HomeMy WebLinkAboutWOODRIDGE BLK 2 LT 11
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MUNICIPALITY OF ANCHORAGE Iz)~0 ~t ~'T ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchora§e, Ataska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE
~'~l~ ¢1 ~S~ E]UPGRADE
MAILING ADDRESS
2.4 z-,5 0 Id ge,~,.,-. ~ I-¥~ 1
LEGAL DESCRIPTION
~CATION .~
DISTANCE TO. ~' ~
~ L q. capac t~ in a Ions DwWling
[ /3~0~ IF HOME'DE: Inside length
DISTANCE TO: Well
DISTANCE TO:
No. of lines
Top of 't~le to finish
Length
Type of crib
I Well
f~ o't-
Le~_~t~ ~f each ~n~
Foundat~0]l~.~. /0
Width Depth
Crib diameter Crib depth
Well Building foundation
DISTANCE TO;
CWss Depth Driller
DISTANCE TO: Building foundation Sewer line
OTHER
PIPE MATERIALS
SOIL TEST RATING
:-so
INSTALLER
REMARKS
NO, OF BEDROOMS
Dwelling , PERMIT NO,
of c9.~. par tments
Material ~'~¢.~ I No,
W dth Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance between lines
Total effective absorpti n area
PERMIT NO.
Total effective absorption area
Nearest lot line
Septic tank
Distance to lot line
LEGAL
13:Z L ~
72-013 (Rev. 3/78)
PERMIT NO.
~'*1t L.It I1'-.11 :E C: 3[: F" ¢'ql L ]E "'IF 'a-' hZ} t:::' I1=11 ~'-41 C: ~-..-!t '-'11f~.':: f--Il ~ EE
[:,E:F'FIF.:TMEI'.,I'r L HEFILTH FIND, EN',,,'I RONME;NTFIL .OTECT I ON
,= ...."' L.'" u.,] KLE l., Hr.,ICl. ll.J~.[ IlaE., ElK.
;;:.'64-472EI
,:: 8Z:O25L=: )
RPPLICRhlT
[...OCFt]" 101'4
L. EGFIL
LESLIE D. ~,.IRSHINGTOI',I 7:1.25 OLD SEWRRD HP.I"¢.
999999
LOT i::t. E:LK 2 I.,.IOODRIDEiE SUE: L. OT SIZE
]:49-65E,±
9999 S6!IJFIRE FEET
TYPE OF SOIL FIE~SORPTION S'¢STE]'"I iS: TRENC:H
I,IEI',¢,IMUM NUMBER OF E:E:DROOMS = 4
SOIL RRTING (SI..! FT,."BR)= 250
THE RE6!UIRED SIZE OF THE SOIL FtBSORPTIOI"~ S'.r'STEM IS:
IIZ> E% F" "11- It.-.1t == :1[. r;.L I1__ EZ i"-.~ L='i 'IF if. It == ::~: ~ ~_~ IF;-; I1:1%-" E IL- [:, lEE F" T I1'-~ .... '7
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TREI",ICH OR [:'RFIII",II:'IEL[:';
THE DE.'F'TH OF FI TRENCH OR PIT I'-~ THE DISTFINCE BETI.qEEN THE SLIRFRE:E OF THE
GROUND FIND, THE E:OTI"OM OF THE EXCR',,,'FITION (IN FEET).
THERE IS NO SET WIDTH FOR 'FRENCHE!-:,.
THE GRFIVEI~. D, EPTH IS THE MII',IIMUM D'EPTH OF' GRR',,,'EL BETWEEN I'HE OUTFRLL PIF'E
RND THE BOTTOM OF THE Ei:',',CFIVFITION (IN FEET::'.
PERMIT F~PF'LICFIi',IT HFI.S THE RESF'Oi'.,ISIBILIT'¢ TO INFORI'd THIS DEF'FIR'Ff, IEhlT DLIRING THE
Ii'.,ISTFILLEITION II'.,ISF'ECTIONS OD' RN"r' [4ELLS RDJRCENT TO THIS F'ROF'ERT'¢ FIN[:, THE
i",IUME:ER OF RESII}ENCES THRT I'HE WELL I,.IILL SER","E.
........... T' B-ti ,]} ,:] ;.-.-.-_" ) ][ li"-,~ E; If:' E'; ,:Z: ]'" ;ICl ~'",1 '.'S; FII t;~: E F4 f~; ~:! LII ); 11;-': i-~;
E:FICKFILL. II"4G OF FINY S"r'STE]"I 14ITHOUT FtNRL INSPEC]"ION FIND EIPF'ROVFIL B'¢ THIS
[:,EF'RRTMENT WILL BE SUE:JECT 'fO PROSECUTION.
