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Home My WebLink AboutYOUNG LT 2 MLINICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I~,NVIRONIVIENTAI. ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE MAILING ADDRESS [~'~ ~ B~'~GINEERI~ l[] NEW .,~UPGRADE LEGAL DESCRIPTION LOCATION LiqlISTANCE TO: '/ ' I Ab, or p't~o~h'r ea/ Dwelllng qOf Inside le,ngth DISTANCE TO: Well Dwelling Manufacturer Material [ Lt~ng~h ~,~..~b line No. of lines / / ,~ ~- Lengtll Width Total lengt,~of line~ Material beneath tile Nearest I o~nfe~ Trench width Depth inches NO. OF BEDROOM~ 'NO. No. of compartr~ Liquid dept~..hh PERMIT NO. Liquid capacity in gallons PERMIT NO, PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line Building foundation Sewer line Septic tank DISTANCE TO: OTHER PIPE MATERIALS REMARKS DATE SOILS LOG PERFORMED FOR:~ ~/"~/-~/J LEGAL DESCRIPTION: ,~ ~ yO(~ /~ ~ 4X /'~ SLOPE 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchora~le, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST // ~ //'~ wi' = · , DATE PERFORMED: -o/ 6 7 8 C'~'- I2, PERCOLATION TEST SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: , 7;2-008 (6/79) WAS GROUND WATER y~ ~" S ENCOUNTERED? L / P E DEPTH? 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TO..~.~ ........... ,,..~:.e..~ ..... ~o, ........................ =,o ........................ ~ ............................... 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 NEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # 1. GENERAL INFORMATION Complete legal description Lot 2; Young Subdivision Location (site address or directions) Property owner Mailing address 102410£d Eagle River Road Ea~le River, Julie and William Patterson 10241 Old Eagle River Road AK Day phone 694-9125 EAGLE RIVER, AK Lending agency Malting address Day phone Agent Laura HamiltonJGREATLAND REALTY Address 11411. Old G£enn Hwy. Eagle River, AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Day phone 99577 694-9125 XXX Individual well Community well Public water 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02§ (Rev· 1/91) Fronl 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 bedroorns 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 Engineer's signature DHHS SIGNATURE hA~. Approved for Disapproved. 17034 Eagle River Loop Road No. 204 Phone bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations g~ven 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 engi0eeCs wJrk. 724)25(Rev.~/9~) aack MOA621 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,I" "~ ~o,~i,~L~ &~r~ Parcel I.D. ~--~)-,-4'-(~)--Z 7,~-Z/ A. WELL DATA Well type Log present (~N) Total depth Sanitary seal Y~.~N) If A, B, or C, attach ADEC letter. Date completed Date of test Cased to FROM WELL LOG ADEC water system number L~-~-1. "/b _ Driller C~/_~ ~ __Casing height Wires properly protected~'N) AT INSPECTION Static water level Well flow Pump level / ?-, 0 g.p.m. d 14 ¢¢- ~¢c-~ ,~¢-c-¢~--/..¢~¢_..-r~ ~ r~-¢'¢. '~ - ~ ~ SEPARATION DISTANCES FROM WELL Septic/holding tank on lot \ o Absorption field on lot \ ~o Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform O ~" "~¢~,..L¢ Nitrate Date of sample: O,/o ~//~' Other bacteria Collected by: S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA , Date installed ~ "' '~' ~//~//~J~Tank size \b,O~ Compartments Cleanouts (~'N) V Foundation cleanout ~/N) ~ Depression (Y/~ High water alarm (Y~) ~ Alarm tested (Y/N) ,J/,4. Date of pumping _ 17034 Eagle River Loop Read No. 204 Eagle River, Alaska 99577 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot toc~ ~' To property line t ~ Surface water/drainage On adja~,~nt lots Absorption fie: J Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electr~ SEP~TANCE FROM LIFT STATION TO: .~/'811 on lot On adjacent lots Manhole/Access (Y/N) · ~~Cyc e~ tested Surface water D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Depression over field (Y~ Resultsd~bil) Peroxide treatment (past 12 months) (Y~) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ('of~ To building foundation On adjacent lots Surface water Curtain drain E. ENGINEER'S CERTIFICATION Soil rating Gravel thickness ,z~ ' Cleanouts present ~/N) ',/ Date of adequacy test -~' for '7"'~ ,~ ~-~¢- ('~ .