HomeMy WebLinkAboutHOCKER BLK 1 LT 2
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
NAME
PHONE
NO. OF BEDROOMS
E~]NEW
[] UPGRADE
4-
PERMIT NO.
~rO I Z. l
No. of compartments
Liquid depth
Top oo.d
DISTANCE TO: Well ,~, 100 t Absorption area iq! Material ~J~'~//
Manufacturer ~ . ~ Dwelling J~ ~
L'q' ~aE~n gall°ns IF MADE: Inside length
DISTANCE TO: Well Dwelling
Manufacturer Material
w.. ~ ~q, ,.~,e.t ~o.,n. 50~
, TANC O: I > 00 Foundation
lNo. oflines .] Length of each line ~ Totallengthoflines~,lT,e.chwidt~i.ches
Top of tile to finish grade 40I Material beneath tile ~ inches
Length Width Depth
Type of crib Crib diameter Crib depth
DISTANCE TO: Well Building foundation Nearest lot line
IClass Depth Driller Distance to lot line
DISTANCE TO Building foundation Sewer line Septic tank
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines N/A
Total effective absorption area
PERMIT NO.
Total effective absorption area
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
A ~'rH ~0 54
SOl L TEST RATING
INSTALLER ~1~_.~1 A~p5
REMARKS
LEGAL
E:25 L :STREET., RNC~HORHGE, FIK 9950f
264-47'2E~
E] ;:'.~ ..... 55!; 5] -iF' EZ :SE; E.E lb..Ii I[~ tF~':. F" E:2 F~.~ iPtl 3ill T'
PERMI'T' NO:
DF!TE I SS[..IED:
F:iF:'F:'L. I Ct:3NT:
RDDRE?,S";:
CONTRCT PHONE:
JOSEPH G.
Z ::L_'2:0 i4
F:!NO H Ot:;;]::IG E, I::tK
2'F (5-' 6;2 ;2
LEEiF:IL [:'ESCRiP:
LOT S I ZE:
L. OT LOCFKFION:
MFI',:'-',' F:':E[:'f;;:OOH:5;:
SUBDZ',,,'ISION: I'"!Cn]KER
:iSECT I ON: 5:5. TOt.qNSHIF': :L2N
,q. 52ES (.C';r;i. FT. OR FtCRES)
t::'[...RT TOF:' ROF:I[)
L. OT: 2 BLOCK
RFtNGE: 2t.,.I
LISTED 8ELO!.4 FIRE THE OI::'TICIi",IS"; F:t',,,'FiILF:IE:LE TO "r'OU IN DESIGi",IING "fOUR SEPTIC
S'¢5TEH CHOOSE THE OPTION 'T'HF:IT BEST FIT:{;
.......................................................... ...................
ql"' E:~:: EF_:': lt"-,,~ C:: tH!.. IF_..'¢
DEPTH TEI PIPE: BOTTOM (FT..:'
GF.'~I::IVEL I.")iEI'":'TH ( FT
TOTI::IL [:,EP'TF! (FT ;:,
GRff,,,'EL 1.4IDTI-..I (FT
GRFi',,,'E:L .E]'-,IG"i"H (F"t". ;,
GRFI'v'E[. ',,,'OL. Uf'tE (CU '.Ft}t~. )
TFtI",tK S i ZE ( GF!L.S )
::.%) I L ',~'.F~ T t t'-,IG (:F;,O. FT. ,.."E:F..: ::,
4. F 4`/ ~ 5 0 4 0
9.0 ~.o 0.5
::[.3. 5 /~. o 5. 5 7. 5
:].9. 0 ~q. O 32. ~ ]:7. 0
:1..6. 7 58. 9 27. 4
:l.., 250. 0 :+::+: :~.., 250. 0 :+::+: J., 250. 8
85 85 85
-'+.':+: TFINK !'dUST Ht:3',/'E FIT L. EI::tS"I" TI,.IC~ C:OMPFiF.:"FHEt",ITS
I CERTIF'¢ 't"HFIT:
:t.. I F:IM F.'FIHIL. II:::tI:;;: !4I'TH TFIE RE:QUIRE:]'dENTS:, F'OR ON.,-':SITE SEiqE:F.':S FIND 1.4EELS RS SET
FORTH B"r' THE i'"iI_tNICII::'I:::IL. IT'¢ 01:: F:INCHO[;;'.FtGE (f'lOl::t) FIND 'THE STFtTE Of:: FIt_RSKR.
