HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 7 LT 9 Thunderbird
Heights #3A
Lot 9
Block 7
#051-581-21
,r~'~ 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
[] UPGRADE
MAILING AD'ESS
LOCATION NO. O~.~ROOMS
, Absorp.t, a a Dwp PER ,p
~ZManufacture~e~ ~e
~ ~ Liq.~ ~9 i~in~ allons IF HOME.DE: Inside length Width Liquid depth
~ DISTANCE TO: Well /~7~wel~ing PERMIT NO.
O ~ Manufacturer Material Liquid capacity in gallons
~,~ ~] N°' of lines ! Length' ~ '~h~Z Total~g~fc~. ]~ Tre~ Z~inches DistancCStT~nes
Top of tile t~inish grade[ ~ M r~ ] ben hile
~1 ~'~ ~ I~ ~1. ~ '~rX ~"--~ ~ches Total effec,ve absorption area
Length Width Depth -- PERMIT NO.
' DISTANCE TO:
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
Class~ Dgpth Driller Distance to Jot Jine PERMIT NO.
~ m DISTANCE TO: Building round, ion Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RAT
R
~ ~ ....
Permi. t ~
Applicant:
!
r.ocation:
Legal Description: ~OT ~ ~/~
Type of Soil Absorption System Is:
Trench: Drainf ield:
Maximum Number of Bedrooms:
MUNICIPALITY OF ANCHORAGE
Departmen~-~ Health and Environment~?rotection
825 .~ Street, Anchorage, AK. J9501 ~
* *'* HANDWRITTEN PERMIT * * *
264-4720
ON-SITE SEWER PERMIT
Mailing Address:
Phone Number:
size:
Seepage Bed~ Holding Tank:
Soil Rating(sq.ft/br) /~
The Required Size of the Soil Absorption System Is: '
DEPTH ?~~'~ '~
LENGTH -~v' GRAVEL DEPTH ' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE.= /~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3L 1 9 8 3 * * *
I certify that:
(!) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the ~idence is remodeled to include mor~ t~ 3 bedrTy~
Signe~: ~-~~~ Issued by.~__,~'F..~
SWP/024 (1/81)o
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
PERCOLATION
TEST
SLOPE SITE PLAN
10Z
11
13-
14-
15-
16-
17-
18-
20-
WAS GROUND WATER
ENCOUNTERED?
~.YES, AT WHAT
EPTH? Gross Net Depth to Net
Reading Date Time Time Water Drop
;
PERCOLATION RATE ~'/,.~) ,'~ ~(~inutes/inch)
TEST RUN BETWEEN ~' FT AND ~ FT
/Z//
MEMORANDUM
DATE: October 22, 1997
TO:
Onsite Services Engineer
FROM: Mike Anderson, P.E.
SUBJECT: Lot 9, Block 7, Thunderbird Heights Subdivision Unit 3A
Septic System Adequacy Test
On October 21, 1997, we inspected the absorption trench and septic tank which serve the
three bedroom home on the subject lot. System was constructed in 1983 and is a 1,000
gallons septic tank with a 63' long x 5' wide x 2' effective depth absorption trench. The lot
is served by a community water system owned by the Municipality of Anchorage.
Our initial probe of the septic system revealed a substantial buildup of sludge in the bottom
of the trench. It also indicated 19" of standing water out of a possible 24" total beneath the
distribution piping. A combination cleanout/monitor tube at the end of the field is the only
access to the field. Two cleanonts am available on the septic tank.
A total of 490 gallons of water was injected into the absorption trench. The water level
rose a total of 3.5" during this process to a level of 22.5". The level was measured a half
hour later and had dropped to 22". We returned to the site approximately 19 hours later
and the water level in the trench had returned to the original 19" level. During this period
water continued to flow into the trench from the house.
