The URL can be used to link to this page

Home My WebLink AboutKASILOF HILLS BLK 7 LT 17 MUNICIPALITY OF ANCHOI?AGE DEPARTMENT OF FIEALI-FI 8,.~ ENVIRONMENTAl_ PRO'IECTION ENVIRONIVlENI'AI. ENGINEEI:~ING DIVISION 825 l_ Street- Anchorage, Alaska 99501 Telephone264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WEI.I. iNSPECTION REPORT UPGRADE IMAILING A D/~gESS .~ IL~GAL DES~RIPTION ILOCATIO~5T Absorption area DISTANCE TO: I0_~ _ _/~ Manufactur DISTANCE TO: IF HOMEMADE: Well I nsicle length Dwelling Length Top of tile to finish grade Width I~)lat er~al beneath Depth fDweliin9 z Materj~l ~ Wid~ Material NO, OF BEDROOMS Liquid d~pth PERMIT NO, Liquid capacity in gallons PERMIT NO. Total eff{~;tive absorpbon area PERMIT NO. Type of crib Crib diameter Crib depth Fotal effective absolptron area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line I PERMIT NO. DISTANCE TO: Building foundation Sewer line S01)tic tank ~Ab~rq~tition a,ea(s) OTHER PIPE MATER IA b~$ ~ ~ SOl L TEST RAT?cL~ t~L~ INSTALLER REMARKS APP DATE LEGAL THE DEF'TH OF F:i 'I'F;i:E~i',[CF! (:)F~: F:'!T (]F~H:)L!!'.:[[) F:lh,![:, TI..f[:i: !'~()TT()I"! OF F!.-!E:: E::'::CFI',,,'FiT:[CIH 'T'Hi~:F['.fZ I:L': NO SE'F !,.!:!:[)TH F::O[~: T!.-I![~: (:~F:F:!',.,'EL [)[~:F:"I"H It!il; THE: HINZ!"!U!"! F:ff'.J,D T!-I[~: [!!;()'l' 'T'()I"! C!I::' THE: E:::.::CF:I'v'FIT :[ Oh.! ,:] :[ H :i: i'.,t I HLt!"! I:::, I S'T'F!H(:::lii!: :!.. [i!!il~!~ t::'!~:[~:'f" I_.i[::'(~'jI.,! "i'H!E 'T'"c'P!iE I'"I :f: !",I Z t'"!LII"I [:, ]: S'TI::II'.fl:::E 'i"O Fi !,![~:L.!... !....()(:!iS !:::ll:~:[ii: !:::IF' !'FIE HELL. OTH[!i)~: F;!I~:(i:!I..I I ff,/F1 ). !. .. F:! E', !.... [:!: TCi T c'. :;'F:'""" F~' ,' 'T'!"!i:::t'T ;:!..: ]: !::ff"l FF:I!"!II..:[Fif~: !:[-I'i-! THE FOI~J'.TH [?,"r~ 'T'F't[ii: i'!L!I",! :[ C J: F'F!L. :I: T", r' !:::' ,'::'- .... 'r,. I,-!:f:!...L. I:I",!:!FTF:I ...... T!'!,C '""~,~ :~ ....... 1 ::i:: :[ !r..li",l[::,!J:il!;i::iii;'!"l:::lf',!l:::, T'I-!i::!T THE (::~F,l.".!ii;]:'i'Ti: ;:: ;::'F' ]' ' ~:: ,.t ~:;, ... :::, .../::, ::. ~'~r-~ .................. ;.. - ........ ; ,,~ ................................. ................................................... PERFORMED FOR: LEGAL DESCRIPTION: [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS WAS GROUND WATER ~O SL ENCOUNTERED? O P E IF YES, ATWHAT DEPTH? Gross Net Depth to Net Reading Date Time Tirne Water Drop PERCOLATION RATE t~~['~ (minutes/inch) TEST RUN BETWEEN ,I~.~,,,,~ FT AND ~ FT DATE: 72-008 (6/79) 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 015-132-22 HAA# 1. GENERALINFORMATION Complete legal description Lot 17, Block 7, Kasilof Hills Subdivision Location (site address or directions) 10201 Stroganof Drive Prope~y owner Tom McCabe Day phone q46-?QRq Mailing address 1 0201 Stroganof Drive Anchorage, AK 9951 8 Lending agency Mailin. g address.. Day phone Agent Day phone.. Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank ............................... Community-on-site- Public sewer XXX NOTE: If community wastewater system, provide written confirmation from r attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA i¢2.1 '- o 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 Ancterson Engineering _ Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature Date 2/1/99 DHHS SIGNATURE Approved for ~Ok'~'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulatic Additional Comments By: The Municipality of An'chorage Department of Health and Human Services (DHHS) issues Health Authority ~o,~al 'Cei'tifidates-based "only upon-the-representations given' in paragraph .5 above-by, an -independent ............ professional eng!neer 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. 72-825 (Rev. 1/91 ) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN sERviCES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4'744 1999 Health Authority Approval Checklist Dept, Health & Human Services Legal Description: Lot A. WELL DATA Well type Pr~ va~e Log present (Y/N) Total depth 200 ~ Sanitary seal (Y/N) 17, Block 7, Kasilof ParcelI.D.: 015-132-22 }Jills Y Date of test Static water level Well production 1 WATER SAMPLE RESULTS: Coliform 0 Date of sample: 1 / 21 / 99 B, SEPTIC/HOLDING TANK DATA Date installed 9/82 Foundation cleanout (Y/N) Date of Pumping 1 / 22 / 99 C. ABSORPTION FIELD DATA Date installed 9 / 8 2 Length 9 0 ' Width If A, B, or C, attach ADEC letter. ADEC water system number Date completed 8 / 13 / 82 Cased to Bedrock 29 ~ Casing height (above ground) FROM WELL LOG 8/1 3/82 Wires properly protected (Y/N) 2I AT INSPECTION 1/,23/99 18' 35' 1.3 g.p.m, g.p.m. Nitrate Tanksize 1,250 .204 mq/L .Otherbacteria_ O Collected by: Bob Cowan - S&.q 'Rng~ ¢_~_r'i Pg Effective absorption area 1 ~ 4 40 Date of adequacy test _1 / 23/99 Fluid depth in absorption field before test (in.); 2" Fluid depth 4" (ins) Minutes later: 157 Peroxide treatment (past 12 months) (Y/N) N 72-026 (Rev, 3/96)* Number of Compartments Depression (Y/N) N High water alarm (Y/N) 2 Cleanouts (Y/N) ¥ ,bedrooms Pumper Northland Pumping Soil rating (g,p.d,/fF orfF/bdrm) 300 SF ' Gravel thickness below pipe 8 ' _Total depth 1 2 ' SFMonitodngTube present (Y/N) Y Depression over field (Y/N) _ Results (Pass/Fail) Pass For Four __ Immediately after4 7 2 gal, water added (in.): 1 0.5" Absorption rate = > 6 00 g.p.d. If yes, give date System type :Deep Trench N D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons F. - None on Lot On adjacent lots > 100 ' On adjacent lots > 100 ' Public sewer manhole/cleanout Lift station N / A Wells on adjacent lots "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot > 100 ' Absorption field on lot > 100 ' Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ' Property line > 5 ' Water main/service line > 25 ' Sudace wateddrainage > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 Surface water Curtain drain None on Lot ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections in conformance with MOA HAA guidelines in effect on this date. Signature ~'~¢-~ Engineer's Name Mi (~h~l Date 2/1/99 "Pump off" level at* Absorption field > 5 ' Wells on adjacent lots > 1 of) ' Water main/service line > 25 ' Driveway, parking/vehicle storage area > 10 ' >lO~' HAAFee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWAN, RE. ROBERT A. SHAFFR, RE. HEN,TN ALq'HOR[TY ~EWER ~ WATER WATER INSPECTtON WELL INSPECTION & FLOWTEST ROAD D[SIGN $OlLTEST ON SITE (~$PO~AL SYST EM DESIGN ADEQUACY TEST FORM CLIENT: ~'-0 ~q M (.- C ,4 ~ ~ LEGAL DESCRIPTION: /.