2. ]: I.,.ItLI.....T. NSTFtLL. TIdE S"r'STEH IN F:ICCORDFIt",K}E I.,.tiT14 FILL MOFI CODES FIN[:' REGULFITIONS.,
F:fND :[ N C:OMPL Z I:::!NCtE I4 :[ 'T'H THE ['."ES'; I Gt",t C:R I TER I Ft OF TH I S PEF.':M l' T.
'.:.,:. :!.' I.,.I!L.I.... R[':,HERE TO !::tt....i.... HEiR F!i",tD '.~;TF!TE OF F:ILFISKFt RE(:':!UIRE]"tEI",ITS FOR THE SET BRC:K
DiS';'I"FII",IIZES !:::'l':i:i::)!"i I:::!i"~h" E;:'-','i[S'I"ING i.,.tELI ..... P.tFtSTEt.,.IFtTER DISF'OSRL S;'¢STEP1 OR PLIBLIC
S:;EI.,.iE.".F..'F!C~E ':5?S:;TE]'d ON TH tS C",R t:::lt'.,th.' FtDJEiCIEI'.,IT OR NERRE:h.' LOT.
.T. IJI'4[:~ER:.'STI::tND '.FHFt]' 'T'N:[S-; PERM [] IE; ',,,'F~L. I D F'(:)I:;: FI hlI:::IXIMUH. OF' 4 BEDROOMS FIND
FIN'.r' ENL. I::IRGEMEN. T I.,.I :l: L.L R!!.:.':(;'~U ! RE RI'.,I F:t[:,D I T I ONRL PERM I T.
IF R [._IF]' S]"FtT]:OI'.~! IS tNS'TFIL. L. ED IN FIN FIi:;~'.EI::I C.:OVERED E:'¢ MOFI 8tJIL. DiNG CO[:,ES.,
THEN (::k::, FIN EL. EC':TRICFII.... F'!ERH!T FIN[:, INSF:'E:CTION MUST BE: OB]"I~:ItNE:D.; (2) FIS-BUILTS
[,ii[...[... hIOT BE FtPF'RO',,,'ED 14]:]"HOLFT FIN ELECTRICFII.... tN.?.'i;PECTION REF:'C~RT.~ F-'II'.,ID (::]:) THE
I-'-.tF'Pt_ Z CFtlqT: (~~2L
I:::,FIT E: Z/~/2- OP r~
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14---
15-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG
[] PERCOLATION
TEST
SOILS LOG- PERCOLATION TEST
-- - SLOP~ ' ¢ ' / SITE PLAN
WAS GROUN JJATE"
-- NCOUNTER-
..
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
+~o ;e~l~ 1:5.9 .-..,.
/
PERCOLATION RATE -~, ~ (minutes/inch)
TEST RUN BE EE ~ FT AND ,~'"~"~ ~ FT
NAME
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
PHONE
~"NEW
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO:
Well
~ Absorption area
Manufacturer
Liq. ( city in gallons
DISTANCE TO:
Manufacturer
DISTANCE TO:
No. of lines
IF HOMEMADE:
Well
IWell
Length of each line
Top of tile to finish grade
Length Width
Type of crib Crib diameter
Well
DISTANCE TO:
Class Depth
Building foundation
Inside length
Dwe ing
DISTANCE TO:
Foundation
Total length of lines
Material beneath the
Depth
Material
Nearest lot line
Trench w dth
inches
inches
I~O. OF BEDROOm.
PERMIT NO,
No. of compartments
Liquid depth ~..~" q____O
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line
Sewer line
Septic tank
IPERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTAELER
APPROVED
LEGAL
'- ,~'OT ~. ~ff~/d. i, HOC~£t~ ,ffU~DIVI~SIOAi
I hereb,/ certify that I have performed an "f,s-Buil~" inspection survey of ~he above
described proner~y and that the immroven,ents as shown hereon have been u~easured on
th~ qround. ~o encroachmentsexist.'' '~
Sm've.,/ed FebrtJary 18, 1977
by
Land Survey~m
906 t. ancaster
Anchorage, Alaska ~9~3
Phcn¢ 2 4-~a~7
34-.8
x-/ ,~ 7- TO P /~ VEA/U£
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 &¢.f 7_ ~tk 1 /-~.k ..... Sug,
Location (site add'ress or directions)
Property owner -.
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone 2:"z~. ~s~7.
