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Home My WebLink AboutKASILOF HILLS BLK 2 LT 5Kasl'* I of Hills Block 2 Lot 5 #015-161-25 MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 I_ Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME NEW ❑UPGRADE _T'0 Aif / e/ /�j��N�9 MAILING ADDRESS 130� r LEGAL DESCRIPTION �`J 74 LOCATION NO. OF BEDROOMS Well Absorption 7 area Dwelling , DISTANCE TO: l(9f) ,1 V PERMIT NO. UY �Ud �� I-_ 2 Manufacturer Mater a - _ /'J No. of compartments , N ILiq. capacity -� in gallons S IF HOMEMADE: Inside length Width Liquid depth 0 �•' DISTANCE TO: Well Dwelling PERMIT NO. Z'4 T H• Manufacturer Material Liquid capacity in gallons O DISTANCE T0: Well Foundation Nearest lot line PERMIT NO. w J u Z F- Z ul No. of lines Length of each line ,� Total length of lineesy / , Trench w TrLt� .. Y inches Distance between , aI /� r QLY:- ¢ F. Top of rile to finish grade J Material beneath the � Total effective absorption area 0 61 nelaer cs 7 ?_ Length Width Depth PERMIT NO. w Q F Type of crib Crib diameter Crib depth Total effective absorption area Lu y DISTANCE TO: Well Building foundation Nearest lot line w Class `7Q Depth Driller Distance to lot line PERMIT NO. J ( W - Lu DISTANCE TO: Building foundation Sewer line - Septic tank Absorption area (s) OTHER PIPE MATERIALS ry% jI SOI L TEST RATING INSTALLER �T REMARKS T3" •. APPROVED DATE LEGAL / /� �0 �� T,&MIT Lmillilla w(bMUZ HOx 136% S'rAlt HOUWN A ANCUORAGEy AILASKA 90502 X44=7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF _ 300 tee't. WELL LOG: _ 0--2.3' S,tlbk cr lmve�L. 40% ctau. Jj bW e -JL 23P�rnA38' R (ine norut), a&uveL wixh, 15% C%crit, lit a-tVL.t,cL, 38----300' BedAock. R ae_d;ae_nAwL crock. 133---137' R ure t aJrcrnu Laic b)'Ac nock �ihow,.a jorim lda�twi, t1_i,e,Ld. 236-2139' letytcuvju W4, nock uyr til. some. 1Jai.wL phod_uc;uon. 1_:e -4n, than. 1/2gli'l. 245--255' lllone c (.emb gLuuwAwt ttjfxe, ieock io ie.Ld ina a yota, 280•,295' ,'l,Lea.6 o f aJuxiut lcUa ;tock pyaodct.c inc u.piaaAd4 al- me. jPlil. T o;t•.ad. I, a�te.)r. ;i Led d 4hota4 at ,tea-of: 2160 avA4 pe & 24 howc t,bibe f uwe a Should inumaae 30 to 50/ ur&th u-je. 280 feet of lac.tvL .6tan,( {n.c,,, .in, cc4,.n,at oa FALL 1.6 aai.6 pec I-oot. 448 g,aaIA to ne,6eAve. One Ilo4Ae Sutrtavz, .ihte Dual) 4h.o",rl be in,6taUed 10 to 15 lee&t o"_ bo C torn. Coot of- J)r z.LC in(,,: 319.00 X 300 ft: 35700.00 Ro Chauie.[,o)c ldeV, Seat. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF i0700.00 THANK YOU VERY MUCH. BERNIE CLAUS OF ---RAMPART DRILLING CORKS DATE Oct.. 3)cd, 1980 l �' SERVICE CHARGEOF lYz% PER MONTH WILL BE ASSESS D ON PAST DUEACCOUNTS. DRILLED AT THE RATE OF —";19.00 PER FOOT. Ilk, Joa lilwr iAo 272-6845 248147.2 PROPERTY OWNER .tit® Btk,,, Y Sit,&. 6"Q -4,(q LOCATION OF WELL SITE 13e'uu.e cla<h of- Ralapcu t. DA' C Lina llojil �. DRILLER WELL LOG: _ 0--2.3' S,tlbk cr lmve�L. 40% ctau. Jj bW e -JL 23P�rnA38' R (ine norut), a&uveL wixh, 15% C%crit, lit a-tVL.t,cL, 38----300' BedAock. R ae_d;ae_nAwL crock. 