ 2)
Special
Instruct:
Che~ab Roi {: 902670 Lab R~pl ID: 3 ~t~ix: WA~EE
Allowable
Parameter ~ested Result Units Method Limits
NITRATE-R ND(O.IO) n~/1 EPA 353.2
3ample RO~IND S~LE. RM{PLE COLLECTED BY L. REID.
Re.ar ke: '
Tests Pezfoz~ed * See Special Inst~uctior~ Above UA-Unavailable
None Detected "See Sample Reaa~ks Above
Not Analyzed LT-Lese Than, 6T-G~eate~ Than
ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
i2OO Wes[ 33rd Avenue, Suite B
ANCHORAGE_, ALASKA -3'~503
(907)'561-5~,40 ~ 2q'-,¢3'~'.~
CHECKED BY
DATE
SCALE
PERFORMED FOR:
LEGAL DESCRIPTION:
4
5
6
7
8
9
13-
14
15
16
17
18
19-
20-
COMMENTS
Municipality of Anchorage ~;~
DEPARTMENT OF HEALTH & HUMAN SERVIC~..~
825 "L' Street, Anohorage, Alaska 99502-0650~)~.
SOILS LOG -- PERCOLATION TEST ~",
_ _ DATE PERFORMED:
.~/ ~' ~'//~- ~-1,~.¢')~' Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT ~ L
DEPTH? pO
0epth Io Water Alter
~o~itoring? I]ate:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER __
FT AND FT
PERFORMED BY: ~ ~ (~'~, ~ I 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)
Location (address or directions)
(c) Applicator is (ch~ck one) Lending Institution
Buyer [---~ ; Other ~ (explain);
(d) Lending !~stitution
Tele~p_ho ne - Home~9 ~¢ /~Bus iness S ~ z~ ~- {~]
Telephone
Address
Real Estate Co. & Agent
Address
Telephone
(f) Uail the I~A to the following address:
Ty,~e of Residence
Number of Bedrooms
Other (describe)
Water S u p~0:l_y-
Individual %?ell t'~'~ Community
Public~--_~
.... ]if communi?.y w~].l system~ must have written confirmation from the State
Department of Er~vtro~en~al Conservation attesting to the legality and status.
~o~a~ If co?;n~ni~y ~ll sy~tem~ msst haw= ,~fitten eonfirmatfon from the State
Oe~r~.enn of Envtropmental Conservation a~testing to the legality and status~
'',,,e I of 2]
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 regula-
tions in effect on the date of this inspection.
Name of Firm--~ ~_~.~..~ ~(~A~C~ Te~p O ~~
·' I/ I~' z/. ~ ~ ~ ~ ~,.
Date .
Condition~
Approved ~ Disapproved .,.
Terms of Conditional Approval
CAUTION
THE ~,fONICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 HONES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL M~D STATE REQUIRE-
MENTS. 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.
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH ALVI~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
NOIl~)310~d 9¥1N3~NO~IAN3
~ H[9¥3H 30
~)'~OH~)N¥ -~O AlllVdlDINfl~,'
Well Classification '/~
Well Log P~esent (Y/~
Total Depth 1[ ~ / ~ Cased to
Static Water Level ~ ~/
Casing Height Above Ground ~,~/
Electrical Wiring in Conduit~N)
Separation Distan~s f~om Well:
To Septic/Holding Tank on Lot / ~- / ~) ; On Adjoining Lots ~[ ~9 D~ / ~
To Nearest Edge of Absorption Field on Lot lO0$/d); o~ Adjoining Lots [0~/ dP
To Nearest Public Sew~= Line ~ /4 To Nearest Public Sewer
C~eanout/Manhole ~/~ To Nearest Sewer He, vice Lir~ on Lot __~_~_
Water Sample Collected By ~ [/~Vv~ ; Date ~/~c]~/~
B. SEPTIC/HOLDING TANK DATA
Standpipes (~_ Air-tight Cap~) ~ Foundation Cleanout ~/N)
Depression over Tank (Y~ Date Last P~ped
Pumping/Maintenanc~ Contract on File (Y/N)/~/~-~ for ....
Holding Tank High-Water Alarm (Y/~) ~/~-- Teapots~"y Holding Tank Permit (Y/N)
Separation Distances ~om Septic/Holding Tank:
·
TO Water-Supply Well To Building Foundation
To Weter Main/Service Line
course
CcTanents ~ '~ ~(~ ~ff/~'7 ~-~-~--~
To' Stream, Pond, rake, c~ Major D~ainage
[Page 1 of 2] 2-15-84
em
Soils Rating in Absorption Strata
Date Installed
Width of Field ~-
Square Feet of Absorption A~ea
Depression over Field (Y~
Results of Last Adequacy Test
Type of System Des_ign _'7~L~
~p~ of Field ~'~( ~-
Gravel ~d ~ick~ss ~ / '~
Stan~ims ~esent (Y~
~t~ o~ ~t ~qua~ Te~ '~/~ V _.
