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Home My WebLink AboutMCKINLEY VIEW ESTATES BLK 2 LT 4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL iNSPECTiON REPORT ~NEW [] UPGRADE NAME MAILING A:DR ESS LEGAL DESCRIPTION LOCATION Well DISTANCE TO: ~lY~, li~ Manufacturerf'3 [Liq. cap&cit~in ~allons DISTANCE TO' lWell ' I Manufacturer DISTANCE TO: I /T°p°ftilet°fi')jshgrad°~ / Length Width DISTA~¢[ TO: Buildin~ ~oundation Absorption area_ Inside length Dwelling Materi~¢ NO, OF BEDROOMS No, of co?~artments Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons Foundatio~.~ (~ ~- Total leng~4~Eof~i n es Material ~neath tile Material J Trench ,,.v~d~: inches Depth inches Distance be~r~)en lines Total e.,~eti~6 a~rption area PERMIT NO, Crib depth Total effective absorption area Building foundation Nearest lot Fine Driller Distance to lot line Sewer line Septic tank IAbsorption area(s) OTHER MATERIALS_ SOIL TEST RA~ING REMARKS APPROVED f i,' DATE 72-013 {Rev. 3/78) LEGAL F:tP F'L I ClaNT L OCFI]" I' ON LEGRL STEVEN SKRGGS CEINSTRUCT I:"0 BOX D CHUC-iIFIK 9956}"" L4B2 M(".:KINLE"r' ",,'ZEN ESTFtTES LO'l" SIZE 688'"-28~:i :'.:)S'~VSS~ SC:!UFIF4~E FEET '),:'.r'F'E OF SC)IL FtE~SORF'TION S'¢STEH :IS: TRENCH i'iFiXIHLiH I'.,IUHBER OF BE[:,ROOHS ~:: 4 SOiL RFITING ,::S6! FT,.."BR>= 22[5 THE I:;~:E(:':!LtIRED SIZE OF' THE SOIL RBSORPT ]( ON S'¢.STEM IS: ')''HE LENG"t"H DIMENSION IS THE LENGTH (IN FEE]") OF THE TREi'.,ICH OR DI;.:FIIt'.,IFIEL[,. THE DEPTH OF Fl TRENC:H OR PIT .'I:S .['HE DI'S';TRNCE BETI.qEEN "FHE SURFI::iCE OF 'f'FIE GROUND RND THE BOTTOM OF .['HE EXCFt'v'RTION ,:.'IN FEET). THERE iS NO SET NI[:rTH FOR TRENCHES. '1"HE GRFIVEL. DEF'TH :IS 'I]4E H.iNi'HUH DEPTH OF GRFtVEL BET!4EEN THE OUTFFtL..L F'IPE FIND .['HE E,'O.['TOH OF THE EXCRVR]"ION (IN FEET). PERMIT FtPPLtC:RNT HRS THE RESPONSIE,'IL I'T"r' TO INFORM THIS DEF'RRTHENT !.'::,URII",tG THE INSTRLLRTION IN::];PEC:TIONS OF' RN"r' P.IELLS FI[:,JFtCENT TO THIS PROPERTY" FIND THE NiJME~ER OF RESit}ENCES THFIT 'THE !.,.tELL 1.4ILL SERVE. .............. T' ~-,,-ti C"." ":: ~!.t" ::" Z It"-,~ ,"%; F" ESE (Z: qF ][ "2" ~.',!I `"SS7, IFil IF:-"." EE IF;r.:'.' ESS ~]r-~. L.tt % t1:;~: EE E) BFtC:KFILLING OF Rl",!'-r' S"r'STEM 1.4ITHOUT FINRL IIqSF'ECTION FIND RPPROVRL Bk" THIS [:'EPRR"H'tEI",IT 1.4IL. L BE: SUBJECT TO PROSECUTION. HIt'-~IHUH [>IS'TRt",ICE E~E'T'NEEN FI NELL. FII'-,I[:, AN"? ON"~Si'FE SEi.,.tAGE [.,ISF'OSFtL. SYSTEH IS :LEIE~ F'EET FOF.'.' FI F'RiVFfTE t4ELL OR ;:LDE~ TO ;F_'E~3 FEET FF.'OM A PUBLIC t.,.IEL. L DEPENDING UPON .['HE "t"'¢PE OF PUBLIC NELL. i'IINIHLIH [:,ISTI:RNC. E FROH F:t i:::'RI',,,'Ft]"E I.,.IELL TO IR PR]:VFrrE SEI.,.IER LIt'.,IE IS 25 FEET FIND .['0 F~ COMHUt'.,II'T'.¢ SE!4ER LINE IS:; 75 FEE'['. OTHER REQUIREMENt'S HFI'¥' RF'PL'.¢. SPECIFICRTiONS RND CONSTI:;.'.UCTION DIFIGRFIH. S I::IR.E FI',,,'FiiLRE:d_E TO :INSURE: PROPER If'-,tSTFILJ..RTION. i' CERT I F"r" "fHFl'i" ::i..: I FtH F:'IVHIL. Itq..R WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIN[> t.,.IELLS FIS SET' FORTH B'¢ THE MLIN I C Z F'FIL I T'¢ OF FIt'4C:HCU:;.':RGE. 2: I I.'.IILL INSTRI..L THE S"r'STEM :[Iq RCCORE:'RNCE I,.IITH TNE CODES. :ii.: ;i: UNDERSTRN[.', THRT THE OI'-,I-S.1:TE SEI4ER S"r'STEM MFI"r' REL::!UI'RE ENL. F~RGEt"IEN.