133---137' R ure t aJrcrnu Laic b)'Ac nock �ihow,.a jorim lda�twi, t1_i,e,Ld. 236-2139' letytcuvju W4, nock uyr til. some. 1Jai.wL phod_uc;uon. 1_:e -4n, than. 1/2gli'l. 245--255' lllone c (.emb gLuuwAwt ttjfxe, ieock io ie.Ld ina a yota, 280•,295' ,'l,Lea.6 o f aJuxiut lcUa ;tock pyaodct.c inc u.piaaAd4 al- me. jPlil. T o;t•.ad. I, a�te.)r. ;i Led d 4hota4 at ,tea-of: 2160 avA4 pe & 24 howc t,bibe f uwe a Should inumaae 30 to 50/ ur&th u-je. 280 feet of lac.tvL .6tan,( {n.c,,, .in, cc4,.n,at oa FALL 1.6 aai.6 pec I-oot. 448 g,aaIA to ne,6eAve. One Ilo4Ae Sutrtavz, .ihte Dual) 4h.o",rl be in,6taUed 10 to 15 lee&t o"_ bo C torn. Coot of- J)r z.LC in(,,: 319.00 X 300 ft: 35700.00 Ro Chauie.[,o)c ldeV, Seat. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF i0700.00 THANK YOU VERY MUCH. BERNIE CLAUS OF ---RAMPART DRILLING CORKS DATE Oct.. 3)cd, 1980 l �' SERVICE CHARGEOF lYz% PER MONTH WILL BE ASSESS D ON PAST DUEACCOUNTS. DEPARTMENT IY 1EHLTH HND ENVIRONMENTAL F TECTION 82.v_-; /� STREF"-'T/ ANCHORAGE/ M.-:'. C)95o: L_ 09 rl Ca CH P-4 1 1- lFe r--! 1"'l I _T' PERMIT NO. '7 / HPPLICHNT DONALD MHR%NO -4m-W PARK BLVD' ` �5 LOCHTION LEGAL L5 B2 KHSILOFHILLS' LOT SIZE ]059] SQUH L) JY TYPE OF SOIL H8�ORPTIOtl IS: TRENCH ' MDIMUM JUMBfR OF BEDrOOMS 4 SO�L ��TING (�� T/BR)� 9] ` THE REQUIRED SIZE OF THE SOIL AEiSORPTION SYSTEM IS: 1_0 J_ �� f -E- r_4 17�� L f7 ...EV~ THE LEN8TH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAYEL BETWEEN THE OUTFHLL PIPE ANC- THE BOTTOM OF THE EXCAVATION (IN FEET). ��U�� F�1� �� I�� L�� PERMIT APPLICANT HAS THE RESPONSU.,ILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBF,:.'R OF RES I DE.NC*E,_7:; THAT T[lE WELL WILL SERVE. "'T" 1-4 CH IC: �� 1 P-4 F-" EH -7. C.-. -T- 1 Ca N fS.' n F�-" l=_" F. -D 1_3 I U 17E_ CA ~. ...... BRCKFILLING OF ANY' SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND HNY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRI�HTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND FID H C011MUNIT'r' SEWER LINE 1-',; 7"; F`[ -.ET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPHRTMENT WITHIN 21:0 DHY5 OF, T�� CCIMPLETION. 0THER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIHGRHMS RRE HVRILHBLE TO INSURE PROPER INSTHLLHTION. �FEE C E--- r-1 ED. U 1--,. 7 I CERTI FITI Ttii�::iT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON ---SITE SEWERS HND WELLS AS; SET FORTH BY THE MUNICIPHLITY OF ANCHORAGE. 2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDERSTHND THAT THE ON�SITE SEWER S9STEM MHY RE8UIRE ENLARGEMENT IF THE RE5IDENCEIS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. HPPLICHNT DONdLD MARINO / ~ DATE _��~��.��.��/ ISSUED B�~�� V4. 0 ® SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION Pouch 6650, Anchorage, Alaska 99602 276-2221 TEST SOILS LOG – PERCOLATION TEST ; PERFORMED FOR:_ (-)CJNEaLn DATE PERFORMED:`_ LEGAL DESCRIPTION: t�, — `,a L/77- •" 2 3 4 15 - 16• 17 - 18- 19- 20 - Or an)L,--) 8•19- 20 OrCcnic„5 Gcnc�( 5r%fy O,, - C'5 kv) (�✓� /i � r4c ea' Low r�7o�a�v�e l_on",'er�C 7116 <5,o P'///l f' CJrQ 1, P/5 I' Y Gr l/!