MINIf'IUM DiSTEINCE E~ETI'IEEN FI kEEL. I.. RhlD FIN'¢ ON-SITE SEI.4FIGE [:,ISF'OSFIL S'¢STEM IS
d. 00 FEET FOR R PRI',/RTE WELL OR ±50 TO 2E40 FEET FROM FI PLIBL. IC I'.IIELL DEF'END, Ii",IG
UPON TFIE T'¢PE OF PUBLIC WELL
MINIMUM DISTFINCE FROM R PRIVFITE I.,IELL TO FI PRIVRTE SEWER LINE IS 25 FEE'.']' FII",ID
TO R COI"IMUNIT'¢ SEI4ER LINE IS 75 FEET.
P.IEL. L L. OGS FIRE RE6!UIRE[:' FIl"4[:, MUST BE RETURNED TO THE DEF'FIRTMENT WITHIN ]:0 DR'ES
OF' THE 14ELL. COMPLETION.
OTHER RE~;IUIREMEi',I'['S I'"lW'r' FIF'F'L"r'. SF'ECIFICFf'FIONS RNI} CONSTRUE:TIOI"4 DIEtGF.:FIM::~; FIRE
Fi',,,'RILRE~I..E TO II",ISURE PROPER INSTFILLFITION.
I C:EI;,'I"IF"r' THFIT
±: I FIt"'I FRI'IILIFIR WITH THE RE6~UIREI"IFi"ITS FOR OI",I-SITE SEI.qERS FIN[:' I.,.IELL. S ElS SET
FORTI-I B"r' THE I"ILIi'4ICIPFILIT'¢ OF FINCIqORFI(_'iE.
2: I I.'.IIL. L INSTI=ILL. THE SYSTEI'd Ihl FICCORDFINCE PltTH THE CODES.
]!:: I LIN[:,ERSTFIND THFIT THE ON-SITE SEi41ER S'¢STEM i'"IR'T' RE~;!t.IIRE ENLRRGEMENT If:' THE]
~'.ESID, EI"~CE IS F~EMOE:,ELE[:, TO INOLU[:,E I"'IOI;.:E THFIN 4 E:EE)ROOM'~i. ~
FIF'PLICFIN'r~-)LESLIE ~'. .5HII'IG~N L¢:: lC)':*)
0 /// ,'/t l/ ' 51
ISSUE[:,
2
3
6
?
8
9
:
8, ENI}INEERS, IN0.
/'12b OLO ~;I:WAI?O ltWY.
ANCIIORAGE, ALASKA 99505
349 - 6.561
:,(HI ,";I (V; IH:HC()I AII()N
16
17
19
2O
% JOIIN E. SWANSON
1834-E
'~OFESSIOt)
PERCOLATION RATE
TEST RUN OETWEEN
(,' ~
]~OX ]869, STAR ][~OUTE A ANCHORAGE, ALASI(A 99.~0~
/_.LA s / ¥ /
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF u._'~.00
PROPERTY OWNER
LOCATION OF WELL SITF
DRILLER
PER FOOT.
?: ~x~ 0040
WELL LOG:
.~. ~ r-.p,. ~ 145 ~.eA..o ~,. 200
220
Coal of. 9~,2Y.~L~9: ,~23,00 pe.,g floo& Z 2-55 7ep.4-: ~58~5.00
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM oF <?5c~(5,00
THANK YOU VERY MUCH,
BERNIE: CLAUS OF RAMPART DRILLING WORKS
~ERVICE CHAR(~EOF 1"~% PER MONTH WILL BE ASSESSED ON pAST DUE'ACCOUNTS.
MUNICIPALITY OF ANCHORAGE
,~ ¢,~ DEPARTMENT OF HEALTH & HUMAN SERVICES
~, ~:~ ':~ 7~" DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Cate
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) PropedyOwner ¢~ ¢¢~ T%lephone:Home . Business
Mailing Address
(c) Lendinglnstitution ~[¢~ ~¢~ Telephone
Mailing Address '~' S~ ~'1~ ~,~
(d) Real Estate Company and Agent . ~/
Address ~ ~ t ~ C ~
(e)
Telephone ~' ~ ~'~'%' ~
Mail the HAA to the followina address: or: Check here~., if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
WATER SUPPLY
Individual Well~ Community [] Public
[]
Note: If corem unity 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 Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 81861 Fronl
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WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
cHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) _
Separation Distances from Well:
Well Classification
Well Log Present (Y/N) _ y
Total Depth _.-'~.-~,~ Cased to
Static Water Level
If A, B, C,.D,E.C. Approved (Y/N)
· Date Comp,eted 7/"Z/'C-S Yield
Depth of Grouting ['"',J I~ N J~
Pump Set At ~"
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (y/N)
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
Comments'
97' -
; On Adjoining Lots
J I{) '[' ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
;Date
SEPTIC/HOLDING TANK DATA
Date Installed ~'/~''/~,~ _ Size
Standpipes (Y/N) '"r''v~¢/[:;~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well C~' "7
To Property Line
To Water Main/Service Line
Course
Co,nme.ts
No. of Compartments "-r
Foundation Cleanout (Y/N)
Date Last Pumped
_ 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 ..~(~ ,'/
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I I ~ ~'
Type of System Design
Lengtb of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N) O'~JL~
Date of Last Adequacy Test ~'/~ ?/~'~
To Property Line
To Building Foundation
Lot ~'~ O ~ ~.
