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HomeMy WebLinkAboutHIGHLAND PARK BLK 1 LT 2  MUNICIPALITY OF ANCHORAGE i, DEPARTMENT OF HEALTH & ENVIRONMENTAl_ PROTECTION , ENVIRONMENTAL ENGINEERING DIVISION 82.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM.~ 1PHONE _ ,~.~ UPGRADE LEGAL DESCRIPTION LOCATION ~ ~ ~ NO, OF BEDROOMS ~ . Absorpdo~ area Dwelli~ PERMIT NO, DISTANCE TO: J~ , - ~ I ' h- Z Manufacturer ~-' ~~_~ // Material No. of compartments ~ ~ Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, 0 ~ Ma~f~E~ rer ~. "~ DISTANCE TO: ~~ Foundati~ ¢~5-' Nearest lotlin~o ' PERMI~)/ To,a, T. n h ~ ~ ~ ~ ~~¢~ ~ inches  No. of lines Length of each~ine length ~ Top oftileto finish grade ~ , Material beneath tile ~ ~ Total effeotivea ' Length Width Depth PERMIT NO. <~ ~ Type of crib Crib diameter Cri~epth Total effective absorption area LU Well Building foundation Nearest lot line ¢ DISTANCE TO: Cla~ ¢,. Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER .~ SOIL TEST RATING I 'L._..I DEPFIRTi',IENT OF HEFILTH FIND ENVIRONMENTFIL PRO'f'EC:TION 82.'.'5 '"L." S'I'REET., PERMIT NE;. FIPPLICFIN'F EFIRL STRUCK 6426 BLFICKBERF.:"¢ LOC:FIT I ON I_EGRL. L;~ BLE~CI',:: :1. HIr. iiHL, fll'~D~ pARK ' LOT '.51ZE T'-r'PE OF SOIL. ABSORPTION S~r'S]"EM IS: TF.:ENCH 243'...- 2ES:.'L ±5000 SI]]URRE FEE7' MAXIMUM NUMBER OF BEI)ROOMS = 2..': SOIL RFITING ,::SQ FT,,"BR)= ::I..5E~ THE I:~'.EQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [) E F' 'T b-I =, ¢5 L.. E IP,II ~3 -I'" H == 7 5 (3 F-: R %-' E L [:" E F' -IF' I1-! =: 2:: THE LENGTH DIMENSION IS THE LENGTH <Ii'-,I FEET) OF THE TRENCA OR [)RFIINFIELD. THE DEF']"H OF Fl TRENCH CIR PIT IS TAE [:,ISTFINCE E:ET!.4EEN THE SURFACE OF THE GROUND FIND THE BOTTOM OF' THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOF.: TRENCHES. THE GRFI",dEL. DEPTA IS TNE MINIMUI"I DEPTA OF' GRAVEL 8El'WEEN TAE OUTFFILL F'IPE FII'ID THE BOTTOM OF THE EXCRVFITION (IN FEET). F"ERM I T FIPF'L.I CAN]" HAS 'THE RESPOI'.,IS I E: I L I T'Y' TO INFORM TH I S [."EPRRTMENT [:,L.IR I l'.4G THE II'4S'f'RLLFITION INSPECTIONS OF Fll',l'Y' NEL.LS FI[zJ'RCEIqT TO THIS F'ROF'EF..'T~r' RI",ID THE NUMBER OF RESIDENCE:7,, THFIT ]'HE WELL WILL SERVE. ........ TI.--IIC~ "::] 2 ::'~ ][ 1",t :E";P'Ef.:: T' .1: ,]ll'-,IS; FiE:E: E:E(F,~LI 1: IF4::i(6T.I[:: BRCKF'ILLING OF FIN"¢ S"r'S"FEM WITHOUT F:'INFIL INSPECTION FIND APPRO","RL B"r' THIS DEPRI:;..'TMENT 14ILL BE SUBJECT TO PROSECUTION. 1'4Ii'4IMUM DISTANCE BETI,.IEEN fl WELL FIND Fll"4~r' ON-SITE SEWAGE DISPOSAL. S'¢STEM IS :1.8¢ FEET FOR fl PRI',/FITE NELL OF.: :!..5¢~ TO 200 FEET FROM FI F'UBLIC WEtJ.. DEPEI",I[:'T. NG UPON THE T"r'PE OF PUBLIC WELL MINIMUM DISTFIi"',ICE FROM Fl PRIVFITE !4ELL TO Fl PRIVI=ITE SEWER LINE IS 2!5 FEET FIND TO Fl COMMUI",IIT"t' SE!.4ER LINE IS 75 FEET. OTHER RE.F..!UIREMENTS MA"r' F:IPPL~r". SPECIFICFITIONS FIND CONSTI'T:'.UCTION DIFIGRRI"IS ARE RVRILFIBLE TO INSURE F'ROPER IN':'";TFILLFITIOI",I. I CERTIF'¢ THRT :L: I FIM FRMIL. IFIR NITH THE RE(.]UIREi"IENTS FOR OI"4-SITE SEI.,.IERS Ri",ID blEL.LS AS SET FORTH B"r' THE MUNICIPFILIT"r' OF Fli",ICHORAEiF. 2: I WILL INSTALl_ THE S'¢S'f'EM IN RC:CORDFINCE WITH THE CODES. APPLICRI',,IT EFIR,L. STRUCK / Gr iTER ANCHORAGE AREA BORO~ H DcrAflTMENT OF ENVIRONMENTAL QUALll~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ____ADDRESS ,~-'~,/~,~; ../r;,>_;.~/' ' '~; ~'2~ / -' " ~'_PitONE ' - - SEPTIC TANK: -- . ,-*- ~,,~-> NUMBER OF ,- ~ . DISTANCE FROM WELL ~ ' /~?' /¢'" _MATERIAl. ._s ~_~. .... COMPARTMENTS - LIQUID LIQUID CAPACIrY~/ /~ ~/~ GALLONS. INSIDE LENGTH ~.INSIDE WIDTH ~ - _DEPTH SEEPAGF SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER ~"~<~ / ___OR WIDTH "-- ' , LENGTH /' , DEPTH LINING MATERIAl ~-'~;~/C~'~/';Z~:~'~::~--"<-'¢'-~'~-~'~';,cz.