� JrOVE/.5 �G Lv� /OU/ ll7pi5 frim lon fnn f" IGn �G r�7:5 6o/YIP_ ��,1/Om lof�b/P-5 �a me D 5 Gbo �e 140E /"7/L"L5 SLOPE rE PLAN —T T Gross Time 5 -- --70 Net Drop 6 '.. WAS GROUND WATER ENCOUNTERED? •4 7 0, o --, — -- -- lam 8 E O. . O O' 9 0.. " b. 10- 00 - 0. 11 0" b 12 O. O. o, 13 O G - 14 • O o ,o 15 - 16• 17 - 18- 19- 20 - Or an)L,--) 8•19- 20 OrCcnic„5 Gcnc�( 5r%fy O,, - C'5 kv) (�✓� /i � r4c ea' Low r�7o�a�v�e l_on",'er�C 7116 <5,o P'///l f' CJrQ 1, P/5 I' Y Gr l/!� JrOVE/.5 �G Lv� /OU/ ll7pi5 frim lon fnn f" IGn �G r�7:5 6o/YIP_ ��,1/Om lof�b/P-5 �a me D 5 Gbo �e 140E /"7/L"L5 SLOPE rE PLAN Reading —T T Gross Time Net Time -- --70 Net Drop WAS GROUND WATER ENCOUNTERED? S_ I�r_ Afin L; _ O P +- - ---i --, — -- -- lam IF YES, AT WHAT E DEPTH? 40 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS ��mm,oi�/( %/'i %//�'r� //� /�.t-�=f7,/� �`!'/ — �o(// ,�"- --�•- /,P PERFORMED BY: ; o;-)orel --E, rc-c1 CERTIFIED BY: T _ DA,rE: Lo —r`JO— Z�3 72-008 (7/76) Development Services Department ,®dam Building Safety Division On -Site Water Wter Program B 4700 ragaw Street P.O. Box 196650 Mark Segich Anchcrage, AK 99519-6650 Mayor www mpn. Oro/nn<pe 1907-)343.7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification NumberLL- l lot "dam Legal Description Property Owner Name & Address: gI LD F E.� Its Gran 14 L.:t�s e -r— L5 l b9 c10uG Installation Date: ,0 /,3/01 Pump Intake Depth Below Top of Welln%Casing:216Zfeet Pump Manufacturer's Name: I �Cze V (Ct Pump Model: CZNS 2 ( V B Pump Size ' hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: MA. -ti n 5 O V�.-- Pitless Adapter Installer. /V/& Well Disinfected Upon Completion? 9Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: rj "I �uLn 5 �e—�esSO t *V Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # D /"S- / 6 / a '5� HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) 4a-$�9 D/100 (a) Legal Description (include lot, block, subdivision, section, township, range) '��nr•a� Locati o&W.iebs t r d i rubor KI ri F '4445 7,,c1 z3 t.) SEC Z - a s Ril►••H••�i•s•� i �iNf�i C. (b) Propettyv rnera..41,� ,,�,�. Telephone : (home) Business Mailingtress� 't '� r fs. ��• 1M� .y (c) Lending Institutia�i *S^'"t i• Telephone Mailing Address (d) Real Estate Company and Agent Nh'eS-rW G/'Ab'* Address ZBa� iJ. GTTT Telephone zw*" 80� (e) Mail the HAA to the following address: (or check here K if hold for pick up.) List contact person and day phone number below: Ae—eS Pica- uP 2. TYPE OF RESIDENCE Single -Family, Number of bedrooms 3 3. WATER SUPPLY Individual Well l9 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-siteX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z 10 d abed MOOR (ssa ase) szo-ac ,�aoM s,aaauibua jeuolssaloid ay; ul suoisslwo ao saoiaa ao; o1gsuodswjou sl 96eaogouy;o A;IIediolunN eq1 •panssl sl aleoilpiao a aao;aq elep Wjeue ao suolloadsui Ion puoo lou op SHHG to saaftdw3 •slua(uaimbaa alels pue Iejapal weliao Alsiles oliapio ui suol;nli;sul bulpual aiagl pue sawoq to saasegojnd o; Aselinoo a se siq; saop SHHa aq1 •e�seIy ;o a;els ay; ui p9a9;s160a aaeui6ue leuolssa;oid;uapuadepul ue Aq anoge 9 gdwBe.ied ui UGA16 suol;eluesaadai 914; uodn Aluo paseq p9;eoilpeo Jenoaddy (;uo14lny g11e9H sanssi (SHHa) saoiAJaS uewnH pue g;1eaH lo;uawl.