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
· ,FT STAT, O.
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 I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company MOA No.
Receipt No.
Date of Payment
Amount; $
Page 2 of 2
72-026 ¢1/84)
Engineer's Seal
MUNICIPALITY OF ANCHORAGE
DEPARTI'~NT OF HEALTH AND ENVIRONMENTAL PHOTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEAL. TH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
/ /
Application Date __ '~./2-.¢/~;~'~
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name~.~ ~, [[-,~ Telephope: Home ~¢; ~usiness ~&~~
(c) Applicant is (check one): kondinO Insfitution~; Owner/buildor ~; Buyer ~: Olhor [] {explain);
(d) Lending Institutior~ Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
,
Co. ll
TYPE OF RESIDENCE
Single-Family~ Multi-Family []
Number of Bedrooms ~
Other
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 and status.
SEWAGE DISPOSAl.
Onsite,~ Public [] Community [-1 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 (11/B4)
5. 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 verify that my irrvestigation 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 ol 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
the date of this inspection. /
Nameo, Firm ~ /~S~I~ ~;~eCFl'~Telephone
DHEP APPROVAL
Approved for -'¢f'¢'v .~¢--
Approved
bedrooms by
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 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 DATA
MUNICIPALITY OF ANCHORAGE (MOA/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
26,.,,2o RECF. IVED
Legal Description: _~ ~-.
'"uv~I'..-I~'ALITY OF ANCHOP. AOI~
DEPT. OF HEALTH &
ENVIRONMENTAl, PROTECTION
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
We Log Present (Y/N) ~ & Date Completed _ ·~T'~'j~ ~-~.- /
Total Depth ~ ~ Cased to ~ Depth of Grouting
~ ~ Pump Set At
Sanitary Seal on Casing (Y/N)
~ ~ Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot ~'7 ! :¢¢¢ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /O~/-~ ; On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results __
Comments
/V' ~/~ To Nearest Public Sewer
/~,,.,/¢/t/~ To Nearest Sewer Service Line on Lo,~ ~;~,~ ~"
B. SEPTIC/HOLDING'rANK DATA
Datelnstalled ~-~,1/~,~/~' Size /~'"'~)~O-No. ofComeartments
-
Standpipes (Y/N) ~,~ Air-tight Caps (Y/N) _ /~ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ Date Last Pumpea
Pumping/Maintenance Contract on File (Y/N)
Temporary Holding Tank Permil (Y/N)
Holding Tank High-Water Alarm [Y/N) _
To Building Foundation /~'"
To Disposal Field ~,~ !
Separation Distances from Septm/Holdlng Tank:
To Water-Supply Well
To Property Line
To Water Mair Service Line
Course / O~ ~'
To Stream. Pond. Lake. or Major Drainage
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 2'~) ~"/ ~;~ ~ Type of System Design '"~
Date Installed ~ /Z~/~ ~ Length of Field ~O-+~
Width of Field ~ ~ ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test '~ij~,
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation 3 ~'''''
Lot /~O
~.~ ~ravel Bed Thickness
/ ~ Standpipes Present
~~ast Adequacy Test
TO Property Line
; On Adjoining Lots
To Water Main/Service Line ~"~ ~ ~
To Slream/PondlLakelor Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Cutbank (if present)
To Existing or Abandoned System on
Comments
Date Installed
Size in Gallons ~
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
u .~nt (Y/N) OA
** Check Permitted Bedroom Rating Against HAA Request **
I certily that I h6v'e ch_~d~d,.verifi, e~, or conformed to all MOA apd HAA guidelines in effect on the date of this inspection.