[' It:' .['HE RES It}Et",tC:E IS REMCE:,ELEr.'!, ~.~:) i t'.,f~::L. UDE MORE THRi'.,! 4 IF~EE:,ROOMS. ¢'/ /' ~ ? ._-;,4. Al.'. FIPPL I CFtNT S]]TE',,,'EI'-,t SKFIGGS CONSTRUCT i ON ., ........... :: .,), , , ,, . ( /,: . Ptussell Oyster 694-2774 O & E ENG.,qEERING & DEVELO, Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Performed for: Name: ~'~ T~F Mailing Address: Legal Description: LOT- ~ / ,vIENT CO. SOIL LOG 688-2280 Depth (feet) 0 Soil Characteristics 8__ 9__ 10__ -,11 __ 12__ 13m 14__ 15__ PLOT PLAN '-'g~c: P RC. TEST J Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No If yes, what depth Drain Field Performed by: Date: :~-/~ E:/oc~ ::~ Russell Oyster 694-2774 O & E EN(~.,~IEERING & DEVELO, Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 MENT CO. Earl Ellis SOIL LOG 688-2280 Performed for: Name: d',//,~[.~ ~ c~ ~?~ ~/4/',/ ~~ /~2,~u?/~-~x-~/~,4$£/V r Tel. No. ~.-~Z~?(o Mailing Address: 1~ ~)' z'~o ;~. ~ ~ '~,, ~/-~,~,~ J?~.~/~-/.z_, /-~/¥~ '~'~'~ '7 '7 ~.L~= Soil Characteristics Legal Description: Z~ ~ T ~, Depth (feet) 0 1__ 3 4__ 5__ 6__ 8__ 9__ 10__ 11__ PLOT PLAN 12__ PERC. TEST 14__ 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No //~ if yes, what depth Drain Field Performed by: 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 1. GENERAL INFORMATION Complete legal description Lot 4; Block 2; McKinley View Estates Subdivision Location (site address or directions) 22463 Centurian Drive, Peters Creek, Alaska Property owner Leo and Donna Yeager Day phone 688-5584 Mailing address P.O. Box 671693, Chugiak, Alaska 99567 Lending agency Mailing address Day phone Agent Address HOMEQUITY ~1700-32243 PO ~25460197 Unless otherwise requested, HAA will be held for pickup, 4 NUMBER OF BEDROOMS: Ed Masingale/HOMEQUITY Day phone. (415) 246-6544 1855 Gateway Boulevard, Suite 950, P.O. Box 4039, Concord, California TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 94524-4039 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 ADEG attesting to the legality and status of system. 72+025 (Rev. 1/91) 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 omsite 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 _ i ¢..'~ ~c,,~l~£~J ~bLG_ .... ~. Address _ ~_ ,~.~ ~: .... ~,~.,~ ,~d,~7~ ~'- Engineer's signature .~ ~ DHHS SIGNATURE .~./~. Approved for ~~_)bedrooms. Disappro~/ed. Phone ~_Y'"~'Z ~¢/'2~'~ Date _~_/~' ~- Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 DH HS 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. 72~02,5 (Rev, 1/91) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A. WELL DATA Well type Log present(Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Total depth Date completed Driller Sanitary seal (Y/N) Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level 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 Public sewer manhole/cleanout Petroleum tank z~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: SEPTIC/HOLDING TANK DATA Date installed ~ Cleanouts~N) ~ -- High water alarm (Y~) Date of pumping Tank size l'~ t~c~ Compartments Foundation cleanout (~/N) ',/ .... Depression (Y~,) Alarm tested (Y/N) ,~/j.4~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~c~o "~ On adjacent lots To property line /4~ Absorption field Surface water/drainage / ~ o Foundation Water main/service line 72-026 (Rev. 3/91) Front MOA 21 CONTI NU ED ON BACK PAGE [LIFT STATION Date installed Size in gallons Vent (Y/N) ........ "Pump on" level at High water alarm level Meets MOA electric~l-~s (Y/N) SISP/\I~/~ION DISTANCE FBOM LIFT STATION TO: Well on lot .... On adjacent lots Manufacturer Manhole/Access (YYN)~ "Pump off" level at Cycles tested Surface water ABSORPTION FIELD DATA Date installed 'd~':izA_,%~_)'~ _ Soil rating ¢~l'~'~/~fz,- _System type 1¢~{~¢Y-/~/~-~¢ __ I_ength ~.~ __.Width ...... :5~. Gravel thickness -~ Total depth ~._ Total absorption area ....... ~L(~ ~ ...... Cleanouts present ~N) Depression over field (Y~ ............. ~ " Date of adequacy test Resull:s~fail) .... ~SS ?-- for ~- ~ bedrooms Peroxide treatment (past 12 months) (Y~ ~tZ_ If yes, give date _ SEPAI::tATIOIXl DISTANCE FROM ABSORPTION FIELD TO: Well or, lot ...... 'l'e building foundation /O On ad.jacent lots Surfa¢;e water Curtain drain E,, IENG~NEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o~-lhe,d.a, te of this inspection. I-IAA Fee $ _ ~.' ~:--7~ ~'--~----'z .................. 72 0;~6 (IJOv, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 June 25,1991 WALTER J. HIOKEL, GOVERNOR 563-6775 FOR: S & S Engineering Ray PWSID #210697 My review of the records on file in this office reveals that the McKinley View Subdivision Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '~H~)~'e~'~ - Telephone: Home~O.~_~j~-~ .'-~ o~c/ Business (c) Applicant is (check one): Lending Institution []; Owner/builder'S'; Buyer []; Other [] (explain); (d) Lending Institution ~c, ~.~ ,,~ A=. V~,¢¢¢-,~,~,-~ Telephone Address qq~ L~, '-4'~0~' ~ ;~,-¢~",4~ ~Ot (e) Real Estate Company and Agent _"~¢~:~4~-- ¢ ~ ~ ~ · Address (f) Telephone Mail the HAA to the following address: $ & S ENG~NEEPJNG, SRB TYPE OF RESIDENCE Single-Family~ Multi- Family ~.~'-~t h er Number of Bedrooms ~_~. ,-,)~ 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 ai~d status. 4. SEWAGE DISPOSAL OnsiteJ~' Public E] 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 1 of 2 72-025 (lb84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA iA AND INFORMATION ~ · As certified by my seat 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 the date of this inspection. Name of Firm Address ~-~, Date Telephone Approved for ~/~ ./~¢__bedroomsby¢'"~ c~"~¢'~ate ~rPrmOsV~conci~.~o~nal Approva~iSapproved _ , Conditional 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) Well Classification~-'~ 4 MUNICIPALITY OF ANCHORAGE (MO~) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ? ~3,'~ / ~r- TO Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ¢¢,¢ '"~' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~f4) Air-tight Caps Y~N) Depression over Tank (Ye) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: ~/. ,~,/'~ Size ~'~ ~'c~ No. of Compartments Foundation Cleanout ~N) Date Last Pumped ; for To Water-Supply Well To Property Line To Water Main/Service Line Course ~'//~ Temporary Holding Tank Permit (Y/N) 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 ,.