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Home My WebLink AboutDALZELL-SCHNEITER BLK 2 LT 17 f'-'~ MUNICIPALITY OF ANCHORAGE Y ~ 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 PHONE r-~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDRO0 DISTANCE TO: I Wel~ 'OO ~ No. Ol compartme~ Manuf~turer Material DISTANCE TO: Dwellin9 PERMIT NO. Manuf~turer Material Liquid capacity in Well Foundation ~ Nearest lot I PERMIT NO. DISTANCE TO: ~ ~ O~ No. of lin~ Length of · h line Total length of I width Distance ~t~en lines inches T~ of tile to finish grade~--~ ~ Material beneath tile ~ I ~11inch~ Total eff~ti~ ebso~fion~ ~area Length Type of crib DISTAN DISTANCE TO: W,dth Depth PERMIT NO. ameter Crib depth Depth Building foundation OTHER ERIALS REMARKS 72-013 (Rev. 3178) foundation Sewerline DATE LEGAL Nearest lot line Distance to lot line Septic tank PERMIT NO. !BPPLICRNT iLOCRTION LEGRL DEPRRTMENT {3' HEALTH AND ENVIRONMENTAL r ]TECTION 825 'L° STREET, ANCHORAGE, AK. 995(~1 2¢4-4720 ~ELL 8ND ON--~ I TE ~E~ER ( 7~27 } J. BUMGARDNER (DBA SUN C 147 B2 DRLZELL-SC~JEITER BOX 474 E SRA iTYPE OF SOIL ABSORBTION SYSTEM i MRXIMUM NUMBER OF BEDROOMS = 4 PERMIT LOT SIZE 52060 SQURRE FEET TRENCH SOIL RRTING (SQ FT/BR)= 'THE REQUIRED,SIZE OF THE SOIL ABSORPTION SYSTEM IS: 85 DEPTH= 10 LENGTH= 29 GRAVEL DEPTH= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXC~VRTION. (IN FEET). THERE IS NO E>ET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCRVRTION (IN FEET). REQUIRED ~;EPTI¢ TANK SIZE= i::~50 GALLONS iPERMIT RPPLICRNT HAS THE RESPONSIBILIT~ TO INFORM THIS DEPARTMENT DURINO THE iINSTALLATION INSPECTIONS OF ANY WELLS RDJRCENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ------ TI~IO (;2:) I N:~PECT I ON~; ARE REQU IRED BRCKFILLINO OF ANY SYSTEM WITHOUT FINAL INSPECTION 8ND APPROVAL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN ~ WELL 8NO 8NY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE WELL~ OR i50 TO 2~8 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS RRE REQUIRED AND MUST BE RETURNED TO THE DEPARTHENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS ARE ~RVRILRBLE TO INSURE PROPER INSTALLATION. PERMIT EXPIRES DECEMBER :~l. 1978 ,I CERTIFY THaT ii: I 8M FAMILIAR WITH THE REQUIREMENTS FOR 0N-SITE SEWERS 8ND WELLS 8S SET FGRTH B~ THE MUNICIPALIT~ OF 8NCHORAGE, ;2: I WILL INSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. ;3: I UNOERSTRND THAT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE 'RESIDENCE IS R~ELED TO INCLUDE MORE THAN 4 BEDROOMS. RP~I'CRNT J. BUMGRRDI~R (DBR SUN CONST) ~OJECT CLIENT W.O. SHEET 11 OF 14 L~'Z'../~ ../_/? TEST HOLE NO 2-i7 ELE~TOPOFHOLE 448+ DATE, 11/3/76 12" Forest Duff 12" Damp, Yellow-Brown Organic Sandy Silt 2-17 (1) (10.7% Silt) Damp, Brown,"Gravelly Sand ~SW) 2-17 (2~ Bot~gm~..Dry Hole '' '~ i6n_rate less than 1 mzn./inch Bedr WELL LOG E. Bumsardner Anchorage, Ak. · Blk ~/ 2 Sub. .Oct. 28', 1979 Phone 344-3433 ;, ~nchorage, Ak. · ' · O' ..... LL ....... 18 ft. ' and ,~ Gravel 18 .... - .......... 37 ft. Clay & Gravel 37 ............... 53 ft. Clay 53 ............... 58 ft. Clay & Gravel 58 ............... 60 ft. Sand, Gravel, Water Bailed 10 CFM 16 ft. water in well :OT I,/,UNIClPALITY D£PT. OF HEALTH ~ION IAPR" 8 ALASKA ENVIRONMENTAL CONTROL SERVI?~,, INC. 1200 West 33rd Avenue. Suite B ANCHORAGE. ALASKA 99503 (907) 561.5040 ~o. L I? ~ 2- .f)AZPLL. SHEET NO OF DATE lu_-' / .... ~ ' . ~ · · MUNCPALITYOFANCHORAGE . . ,~, · ,. '. ~ , · c: ;.;'~ ":',~': ;.:. '...' i. '. :.." ,~"~.