Signe2~-.~?2~./~. ~_~---~ Date ~ ,/~/---~.-~
Company' "' ~-~ MOANo. ~--~--~--O/~
Receipt No. '~ ~ ~ ~ ~ ~
Date of Payment '~'- q' ~
Amount: $ C. ,)
Page 2 of 2
72-026 (11184)
Municipalityof
Anchorage
P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOFI
DEPARTMENT OF HEALTH & HUMAN SERVICES
March 10, 1986
Wayne Henderson, P.E.
Peninsula Engineering
440 West Benson Boulevard
Anchorage, Alaska 99503
Subject: Lot 11 Block 2 Woodridge Subdivision
Waiver Request, WR86-031
Dear Mr. Henderson:
Your request for a waiver of the separation distance required between
the septic tank and well on the subject property has been approved. The
separation distance stipulated in 18 AAC 72.021 has been waived to
97 feet.
This waiver is valid for the existing five bedroom single family dwelling
only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
,SSM/ljw
CONSULTING ENGINEER [ELEPHONE (90/~279 3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOCATION:
LOT 11, BLOCK 2, WOODRIDGE
4900 WOODRIDGE CIRCLE
OWNER: HOME EQUITY
RESIDENCE:
SINGLE FAMILY, FIVE BEDROOMS. VACANT SINCE
MARCH 1986.
WELL:
SEPTIC
SYSTEM:
PRIVATE, ON SITE
FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1500 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 1456 SQ. FT.
SOIL RATING: 250
INSTALLATION DATE: JUNE 1983
DATE OF PUMPING: 2/26/1986
DATE OF TEST:
2/27/1986 PENINSULA ENGINEERING
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED ON MARCH 13,
1987. TANK WAS FOUND WITH 3 FEET OF COVER AND
46 INCHES OF CLEAN LIQUID. TRENCH SUMP WAS 7 FEET DEEP AND DRY.
SINCE THE SYSTEM WAS TESTED IN FEBRUARY 1986, AND THE RESIDENCE
HAS BEEN VACANT SINCE THAT TIME, THE SYSTEM WAS NOT RETESTED.
The operational life of all septic systems depends on the local
soil conditions, groundwater 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 long the system will continue to meet the operational requi-
rements of the Municipality and State.
440 W, Benson Blvd.
Suite g06
Anchorage, Alaska 99~03
(007) ~61-3107
February 28, 1986
Homequity
1300 Post Oak Blvd. Suite 950
Houston, Texas 77056
Attn: Cheryl
RE: Lot 11 Block 2 Woodridge
Case #230878 Sewer & Water Health Authority Approval
Dear Cheryl:
Per your request we have performed the adequacy test of your septic
system as required for health authority approval on the above
referenced property.
The test was performed by adding water from the well at 6 gpm to the
end of the absorption trench and monitoring the levels in the trench
and septic tank at regular intervals. This procedure was repeated on
two consecutive days and the test results are tabulated below:
Qnty
Date Time Tank CO Rate Gals
2/27/S6
0 21" 0" 0 gpm 0
10 21 1t 6 60
30 21 10 6 180
60 20.5 9 6 360
90 20.5 9 6 540
120 20.5 9 6 720
125 20.5 9 6 750
2/28/86
0 22" 0 0 0
15 22 8.5 6 90
30 22 11 6 180
45 22 11 6 270
55 22 3 6 330
85 22 3 6 510
108 22 3 6 630
130 22 3 6 780
The test result indicate that the sewer
performing adequately for a 5 bedroom home.
found to deliver a steady flow of 6 g.p.m.
absorption system is
The well as tested and
There is only one problem with the subject property and that is that
the well is located 97' from the septic tank and the Municipality
requires that it be 100' . A request for a waiver will be made
directly.
Sincerely,
WH:js
APPLI( NT FILLS OUT UPPER HA[ ONLY
" ~ ,~ ,~...::-~q~ ~-)~ zip cod~
Buyer
Address Zip Code
Realty Co. & Agent Phone
Address Zip Code
Type of Residence
~Slngle Family
~ Multiple Family No. of Bedrooms~"Z~'~
~ Other
Water Supply
~ndividual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utlllty
Sewer Disposal
~lndlvldual Year Individual Installed: ~ ~ ~'~
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time
Time Time Time
Inspector Inspector Inspector Inspe3tor
Field Notes:
MUNICIPALITY OF ANCHORAG~
DEPT. OF H~/',LT [':
ENVIRONMEN1AL P~OT~CI-ION
NriV ~ ....
R E CELV_E D
) APPROVED BEDROOMS
) BISAPPROVED
) CONDITIONAL APPROVAL'
[)ATE
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank /~) ~ / "/
Well Log Received
Septic Ta~k Size // .,~' ~