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Home My WebLink AboutSTONY BROOK BLK 2 LT 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONiVlENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0N-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [] UPGRADE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Manufacturer MateriST¢ e No, of compels ¢ ANu4 TANI -L Liq, capacity in gallons I~~ HOME.DE Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, 0 ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: Well : Fo~n~i~n N~arest lot line ~ PERMIT~ ~ Trench wi th Distance between lines Length of each line Total length of lines ~ Top of tile to finish grade ~ I Material beneath tile Total effective absorption area Length Width Depth PERMIT ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to Jot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS CA~T ~ PV 0 8OI L TEST RATING IN$TA~LER REMARKS [ I ~ 72-013 (Rev. 3/781 Dat~ /,'/ '--- f--. o SOILS LOG CASING LOG (-) / c; ~"~ ~' 7~ f-~/; c/ ' ? ~'/:"~' ':/ SUBSURFACE EXPLORATION Shift Report of Operations I' ~ ~ ~ ,? l~.y ,/ ,~:.,, ...,, ,.,.,, .. , - / r [~ GPM-YIELD /-¢' ., -.,.. .. TIME DISTRIBUTION HOURS ' LABOR EQUIPMENT /~~ - .... Flatbed PERMIT NO~ APPLiCBNT LDCATION LEGBL DEPFlRTMENT Or HEALTH FIND ENMIRONMENTFIL PROTECTION 825 "L" STREET., FINCHORFIGE., FlK. D950± F264-4720 ~-~Ei_C' f~'t[:' w_-i[--~--'__~. ~ TE SE~.-iE~ F'EF~:~"'t I T ( E~'C~ > JOHN R. RZLE¢ 6801 MCBETH SRB BOX 412 ~44-5~5~ LOT I BLK 2 STONY BROOK SUB LOT SIZE 9DDD9D SQUFlRE FEET TYPE OF :~,OiL FIBSORPTION S'T'STEM IS: TRENCH i'IAXIMOM NUMBER OF BEDROOMS 4 SOIL RFITING (Si.:.! FT,.'"BR)= t50 TFiE REQUIRED '=' ~ '=' "- '- ' _,i~-E OF THE SOIL FIBSORPTIZN _,~--,TEfl THE LENGTH DIMENSION IS THE LENGTH (tN FEET) OF THE TRENCH OR [:,RFIlNFIEL[:,. THE DEPTH OF Ft TRENCH OR PiT IS THE [:,ISTFINCE BETWEEN THE SURFFtCE OF THE GROUND FIND TNE BOTTOM OF THE EXCA',/FITION (IN FEET::, THERE iS NO SET WIDTH FOR TRENCHES. THE..GRB',/EL [:,EPTH IS THE MINIMUM DEPTH OF GRFlVEL BETWEEN THE OUTFFlLL PIPE F~ND THE BOTTOM OF THE EF-';CFIMFITION (IN FEET). PERMIT FIPPLiCFINT HAS THE RESPONSIBILITY TO INFORM THIS DEPFlRTMENT DURING THE iWSTFILLATION INSPECTIONS OF RN'¢ ~,.IELLS FlDJFlCENT TO THIS PROPERTY FIND THE NUIiBER OF RESIDENCES THFlT THE WELL P~ILL SER',/E. T[~C~ (:2) i ~$F'EE:TZ~]F~S Ia E~E BACKFILLING OF FlN~ SYSTEM WITHOLIT FINAL INSPECTION 8ND DEPFlRTMENT WILL BE SUBJECT ~3 PROSECUTION. F:Eg!L~I ~:E[:. APPROVRL BM THIS MiNIMUi'I DISTANCE BETWEEN la WELL RND FtN~¢ ON-SITE SEI.4FIGE DISPOSAL SYSTEM IS t00 FEET FOR ~ PRIVATE WELL OR t5~ TO 200 FEET FROM B PUBLIC NELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL, MINIMUM DISTBNCE FROM 8 PRIVBTE WELL TO ~ PRiV8TE SEWER LINE iS 25 FEET 8ND TO A COMMUNIT'¢ SEWER LINE tS Z5 FEET. [,.IELL LOGS BRE REQUIRED ~f.,ID MUST BE RETURNED TO THE DEPRRTMENT WITHIN 3:0 OF THE WELL COMPLBTION. C~THER REQUIREMENTS P'IR'¢ RF'PL'¢. SpECIFtCRTIONS RND CONSTRUCTION DIFIGRRMS BRE BVRIL8BLE TO INSURE PROPER iN9TRLLRTION. F'EE:[.-~ i T E..."-.F' I F:ES [:.EE:E["'~E:EE: 2~1.. " i CERTiF'¢ THRT i~ i BM FFIMILIBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS ~ND WELL~ B~ SET FORTH EW THE MUNICIPBLIT'¢ OF BNCHORBGE, 2: I HILL INSTBLL THE SYSTEM tN BCCORDBNCE WITH THE CODES. ],i i UNDERSTBND THBT THE ON-~iTE SEWER SYSTEM MB'¢ REQUIRE ENLBRGEMENT IF THE R~SIDENCE I~EMODELE[:, TO INCLLI[:,E MOR. E THBN 4 BEDROOMS. ..,,-, . .,- ..