-0T 13 ~,LoC~c 7 ~'~-~F CIVIL ENGINEERS (907) 894-2979 DATE:*/q '7 #OF BEDROOMS: ~ SEPTIC TANKfFIELD SEPERATION TO WELL: TYPE OF AB$ORPT{ON SYSTEM: 7-,~.e.,¥ c ~ ~EPTIC TANK SIZE: _ .} ~, ~LB_._S. ORpTION FIELD ~AT~: Depression over field (Y/~: /v 0 SEPARATION DISTANCE FROM ABSORPTION FIELD TO; SEPTIC DATA: ,LIFT STATION: Driveway, parklnglvehlcla ~torage araa: Curtain drain; Foundation: Date of pumping: Foundation =leanout ~N); !'PUMP ON" level at: Pumper: Depression (Y4~): METER OALLONS LIQUID LEVEl. TIME READING A_.0DEO ~' ec¢,~ COMMENTS (TOTAL) S.T. M.T. M.T. I~I~SULTS: PASS/FAIL: EXPLANATION: TESTED BY: ~ C . THIS SYSTEM IS NOT GUARANTEED AGAINST SUBSEQUENT FAILURE · 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGL[ RIVER, ALASKA g~577 01/28/1999 18:46 9076941211 S AND S ENGINEERING PAGE 05 ROBERTC, COWAN, RE. ROBERTA,$HAFER, RE, CIVIL ENGINEERS SEWER & WATER MAIN EXT~NSION~ ENGINEERING STUDIE3 W~LLINSPECIION &FkOWTEST ROAD DE S IG N PERCOLAIION TEST STRUCTURAL& WA$1F. WATER DL~PO~AL SYSTEM (907) 694-[:'970 FAX (907) 694-1211 WELL FLOW TEST DATA CLIENT: .TO~ /~ ~ C ~ ~ ~ DATE: //,~ ~/?__~ LEGALDESCRIPTION: ~ t ~ ~oc,~ ~ ~c~u~ ~,~ j WELL DEPTH: ~0 o ' CASINe DEPTH: ~. ' -~ DATE DRILLING COMPLETED= DRILLER: jMISC. DAT/~ CASING HEIGHT: I /-'~" SANITARY SEAL: >~ ~f WIRES IN CONDUIT: ¥~J- GI~.DING O.K.; Y/~ .£ BACTERIA AND NITRATE SAMPLES COLLECTED (date): _..~/~- r / ~ q .._ TEST DATA: ,~v,, ..... ' METER' ~'~JMPING" ' b'~=~TH T° ........ CLOCK READING RATE WATER REMARKS TIME {GAL) (GPM) (FT) - ,,,, ~ ..... ~~ , ~.,~SULTS: WELL CURRENTLY PRODUCES I, '~ GPM WITH A t 0 o/ DRAWDOWN TESTED BY: ~ 0 ~' C~. FLOW RATE NOT GUARANTEED..SUBSEQUENT VARIATIONS CAN OCCUR. 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, AL.A~KA ~9577 01/28/1999 18:46 90?6941211 S AND S ENGINEERING PAGE JAN-~8-Sg Og:l~ FRO~I,.~TE Efi¥1RON~NTAL ~6i~301 T-$15 P.O~/03 F-B?O P~r~er KesuL~s P~k Wni~ o.lOO mll/L DATE: TO: FROM: SUBJECT: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM February 1, 1.999 Onsite Services Engineer Mike Anderson. P.E. Lot 17, Block 7, Kasilof Hills Subdivision Separation Distance Well to Septic Tank RECEIVED FEB 2 1999 Municipality of Anchorage Oept, Health & Human Sorvlce~ The septic tank on Lot 17, Block 7, Kasilof Hills Subdivision was installed in September of 1982. The as-built completed at that time by Jolm Kennedy of the City indicates the tank was placed 12' fi'om the house foundation and 105' fi'om the proposed well location. The surveyed and certified as-built of the lot completed in January of 1997 by Tryck, Nyman, Hayes, Inc. shows the well location and the back cleanout of the septic tank. We have added the septic tank to their drawing using the back cleanout for control. Their measurements indicate the well is at least t00' fl'onl the septic tank. Based on these documents we are confident the well is 100' from the septic tank. JAN-29-99 FRI 11:19 TRYOK NYRRN HRYES INO =, F,qX NO,' 9072767679 .LEGI:,ND, / / NOTES P, 01/0I SCALE 1"=40' AS BUILT I hereby certify that I hove performed O Mort~ ;n.~pection of the tallowing described proDerty: LOT ,1,.7,, BLOCK 7, , AS .OF H LLS Anchor~ Recording Oistrlot. Alaska. and th~ ~he provements sltuoted thereon ore w~[hin the property line end do not O~rlop or encroach ~ the property I~ng ad,cent ~heret0. th0t no ;mpr0~ents on pre- tty I~ng ad,cent there~o encroach ~ the premises tn ~uesfion and that there ore no roodwO~, trans- miss;~ I;nes ~ other ~ible ~s~en[s ~ s~id prop- ~ty except ~S indicated h~e~. Dated at Anchoroge. ;mis . 