~, :"." DEPARTMENT OF HEALTH & HUMAN SERVICES ,:'.' :;~ ~L~: · ,...... ............................. , ,.. , ..~ ;,, ,. , ,, ...... .~.~'~_~/l~r,,ji,/.. ....... ; Division of Environmental Services . .... ~ ..,. ......... P,O. Box 196850. Anchora e, Alaska.. 99519-6850 .... · . .. ;' .": ,' ",~ -' '," ..... ~ '. CERTIFiCATE OF HEALTH AUTHORITY,' '.,'.., . . ~. :'. ' ' '.. ,.~ "'.'.' . ~' '.}. APPROVAI.~FOR ASIhOLE FAMI[Y. DWELLINo- ., " , late ai ~eSc'~i i ' . ~-" -:' ~=' ' Location (site address or directions) - ProDerIYowner .. ~o~1 and Po~*~ R~n~.'ck :- ' · Dayphone 546 1~6 ...... . .... , ~-' : ". "Mai fiaaddress '". 1021I.,Eu~t~c~e~t · *__ _..~L~.ndmn agency ...... ....... ' ........ * ..... ~*, '*:u~v__, .-------~3n°ne. ' . .*,.*' ....... ,~,~'i .........., ..... ...~........ ... ~ . , ... ..',." . f?.~ . ....... . .... ~ ~,,.,,.~. ,:. .. .*'.. "r' :' ...a..m,. address . ..................... , ................ ';{~, · . ~. , . ... ,. ,. .... ,. . , . .~, . . , . ,. .,..~, . ;, ,.....,.... g.~ ,, .....~t.*. ;,..~., ~ . '.,', ' . ' :,. Unless otherwise requested,'HAA wtll beheld.for pickup., ' , -. ~. ~.,.' ?, ~ .,,~ - ,',.. , .. :; ..... ~ -. . . .... , , , . .*,, , o . ..... · ...:........... WATER SUPPLY ............. ... .................... I , . . . , . .-. .... - ...'. ,u v dual wel .. ......... . ......... ...-. ............... .......,...:... ,.. ·.. ..... · _ Commun tywe . . ;. . ..- ..... , Public water ......., ...... ;. ": v '.' NOTE' 'elf community well svstem,'provtde written confirmation fromState ADEC attest .......... Indivldua on s te ...... X×× ............. : , . :'., ...... . ?. -'. ' .-: ..~...~;~:Holdingtankr...*..'.-, "... '.* ..' ',' ...... :;. '.- -_.:,, .~ .....:: .... ~ ..... ~:..'.. ~:-;~;-, , ' ' r , · .. _, Commun ty on-s to . ..... ~,., , .... ,.ru~,,.,o~='~'~, ....... ~ ...... . - -.. .......... - ,, !.-:, ' ' .,-NOTE:... If communtty, wastewater system, provtde written confirmation from State ADEC, w. , .::~. ~ . ~ ', 5.' STATEMENT.oF.. INSPECTION!By~EN(~INE~R'~ .' ...... '. "...'. ': ':,:.' .' ' .':,:' .::.. ...... :. *, - As cert~hed by my se:~l afl xed hereto and as of the va dar on date shown belo~v~ I ver fv that my: ::..~ .. ~ Investigation of th~s Health Authopt7 Approval apphcat~on shows that the on-s~te water supply: '. ·. : , :..:, : and/or wastewater d~sposal system ~s safe, functional and adequate for the number of bedrooms andtyp~ofstmcture nd~catedhera rill furtherverihtthatba.~d onthelnformat onobtained from '.' : ' the Municipa ty 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 code~ ": :~. :. '. . ordinances, and regulations in effect On the'~t'~ of~s ir~spection. -' · · :: · .;- , · . · ., . .... .:'.' . . - .. .-.';...~..-:,.' ~N,amoofFirm ~__<=_-~-,-=~:,,-~' ~./ .-Phono.d¢/'//"~-~;;'~'~, ..., ..... · :.... ..... · ..... .., 7034 .... . ' ? ,:' ,,.Aoore~s - . _., ,-..,.~. zr_-/_ -,/ ....... , ,- ,. '..' ,-. - . .~, .,-..? !",',~..-' Engineer's signature. ' ........ ~ ..... Date ~A ~ : 'i' "':" ":'" ': ':':' .... .' ":' ";': ~ '"~'-: .... "~':"::'":' :': ' ~,~.,'~ '.,-". ~-" ' ''" '.' '":'-'"~' ................................ ~ . ...-~,.~Z'.~_2~.~.I~,,<.~ . ~ ....'. ......... . .' .. .' -,' ........... '., : , ', '// /~-..". ,~.,~4 ~:~-..: :Iv"&~ff-~ · ~_~_:. I-A;~. , . , : "Z"-'';' : , ''~ ' ' ', . '. ,. .'.- . ,':"~-~.*'.~-~ ,:; ...... '. , ..... '~,/~.":No. 1432'4E. "~.",a~74 '.. '' ',.'- ' ., .~.' .... ~ ....... z ..........:., ...... -... ~~ ~.' .:~":.~7.,~., , · , ...... .-,.~,r .. ................. ;~ ............... . ............................. ~.;';;.'ffX,,~i0': .... ... ....... , . ...