- ._ o ON ~E.[ G~AVEL DEPTH ]S THE H]N]I%ql DEF']H 0F ~3R:RVEL E:ElNEEN THE OLIT~RLL lH[ ~OllOl', OF 1HI EXC. t]VRTION (IN FEET:,. RF'F:L~C-~N7 HR~, ~HE ~E~PON&IB]L]~ TO ]NFORI'I TH]5 DEP~R~I'IEN~ [~LI~JNG THE OF ~,]DENC.E~; ~H~l 3HE HELL H]LL ~'~LL~NG OF eH9 SVS,7[I,I HITNOUT FINRL INSPECTION RND flF'F'F:OV~L ;~T~IENT: HILL' DE ~LIE;JECT ~EE~.I~{: ......... fTHE IYF'E 0F F'LIEtL][: HELL ~LOGD. ~E ~[~LI~DED AND HUST BE RETURNED 70 iHE DEF'~RTI,IENT NITHIN 30 NELL COHF'L~T ] ON. ',? ] F'4 ~]LL INSTALL ~tIE 5YS][l'l :~ENCE 15/~E~IODELEP ~0 }NCLLIDE I, IORE 1H~N 4 ~'PL~N~ JOHN ~:, / ~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 5- 7 10 2225-E 20 gToN ~ "/ SLOPE DATE PERFORMED:__'-7/'~/~'~ SITE PLAN WAS GROUND WATER ~ :OUNTERED? O, ,ATWHAT ~! DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND __ FT COMMENTS PERFORMED.Y: h-/'7', ~ CERVIF,EO SY: ~--7,__~ DATE: 72-008 (6/79) 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'~o~.~ ~,"~,["~_ Applicant Address Telephone: Home --~ -- ~7~ ~, Business (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); -- (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Familyt~ Multi-Family [] Number of Bedrooms ~" Other WATER SUPPLY 'r Individual Well~ 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. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank [] Note:/tl, f community well system, must have written confirmation from the State Department o! Environ mental Conservation attesting to the legality and status. Page 1 of 2 5. ,ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and es of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/er wastewater disposal system is safe, functional arid 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ~o,o~7q_ ~'/~ Name of Firm Address Date Engineer's Seal AD;pEr :2: :oRrO V~b ed r oo ms b y~'~'~ Approved ~ Disapproved Terms of Conditional Approval ate 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 WELL DATA We~l Classification ~.E ~,~ 1.~_ _ , B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed ~-~, e~ Yield Total Depth_ (~ Cased to Z~ Depth of Groubng Static Water Level ~' Pump Set At j~ O Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 -F ANc~O~64-4720 iCUNtCtP^LIIY .,~t~ AL'f H & ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Casing Height Above Ground Electrical Wiring in Conduit (y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~J ~ To Nearest Edge of Absorption Field on Lot I,~, ! To Nearest Public Sewer Line NO I~, ~ ~_ I~ i~_/~- To Nearest Sewer Service Line on Lot ,~ / (.~ '77, . ; Date / .Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date InstalLed ¢' Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Wafer Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size if~O N(~.-of Compartments Air-tight Caps (Y/N) ~ Foundation CleanDut (Y/N) Date Last oumped l~/'~ ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation ] ~' To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(1~/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~./~¢;~/~"' Width of Field _ ~O~) Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test _. Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test I To Property Line ~ ~ ~ To Existing or Abandoned System on ; On Adjoining Lots ') ~ ~) To Cutbank (if present) ~'~/k/~=='~" NoNl lc) D. LIFT STATION J~J C) ~ ~. 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 that~ check~ed~verif!,~or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company ' MOA No. v Receipt No. Date of Payment Amount: $ Page 2 of 2 Engineer's Seal DEPARTUENT OF HEALTH AND ENVIRONMENTAL PROTEOTION DIVISION OF ENVIRONI~IENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 254-4720 Application Date GENERAL INFORJViATION (al Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (bi ApplicantName?Xd ~'~3 Telephone:Home ~¢¢--~7¢~ Business Applicant Address ~O / ~ ~ (c) Applicant is (check one): Lendin9 Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); Lending Institution I J//./.~-'~ ¢/¢--'f.'~¢/'//-¢/¢~'~ ,'~ ~- Telephone (d) Address Ud~ Ij/'/ '~-v"- ~-~-~-¢' (el RealEstateCompa.ya~dAgent_ ~ ~*¢* ~/ Address ~ ~ [~ E Telephone ~(P ~ '- ~--~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family E] Number of Bedrooms -~ Other WATER SUPPLY Individual Well~ Community F'I Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/[~' Public [] Community [] Holding Tank [] Note:'/" ---If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION '~ '" ' .... AS certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional aed adequate for the number of bedrooms and type of structure indicated herein. [ further verity 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~in§~p~e~ti°n'~ ~t~~ ~-~" ¢'~'~7~ ¢' ~ ~, ~ Name of Firm -- Telephone Address t¢-~) '~ [~' ~'~'¢ Date ~¢~,¢/ 8~¢~'~ ~? ~¢"~ Approved for1,t'~c~'J4'-~bedr°°ms b~L~ ~~~Date Approved (~ Disapproved Conditional Terms of Conditional Approval 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 independen~ 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) MUNICIPALITY OF ANcHoRAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPAUI~f OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION NOV ? WELL DATA Well Classification Well Log Present (Y/N) Total Depth j c~.~ Static Water Level Cased to I '¢{.--~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ Yield Depth of Grouting N (~'~N I~. Pump Set At ~E~ ~7"T'~ ~ CJ~ Sanitary Seal on Casing (Y/N) ~/ Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cieanout/Manhole Water Sample Collected by ; On Adjoining Lots ; On Adjoining Lots Water Sample Test Results Comments To Nearest Public Sewer J~ ohJ ~ To Nearest Sewer Service Line on Lot ~ -~ * ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Size l ~Z ~*O No. of Compartments 'r' ~O Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course > To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026( 11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata _ /:~ Date Installed Width of Field ~ (:~ ''/ Square Feet of Absorption Area ~' Depression over Field (Y/N) !*"~ Results of Last Adequacy Test "~"'"'~'~E.~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field /z;,O Depth of Field ~ Gravel Bed Thickness ~ Standpipes Present (Y/N) Date of La/st Ad,~uacy Test Y To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Not4 -- I0! Comments D. LIFT STATION Date Inslalled 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 that I have c~hecked, verified, or,~conformed to all MOA and HAA g uideli nes in effect on the date of this inspection. Sigaed ~?