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Home My WebLink AboutPARK PLACE LT 2 [:,EF'FIF:THENI i..~ FIE ::tLTF FINE:, EN',/I [4:Ot'.~.HEN"I"F~L ....., .. ,.;' 'f'EC't"Z ON ':"::"~ '"L'" ~;TREEZT., RN'":H'"~'~F~, RK. _..2... ~.. , ~ '..,~,,:$~1. F F~ '3OF"~.' HI_EST BE OBTR~NEE:, FF::!'"! THE F~LE55 - D~TFt NOT ~',,,'Ff~LFIBLE ~N IHE CDHF:'UTE~: Permit #810735 Roundhouse Builders Star Route A Box 1561-Z Legal Description: 345-3875 99507 Lot 2 Block 1 Park Place Subdivision Z- Log Permit Mound system - design by John Lambe Engineering Issued: 7-17-81 by Les N. Buchholz REPLY SIGNED ~TF-ORMJ¢ ' ' 4S 472 $~'~D PARTS I AND 3 WITH CARBON INTACT. PART 3 WILL BE RETURNED WITH REPLY, DATE // MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description LoT 2 ?ARIc ?LACE Location (site address or directions) IGC31 ,ST. J/IHE$ CIRCLE Property owner 5.~bR^ y~[~)'I)L~'TO~4 Day phone Mailing address (~' ~(.7/ 5'¢-. ,.T~rn-*' ('r~-¢/¢/ /3r~AO'~¢/¢., ,,~1< Lending agency ~LAS~A ~HE HO~T~GE Day phone Mailing address % ~e~¢~ ~,~t~ / ~ ~o/ "E" 5~.2 ~ Agent ~ WikSo~ , REALT9 "CT~. Day phone 3~-OWO~ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 5. 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 FLATTOP "FECI'~ 5¢c $, Address 1~53o ECH° '5"r. f~NCf/o~56E Engineer's signature ~_~ ~. ~ Phone 3~5- 135S' Date .~/>.' ~_',k~' '. ir' ~,. ~ · THEODO,~E F fY, dORe ~ ~ DHHS SIGNATURE ~ l~ ~'[~ ~ Approved for ~'~5) ''~'*~'bedrooms. Disapp¢oved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. {~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J.,o~ ~ P~-~'~ ?1~c¢ ~ /~ Parcel I.D. (~ % O A. WELL DATA Well type Log present (Y/N) Total depth 1fl5 ' Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. Date completed Cased to ~5 ' ADEC water system number ~q,~r. Driller uNK. Casing height I&" Wires properly protected (Y/N) FROM WELL LOG g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE ¢/J/-{-I c/2. FNV RONMENTAL SERVICES DIVISION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main N .~. Sewer service line _ ~ ,/~. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank 60' '7/cO ' WATER SAMPLE RESULTS: Coliform ~co! /~¢'~ ~/ , Date of sample: Nitrate I, ~'~,,~' ("(- Other bacteria Collected by: F'LA'rTOP B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ~' - High water a arm (Y/N) Date of pumping E~? ~' Tank size I '~,5-c~ ~'~'/ Compartments FolUndation cleanout (Y/N) 'r' Depression (Y/N) /V, ,4 Alarm tested (Y/N) N. I0 / .I.7 I ~ I Pumper_ ~o~-o ' SEPARATION DISTANCES FROM SEpTIC/HOLDING TANK TO: Well(s)onlot I1'¢¢ ' Onadjacentlots --~ t~o / To propertyline ~'¢ ~ ,Absorption field ¢ ~ ' Foundation IOI :~"~ Water main/service line ~ lo~ Surface water/drainage .~ toe,' CONTINUED ON BACK PAGE 72-026 (Rev. 7/91) Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) _ ~' High water alarm level ?/ 2-2 / ~/ Manufacturer ~r~r / ~5'~;~ Manhole/Access (Y/N) "Pump on" level at '~3'" "Pump off" level at Cycles tested Meets MOA electrical codes(~N) No SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ! ~o' On adjacent lots Surface water > (~'o ' D. ABSORPTION FIELD DATA Date installed ? / Length _ ¢"O ' ~Width /,5" Total absorption area _ ~Oo c~' Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) N Soil rating 415' c~'/~',-,~ System type. Gravel thickness_ 9' ¢~ to~ Cleanouts present (Y/N) Date of adequacy test for _ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot_ ! To building foundation On adjacent lots Surface water Curtain drain )~1~' On adjacent lots IO5- ' Property line_, fZ,-¢ ~o' To existing or abandoned system on lot A/.,4. .?