-/-~-~ o~,~,r,,w,, ~.,_-.. ~ ...,,; ..... . ............... . .... ...,. .approval .for'' ......... ?.bedrooms, w t~..the,fo owing sbpulat~ons' ', . " "'- 'i'.:'~ ~;'i'.~..'.:" '.:;g ..... '"' The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority A. pproval Certificates based only upon the representations given in paragraph 5 above by an independent :~Pr~f?si~a~engineerregisteredinthestate~fA~aska~;rhe~DHHsd~esthisasac~urtesyt~purchasers~fh~m~es~ ... :i~ their,'l&:p.~ing [l~stit:~t 9I~S' ~ o. 'i',d~ r,-t~'~'t.i~ f~'&~i~ fe~l-~n~'s.'~f~'r~ciui~r~t~: Employees of DHHS do not '~Con~dct in'specti0ns o~. an~lyze 'data b~f(~re a' certifica/e IS issued. The' M~JniCipality"of Anchorage is' r{ot :':: ,', :~4espons~bleforerrorsoromlsslons ntheprofessona engneer'swork. :' ,, . . Municipality 0f An~:horage , Department Of Health ~r~d Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /....c,T I') /~_/~, ~- [~&~_.EZ./_ Parcel I.D. A, Well Data Welltype J::~h,,/~.~ IfA, B, orC, attach ADEC letter. ADEC water system number Log present Total depth Sanita~ seal'N) Date completed /~/2-g7/7 ~ Driller Cased to ~_,,c~ · Casing height Wires properly protected(~) Date of test Static water level Well Ilow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /(~ fY.- Absorption field on lot / Public sewer main FROM WELL LOG /'/~ g.p.m. Sewer service line AT INSPECTION ?, ~ g.p.nl~l , ; On adjacent lots //C~3 ~'-~' ; On adjacent lots / ~ tq'- Public sewer manholelcleanout / ~..~r./-- Petroleum tank /Oo/J E- ~'~,.Ib~v~ WATER SAMPLE RESULTS: cDr, form 5//o0 *. Date of sample:/Z~'[Z'c~ t/ B. SEPTIC/14~N~-TANK DATA Date installed /C) c eanouts High water alarm (Y~'~ Nitrate ~,,~' ~ ~] /'~ ~/~' Other bacteria ~//~ '~ / Collected by: ~' ~'-~ ~"~,~/,~,'"~;~1~- Tank size /~--'cO Compartments ~ Foundation cleanout<J~N) (r~.~ Depression (Y~) Alarm tested (Y/N). ' 4',,///'~J ,- Date of pumping SEPARATION DISTANCES FROM SEPTIC/HCLC~C TANK TO: Well(s) on lot /(..,~,D C/.. On adjacent lots To property line /~.~ (~- Absorption field ~ I ~'- Surface water/drainage [(',~--~ ?2-026 (~gG)* From Foundation 5 /"~- Water main/service line CONTINUED ON BACK PAGE Date installed Size in gallons. Vent (Y/N) 'Pump on' level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATI~ATION TO: . ~ On adjacent lots D. ABSORPTION FIELD DATA Dat~ i~stalled / o/[o / r~ ~ Soil rating (GPD/Ft2) .Manufacturer /* Manhole/Access (Y/N) ,~ .Surface water. ~,>.~. ~3-"//~,.~ System type Length r"-~(~3 ~£~ W'~h ~ / Total absorption area '~ ' "q-: ~ ReSUlt aa) D~te of adequacy.test c~ W~ter level in absorption field before test ~ Pero~(ide treatment (past 12 months) (Y/N) /'~13/(.J~ /~'f,J~..~r-.J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: To building foundation On adjacent lots ~ , Surface water //Oo ~'-~- E. ENGINEER'S CERTIFICATION for After test yes, give date Gravel thickness' ~ ~ Total depth (~leanout present ~N) * t'//~' ~ ' Depression over field On adjacent lots /(::::) O (-~- Property line To existing or abandoned system on lot Cutbank /Ja,~E- /o,~E'~Watermaln/sewice line Driveway, parking/vehicle storage area I cern'fy ihat I have checked, vedfied, or c~fom3ed to all MOA and I-IAA guidelines in effect Signature ......... Engineers NameEagle River, Alaska~gg77 ~/ Date Date of Payment zTr CT&E Kef.# 15:~ CT~-E £NUI~Oixt1ENTRt_ L~B SEA"JI~S 140. Commercial Testing & Engineering Co. 1 Environmental laboratory Services LABORATORY ANALYSIS REPORT 9,1.1732-1 LI7 Fs2 I )A I ?.E li-S C~'D~'EITER $/D WA'rL~, CiicntN~rne S & S I~NGLN£ERING weEK Order 77520 Ozxlcredlb' IL S~R ~tcd D~ ~5/94 ~ 14:51 h~. Co~ccl~d~l~e ~0194 ~ 14:20 h~. ~Ject Name ~c~v~dDxte ~019.t ~ 14;4S I~rs. . PWSID UA T~hnlcal I~r~or $~I~N C. ~;~'uple R~mark~: RO-[~5'E $A.