~- DISTANCE FROM WELL_ ~), /z?, //-', BUILDING FOUNDATION NEAREST LOT LINE /5~/V'//~'' '~"-~ , TOTAL EFFECTIVE ABSORPTION AREA {WALL AREAt ,6- _:~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER 0 F ...L~- ' ABSORPJI~ AREA TOTAL LENGTH / .... , FOUNDATION "~ , NEAREST LOT LINE OF LINES ____DISTANCE BETWEEN LINES _TRENCH WIDTH - --- INT'TO~L EFFECTIVE SQ. FT. LENGTH OF EACFkLINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAl. BENEATH TILE IN. ABOVE TILE TYPE~E"~c~/~.- m - , DEPI'H ...... NEAREST SEPTIC LOT LINE "~-- _, SEWER LINE ~ ,TANK DISTANCE FROM c - WATER , BUILDING FOUNDATION. SAMPLE. SEEPAGE , SYSTEM .... '"--'- _, CESSPOOL /: , NEAREST OTHER ' - , SOURCES~'.'~ DISTANCES: DIAGRAM OF SYSTEM GREATER ANCHORAGF AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INStALLAtION LODAtION --%/~ INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD , OTHER tYPE AND SIZE OF FaCilitY TO be SERVED SOIL TEST RESULTS ~/~~ NOTE: THIS PERMIT I~ NOT VALID WITHOUT SOIL TE$~ COMPLETION DAte ANT[ClPaTED ~' FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE BUBJECT TO PROSECUTION, MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION tO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIt WALL ~-~?-- /'~' ~ / SEPTIC TANK TO NEAREST LOT LINE. WELL. TO SEPTIC TANK DRAIN FIELD SEEPAGE PIt ., DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK .K/~ , SEEPAGE PIT //~' DRAIN FIELD SEPTIC TANK, ,%-,~L~%~' , SEEPAGE PIT DRAIN FIELD SEEPAGE AREA SIZE DIAGRAM OF SYSTEM TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB GROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED With AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. H EALT/H ~UTHdRITY ] CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGe AREA ~OROUGH ORDINANCE NO. ~i~68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, ~/~ ~ /~ //~ / Performed For Legal Descri p~-i on: This Form Reports Soils-'[-o'g___2 GRF'~TER ANCHORAGE AREA BOROUG~ DEPA. ,,~ENT OF ENVIRONMENTAL QUALIJY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 2o~Ec~ ~s'~,~o,~,:~ate Performed Lot t Block ~ Subdivision ~,~,~ p~ F~t~~ t CASE # Depth Feet 4,-~ 5~ Soil Characteristics Was Ground Water Encountered?_~//o If Yes, At What Depth? Reading Gross Time Net Time Depth to N20 Net Drol Date Percolation' Rate Minute Proposed Instal~[~-~-fon: Seepage Pit ?- Drain Field Oepth Of InJet Dep~' To Bottom Of Pit ~ Trenc~ COMMENTS:= TeSt Pert'ormed By 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~, - ~'~o~-\-r~;~ HAA# GENERAL INFORMATION Complete legal description Lot 2; Bloc~ I; Hi~hland Park Subdivision; Location (site address or directions) 6426 Blac~berr~ Street Property owner Mailing address Lending agency Mailing address. Gail Ach&son 6426 Blackberry Street, Day phone Anchorage, Ak. Day phone 245-2558 Agent Ei~een McGauran PHH/HOMEQUITy Day phone (510)246-6538 Address 1855 GAteway Circl& BOX 4039 Concord, Calif94524-4039 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 N TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X× 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, lfurtherverifythatbased 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 Engineer's signature S & S ENGINEERING 17034 Eaqle River Loop Road Eagle River, Alaska Phone Date 1\- Iq ~ \ DHHS SIGNATURE '~L Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: 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. 724)25 (Rev, 1/91) 8ack MOA ~f21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Log present (Y/N) If A, B, or C, attach ADEC letter. Date completed ADEC water system number Driller' Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level SFPARATION DISTANCES FRO~ ~TO: Septic/hoMing tank on lot Absorption field on lot .