It is apparent from our test the trench is capable of absorbing more than 450 gallons of
water per day. It is important to note however, the trench is nearly 80% submerged. Only
20% of usable area remains in the trench for continued use. We have notified both the
realtor and homeowner of the results of our test and recommend that the Health Authority
Certification be issued based on these results.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(9O7) 343-79O4
(~.ERTIFICATE OF HEALTH '.b, UTHORITY .b, PPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 051-581-21
1. GENERAL INFORMATION
H~ 030~
Expiration Date:
Complete legal description THUNDERBIRD HEIGHTS SUBDIVISION i~3A; .LOT 9, BLOCK 7
Location (site address or directions) 24311 THUNDERBIRD DRIVE * CHUG1AK~ AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
NICK SPIROPOULOS Day phone 343-6443
24311 THUNDERBIRD DRIVE * CHUGIAK~ AK .99567
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
· Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are i'equired for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Jssue for properties served by a pdvate or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a pedod of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) 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 investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address .3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GAENESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identitiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions ere outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there ara no hidden defects or encreachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system w~ll continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authofized, nor will it confer any legal fight whatsoever.
Date
337-6179
DSD SIGNATURE
Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the fllowing stipulations:
~ j WATER
~ ~ WASTEWATER
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
~'~'~,~'O~, ....
Manitenance Agreements
Supplemental Engineers Reo~
Other
(Rev.
Original Cedificate Date:,
Municipality of Anchorage
Development Services Department
Building Safety Oivlslon
On-SRe Water & Wastewater Program
4700 South 6ragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
wv.v.cLanchorage.ak.us
(9O7) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalOescdpflon:
, THUNDERBIRD ,HEIGHTS~ LOT 9t.,BLOCK 7 , Parcel ID: , 051 ,-581-21
WELLDATA
Well type PuBuc If A, B, or C provide PWSID# 2! ! 1_56 We~
,Date completed Sanltary s~ires properly protected (Y/N). _
Total'depth , fl ased to, ~, ff. Casing height (above ground) ~ , in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
./
Well production .'""~,~ , ~ ~ g.p.m.
WATER SAMPLE RESULTS:
~,/ _ , g.p.m.
Coliform colonies/100 mi. NIt~ ~ ~~~~,.~_...~;,,=,;,~'
Arsenic: Date of sample: Collected by: ....
B. SEPTIC/HOLDING TANK DATA
colD'lea/100 mi.
TankType/Matarlal , STEEL
Date installed , 10/10/85
Tank size,.1000, gal.
' Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) ,YES, Depression over tank (Y/N).NO High water alarm (Y/N) N/A
Date of pumping .. 6/11/2005 Pumper ,, . JR'S 'P..UUPING
ABSORPTION FIELD DATA I*sELow' ~h~,,,,ORA~EI
Data installed lO/10/S3 .......Soil rating (g.p.dJft~or(~,;t 50
Length .......... 65 ., f. Width ....... 5 , fL
Total depth e.3'+/, fL Eft. absorption area,,4,50, ft~ Monitoring tube ,YES.
Date of adequacy test 6/1!/2005 , Results (Pass/Fall) PASS.
System type ,, TRENCH
Gravel below pipe , 2 ff.
OePres~ion over field. NO
For _5 bedrooms
Fluid depth in absorption field before,test ,, 18 in. Water added 550 gal, ' ' New depth 27 in.
Elapsed Time: 15 min. Final fluid depth21.751n. Absorption rate >=, 4,50,+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN ....... If yes, give data..___T_.~
D. LIFT STATION
Date installed Size in gallons .
"Pump on" level at ~ High water alarm level at in.
Da...~F~tum ~ Cycles tested Meets alarm& circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
...--- Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundaUon 5'+
Property line .... 5'+..
Absorption field
5'+
Water main 10'+
Water service line 10'+ Surface water,
100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
COMMENTS
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots. 200'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems ere in
conformance with MOA HAA guidelines in effect on this date.
Water main 10'+
Driveway, parking/vehicle storage 25'+
Engineers Pdnted lyame
Date
JEFFREY A. GARNESS
HAA Fee $ ~ ~5~.OO
Date of Payment ~
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
AUG.-Ig'00(FRI) 12:08 .~ SVS/$VM~ (PABAff) TEL:90775~9474
P. 002/002
'q'c oo,.
Anth~r~.w~ Re~rdlnl Pr~dn~,.At~{B, and that the im~v~
m~t~, SRunt~ ~ereon ~e wit~ the Dto~ ll~es and do
r~dway~, t~n ~e~ or o~ ~si~{t e~emen~ on
S~ / ~:t~ Land ~eycr No. ~O-~
Parcel I.D. #
1.