~A' ~ Type of System Design Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~_ ~ To Building Foundation ,-~ '¢ Length of Field _ ~'~ Depth of Field _ _ Gravel Bed Thickness __ Standpipes Present (~/N) Date of Last Adequacy Test To Water Main/Service Line ~'~ ¢-¢ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) f'[//I ___ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t i~at~i~a~:~~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date Signed S~~ Compan~~ MOA No. Date of Payment .... ~ ~/ ~ ~ Amount: $ Page 2 of 2 ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BIlL SHEFFIELD, GOVERNOR 7blephome: (907) Address: 274-~533 DATE: ~2-o2-86 PWS I,D.~ 210697 To Whom it May Concern: According to records on file 'in this office the SUBDIVISION Water Regulations MCKINLEY VIEW Water System is in compliance with 'the State Drinking Sincerely, MONICIPALJT¥ OF ~CHORAGE DIVISION OF ENVIRO~fAL ~tE~TH DEPk~NT OF I~ILTH AND E~IRO~IENTAL PROTECTION APPLICATION FOR ~I~TH AUTHORITY APPROVBL CERTIFI~A%E (a) Legal Description (inclu~. lot,~ block, subdivis~)G section~gwnship~ rm~ge) (b) Applicaa~s NameA~ ~.~,U /~'~/~ -. Telephone - Home / (c) Applicant is (check oae) Lending I~,tit~tion Buyer ~ ; Other [[5[~ (explain); (d) Lending Institution _~: //(~f Address Real Estate Co,, & Agent Address Telephone (f) Mail the ~. to the following ~xldress: 2. Ty_yj!e- of Residence S ingle-F amil y '~5~~' Number of Bedrooms Multi-,Family ~i~'JlI Other (describe) ..... 3. Water Su_E~p_I,z' Note: If community well system~ faust have wr'f. tten co~'irmation from the State Department of Environmental Conse~atioa 4[.t7 stin~, to the legality and statur;. 5~o~e~ If c~muni~-,,..~ well system~ must have writ:ten cor~irrttat, ior~ f~:om the Department of En,lr'o~nental Conservation attesting to the legality and status. [Page 1. of 2~ e ~3~Jneerin.g .Firm Providi~n~_~l:~.t~t~ecti°t~sz__~_['ests~File Search, Data and Infomaation As certified by my seal affixed hereto and as of the validation date show~:~ 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 t'he i~nicipality of Auchorage files and from my investigation and inspection~ the on-site ~ater supply and/or wastewater disposal system is in compliance ~ith all Municipal and State codes~ ordinances, and regula- tions in effect on the date of this inspection~ Tel ephone Name of Firm' (ENGINEER / DttEP Approval Approved , for Approved _~__ bedrooms By Disapproved ..... Conditional Tezm~s of Conditional Approval~ C ADT I 0 N THE MUNIC'IPALITY OF ANCttOILIGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION CER.[.IFI6,:,.II,~ BASEl) SOLELY UPON THE REPRES~r~NT'- (DHEP) ISSUES }:Dr, ALTtI A[JIti[itlTY APPROVAl ATIONS GIVEN IN pA~GRAPH 5 ABOVE BY ~'f INDEPENDENT PROFES~ONAL E~G_NLLI.,. R~,GISTERED IN TI~ STATE OF AI.&,S~o ']?~E DHEP DOES THIS AS A COURTESY TO pURC1AiSERS OF [tOMES AND THEIR I~ENDING INST[~.UTION~ IN ORDER TO SATISFY CERTAIN t~nDELAL ~qD STATE REQU!RE~' .~o .., "' OR ~A.LYZE DA. TA BEFORE A MEI'~.