(sdaa a6eaogouylo A;iIedioiunW eq1 9112(] 4t Ieuollipuo0 jenoaddy Ieuoi;ipuo0 10 swaal panoiddesia --j— panoaddy (q swoojpeq eryl ao; panoaddy 1VA08ddV SHHa '9 a}e4 JW i// ssaaPPy auogdalal Wid 10 9WEN -uoiloadsui s1gl;o alep aql uo;oalla ui suoilejn6aa pue 'saousuipao 'sapoo ale;S pue jediownW Ije glint aoueildwoo ui si walsAs jesodsip aaleMalsum ao/pue AIddns aa;eM alis-uo 941 'uoi;oadsui pue u0i;e61;s8nu1 AW woj; pue sali1 a6ejo14ouy ;o A;qedioiunw aq; woal pauielgo uoi;ewaolul aql uo paseq leg; (1iaaA aa14;in; I •uiaaaq poleoipui ain;onils to @dAl pue swooapaq;o aagwnu ag; aol alenbape pue jeuoilounl 'ales si walsAs lesodsip aalemelseM jo/pue (Iddns ialeM ails-uo aq; ;e14; sMo14s Ienoaddy (1uo4lny 141leaH siq; }o u01le6I;sanui Aw ley; (lia9A I 'MoIaq uM014s alep uoI;epiIeA 9q; yo se pue 019aaq PDX Ille leas A Cq paililaao sy N0I1VWa0dN1 aNV V1Va `HOUV3S 31ld `S1S31 `SN01103dSN1 JNIOIAOkld INUH ON1833NION3 '9 t71�J 40 -Ms- —c g _.,,"-7 A. WELL DATA MUNICIPN ITY OF ANCHORAGE (MOA) *�, OF #�iprity Approval (HAA)LIST - FEBRUARY 1984j343-4744 Legal Description: Well Classification _ ��y'��TE If A, B, C, D.E.C. Approved (Y/N)/ 14 Well Log Present(ON) Date Completed /o 3` ffO Yield "7 4>%k Total Depth __/Cased toM4� 9 Depth of Grouting Static Water Level — 7-3 _Pump Set At IJ/A Casing Height Above Ground / Sanitary Seal on CasingoYN) Electrical Wiring in Conduit&N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot /ne) Depression Around Wellhead (Yo ; On Adjoining Lots /e -r- To Nearest Edge of Absorption Field on Lot /6re -t ; On Adjoining Lots _ /" /,)�_ To Nearest Public Sewer Line _ I To Nearest Public Sewer Cleanout/Manhole �Jk�4 7 To Nearest Sewer Service Line on Lot 2--5, Water Sample Collected by / L� ✓� �/t `l Date �7'6 -r9 Water Sample Test Results �5!M! Al/7_,'AT4rS Comments /JRZL fi&J -7-057- 6-2-V-97. B. SEPTIC/HOLDING TANK DATA Date Installed Size /Z-0 No. of Compartments nJ StandpipesON) Air -tight Caps (Y N) — Foundation Cleswou (YO�./1" 4f, f h S.►�S Depression over Tank (Y® Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ; for A Holding,fanl H160-Water,Alarm (Y/N) 'Temporary Holding Tank Permit (Y/N) � %9 SEIOIAQISTAN,CES-FROM SEPTIC/HOLDING TANK: NO / Tata ST!L1i ,�Y, / To Building Foundation PrgerYn�in.e,� /U 1"o Disposal Field — J To: Water Mgin/Service 4 - To To S4rearn,:Pon cl-L6) e or Major Drainage Course Z" / Comments '> 72-026 (Rev. 7/88) Front Page 1 of 2 G 5 Z_ W14-Zf C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed/o �A. b'b Width of Field 3 ' 93 Type of System Design Length of Field 3 1 Depth of Field 9� Gravel Bed