//' Public sewer main Sewer servic~/~ WATE~MPLE RESULTS: ~aOt~e ~f~amp e.. Nitrate Cased to Casing height Wires properly protected .(Y_.~.. FROM WELL LOG ECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed c~ . .?..~ ~--~ Cleanouts I~N) k/ High water alarm (Y~.) __ ~, Date of pumping Tank size \oc.~C~ _ Compartments Foundation cleanout (:~'N) _ ~ Depression (Y(r~L~ Alarm tested (Y/N) ~'Ll~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line ~'~ Surface water/drainage On adjacent lots ~'~ I A~ Foundation. z~- ~ Absorption field \~-~ Water main/service line / ~;:;~ 4- 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA e~~ S~ DISTANCE FROM LIFT STATION TO: V?ell on lot On adjacent lots Manufacturer Manhole/Access (Y/N~)._ "Pump on" level at ~ "Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~- ¢ Length ~"7'- ~ Width '"~L~' Total absorption area Depression over field (Y/~ Results (~fail) ( Peroxide treatment (past 12 months) (Y~N~ /~ Soil rating [~d~ Gravel thickness Cleanouts present ~/N) Date of adequacy test for "~rt, ¢-P_C_..- ¢-~,J,d If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /"\ I/k- On adjacent lots ~L[ ~ Property line To building foundation /c~+~ To existing or abandoned system on lot On adjacent lots Surface water Curtain drain I~.~ E. ENGINEER'S CERTIFICATION Cutbank ~/~ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec.!c2n the-d~t..~ of this inspection. 5 & 5 ENGINEERING ~ ~... ,' ~? ,~ ~ HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number r,/iUNICIPALITY OF ANCHORAGE DEPARTI~,.IENT OF HEALTH AND ENVIRONIVIENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTFI AUTI-IORITY APPROVAl_ O1[ ©N-SI-FE SEWER AND WATER FACILITY 264-4720 Application Date °g/?- GENERAL I NFORIV~ATI O H (b,~ Legal Description (include lot, block, subdivision, section, township, range) Location {addr633 or d~rections) App{,cant Name =~L: ~J~.~L/I~]~ ...... Telephone: Home ~/~%~¢'~,~_. Business AppiJcant m (check one) L.endin9 Institution ~J; Owner/builder [~; Buyer [:]; Other E] (expIain); z-'"'Z_"£ ?: ....... Telephone Rea: Estate Cornoany and Agent Telephone ._ . the HAA to ':r~e following address: TYPE OF RESIDENCE Smg',e-Fam¢7 ~ Mult~-Farmly ~ Other Number of P-,edroorcrS WATER SUPPLY ind?/iduai We;i E] Ccrr;mur':ty ~ Public.~ i',;o~e'.¢ !f corr'rnur,,ty we s.zstr, m must have written confirmation from the State Department of Environrnental Conservation aHesting te the ega ~t,/ard status. SEWAGE DISPOSAl. Piibi:c. ['._~ C~ornrnur/ity E~ l'iolding Tank E] ~';$tf-; i" com~;uR~t / ',,,cji] ~/~.ten: rr, ust have written confirmation from the State Department of Environmental Conservation attesbr, g to the ~ega~ :t 8Rd s~atus 5. ENGINEIERING FIFI,~¢I PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ,¢.: ..rtmed b)' rn7 seaJ aflixed hereto and as of the validation dale shown below. I verify that my investigation of this Healt Authority Appro'/a~ sr, ows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the irfformation obtained from the Municipa]it7 of Anchorage files and from my investigation and inspectien, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ................. ................................ Engineer's Seal Approved /" ..... Disapproved Conditional Terms of r'¢..~,¢,. ...... :-. Approval CAUTION The f,,',u~ c ;~ !? o' ;-~;t~'crage Department of I-tealth and Environmental Protection (DIdEP) issues Health ALIthoFity Appro,/8$ cert¢ cares ,5¢tgd solely upon ti~e representations given in paragraph 5 above by an independent professional oF~:r, eerre~,s'e-e% ~ ~-eStateofAtaska, The DHEP does this as a courtesy to purchasers of homes and theft lending ~r-,,Gtltbt~or 3 =, tree' ~$ s;!!