~ EMPLOYEES OF DHEP DO NOT CONDUCT CNR[_.olCA1E IS ISS~f~D~ %'~ MONICIPALI-Y OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE pROFESSIO~L ENGINFERNS (DHEt~ SEAL) RR4/ej/DlS [Page 2 of 2] 7-19-'.84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A® Date completed Yield Pump Set At Well Classification Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Abo,ve .:G..~0und Electrical wit{igc'in ~du-it (Y/N) Separation 'Distances f~om Well: To Septic~Tank on LC).t ~ To Nearest Edge of Absomption Field To Neares~ public] Sewer Line Cleanout/~anhole . Water Sample C6ilected ~y Water Sample Test Results Depth of Groutinq Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~.j~ -/~; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Co,~nts 80 SEPTIC/~ TANK DATA Date Installed '~131 ~'~ Size _~%~-O No, of Compartments Standpipes ~/N) Air-tight Caps ~N) Fou~dati~ C!eanout ~/N) Depression ove~ Tank (Y~_~. Date Last P~d 7/~/~."~~ Pumping/~intenance Contract on File (Y~) ~., for__ ~_ Holding Tank High-Water Alarm (Y/N) A//~ . Temporary Holding Tank Permit (Y/N) Separation Distanoas f-~om Septic/H~ Tank: To Water-Supply Well 2~? 7 / To Property Line /~ To Water Ma!~rvice Line Course , TO Building Foundation To Disposal Field To Stream, Pond, Lake, cr Major Draina,~e [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absor~tio~ .S.t~ata Date Installed ,S~/1~,~'~ Width of Field .~9(co Square Feet of Absorption A~ea Depression over Field (~ Results of Last Adequacy Test Separation Distance from Absorption Field: of System Design Length of Field ~-' / Depth of Field .// / Gravel Bed Thickness Standpipes P~esent~/N) of Last Adequacy Test To Water-SupplY Well ~ Z~ d.'?~'C~~' -/- TO P~operty Line /C /-~ l To Building FouNdation ,'~7~._~-~ To Existing or Abandoned System on Lot /%//~ ; On Adjoining Lots ~ To Water Main/Service Line '~,~ t To Cutbank~if present) To Stream/Pond/Lake/ca~ Major Drainage Course To Drive~ay, Parking A~ea, esr Vehicle Storage A~ea ~L~ D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at // / Tested fo~ Electrical Codes(Y/N) Comnents / Dimensions Manhole/Access (Y/N) "~Off" Level at Vent (Y/N) ~cles du~ lng Adequacy Test. Meets MOA ** Check Pe~'~ '~%c~d/l//~/._~Bedr°°m Rating Against HAA Request ** ~at~-~77~:-~, ---I~a~'/~e~k~d, v~eified, or confo~a~d to all MOA HAA Guidelines in effect certify Si~ned//,/ .~'~ e ~ ~;lt~,~ Date ,// ~., 2-15-84 BILL SHEFFIELDt GOVERNOR Telephone: (907) Address: SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 To Whom It May Concern: According to records on file in this office the f lC ~L~c~--'-'./ ' '-' ~ ~.~ Water System is [n compliance with the S~ate Drinking Water Regulations. Sincerely, APPLI¢' NT FILLS OUT UPPER HA[ ONLY Property Owner /:'/~I-,:': ~/ ' ' - ' Mailing Address Zip Code Buyer Address Zip Code Lending nstitution Address Realty Co. & Agent Address Zip Code Zip Code Phone Phone Legal Description ,,,:, Street Locatic~ Type of,Besidence '~]'"§'i n gle Family [] Multiple Family No. of Bedrooms [] Other t ,) . L [",I. Water Supply [] !_l)divid ual ~'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). Sewei~,,Disposal ~/Individual [] Public Utility ~ Holding Tank Year Individual Installed: I'?'~i' ::; When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: (' ~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received , Well to Tank Septic Tank Size