~'~/~ IJ~ If yes, give date On adjacent lots / ¢,o Property line /O / -,' To existing or abandoned system on lot Cutbank '"//z~- 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 S & S ENGINEERING 17034 Eagle ~iver Loop RoacJ Signature Eagle P, iver, Alaska 9')577 System type "~--~--~, Total depth bedrooms ~te of this inspection. Engineer's Name Date HAA Fee $ i ~'~ ~ Date of Payment '~ ¢ ~''- ReceiptNumber ~ Z~"~('-/ L-~¢-~,~/ 72-026 IRev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ~PR- ]-93 THU I0:04 P, Oi OREPiT L~ND F,qX NO, 9076943093 FLI1 E14/05-73 I0: .... '~.~ Ei-&.'~F,C~%,~IEHTAL LRB EiEE'~Jii]E'B HO. 170 ~k~2 ?WSID CHEMICAL & GEOLOGIC".AL LABORAiFORY A DIVISION OF COMMERCIAl. Tr~$TING & ~'MGINEERING CO. 5833 Et ~,I'~E~T ANC;qORAGE ALAS,~A 99518 f'6LEFF40,'IE (907i $62-23~3 ¢~X: (9¢7; 561.5301 ?,O'~iN2 SAILS COLLlSCTI~ $? ~,A~. NITZATB-~ ~.J, ra~/l E?k 3fi3.2/300 0 ,a 04/02/93 MUNICIPALITV OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMFNTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTNORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Lega Description (include lot, block, subdivision, section, township, range) Location (address or directions) (c) Applicant is (c~eck one): Londing Institution ~ MUN C ~ALITY OF ANCHORAGe' DEPT. OF HEAI.Ttl & ENVIRONMENTAL PROTECTIOH I,i/ i' ,, 0 1985 RECEIVED Business '~2¢¢ ; Owner/buil~; Buyer ~; Other~ (explain); (d) Lending Institution Telephone Address (f) 4~'~h~e"~/?A to the following address: ltYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Wel~.,. Community [] Public Individual Note: If community well system, must have wren conf 'mat on from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsit~)~. Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from tire State Department of Environmental Conservation attestin9 to the legality and status, Page 1 of 2 72-025(11~84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of tbe validation date shown below, I verify that my investigation of this Health Authority Approval shows that tbe on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated berein. 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. ~Hlu Ul ri/H/ Z~ '¢'. -:~,~'.. ' .~(,¢.~. Telepboae Ad~ress __ , ,,',.~,,,- :~60~¢~~ Dt,'IE P APPROVAL Approved for - .L bedrooms by Approved /\ , Disapproved ............ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depsdrnent of Health and Environmental Protection (DHEP) issues Health Aethority Approval certificates based solely upon tile representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. Tile 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 eot condLICt inspections or analyze data before a certificate is issued. ]-he Municipality of Anchorage is no[ responsibJe for errors or omissions in the professional enginee(s work. Page 2 of 2 MUNICIPALITY OF ANOHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT 0F HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTLFICA~ .~'.iGeneral Information Application Date . . 11/8/84 d..'.. :'~ (a) Legal Description (iaclude lot, block, subdivisioa, section, township, range) Telephone - Home Business ~-~; ~mer/bu~lder~; Telephone Lot 2r Youn.~ S/D Location ( drsas or direc io ) }~.~' ~ .. Mile .7 Old Eagle River Road i ' (b) Applicants Name Sharon Sterling ~ d c/o Jack White Applicants Ad tess : ~' (d) Lending Institution ' ' Ak ss (e) Real Estate Co. & Agent Jack White/Coldwell Realty Address ~ary Ann Scott Telephone 694-5500 Hrao 694-7991 (f) Mail the HAA to the following address: ' 2. Type of Residence Singla,-Family ~-~ Number of Bedrooms Multi-Family ~_~ 3 Ocher ,(describe) i 3. Water Suppl. z Individual Well~ Community Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality a~d status. Sewage Disposal Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page i of 2] 5. ~ngineering Firm Providin~ Inspaetions~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify ~:hat my investigation of. this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional an~ a~equate for the number of bedrooms and type of structure indicate~ 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 wastawater disposal system is in compliance