HomeMy WebLinkAboutT15N R1W SEC 9 Lot 23A
ChhF1 iF C:A'i E OF [N~;f ,'=:C'['ION FOR HI]ALI'[ [ AUTHORITY APPtlOVAL
OF O~'I-SITE 8t~WEIR AND WAICR FACILITY
Application Data'
~986
?ga )es;~ )t o ~ ncludo m [ block, s?divis~on, sect o ) township, a 9e)
[ o: t on (addiess or direutions)
Core,er of )berg a,~d fome~ead West
(~[~Jff'?~te[S(n' T¢opt~one: ltome
' P O, Box 6105i9; ".hug~Ik~ Alaskl ?9567
~,p¢ ~.;aRt Address : ..... ~ .............. '. - ~ ....
(c) Apl)llca~t is icheck 2ne) .ending abtitL t on I]; Own~r/bufl( er
Address AflENI ~Ot,l: J~ mi~ /Fac l¢ iA;e%
(el Roe (st~te Go panyand Agora
To f~p~oBe .......... · ..............................................................
(l) ~ th~ HAA to the follow n9 address:
SRB 196X
I*YPE OF RESIDENCE
S ' 9Ia, Family ~] Multi-Family ["1
Number of Bedrooms ~ ....... 4 ....... ,~?':': '
WATER SUPPLY : '"
leoividual Wall ~ CommOnity [] Public [] %' ",, '",
Note: If community well system, rnusl haYe written confirmation fro ~ the State Department et Environmental Con~.ervation
attesting to the legality ane status.
4. SEWAGE DISPOSAL
Onsil3 [] Public E] Community [] Hslding Tank [] '.
Note: ff commd'ni{y We System, ~ust Lave wr tten cent rmat on'from the State Department of Environmental Conservation
attesting tO th'e I~g~lity and ~(at~s, , ' ;
Page 1 o! 2,
',JEERING FIR~i PROVIDIi.,,_, INSPECTIONS, TESTS, FILE SEARCH, D, ~, AND INFORMATION
i~ by ~y seal affixed he,:et0 a nj as'of thee validation date shqwn belbw, I Verify th at rny i nv¢~tig aiion o[ this He,
y Ap pro(,b,I shows that the omsite ;,Vater'~epply and~or wast~A, ater di~posai s~stem is safej functi?al and adequa
umber ~)f bedrooms and type'of structure indicated l~erein, further verify teat based on the nf0ri~ation obtalner~
) MunicipalitY, of Anchorage files and from my investigation an'd ins'~ection, the 0n-site water supply and/or
westewater disposa~ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspecuon
SRB '196X
Address
"' EAGLF. RI¥1~R, AK 995:~. JUN I 6 1986
D~te
Approved ....
Terms of Conditionai Approval
WELL DATA
MUNICIPALITY OF ANCHORAGe.
DEPT. OF HEALTH &
ENWRONM NT^L PRO cT O
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) ,][JN '~ '/1~
.CHECKLIST - FEBRUARY 1984
:~' ~', If A, B, C, D.E.C. Approved (Y/N)
Date Completed /O/'/~ z/L' Yield
Cased to !~ // Depth of Grouting -'-"----
/cz'' ¢)~ Pump Set At f~t ~
~(..,1~ Sanitary Seal on Casing(~/N)
Depression Around Wellhead (Y~
Well Classification
Well Log Present'N)
Total Depth ) ~)J t
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduil~N)
Separation Distances from Well:
To Septic/b4efd11~r'Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole ~//~
Water Sample Collected by
/ 5" 47/u/
Water Sample Test Results
Comments
/ ~.~'- ; On Adjoining Lots
/.~7 t ; On Adjoining Lots //4:~ /?C .
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
B, SEPTIC/~G TANK DATA
No. of Compartments
Standpipes t~N) Air-tight Caps,/N) Foundation
Depression over Tank (Y/I~ DCte Last Pumped
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septi~ank:
To Water-Supply Well / ~::2_~'-
To Property Line ID /'/-
To Water Main/Service Line '~ C) '~
Course /~A
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata '~'~=;_ ~;:~/~'~--~ ~'
Type of System Design
Date Installed //~)/~ ~ Length of Field
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~D
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
Depth of Field
Gravel Bed Thickness ~ ~ V
Standpipes Present(~VN)
Date of Last Adequacy Test
To Property Line /~:~ /"/-
To Existing or Abandoned System on
; On Adjoining Lots '"~D /../t---
To Cutbank (if present)
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
2~; Ime/P'~ ~ 'cf ': S~e(vYe/' Na)t
Pumping Gycles during Adequacy Test. Meets MOA
Comments
** 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.
Signed $&$ENGINI=I=I~!NG 'Date .]IJN ! 6 1986
CompanyS~ J~ 'J~6X MOA No. ,~5'"-
F-'A K 99577
Receipt No.
Date of Payment '
Amount: $ (.-~
Page 2 of 2
72-026 (11/84)