~gfy certain federal and state requirements, Ernp!oyees of [}HEP do not conduct inspections or ar:~ /ze (;eta ce%':: a ce.!,:flcato ~s issue(J, Tho Municipality of Anchorage is not responsible for errors or omissions in the prc. fes-.,or~ nr:g',ee's ~,,ork. A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Cased to MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /,g)'T'4:~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ~0[,,~. If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ~"//~/~ ' ~ ; On Adjoining Lots /~)/r~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA D at e I n sial I e d--~/i/~/¢'~ _Size //~)g)(~ No. of Compartments, ¢"~" StandpipesON) Air-tight CapsON) Foundation Clean.ou~;~)N) Depression over Tank (Y~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ,/¢'~/~'~ ;roi' /t~/~,z:~ . Holding Tank High-Water Alarm (Y/N) /,~-'~'""-- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well z¢-.)//"'¢- To Building Foundation _ ~ '~ ~ To Property Line '~ J / ')('''- To Disposal Field _ ~) l ~ To Water Main/Service Line J¢[ ~)/' - To Stream, Pond, Lake, or Major Drainage Course . ~ ~)E)/ Comrnents 4~13'~l'~,~ ~1.e-*¢~. ,/)l[¢4~~j~.tcJ4- ~'~A. Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~//' ,~/~:'¢--.~ Width of Field ~ Square Feet of Absorption Area ~'/'~ Depression over Field (YO' Results of Last Adequacy Test Separation Distance from Absorption Fiel : To Water-Supply Well To Building Foundation Lot .-~ I ~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~)/~'~'~)/x~4~¢(, ¢ ~e'/~/ '7/¢'6/~ Type of System Design Length of Field '~/ Depth of Field Gravel Bed Thickness ~ / Standpipes Present. N) _7ate of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots -~ ~O /~- To Cutbank (if present) ~,t~/ / ~ .? D. LIFT STATION Date Installed Size in Gallons "Pump Cfi" Level at High Water Alarm Level at Dimensions Manhole/Acc~ Tested for ~ ~.~*~'- Vent(Y/N) Electrical Codes (Y/N) ~"~'- ' Com~ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company /~ q/v~-- MOA No. Receipt No. Date of Payment Amount: $ ~ ~ Engineer's Seal Page 2 of 2 72-026 (11/84) GAIL OZMINA 6426 BLACKBERRY ANCHORAGE ALASKA 99502 SELLER-SAME GAIL OZMINA 6426 BLACKBERRY ANCHORAGE ALASKA 99502 AUGUST 9 1985 50473 LEGAL:HIGHLAND PARK BLOCK 1 LOT 2 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-AUGUST 8 1985 THE TYPE OF ABSORPTION SYSTEM IS A CRIB/TRENCH WITH AN ~EA OF 492 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 460 GALLONS. BASED UPON ~E TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON AUGUST 8 1985 . 1200 I~lesl 33~tl /~uenue, ~uil¢ [~ ,,/~n¢~oroq¢. /~losko 99503 o (907) 561-50z10 APPLI(r" NT FILLS OUT UPPER "' ONLY Buyer Phone Address Zip Code Lending Institution Address ~ /' ~/-~-~' ~/ Realty Co. & Agent Address Zip Code Phone Phone Type of Residence [~'~rr gle Family _'~;, [] Multiple Family No. of Bedroorrks ~] Other Water Supply [] Community ~.iblic 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). Sewer Disposal E~'q'ndivid ual [] Public Utility [~ Holding Tank Year Individual Installed: When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Date Date Date Inspector Inspector Inspector Time Inspector ~- APPROVED BEDROOMS ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE f ~/2~'' ~ 2~ '"~'" MUNICIPALI'rY OF ANCHORAGE f'EPT. OF H:/.LT!; ENVIRO;',MLN1/',L pEOTLC~ION 'CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well -re Absorption Area Well Io Tank Well Log Received Septic 'rank Size