w-lth all Municipal and Stage eodes~ ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address -- Telephone ])ate (ENGINEER SEAL) DREP Approval Conditional for 13 edrooma Ey Approved Disapproved ENGINEER'S ORIGINAL SEAL AND STAMP IS ON FISE WITH THE D.H.E.P. AND IS AVAILABLE FOR REVIEW UPON REQUEST. Date 12/12/84 Co~ition~ XX Terms of Conditional Approval Conditonal approval valid until June 30t 1985. This Department will require that the existinq septic tank and seepage pit be abandoned and moved outside of pKptective radii :for class C well on Lot 1 and individual well on Lot 2. Water samples will be taken for Lots 1 and 2 on alternate months until the upgrade is complete. Failure to submit samples will void this Conditional approval. THE MUNICIPALITY OF ANCHOIhkGE DEPARTME~ OF }~-~LTH AND ENVIRONMENTAL PROTECTION (Dt[EP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TItE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAf ENGINEER REGISTERED IN TRE STATE OF ALASKA. TRB DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN 0RDER TO SATISFY GERTAIN FEDERAL AND STATE RE~QUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDU~T INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR 0MISSIONS IN THE PROFESSION&L ENGINEER'S WORK. (DflEP SEAL) RR4/e3/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HFAL~{ AUthORiTY APPROVAL (~A) Well Classification Well Log P~esent Total Depth_ //~ Static Water Level Casing Height .Above Ground..~_~._~/8 Electrical Wiring in Conduit Separation Distances f~cm Well: To Septic/N~l~!n~ Tank c~n I~t_ ~ To Nearest Edge of Absoz~ption Field on Lot To Nearest Public Se%~r Line MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PI~OTECTION CHECKLIST- FEBRUARY 1984 REClE[VED Legal Descrigt"ion: /...~_~L_/,..; ~ . Zf~ A,, B, c~ C,, D.E.C. Agproved(~/N') Cased to ~P /~z_ Depth of Grouting. Pump Set At Sanitary Seal on Casing~.Y~.) Depression A~ound Wellhead (~ ; On Adjoining Lots ~6 ~- ' ; On Adjoining Lots //'~ To Nearest Sewer ~blic ~ / ~ To ~est ~= ~vi~ Li~ on ~t Clean~t~a~ol9 Wate~ S~le Colle~ed By .~'~' ~ J~ Jh~ ; ~te ;nJ Wate~ S~le Test ~sults .% ~ ~ ~ ~ ~,~ ~ / SEPTIC/HOLD:rNG TANK DATA Date Installed /~,~___ Size ~ ~6__~ No. of Cc~i~a~tra~nts stan i s ir-tig t caps6r 7- Founda 0 . ~essio~ ~ Ta~ (~ _ Date ~st ~d ~O ~.~,~l~ P~ng~intenan~ ~l%~a~ ~ File .(Y~)~ ; f~ . ... Holding Ta~ High-Wate~ ~a~ (Y~)~/~ ~a~y Holdi~ Tank Per~t Sep~ation Distan~s ~ ~gti~Tank:~' '~ dl-6~I ~ ~C, ~ ~' ~ To Water-Supply ~11 ~ f o~ A~ ~ To ~ilding F~ndation TO ~o~ty Li~ ~ ~ To Dis~sal Field ~ ' To ~te~. Main/Service Line Course Co~nts ~/9 '~ d ! To Stream, Pond, Lake, c~ Major D~ainage Receipt ~ ~%-~-5-[o Date Paid: t~-~o-~-I Amount: L-L,~ ,pC) [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed /~ ur~ Width of Field ~c ~t Square Feet of Absorption A~ea Depression over Field (~ Results of Last Adequacy Test Length of Field Gc D~pth of Field L~ Gravel Bed Thickness Standpipes P~esent ~) Date of Last Ad~=quacy Test Separation Distanc~ from Ab~so~ption Field: ~6 '~q cL~g C ~ ~. To Building Foun~tion ~D f~ To Existing or ~ndo~d System Lot ~m~ ; ~ ~joining ~ts /~ W To Wate~ ~vi~ Line ~ ~ To ~t~(if p~e~nt) ~ D~ To St~e~ond~ke/~ ~jo~ ~aina~ C~se ~ o ~ ~ To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~ /~ D. LIFT STATION Date Installed Size in Gallons "Pu~p On" r~vel at High Water Alarm Level at Tested for Electn~ical Codes(Y/N) Dimensions Manhole/Access (Y/N) ".P~u~p~f/ Level at Pumping Cycle~//du~g Adequacy Test. Meets MOA Co~uents ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checke, d, verified, o~ confc~ed to all MOA HAA Guic~lines in effect on the date of this inspection. KB1/d5/s ~....o.~.~ ,~. ~,~ : ,~ [Pa~ 2 of 2] 2-15-84 [3 E P A R T M [': fi25 / a.m. ~/:2: -I77 Wednesday MUNICIPALITY 0l:' ANC!iORAC5~:. OFJiEAI_TH AND ENVIRONMEN 279-"2511, ext. 224 or 225 3 % . Zega]. De,.,¢.,.cl~ t..[on. Ii REQUES'i' FOR APPROVAL OF INI)IVII)UAL AND WATER FACILITIES Mailing Address: Post Office Box 720 99510 Phone: 276-.6300/483 ,PrOperky OWner: William/Ann Van Brunt Phone: 694-.9607 Mailing Addre ..... Post Off:Lee Box 534 995'77 Lot 2 Yeung Subdivision 4,( SiI%gle FamLt. y kes.i.dcnce: (x) Number of gedrooats: .? ......... Multiple Family Residence: ( ) , '! 