~ ' Cutbank ]',l, ,,Y. Water main/service line. :> ~o ' /~,o / Driveway, parking/vehicle storage area _ ,5'¢' ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in ~f~c~q~n, the date of this inspection. Signature .[~~ Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE $ 577i2 Chemlab ReE.~ 92.4556 Sample ~ I Matrix: WATER FAX: (907) 561-5301 Client Semple ID PWSID Collected Received PzeserYed with L2 Bi PARK PLACE NORTH ~OSE BIB UA AUG 31 92 ~ 12:15 AUG 31 92 ~ 15:10 AS REQUIRED Client Name :FLATTOP TECHNICAL SRV Client Acct :FLATTOT BP¢ : PO~ :NONE RECEIVED Raq~ : O~dezed By Analyszs Completed : SEP 2 92 Laboratory Superwse=~ STEPHE~ C EDE Released By ~ Send Reports ~o: 1)FLATTOP TECI[[IiCAL SRV Parametez Results UL%lt s }~ethod Allowable Limits Sample ROUTINE SAt~LE COLLECTED EY: CHRIS Remarks: [ Tests Peziormed ~ See Special Instructions Above UA-Unavailable ND= None Detected "Lee Sample Rer~rks Above NA~ Not Analyzed LT~Less Than, GT~Greate~ Than ~sr~s Member of the SGS Group (SociSt~ G~n~rale de S~rveillance) Parcel I.D. # MUNICIPAUTY 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 t(~°~ ~ - ,L.\~ HAA # 1. GENERAL INFORMATION Complete legal description ·2. LocatiOn (site address or directions) Property owner Mailing address Lending agency Mailing address Agent f'¢'/~ ¢' Address 1/o Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone ~7~f /J,_~ ~,~.¢-/~'. Day phone 5-6' ~- 5'~' ~-~' Day phone 3. TYPE OF WATER SUPPLY: Individual well . Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: . ndvdua on-site , , · . :.. ..... , ., · ,,, :~. : :'~" ,, ..: ..i ~:'L: .: .:;'. .;i~'?:,,; i...'. ~: : · ', ._ :~ ' - · · Holding tank Community on-site ...... :' - · :: "r u,,l:3ul~llc.~*;'wer '; ":-" ' ' NOTE: If community Wastewate'r System, Provide written Confirmation from State ADEC attesting to the legality and status of system. .. 5. 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 ~'/~/-A*/~ T~¢~ 5'~-~ Phone Address /Y,5-3'~ ~c~, ~'/~, /z~c/~'¢,~,. ~ ~/~ ' Engineer's signature ¢~ ¢ ~ Date / ~ / ~ / / 9/ D/~ SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date 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 D_F-IH.S~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, 1191) Bsck MOA~21 ~ M~jn'iCipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descr!ption: /--'~: ~ '// ~/<: P',/c~CE S/'D Parcel I.D. A. WELL DATA Well type Log present (Y/N) Totaldepth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ~ADEC water system number N,~. Date completed ~2 / '~/ Driller t~ Cased to . MUNiCIPALI'[Y OF ANCHORAGE AT INSPECTIONENVIRONMENTAL SERVICES DIVISION Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test ~/~! Static water leVel ,5- Well flow q. 5- - ,5' Pump level g.p.m. to/t?/~t OCT 2 1 1991 RECEIVED /,~' g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer serviCe line ; On adjacent lots ; On adjacent lots ~ tOO ' Public sewer manhole/cleanout N,/~. Petroleum tank ~'~ ' WATER SAMPLE RESULTS: Coliform 0 cot Date of sample: tO Nitrate ~, 70 ,',,.~/'-E Other bacteria Collected by: cot/'too B. SEPTIC/HOLDING TANK DATA Date installed ~ ,/'~ ! Tank size I Cleanouts (Y/N) ~ Foundation cleanout (Y/N) High water alarm (Y/N) N,/t. Alarm tested (Y/N) Date of pumping ~:'~/~/'~' ~o/'~7/~/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot II 0 ' On adjacent lots To propertyline ,5-~' Absorption field Surface water/drainage ,~ Compartments Depression (Y/N) Foundation Water main/service line (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Y "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot / ~d,,' On adjacent lots ~ 4oo ' Surface water D. ABSORPTION FIELD DATA Date installed Length ~'O Total absorption area Depression over field (Y/N) Results (pass/fail) Width ~00 0~ Cleanouts present (Y/N) Date of adequacy test for 5/ /v Soil rating ~--? ('J~b' ~[orz',~)System type Mc, c4no( Gravelthickness ~ /~ef~,~/4yt4 Totaldepth ~,~, 10/17/~I o.G- If yes, give date Peroxide treatment (past 12 months) (Y/N) /Vo4e SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot IZo°' On adjacent lots Propertyline bedrooms To building foundation 80,' On adjacent lots ~- .?o' Surface water _ >' ~oo' Curtain drain To existing or abandoned system on lot N,A. Cutbank N,,4. Watermain/serviceline ~ fo' Driveway, parking/vehicle storage area 5-o ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature TJ*~'¢-'~ ~. ~ Engineer's Name '7-/~ ~0¢..¢¢~ F. /'-~o¢,-¢ Date I0 ,/ ~. l /?1 HAA Fee $ Date of Payment .ecei,t,um or 72-026 (Rev 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 T~LEPHONE (907) 562-2343 ANALYSES REPORT BY SAMPLE for WORKorder~ 39151 Date RePort Printed: OCT ll 93. ~ 3.~:~9 FAX: (907) 561-5301 Client Sample ID:L2Rt PARK PLACE Cli*nt Namo PWSID :UA Client Aect Collected OCT 9 91 @ 12:00 hrs. BPO ~ Received OCT 9 91 @ 16:50 hfs. Req ~ Preserved with :AS 5EQUIRED Ordered By Analysis Completed :OCr 11 91 :FLATTOP TECHNICAL SRV :FLATTOY PO % }lONE RECEIVED :T~D MOORE Send Reports to: Laboratory Supervi~or,:STEPHgN C. EDE lJFLATTOP TECHNICAL SRV Chemlab Rof ~: 915403 Lab Slapl ID: I Matrix: ~TER Allowable Parameter Tested Result Umte B~athod Limits NITRATE-N 0.70 ~/1 EPA 353.2 i0 S~ple ROUTINE SAMPLE COLLECTED BY: ~. F, t,{00R~. Reina~ks: 1 T~sts Performed * See Special Instructions Above UA~Unavailabie ND: None Detected '* See Sample R~mazks Above NA~ Not Analyzed L~-Loss Than, GT-Gzeater Than ~r~_~ Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) : ~., 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 Application Date ~ Legal Description (include lot, blo~k, subdivision, section, township,~ange) ' . . Location (add.ss or directions) ~ Ap;iican~me¢~¢X Z~~ Telo;h0n2: Home' ' IBusiness ApplicantX~Oress ~C~ ~ U~eS App:icam is (check one): Lending l.s~i[ution D: Owner/builder: Buyer; O~her D (explain): GENERAL INFORMATION (a) (b) (c) (d) ·Lending I~stitution (e) Real Estate Company ~d'Agent Telephone -'Telephone (f) "Mail'the HAA to the following aCdress: I I ' I ; ' ' I '' -- TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family [] Number of Bedrooms ~ Other 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 communi{y 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) 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 date of this inspection. , - ' DHEP APPROVAL "- : : ~ / Disap~oved ,_ Condi~nal Terms of Conditional Approval _ Date 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 (11/84) MUNICIPALITY OF ANCHORAGE (MOAT' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ ~-- ENVIRONMENTAL P.I~OTECTION ,!AN 2 8 1988 WELL DATA Well Classification 'Ff'~/'~"¢~"'7¢~--~ If A, 'B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) y Date Completed Total Depth ! ~'-~ /Cased to Static Water Level ~' / Casing Height Above Ground ~ Electrical Wiring in Conduit (Y/N) Depth of Grouting /V~/,4 Pump Set At ?' ':~ -~/ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: / o/ ¢-- ) To Septic/Holding Tank on Lot / ~ 7 ; On Adjoining Lots To Nearest Edge of Absorption Field on I~ot //~'~ / ; On Adjoining Lots To Nearest Public Sewer Line ~///z~ To Nearest Public Sewer Cleanout/Manhole /'L'////~ TO Nearest Sewer Service Line on Water Sample Collected by' ~ ~ ~_~./,/¢~/~ ~/-~ ; Date /,/~ 7J~:;~ Water Sample Test Results ~ ~'~ '¢" '¢~ ~'~(-~ -~-/"'-~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed '/ Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septi.c/Holding Tank: TO Water-Supply Well /[~0 TO Property Line ~;) / To Water Main/Service Line Course Air-tight Caps (Y/N) Size t~-~ EO3//NO. of Compartments Foundation Cleanout (Y/N) · Date Last Pumped ; for Comments Temporary Holding Tank Permit (Y/N) 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 S ~ F ¢' Square Feet of Absorption Area Type of System Design Length of Field ~ ~ ~ Depth of Field ~ / Depression over Field (Y/N) 4/ Results of Last Adequacy Test /Gravel Bed Thickness / L Standpipes Present (Y/N) Date of Last Adequacy Test Z'~.,_j~"} ~ ~d~> ~ / To Property Line To Existing or Abandoned Syste'm on ; On Adjoining Lots / ~) ¢) To Cutbank (if present) /~/0¢~ ~' Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~-~ Lot /V c~ P'2 cc=' To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Cours~ /~ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed / ¢~/ Dimensions / ~-. ~0 (~-cg // Size in Gallons ,/ '~ ~0 Manhole/Access (Y/N) "Pump On" Level a, ~¢'~"~ /'/~¢'z-OC). ~"¢.*)"PumpOff"Levelat High Water Alarm Level ~t '5'~- ~ .... Vent (Y/N) Tested for ~ ~ ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checke~ veiled, or conformed to all MOA and HAA ~uidelines in effect on the date of this inspection. Signed ~~Date ~ F,/~ ~ Receipt No. ~'7OG~ x/~, ,.~.~'~ Date of Payment ] DS~F~ ~/~.,,,~.. .¢ ' ~~" Amount: $ ~F ~ ¢~ ../' ~ ..... 72-026 (11/84) ~'% -' -~-/ '~ ~ 'K e_.c " INSPECTION APPOINTMENTS TIME- TIME TIME DATE DATE DATE ,NSPECTOR ,NSPECTOR ,NSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ........... DFpT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL ~,u~ONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION NOV ~ ~ 1981 Telephone 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SE~ ~ ~ OIRECTIONS: Complete all par~s on page 1. Incomplete ~eques~s will no~ be p~ocessed. Please allo~ ~en (10> days ~or processing. ]. ~OPERTYO~NERI ~ ~ ~ PHONE MAILING ADDR~S PROPERTY RESIDENT (If different from above) J PHONE PHONE 2. BUYER MAILING ADDRESS MAILING ADDRESS 4. REALTOR/AGENT I PHONE 5. LEGAL DESCRIP. T[ON STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDRO~,~S .~../' [] One ~ Four SINGLE FAMILY [~] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATE~.SL?PLY ~"' 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 DI.SPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE~* [] PUBLIC UTILITY YEAR ON-SITE sYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EA(~H REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [~ ONE [] THREE [] FIVE [~) OTHER [] MULTIPLE FAMILY [] TWO [~] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] 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 E~Holding Tank Size: /j~L~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOT AL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~;~"~'~'P P R O V E D FOR ~:~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ 72-010 (Rev. 6/79) A N C H O R A O E....:A~.S K A 99601 (90'7, 264-11'1, i,~.y~ i~).._-'~1-- DEPARTMENT OF ttEAL. TI I AND ENVIROF,UviEN'IAL PROTECTION November 23, 1981 Round-House Builders, Inc. Star Route A Box 1561Z Anchorage, Alaska 99507 Subject: Lot 2 Block 1 Park Place Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: 1) At the time of our inspection, we were unable to obtain a water sample for analysis since the water was too turbid for sampling. 2) The seal on the well head needs to be tightened so that it is water tight. 3) Exposed wires to the well head are in violation of the Municipality of Anchorage codes and must be placed in conduit. Please call this office for another inspection when the noted descrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska Mutual Savings Bank 1503 West 31 Avenue 99503 Lynn Burns % Rainbow Realty