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
05158121
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
NAA # ~,~C~'-~-"~
GENERALINFORMATION
Complete legal description
Lot 9, Block 7, Thunderbird Heiqhts
Subdivision Unit 3A
Location (site address or directions) 24 31 1 Thunderbird Drive
Property owner Dan & Diana Pike
Mailing address 2431 1 ff'h~ndc~rh'i rd
Dayphone 688-4363
99567
.Lending agency
Mailing address.
Day phone
Agent Arlene Meyers "?.Day phone 688-1236
Address
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
mh?-c,c, (~)
NOTE:
TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual well
Community well xx
Public water
If community well system, provide written confirmation from State AD£C attest-
ing to the legality and status of system.
Individual on-site
Holding tank
Community on-site
Public sewer
xx
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~25 (Rev, 1/91) Front 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 th'~t my
· investigation of this Heatth Authority Approval application 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. ~ 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 Anderson Engineering
Phone 563-7155
Address P.O. Box 240773 Anchoraqe, AK 99524
ng,.eer'ssi nature Date
DHHS SIGNATURE
~ Approved for 3
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
7he Municipality of Anchbrage 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.
Legal Description:
A. WELL DATA
V~ell type A
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division J~ E (~ E ! V E
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
OCT2 ;5 1997
Health Authority Approval Checklist Municipality of Anchorage
Dept. Health & Human Services
Lot 9, Block 7, Thunderbird ParcelI.D.: 05158121
Heights Sub. Unit 3A
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 1 0 / 83 Tank size
Foundation cleanout (Y/N) Y
Date of Pumping 10/23/97
C, ABSORPTION FIELD DATA
Date installed 10/83
Length 63 ' Width
Effective absorption area 450 SF
Date of adequacy test 10/21 /97
Fluid depth in absorption field before test (in.);
211156
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Public Water
Nitrate
g.P.m, g.p.m.
System Currently in Conformance
Collected by:
1 , 000 Number of Compartments __
Depression (Y/N) N
Pumper JR ' s
Other bacteria
2 Cleanouts (Y/N) Y
High water alarm (Y/N) N
Soil rating (g.p.d./ft2orft2/bdrm) 1 50 SF 5' Wide Trench
5 ' Gravel thickness below pipe to 7 '
Monitoring Tube present (Y/N) Y N
Results (Pass/Fail) Pass bedrooms
! 9 Immediately affer490 gal. water added (in.): _22.5"
System type
2 ' Total depth 6 '
Depression over field (Y/N)
For
Fluid depth 1 9" (ins) Minutes later: I ~ 1 50
Peroxide treatment (past 12 months) (Y/N) N
72-026 (Rev. 3/96)*
Absorption rate = > 450
If yes, give date
g.p.d.
D. LIFT STATION
Date installed
Manhole/Access (Y/N).
High water alarm level at*
Cycles tested
E, SEPARATION DISTANCES
None on Lot
F,
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > 5 '
Water main/service line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 1 0 ' Building foundation > 1 0 '
Surface water
Curtain drain None Observed on Lot
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections
in conformance with MOA HAA guidelines in effect on this date.
Signature ~.,.
Engineer's Name Michael E. Anderson~ P.E.
Date October 23. 1997
"Pump off" level at*
Public Water System
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
Driveway, parking/vehicle storage area > 2 0_ '
Wells on adjacent lots > 2 0 0 '
HAA Fee $ '~ff'~f'~.