5i' well System: Individual well (x) Conmulni. ty/Public System ( ) Permit ~ ..................... Depth o:[ Well ...... ~.[,._~ ....... Well Log on F:[le N',~i~lber of Bedrooms: ( ) Sewage Disposal Syst, em: On-siLa Syskem ~ Publ_ic Ut;J. lity ( ) Absorption Area ....................... SoiLs Rate ....................... Material 7. Distances. Wel:l ,to Septic Tank ~--O ~ 1:.o Absorpnion Area to Sewer Line to Nearest, Lot Line Lot. line Absorption Area Departmen~ of for Apploval Health and Environmental Protection of [[ndividla] Sewer and waner Facilities gal Dc~..¢,z iption. Lot 2 Young Subdivision :adaVlt !%.ttache'd: ( ) ,~pprovecl, Disapp~ove. d Old Eagle River Road (the one up the valley) past the telephone company building, blue and white house on the curve on the left side, behind their house is the Hillcrest Apartments, can see the sign, dead end sign past their driveway, 6/10 mile up. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF FIEAL'rN AND ENVIRONMENTAL PROTEC'DION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGD DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AU8 1. 6 1977 RECEIVED 1. Type of Inspection: CMRO VA 2. Property Owner: W±ll±am & Ann Van Brunt FHA CONY. × Mailing Address: P. O. Bo× 534 Eagle River Day Phone:_694-9607 Name of Buyer: Patrick L. & Sharon L, Sterling Mailing Address: 909 Chugach Way ~r2]. Anchorage Day Phone: 864-3136 4. Name of Lending Institution: First National Bar~ of Anchoraqe Mailing Address: P, O. Box 720 Anchoraqe .Phone;. 276--6300 exh 483 5. Name of Realtor or Agent: Jonnie Tanner Mailing Address: Great Land Realt¥-EaqlePhone: River Legal Description: Lot 2, Young S/D 694-9125 Location: Mile ,6 Eaqle River Road 7. Type of Facility to be Inspected: Existinq Sinqle Family 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. Individual X Individual (on-site) X Marie Iiams 8/12/77 72-003(3/76) GREATER ANCHORAG~ AREA BOROUGH Department of ~nvironmental Quality 3500 Tudor Road~ Anchorage~ Alaska 9950'1 279-8686 Date RoceiveO ~/?L 75 Time of Inspection Date of Inspection REQUEST FOR APPROVAL' OF ZNDIVIDUAL SE~ER & WATER FACILITIES FoR ~a7 '~-.~'~ ~ 1. Approval Requested _~ ~ ~_~ .... Addres~ ~~~..~ ~., ~m~~h°ne :. ~¢~ · Well Data: A. _ C, Construction D. Bacterial Analysis' . Sewage Dtsoosal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. Disposal Field: 8. Installer Size 2. ~aterial Total Length of Lines 8. Distances: A. Well. To: Septic Tank , Absorption Area____, Sewer Lines .......... , Nearest Lot Line Foundation to Septic Tank "} Ab¢orption Ares._ · Other Contamination C. Absorption Area to Nearest Lot Line · Request for Approval r '[ndivldual Sewer & Water FoamilY'' Fage Two Comments: Approval Valid for One Year From Date S~qned G~-~ater Anchorage Area Borough, Def~rtment of ~nvironmental Quality DIAGRAM OF SYS'rF.M 'i cart. fly that the informat].on contained in this request for appreval to be a true and accura[;o represe~tat~en of the subject' sewer and water fac].littes located at: Signed Date d. D'tgtance fro~ well to closest existing od proposed: 1, Sewer lihe. 2. Sepl:~ c C~sspo(~] ' . 6. Other sources of'ppsg~h:¢e contamination, tiouse~ ,, Sewage d~sposal system, - b. Se~t ~c tank. ,qapaa~y e. Pex~co~t±o~L Test hrs..suLk:s__ _ f. Percolation Test performed by Use the revemse .side of tbls form to ~J~ow dia~rara, Dia[~ram should include '[~-~he fo]low,~ng info~matiom. ~opePty lJ. nes~.weli location~ house location~ ~Ut~c tank location, disposal apes location, ~t~ca'tion of perco].ation tes~, a~ direction of ground slope. The ln-fo~.~tiom on t~J.s fo~f~ ~s true and correct to the best of my knowledge, TO BE FILLED OUT BY HEALTH ;DEPARTHENT PERSONNEL above described san,[tePy fabii,it~,-::¢ are hereby approved, .s~u~'~¢~h.~e.. The above described sanitary facilities are disapproved far the follc,win~j reasons: Approval is valid fo~, one year following the date of approv~]. CPJ:cw ~tox tia!flc I;[iw~r, Ak. *.19577 f/oil, I,ot ~ Groat~r A~lcho~agc A¥oa Bol'ot~[:,h Health chocked tha lill]ljOC~ proporty for t ~. location of tho lot, Ii; shonhl bo lacated toll fcog hi f'l'o'a tho potty lino. !leo att, achod drawing, St~ icorol7, Admini;~tragivo Director