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Pub ic water
If co mmunity 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
NOTE:
X
Public sewer
]f community wastewater system, provide written confirmation from State ADEC
attesting to the legality aha s~atus of system.
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 bedroom8
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 ~ I~J~(~
E nglnee~s signature
Date
DHHS SIGNATURE
,/~ Approved for
bedrooms.
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 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 ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: £o ~ z,. ~ J ~, F- it.::'~:. ', ~ .... :"' Parcel I.D.
A. WELL DATA
Well type
Log present (Y~
Totaldepth
Sanitary seal
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~.~-,~ Driller ~
Casedto ~.~ (~ ~ ~.~ Casing height ~:
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I ~ G ~
Absorption field on lot t~ '
Public sewer main ~I ! A
Sewer service line ft)//~
Wires properly protected (Y/N)
AT INSPECTION
g.p.m. Z, ~t ¢.
; On adjacent lots Id dj +
i On adjacent lots ~dJ~ ~
Public sewer manhole/cleanout /d//~.
Petroleum tank /V / A
WATER SAMPLE RESULTS:
Coliform
Date of sample: ~9/;¥~ /q
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed 7//~¢/,¢,-1
Cleanouts (~1) ~?¢ ~
High wateralarm (Y/~j) ~J¢
Date of pumping ~' / ~//~/
Tank size I -Z .~ ~ Compartments
Foundation cleanout ((~N) ~% Depression (~,~ /LIP
Alarm tested (Y/LNi~ ~<~ '¢
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot / 3 ~ '
To property line ~
Surface water/drainage
On adjacent lots
Absorption field
~;/~
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION ,d / it
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length '. ~
Total absorption area
Depression over field (Y/~
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/~J-i 't~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Soil rating :t" 1/~, System type
Gravel thickness ~ ' Total depth
Cleanouts present (-Y)N)
Date of adequacy test , ' '
for
If yes, give date
Well on lot ;
To building foundation
On adjacent lots
Surface water . .
Curtain drain
On adjacent lots /~' ~ Property line
To existing or abandoned system on
Cutbank ~ '../, Water main/service line
Driveway, parking/vehicle storage area
bedrooms
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,
Engineer's Name
Date ~_/'~4..-w.~
HAA Fee $
Date of Payment
Receipt Number
/'70 ho
Waiver Fee: $
Date of Payment
Receipt Number
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 ', FAX 274-9645
Dave Merrell
11766 Wilderness Drive
Anchorage AK 99516
Attn: -
Report Date:
08/29/91
Date Arrived: 08/23/91
Date Sampled: 08/22/91
Time Sampled: 1635
Collected By~ KMA
Our Lab #:
Location/Project=
Your sample ID:
Sample Matrix:
Comments:
Al13385
Lot 2 Blk 1 Hocker
Water
Flag Definitions
U = Below Detection Limit
DL Stated in Result
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Below Detection Limit
Estimated Value
Date
Method Parameter Units Result Flag Analyzed
EPA 300.0 Nitrate-N mg/1 2.9 08/27/91
Reported By: William E. Buchan
Anchorage Operations Manager
LOCATION:
Subdivision:
Lot:
Block:
Date:
Client's Name:
Address:
TESTER
Initial Reading on Meter:
DRAW GALLONS GALrONS FIELD METER
DOWN TIME GPM VOLUME TOTAL MONITOR LEVEL READING
Production Rate: 2,46 GPM 24-Hour Capacity 3~ Gallons
MUNICIPALITY OF ANCHORAGE
,DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date /~
(a)' Legal Description~(include lot, bl~ock, subdivision, section, township, range)
Location (address or directions) '~tY~O
(b) Applicants Name ~( ~C~(:(~ Telephone - Home
Applicants Address
(c) Applic_ant Lis (check one) Lending Institution
Buyer ~--~ ; Other ~--~ (explain);
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Individual Well~
Multi-Family ~-~
Other (describe)
Community~-~ Public~-~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewase Disposal
0nsite ~ 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.
[Page 1 of 2]
_E_n~ineering Firm Providin~ Inspections~ Tests~ File Search~ Data and Information
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
investigatio~ and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this ~nspection.
Name of Firm ~.~.~
Address /~-~/~
DEEP Approval ·
Approved for bedrooms By~ ,
Approvad .~ D~sapproved
~O
Te~s of ~ud~t~onal Ap~rov~
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENVr-
ATIONS 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 CER.TAIN FEDEP~ AND STATE REQUIRE-
MENTS. 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.