Separation Distance frcxa Absorption Field: /
To ~ter-Supply ~ii ~O~ri/- To Property Lin~ _ ~/~
TO Buildin~ Foundation ~(~ / ~ TO Existing or ~ndo~d System
Lot ~)/~' ; ~ Adjoining ~ts ~/~ .
· ~ stre~on~/~ ~o~ ~a~na~ C~ ~(~-/~
To ~iwway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~/~
De
STATION /-
Sizein Gallons ~ Nanhole/A~c~e~)
"Purap ~" ~1 at~~~f"/ ~vel at
High Water ~ ~vel at ~ ~ Vent (Y~)
Tested for ~//_ ~ing Cyo~~a~~ ~st. ~ets ~A
Electrical Co~s(Y
** Check Permitted Bedroom RatingAgainst HAA Request
I oe~tify that I have checked, verified, o~ oonfo~m~d to all MOA HAA Guidelines in effect
on the date of this inspeetioa. ~'~"
Signed
Company
KB1/d5/s
[Page 2 of 2]
Date ' "~/,~-~//~'~
2--15-84
ALASKA E nOIROIqmE IqTAL COI]TROL Sel lCE $, II]C.
~nclin~rin§ ~* (~nuirenmenlal ~luclies
AUGUST 1 1984
KATHRYN PS~REZ
4531 SNOWCUP
ANCHORAGE AK 99516
SELLER - KATHRYN PEREZ BUYER -
SUBDMSION - TALUS WEST BLOCK - 3 LOT - 21
ADEQUACY TEST FOR SE~ER SYSTE~4
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 750 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 1200 GALLONS.
BASED UPON THE TEST DATA THE SYST~4 IS ACc~PABLE FOR A
4 BEDROCM HOME.
THE SEPTIC TANK WAS PUMPED ON JULY 23 1984 .
FLOW TEST ON ~T~,T,
TEIE WRr.L FLOW RATE WAS 3.2 GPM FOR 3 HOURS.
SEPTIC TANK ADEQUACY
THIS HOUSE HAS A PACKAGE PLANT IN LIEU OF A SEPTIC TANK.
~200 [Ucsl 33rd Avenue. Suile ~*Anchoro9¢, Alosko 99503,[907) 5GF5OIIO
#1:
1.
DEPARTMENk.,OF HEALTH AND ENVIRONMENTAl/PROTECTION
825 L Street, Anchoraoa, Alaska 99501
264-4720
~ ~ Date Received: Q6tober 18, 1977
Date 10-~-U~ Wednesday Date /O~/-U~[3¥/ '///Da~ ~/~-~77
Lending Institution Request: Alaska Mutual Savings Ban
Mailing Address:
Phone:
2. Property Owner: Buck Hight Phone: 349-3494
Mailing Address: Star Route A Box 1586C 99507
Legal Description: Lot 21 Block 3 Talus West Subdivision
Snowcup Circle
Single Family Residence: (x)
Number of Bedrooms: Three
Multiple Family Residence: ( )
Number of Bedrooms:
o
Well System:
Permit ~
Construction
Individual well (x) Community/Public System ( )
Depth of Well 116 Well Log on File
Bacterial Analysis
Sewage Disposal System:
PArmit #
Septic Tank Size
Absorption Area
Installed
On-site System (x) Public Utility
1977 Installer
'Manufacturer
Soils Rate Material
( )
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Page Two
~ Department of Health and Environmental Protection
· Request for Approval of Individual Sewer and Water Facilities
Legal Description: LOt 21 Block 3 Talus West Subdivision
Comments:
Af fadavit Attached
Approve '~.~~
Disapproved:
Letter Attached: ( )
Date:
Department Worksheet:
· ~ ' (~MUNICIPALITY OF ANCHORAGE~,~)
' ~ ' Departmeht of Health and Environmental/Protection
[/~]]. 825 L Street, Anchorage, Alaska 99501
-' ~- ~quest for Approval of Individual Sewer and Water Facll~tzes
1. Property Owner:
Mailing Address:
Name of Buyer:
Mailing Address:
'Lending Institution:
Mailihg Address:
Phone:
Phone:
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Phone:
6. Single Family Residence: ~ Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: * Individual Well ~ Public/Community
Individual Well, well depth
If Community System, name of system
System
( )
Sewage Disposal System: On-site ny'stem
If On-site System, date of installation:
Public System
( )
*NOTE:
A well log is required on ALL wells drilled since 6/75.
If on-site sewer system is over two(2) years old, an adequacy
.test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
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