Thickness & / Square Feet of Absortion Area Statndpipes Present( Depression over Field (Y®I Date of Last Adequacy Test Results of Last Adequacy TestEQu�7� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well le" � To Property Line i To Building Foundation SO To Existing or Abandoned System on i Lot �� ; On Adjoining Lots /o i To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area — Comments LIFT STATION Date ed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines i inspection. �I /- J 4 Signed G� —� AV Company-Cfr Date �4�0 I MOA No. Oz -,el Receipt No. 0 '1 Receipt No. Date of Payment Waiver Fee: $ — Amount: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 of this MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services a� t DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # L16 - Kn I-216 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) �� s �� z- K��a� ,��s rte 1 z3r� A� 7-V Location (address�br"directiohs) (b) Property owner._ FG Telephone: (home) Business Mailing±A�dress IGIDc`�b k�A r /1rC1Q I�JIP}!1/r�h� ��1�— 1L��U (c) Lending Institution Telephone Mailing Address -- (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here 1� if hold for pick up.) List contTct person and day phony number low: i ii nz / / 2. TYPE OF RESIDENCE Single -Family X Number of bedrooms 3. WATER SUPPLY Individual Well K 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 (Re.. I/M Page 11 of 2 Z jo Z abed ADe9 (88/L'Aad) 9Zo-LL •iIaoM s,aaauibua Ieuolssojoad ay; ui suoissiwoao saoaaaaojalglsuodsaa jou si a6eaogouV pAj!IedlolunN eqi •panssi si aleoljljaao a aaojaq elep azAleueao suolloadsul jonpuoo jou op SHHO jo saa (oldw3 •sluawaalnbaa alejs pue Ieaapaj uie}aao Alslles olaapao ul suollnl!lsu! 6ulpua1 alagj pue sawoq jo saasegoand of Asajanoo a se sigl scop SHH4 agl Te selV jo ajejS agju! p9a9lsl6aa a0aul6uo leuolssajoad luepuedepui ue (q anoge g ydea6eaed ul uan16 suoijejuesaadaa eqj uodn Aluo paseq paleoilpoo IenoaddV Al!joglnV glleaH sonssi (SHH(l) saoiAJeS uewnH pue glleaH jo juawlaedaa a6eaogouy jo AjlledlolunN aql NOI1t1VO I :'i IenoaddV jeuoij!puo0 jo swaal Ieuolj!puoO panoaddeslQ panoaddV 88 —Z f--d j�r...wr►��6 ♦ 1cudp,� # ' 9 Y •�jr IN �Oto.... * ,,ter,•-•- Aq swooapaq aoj panoaddV IVAOHddV SHHa '9 ajea �6 r� d ice % �. FF /� �/ f,/ ssaaPPV jSSf —64--Zauogdalal S��t� wald jo aweN •uolloodsul slgl jo alep aqj uo loajjo ui suo!lelnbei pue 'saoueu"Ipao 'sapoo alels pue IedlolunN Ile gum eouelidwoo ui sl walsfs Iesodslp aaleMalseM Jo/pue L(lddns aaleM alls-uo aqj 'uoljoadsul PUB uolje6ljs9nul L(w woaj pue sal!j a6eaogouy jo Al!ledlolunW aqj woaj poulelgo uollewaojul agj uo paseq legl AjlaaA aaglanj I •ulaaaq paleolpul aanjonals jo adAj pue swooapaq jo aagwnu aqj aoj ajenbepe pue Ieuollounj 'ajes si welsAs lesodslp aajumalseM ao/pue Alddns aaleM ails-uo agj jegj sMogs IenoaddV Al!aoglnV gjleaH slgl jo uolje6ljsanul Aw jegl Al!aaA I 'Molaq uMogs alep uolleplleA aql jo se pue olaaag poxllje Zeas lw /q paljllaao sV NOIlVINdOcINI (INV VIVO `HOdV3S 3-1Id `S1S31 `SNOIlO3dSN1 OWIAOad YYHlJ JNIM33NION3 '9 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES DIVISION • Health Authority Approval (HAA) CHECKLIST CHECKLIST - FEBRUARY 1964 914-111I 11 SEP .1 5 1988 343-4744 Legal Description: 45" /sem / EA D _ Wiz../ ,t 5rcJ yer Z -Y A. WELL DATA Well Classification __ �'IV C_ Well Log Present &N) Date Completed _� Total Depth Cased to f�� Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit bN) SEPARATION DISTANCES FROM WELL: If A, B, C, D.E.C. Approved (Y/N) _1"A -3 -9b Pump Set At Yield * 2-1 7 6A- / Sanitary Seal on Casing 6f N) Depression Around Wellhead (Y4 To Septic/Holding Tank on Lot /ov ; On Adjoining Lots /4V -A- To Nearest Edge of Absorption Field on Lot /07) �',, ; On Adjoining Lots /6r?) /`t - To Nearest Public Sewer Line _ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 7-5' Water Sample Collected by /4957t-1 W/�� ; Date Water Sample Test Results Me_ 7— Comments Comments -* a/6_1e, )*#,;J 7—c%T 19��Y"��• B. SEPTIC/HOLDING TANK DATA Date Installed /o-4 _?$ Size No. of Compartments Standpipes (j'N) Air -tight Caps ON) 2 - Foundation Cleanout (Y19 Depression over Tank (Y/0I Date Last Pumped /TSS Pumping/Maintenance Contact on File (Y/N) AJ A+ ; for __ JA Holding Tank High -Water Alarm (Y/N) 4J1f Temporary Holding Tank Permit (Y/'N) A) 14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation To Property Line /o To Disposal Field / To Water Main/Service: Line/o r To Stream, Pond, Lake or Major Drainage Course /era �- Comments 72-026 (Rev. 7/88) Front Page 1 of 2 G5" 8a -hu F C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 93 Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area elo3' Depression over Field (Y/6) Results of Last Adequacy Test AMuA-76- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well _ Y'rh To Building Foundation Lot To Water Main/Service Line Statndpipes Present ®N) Date of Last Adequacy Test To Property Line T� �a To Existing or Abandoned System on On Adjoining Lots To Cutback (if present) �J �4 To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area & -)I- Comments D. LIFT STATION `�-Q to Installed Size in �Leveli "Pump On High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ��e1s tlS MAy�td Signed -� - �� ®r- A/ 8� � °see.°•°•° 1 CompanyC ��w`T,°°° 9-i� 0�J; Erf gegr'sSeal DateMOA No. 0 ®•o.: C/�o e°s 0aw• eoe°o�e- e•eoao•s° • •a.•F� ® e ROY C. REID, J 7y ® °. CE - 2251 •° ® h, • °° �. Receipt No. ✓ 121 0 r�) �226 e'6 Receipt No. �� °.... ��\�ra Date of Payment 91, Waiver Fee: $ Amount: $ 12()-00 Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 APPLK Ni PILLS OUT UPPER HAI ONLY P•.iperty Owner ' _. _ ,j `;� , Phone Mailing Address'f .. ":• r ; � �)F' �,; I �. ., •,r r, , Zip Code �_I `'% � D �- " ( J Buyer + r `� "^ u Vc 0 Address Zip Code Lending Institution <-'� „ - .j + �'I LL_ �r�r Phone Address -) �- ; t,= -I - - r� r Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description Inspector Street Location Type of Residence z� Single Family ._ ❑ Multiple Family No. of Bedrooms, ❑ Other Water Supply MUNICIPALITY OF ANCHORAGE Individual DrnT (-- ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal --individual - J ,P ., Year Individual Installed: ARN.