Sm L)
RR4/ej/D18
[Page 2 of 2]
7 -19-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY O~: ANCHOP'AGF-
DEPT. OF HEALTH &
ENVI~ONMEN'~AL pROTECTiON
RECEI. UED
Well Classification ~r~L If A, B, ~ C, D.E.C. ~p~o~d(X~)
Total ~p~ ON~N6wN Card to UN~ ~pth of ~outing ~/~
Static Wate~ ~1 ~ .~ ~ ~t At O~KN0W~
Casing ~ight ~ Gr~nd ~; Sanit~y ~al on Casing
Elec~ical Wi~ing in ~nduit ~) ~.s ~p~ession ~ound ~l~ead
~p~ation Distan~s ~
To ~ptic~oldin~ Ta~ ~ ~t /~ ~ ~ ~joinin~ Lots
To ~a~st ~ge of ~sorption Field on ~t /~' ; ~ Adjoini~ ~ts
To Newest Public ~ Line ~/~ To ~est ~blic
Clean~t~a~oleB~"~/~ To ~est ~ ~Qvi~ Li~ on ~t
Wate~ S~le Colle~ed ~,~ ; ~te ~/~ ~
Water S~le Test ~sults
C~[.[ents
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/ZO//~,~ Size /Z~O No. of Compartments ~
Standpipes ~/N) ~[G' Ai~-tight Caps ~N) ~3 Foundation Cleanout'~N) ~
~ession o~ Ta~ (Y~ ~O ~te ~st P~ ~/~ 0
P~ing~intenan~ ~n~a~ on File (Y~) ; for ~
Holding Ta~ High-Wate~ ~a~ (Y~} ~/~ ~ra~y Holding Tank ~t (Y~)~
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Water-Supply Well
To Property Line
To k~ter Main/Service Line
Course
To Building Foundation,,,
To Disposal Field / ~ t
TO' Stream, Pond, Lake, c~ Major Drainage
Conm~nts
[Page 1 of 2] 2-i5-84
Ce
ABSORPTION FIELD DATA
Soils Rating in AbSorption Strata
Date Installed
Width of Field ~,~
Square Feet of Absc~ption A~ea
Dep=ession ove~ Field (Y~
Results of Last A~equacy Test
~/~1/' t Type of System Design
Length of Field ~O'
Depth of Field
Gravel Bed Thickness
~ Standpipes P~esent ~/N)
Date of Last Adequacy Test ~/~
To Wate=-Supply Well
To Building Foundation
Lot
To Water Main/Se=vice Line
To Stream/Pond/Lake/c~ Majo= Drainage Course. ~/~
To D=iveway, Pa=king Area, c~ Vehicle Stc~age Area .
Separation Distance f~cm Absc~ption Field:
/3~! To P=operty Line 50/
~9~ To Existing or Abandoned System cn
; On Adjoining Lots ~/~
~'0'~ To Cutbank(if present) ~/~
Dimsnsions -'"-
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N) ~--
Pumping Cycles du~ing Adequacy Test.
Date Installed --
Size in Gallons
. "P~p On" Level at ~-
High Water Alarm Level at
Tested fo~ ~
Electrical Codes (Y/N) --
Con~ents -
Meets MOA
** Check Pe=mitted Bedrocm Rating Against HAA B~quest ** ~ ~
I certify that I have checked, verified, c~ eonfcz~red to all MOA HAA Guidelines in effect
on the date of this inspection.
Signedd~ ~F- , Date ~
Cc~pany ~(}6~ ,~(J0~O(~}~ MOA No. ~7~'-~
KB1/d5/s
[Page 2 of 2]
ENGINEERS
2-15-84
APPLIC/ ?T FILLS OUT UPPER HALF ' NLY
Buyer
Address Zip Code
Lending Institution Phone
Address Zip Code
Realty Co. & A~nt Phone
Address Zip Code
Type of Resi~nce
Single Family
Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l Icg is required for ail wells drilled since June 1975.
~ Community For wells drilled prior to that date, give w~ll depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OOESSlNG CAN BE INITIATED.
Time Time Time Ti m e~ ,~. . .