1:3~__ T~YCK N'flvlAN HAYES, INC. Sur v~rs/En g;neers/Ptcnn ers/L~ndsca~e Architects 911 w. 8tn A~, An~oroge, Ag g9501-3497 (907)27g-0543 FAX: 276-7679 ~ .... ~., DEPARTMENT OF HEALTH & HUMAN S 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 Parcel I.D. # - . 1. GENERAL INFORrMATION Complete legal descriptipn ..... / Location (site address or directions) Property owner '. ~r'J :TOP~' Day phone Lending, agency~'~' ' Mailing ad,ross' ' ~gent .~,, .... . Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~OL/I~-.. 'V TYPE OF WATER SUPPLY: Individual well ,¢-- Y', ;~ Community well Public water '~C~WAL SERVIce8 DIVI$10~. dAN ?-1997 RECEIVED NOTE: ing to the legality and status of system: TYPE OF WASTEWATER DISPOSAL: Individual on-site, ~ ¢. 7. ' Holding tank' ' ';" ' ' '"; Community on-site Public sewer ' ~ ' NOTE: If community well system, provide written confirmation from State ADEC:atte¢t- If community wastewater system, provide Writt'bn confirmation from State ADEC attesting to the legality and status Of system. 72-025 (Rev. 1/$1) Front MOA#21 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. NameofFirm //~JO~"(7~O~J ~,/,t,J~FIZ, tx, J~ Phone Address ~0 ~O,~L, Z.'-/O ~'7~ /~ (~a rZ.¢l. ~ ~' Engineer's signature f DHHS SIGNATURE ~'-~Approved for ~./z~LL/) Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date '~-~fhe Muni¢i'~alit~x~'~',~nchorage Department of Health and Human Services (DHHS) issues Heallh Authority ApPr~v.a.l,~b_rtifi.cates 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, 1/91} Back MOA iff21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division: ~4~y [ D 825 L 8tm~t, Room 502 · Anchorage, Alack8 @@50i · (~07 JAN Health Authority Approval Checklist Legal Description: A. WELL DATA Well type Mumcq)ality ol Anchorage Parcel I.D',: Dept, Health & Human Services Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water s,stem number Date completed ~//~/~' ~L. Cased to ~'~-'1z°¢]'"-~'°'~7-9 asing h~ight (above ground) ~-~ k~" Wires proper)y protected (Y/N) 'Y Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ Date of sample: / Z/L'I B, SEPTIC/HOlDING TANK DATA Date installed FROM WELL LOG Nitrate g.p.m. AT INSPECTION ,/.iq g.p.m. ,~ / /¢1 '..~ Other bacteria Collected by: ,~' l¢/ftd'Z~ ~ Foundation cleanout (Y/N) Date of Pumping ,/~0/~ C. ABSORPTION FIELD DATA Date installed ~ / ~ Length 6/~) Widtl~ Number of Compartmbnts ~"' Cleanouts (Y/N). Depression (Y/N) ,~ High water alarm (Y/N) /~J _ Pumper f'~', System type Soil rating (g.p.d./fF or.ft2/~Cbd.r.E)) ~'~/'~ :'~ ''" b --6.';~--P / Gravel thickness below pipe ~ ! Total depth / Effective absorption area /t' q¢~¢) t-WTMonitoring Tube present (Y/N) Depression over field (Y/N) /~ Date of adequacy test _ //~/c"//,, Results(Pass/Fail) /"-"~*.,~5 For f~-:t-~¢"t'~ bedrooms Fluid depth in absorption field before test (in.); ~-. ~ ~"' Immediately after ~O~)ga. water added (in.): ~. ~ ¢' Fluiddepth ~-~YZ~-~' (ins) Minutes later: Z/"// /'-//c$. Absorption rate = ')'~¢c0~) g.p.d. Peroxide treatment (past 12 months) (Y/N) /J If yes, give ~ate 72-026 (Rev. 3/96)* -~=~L~STATIO N Date in~~.._~.