- 4 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 4(ACrt`;1 Time Time Time Time + r `� "^ u Vc 0 Dale Date Date Date c; 2 Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DrnT (-- AI . (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ARN.- 4 ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received l �) - /,' e�'•� Well to Tank Z Ln 0 Septic Tank Size 72.023 (3182) Pebruary 2. 1903 Donald M. "I'larino 2550 Denali 'itr Suite 602 Anchor es 7\1\'- 9950: ock 2 Kwsilof sills �,),ubdivisioll tot 5 t 1-1 1 Aj..)-r.,roval l,or the indivichl-.1l newer and, water facilities cannot be granted 111211 the £ollluwirlcj ii.-clirl" have nee "he eater analysis report to be !3uhmjA-A-.P(-1 to uao office froin the ('11oll'i Lab, sola JB GI- ruc, i- t for our -ro, vine. 'i'llo septic taril" pumped with a Y.-C-c-cipt our fitted to I-Adr; department. ') ± (Z- Plea'.,,e, notify this Dega<t nt J'017 cl Y'Cinsvmci.i.ori when the noto(l discrnrwlllcin-1 havc been corrnoted, If therc are any fez or cjuestinns, tpleam, call thin office at 26/1-4.7)0. Sincerely. Jim Rom its Associate Env j. roronmi Lal 1;pcciilisO-1 5. LEGAL DESCRIPTION—s® DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME �,/��. 499 I4" �^ DATE DATE DATE f( D-' a;3 INSPECTOR INSPECTOR - INSPECTOR MUNICIPALITY OF ANCHORAGE ��,qq��NN� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'ITOWPALITY OF ANCI-IORAGC Street Anchorage, 99501 DEP7". OF I-IEAIJI'l 825 L - Alaska & ENVIRONMEN)-AL P)'OTECTION * ATTACH WELL LOG. A well log is required for all wells drilled ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 OCT 2 8 9980 since June 1975.1=or wells drilled prior to that date, give well REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S�U riff 153 depth (attach log if available.) DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONEE ,/rX MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION_ - Ze MAILING ADDRESS 4. REALTOR/AGENT PHONE- MAILING ADDRESS - 5. LEGAL DESCRIPTION—s® STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One W Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY kj INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975.1=or wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM / �' 6_YEAR X' INDIVIDUAL/ON-SITE** / C) ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) N -'n THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY - ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED nn AA 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER t j - (� ❑ Septic Tcannk or ❑ Holding Tank Size: 0-.7 6 If Tank is homemade give dimensions: SOILS RATING TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS QAPPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED 1 DATE ^` BY