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
01.¢' ~ ~ MUNICIPALITY OF ANCHORAGE
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVA~
( ~APPROVED
( ) CONDITIONAL APPRO~*
DATE ( 2 -
Soils Rating Date ~wer Installed Well To Absorption Area ~ ~ Well Log Received
Novem~er 28, 19,'J3
Ooseph G. Franco
Star Route 7401-A
Anchorage, AK 99516
Su[)ject; Lot 2, [{lock 1~ ffocker Subdivision
Approval for the individual sewer and wat,.~r ~acilities cannot
be ~ranted until the following items have been completed~
The septic tank pumped with a receipt submitted to this
department. The total number of ~.jailons pun~l,>e{J needs to be
on the receipt and verified by a registered engineer as to
the actual numDer of gallons pu~q)ed. This is to verity the
size of tile septic tank.
o,~:{~ adequacy testa,needs to be performed on the existiml
~leacilin{3 area. this test will [~etermine if the system is
adequate accordi~lq to National ~tandards. A listing of
private firms performing the test is enclosed. Tt]is report
needs to be submitted to this office for our review.
Please notify this Department ~or a reins[,~ection when t~%e
noted discrepancies have beer~ corrected. .If there are any
f~]rt[ler questions, [}lease call this o£tice at 264-472~.
Sincereiy,
CWS2/ej/EI
Cory %~iliis, R.S.
Acting Sewer & Water
Program i'tanager
STANLEY BRUST & ASSOCIATES
Enginee~ - P~nners - Sur;,~,ors
1610 Dimond Drive
Anchorage~ AK 99507
S E 'TIC
ADEQUACY
SYS'f E M
REPORT
LEGAL DESCRIPTION '
OR, .SECTION
SUBDIVISION
, ALASKA
REQUESTED BY:
~,.,-,-t'
TYPE OF SYS'I'EM '
SEPTIC TANK - SiZE _/_[.~_~-?U_O_ GA[ LONS
NUMBER OF BEDROOMS
CRIB OR SEEPAGE PiT
LEACH FIELD
SEPTIC TANK WAS PUMPED I~YES
[] NO
STANLEY BRUST & ASSOCIATES
£ngineers - Plant,ers - Surve3'or.~
Project No. ::~ -~ x-
Adequacy Test Log
Legal Description
No of Bedrooms
septic tank
~:; · , /
~ t
o
4.
5.
6.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
e
Date Received February 15, 1977
Time of Inspection
Date of Inspection ~-/7 77
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv,
Appr0va] requested by: Alaska Mutual Savings Bank % Debbie Johnson
Mailing Address:
Property Owner:
Mailing Address:
Post Office Box 1120
Robert B./Beverly Hocker
Box 400 Star Route A 99507
Phone:
Legal Description: Lot 2 Block 1 Hocker Subdivision
Phone:
Location:
Type of facility to be inspected
Well Data:
A. Type Individual
Flat Top Avenue
Single Family
C. Construction
Sewage Disposal System:
I. Size
1. Absorption Area
Total length of lines
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
274-3561 x 216
344-1822/277-2481
No. of bedrooms 4
B. Depth
D. Bacterial Analysis
On-site system
B. Instal ]er
2. Manufacturer
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
, Other contamination
C. Absorption area to nearest lot line
2. Material
, Sewer Lines
, Absorption area
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIOI~NVlRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
FEB i 1977
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES RECEIVED
1. Type of Inspection: CMRO VA FHA
2. Property Owner: HOCKER, Robert B, and Beverly
CONV__ X
Mailing Address: Box 400 SRA
Name of Buyer: FRANCO, Joseph G.
Day Phone:
344'1822-Home
Z//-Z4~A wor~
Mailing Address:
4. Name of Lending Institution:
Mailing Address: P, O.
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
3620 E. 42nd Circle #2
Day Phone:
Alaska Mutual Savings Bank
Box 1120
N/A
Phone:
Phone:_
Lot 2, Block 1 Hocker Subdivision
279-8686 ext. 377 Work
274-3561 ext. 216
Location:
Flat ToP Avenue
ATTN:
Debbie
Johnson
Type of Facility to be Inspected:
SF
No. Bdrms.
Water Supply
Type of Supply: Public Utility.
If Individual~ number of dwellings presently served
If Individual, depth of well.
Individual
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site),
X
MUNICIPALITY OF ANCHORAGE
DEPT. OF H;~ALTH &
ENVIRONMEN1AL PROTECTION
FEB t 5 1977
RECEIVED
72-003(3/76)
Pag~ 2 of two pages - Re~~-st for Approval of Individual Y '~r & Water Facilities
Legal ~escription Lot 2 Block 1 Hocker Subdivision
Comments
Approved
Disapproved
~ Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
E0-034 /1/74~