__ Size in gallons Manhole/Access (Y/N) ~~¢~______~_~ "Pump off" level at* High water alarm level at* *Datum -~ Cycles tested E. SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~ f~ 0 ! t On adjacent lots On adjaceni tots Public sewer manhole/cleanout Lift station ! SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation '~ ~'~' ! Property line '~/~ ~ Absorption field Water main/service line ~ 'Z,~"' Surface water/drainage *~/00 ~ Wells on adjacent lets SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation ~, /O / Water main/service line ~" Driveway, parking/vehicle storage area "~' /'0 ~)~J ~, ,r' Wells on adjacent lots '~/~O t F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name /t//ic4''j4-L''~'''C" '-~ ~C~ ~O *J Date ;'above systems are HAA Fee $ Date of Payment \._ \~ .o~-'j 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 18:15 CT&E ESI ~NCHOR~GE ~ 5~5~8~ N0.817 ~0~ li,CT&E EnvJroomelltal Services Inc. CT&E Ret'./] Client Name Preject Name/t/ Client Sample ID Matrix Ordered By PWSID 967075001 Aader.qon ~l~giaeeritlg L17 B7 Ka,siloff Hilb S/D Private well water Dd~ng Water Sample Rem~trks: Smnple collected by: A.H. Client POt/ Printed Date/Time 12/30/96 16:07 Colltxted Datc/Tin~ 12/27/96 13:30 Received Date/Time 12/27/96 15:50 Technical Director: Stephen C. Ede Released By Nitr~te-N Total Coliform O,lOO u o Altouab[e Prep Analysis PaL Unit~ Method Limits Date Date Init 0,100 mu/k ~MlO 4500-UO$r 10 max 12/2fl/96 eMB 0 col/lOOmL aMI§ 9222B 12/27/~6 TAV From : RLPINE DRILL 90? ~45 0202 ~Tan. 08. 1997 . . ,.' ." ?ATERWELL.~ TES~ PUMP~ REPORT'. -..' ,'-'?,. 1......:.. ~.,, ~,;~2~~ 7 ~.~. ]: . :':--7. .... . .... . ' . Cnsln9 81ze /~' ' 8eroo~ OIom ' ' . .S~rooa S BI ., '~ ' ' ... ' · ,', ~,m.~, - ' · - ' · ~~ ~'"':~ ~um~ o,; w~, t~ 17~ ~ u~, ~.'.-~,~, o,: ~ · ' wm,~~n,~o~../'~ ~'~ WATEfl PIF. ZO- FLOW REI~ARI~.8 TIME WATER PllilO. FLOW REMARKS TIME LEVEL 'TUBE GPM LEVEL TUBE OPM ,~'LZ_~_" .... , - ~ ............. : · '. ~ · - _~__/~ ~ . j' ...... .~ /~/., ,_~_~ ~ .~ ........... ~.-¢7 · ~ ~~ ~-~- ~ - ' rf ' . 'J . . ....... . . ~_._,~ .~~_' ~ ~i ~ ~.~ ........ '' '~ ' ~~'.~. _e_2 ~~ ~ ~~~ ......... ~ ~~'~ ~.__.__,_ . .... . ~_ ~~ ~. ~ ~ ~ _~_. ...... _ ........ ~d~.~ ~ ¢~: ~ ~? ~, ~ .,. _. · ...... ~ .......... ~ ....... . 2 .................. APPLIC, FILLS OUT UPPER HAL ONLY Property Mailing Addre~ Buyer Address zip Code_~_~?' ,.. ,~ Zip Code Phone Lending Institution Realty Co. & Agent Address Zip Code Phone Z.-?& ~'~'~" Phone Legal Description ~ ./.~¢ ~ ,~/ /Z~/-'~, % / 4 0 t-- Street Locati~ /C~ ,~ F;) / "~ ~ ~ ~ ./~ /}J ~) /'- Type of Residence ~- Single Family Bedrooms~/~¢ ~ Multiple Family No, of [ ~ Other Water Supply ~/'-Individual ~. ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Li Community ~.! For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ~' Individual [] Public Utility Lq Holding Tank Year Individual Installed: ____~/~_~' When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date Inspector Time Time Date Inspector Date inspector Date Inspector APPROVED BEDROOMS ( ) DISAPPROVED ( ) CO~DITIgNAL A~?~,I~VAL' BY:[)ATE -~'~L~- MUNICIPALITY OF ANCHORAGE 0~P'I', 05 H[!ALrH 8, ~-INVIP, ONMEN rag PRO FECTION AUO r: 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to 'rank Well Log Received Septic Ta~k Size