Date of Payment \~'~- ~.?~ -¢~--~
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
Water main/service line > 2D '
Absorption field > 5 ~
Wells on adjacent lots > 200 '
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1 o Ceneral Information Application Date J'~/~ (/-
(a) Legal ~esc~_ iption (inclu~, lot, ~locg, .subdivisioD,/ section, township, range)
Location (add~ess or directions)
(b) Applicants Nar~ /~j_~ ~/C)~"7 Telephone
Applicants Address
(c) Applicant is (check or~) Lending Institution ~-~ ; Owner/builder,S..';
Buyer F--~ ; Other~_~ (explain); '
(d) Lending Institution Telephone
Address
(e) I~al Estate Co. & Agent
Address
Telephone
2. Type. of l~sidence
Single-Family~
Numbe~ of Bedrooms
3. Wate~ Supply[
Individual ~11[~
Ymlt i-Family ~
Other (d~scribe)
Note: If community w~ll system, ~st have w~itten confirmation from the State
Depa~tmsnt of Environmental Conservation attesting to th~ legality and status°
Is the w~ll adequate fo~ the number of bedro~ns specified in this HAA (Y/N)
4. Sewa.qe Dispo~.a_~l
Onsite~ Public ~-~ Conmunity ~--~ Holding Tank ~Z~'
Is the wastewater disposal system adequate for the rnmber of bedronns ~N)
[Pa~e 1 of 2]
2-15-84
5. Engineering Firm P~oviding Inspections, Tests, Data and Information
that~e_ehecked,., verified, or confom~d to all MOA HAA Guidelines in
certify
effect~/~°n~/dateJ~i~sPecti°n° e~~/
S igne d~.{f/ff~96/~ ~- Dat ,
Nam~ of Firm Telephone '-5
Date · ,~,
6._DHEP Approval
Approved for
Approved ~
~ bedrooms
Disapproved ~
Conditional~
Terms of Conditional Approval __
The Municipality of Anchorage Department of Health and Environmental P~otection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastew~ter disposal system. This approval indicates that, as of the validation date
sho~n above, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the number of bedrocks and type of structure indicated. ,
(DHEP SEAL)
Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Classification
Well Lcx3P~esent (Y/N)
Total Depth
Static Water Level
Cased to
MUNICIPALITY OF
DEPT. OP HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
L
Date Completed Yield
Depth of G~outinG
Sanitary Seal on CasinG (Y/N)
Depression A~ound Wellhead (Y/N)
; On AdjoininG Lots
; On AdjoiningLots
To Nearest Public Sewer
To Nea~est Sewer Service Line on Lot
Pump Set At
Casing ~gight ~bove Ground
Elect~icalWiring in Conduit (Y/N)
Separation Distances f=omWell:
To Septic/HoldingTank on Lot
To Nea~est Edge of Absorption Field on Lot
To Nea~estPublicSewe~ Line
Cleanout/Manhole
Wate~ Sample Collected By
Water Sample Test P~sults
B. SEPTIC/~ TANK DATA
Date Installed /'d)~/O--~3 Size /~/3Z3 ~/~/-. No. of Compartments ~
Standpipe ~) Ai=-tight Caps ~) Foundation Clean~t ~)
~pression over Ta~¢ (Y~ ~te ~st ~
P~ing~intenan~ ~n~a~ ~ File (Y~) ; fo~ ~
Holding Ta~ High-Wate= ~a~ (Y~) ~/~ ~ra~y Holdi~ Tank ~t (Y~)
~p~ation Distance ~ ~ptic~olding Ta~:
To Water-Supply ~11 ~O~h~ TO ~ilding F~ndation ./~ ~
TO ~o~rty ni~ /~ ~ To Die,esl Field ~ ~
To ~ter MaipJ~ryi~ Li~ ~
To Stream, Pond, Lake, c~ Major Drainage
[Page 1 of 2] 2-15-84
DEPT. OF EN~/~RONME~T/~L
437 "E" STREET~ SUITE 200
ANCHORAGE, ALASKA 9950
RILL SHEFFIELD, GOVERNOR
Teleohone: [907)
Address:
274-2533
To Whom It May Concern:
According to r,e. cprds on file in this office the
~]'~LAJ~::~i~b ~¢:~-~Water System is in compliance with the State Drinki'ng
Water Regulations. ·
APPEIC~NT FILLS OUT UPPER HAL~.,iONLY ,
~ f_ '? Phone
Properly Owner /'~ ~,.L//~ ~ .,~,~ (-/~.~//~/'.~/~ ~~ ~-~
Buyer ~
Address Zip Code
Address Zip Code
Realty Co. & A~nt Phone
Address Zip Code
Street Locati~
Type of Resi~nce
Single Family
~ltiple Family No. of Bedroom ~
~ Other
Weter Supply
~ Individual A~ACH WELL LOG, A w~l Icg is required for all wells drilled since June 1975.
ommunity
~ublic For wells drilled prior to that date, give well depth (attach log if available).
Utility
Sewer Disposal
~ividual Year Individual Installed:
blic Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE iNITIATED.
Time
Date
Time
Inspector I~~..."~ ~
Field Notes:
( ) APPROVED BEDROOM,~
( ) DISAPPROVED ~
VAL'~
( ) CONDITIONAL APPRO
DATE
BY:
Time
Date
Inspector
-~ L~ L~ U VJ LS
JUN 0 7 1983
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
72023(3/82)
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size