~¢;? Date Company T, ~~~ MOA No. Receipt No. ~L[ ~ Date of Payment li/~;..l~c411~ Amount: $ _~ ~*(~ ¢~'~ 49ZU ~- 4 ~' Engineer's Seal ' C, ONSULTING ENGINEER ' TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: LOT 1, BLOCK 2, 6801 MCBETH JOHN RILEY STONEY BROOK SINGLE FAMILY YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 15 GPM WELL YIELD FROM TEST: 6.5 GPM @ 8 FEET TOTAL DRAW DOWN PUMP YIELD: 6.5 GPM. DATE OF INSPECTION: NOVEMBER 27, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND TO BE 174 FEET BELOW TOP OF CASING. AFTER 40 MINUTES OF PUMPING THE WATER LEVEL STABILIZED AT 182 FEET. AT THE END OF PUMPING WATERLEVEL RECOVERED TO 174 FEET WITHIN 3 MINUTES. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON NOVEMBER 20, 1985. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. S E P T I C :S X S T-_E-M A D E Q U A C Y TEST LOT 1, BLOCK 2, STONEY BROOK 6801 MCBETH JOHN RILEY SINGLE FAMILY, THREE BEDROOMS ON SITE wEL~ FROM MUNICIPAL RECORDS: LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: TANK:-~ANCH. TANK, TWO COMP· 1000 GAL ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 600 SQ. FT. . SOIL~RATING: 150 ' INSTALLATION DATE: 9-26-83 DATE OF PUMPING: NOVEMBER 27~1985 DATE OF TEST: NOVEMBER 27~c~1985 TEST PROCEDURE: SYSTEM WAS'~NSPECTED AND MEASURED· TANK IS ~.:~?~,~ COVERED BY /:THREE FEET OF GRAVEL AND HAS 48 ~ ~ ~ ~'~ INCHES OP LIQUID. TRENCH SUMP IS 9 FEET DEEP ~.o ~ · ..'x:. AND.HAS 10 INCHES OF LIQUID· ~ ~. ~- -~ ..~., WATER WAS ~ADDED TO THE TRENCH AT A STEADY ~*:49.L~.~ ?~ ~> RATE OF 6.5 GALLONS PER MINUTE. THE LIQUID LEVEL IN THE SUMP WAS MONITORED. A TOTAL OF f, 330 GALLONS WERE ADDED. THIS CAUSED THE WATER LEVEL TO RISE 5 INCHES· WITHIN THE NEXT 30 MINUTES THE WATER LEVEL DROPPED 1 INCH . ~". .'~:? THE SYSTEM ABSORBED 66 GALLONS IN 30 MINUTES ~.~$~ ~SULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF ~'~ THE MUNICIPALITY OF ANCHORAGE FOR A FOUR BEDROOM HOUSE. The operational life of all septic systems depends on the local soil conditions, §roundwater levels that may fluctuate during the year, and the water usage of-the family being served by the system· These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how lon§ the system will continue to mee~ the operational requi- rements of the Municipality and State. APPLI(-'NT FILLS OUT UPPER HAIr''~ ONLY Prd~rtyOwner ~'~ 3~t,.~ ,0~,.~_-~1 ~ ~ /~ ~ ~ Buyer Address . Zip Code Lending Institution ~ ~ ~2~ ,~ O o~;,[ r~ Phone Address ~.~ ~-3 ~ ~ j~-.l O~ ~ [~ ~% % ~ ~ ~A~' % Zip Code Realty Co. & Agent Phone ~'lndividual [ ~P~ Year Individual Installed: J fi 7 ~ ' Time Time Time Time Inspector Inspector Inspe~;tor Inspector Field Notes: · ~ DEPT. OF HEALTH & ~q b[ -~ ~ ENVIRONMENTAL PROTECTION RECEI EB ,~)~ APPROVED BEDROOM8 ~- 'CONDITIONS OF APPROVAL ( ) CONDITIONAL~PPROVAL* CONSULTING ENGINEER 203 W. 15th AVE "C" SUtTE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 MUNICIPALiTy OF ANCHORAGE MUNICIPALiTy OF AN · RECEIVL i CE.i ED. John Riley SRA Box 41Z, 6801 McBeth Street Anchorage,Alaska 99507 December 7,1983 WELL INSPECTION LEGAL: SEPTIC SYSTEM SANITARY CAP SURFACE GRADING CASING ABOVE GROUND RIGID CONDUIT TYPE OF WELL LOT 1, BLOCK 2, STONEY BROOK DISTANCES OK. CAPS IN PLACE YES YES 24 INCHES YES