~ff'LE COLI.I-.CTEI)BY: S.S. QC Allox~le Ext. Amd parameter Result~ Q,.lal I.,~flt-~ MtL~od Li:t~t.~ Date Da!c Hitrate-~'---~ 2.39 mt:l. I:I'A 353.2/'J90.0 13 04/25194 See SpeciAl Inst~tlons Above UA m t~lt~'[ila-~lc S~ S~lz ~8 Above ~ u N,~t Analyzgd ~633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) ~82-2343 Fax: (907) 661-~301 .. ENVIRONMENTAL FACI~IES IN A~$K~ COLORADO, FLOR!D~ IL[INOIS. MAR~NO. ~EW' JE RS~, OHIO, U~AH, WE$~ VIRGINIA 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 Y//~'~/[;~'~' ' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name (c) Telephone: Home Applicant Address ~ Applicant is (check one): Lending Institution I-I; Owner/builder (d) (e) Lending Institution ,(/~,t~ Real Estate Company and Agent Address ~. ~' ~_~Ug Telephone (f) Mail the HAA to the Iollowing address: TYPE OF RESIDENCE Single-Family J~ Multi-Family[] Number of Bedrooms ,.~ Other WATER SUPPLY Individual Well [~ Community [] Public [] Note: II community well system, must have written confirmation from the State Department of Environmental Conservation attesting to Ihe legality and status. SEWAGE DISPOSAL Onsile~ Public[] Community[] Holding Tank [] Note: f community well system, must have written conhrmat~on from the State Department of Enwronmental Conservation attesting to the legality and status. Page 1 of 2 t2.o~5 111,84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE ~EAR~H, DATA AND INFORMATION As cedified by my seal affixed hereto a nd as of the validation date shown below, I verily that my investigation of this Heallh Authority Approval shows that the on-sile water supply and/or waslewaler disposal system is safe, functional and adequate for the number of bedrooms and type ol structure indicated herein, I fuflher veri~y thal based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, thegn-site water supply and/or wastewater disposal system Is In compliance with all Municipal and State codes, ordinances, and regulations in effect on Ihe date of this inspection. Name of Firm ~ I~, Telephone ~/- ~O g~ Date Approved ,o~ bedrooms by" te Approved /...'~ Disapproved 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 .......... MUN~O~AUlr OF ^NC~OAAGE I~PT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 2644720 Legal Description: B ~. ~,, ! 7 ENVI~NM~NTAL PROTECTION APR 1 8 RECEIVED WELL DATA Well Classification IJVOIEI DhlJl... If A, B, C, D.E.C. Approved (Y/N) ~//~1 , Well Log Present {~)N) Date Completed Z~ (3~'/9 7~' Yield ~,~ ~P,4~ ~ Total Depth ~0/ Cased to ~0 / Static Water Level ~ 0/~ Casing Height Above Ground ~ / Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting Pump Set At UAl Sanitary Seal on Casing (~N) Depression Around Wellhead {Y(~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line CleanoutJManhole Water Sample Collected by Water Sample Test Results Comments 100 f'~ ; On Adjoining Lots ; On Adjoining Lots /V/~'~/~f To Nearest Public ~wer TO Nearest ~wer Se~ice Line on ,). '~AIr~HUCI~ ;Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (~'N) ' Air-tight Caps ~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank.; To Water-Supply Well ~ ,~]'~ - To Property Line ~_~'~t" To Water Main/Service Line J~//~::~ Course 100C/ JOi/!O/Te Size ~-~0 No. of Compartments ~ Foundation Cleanout (~N) Date Last Pumped =,or ' Temporary Holding Tank Permit (Y/N) To Building Foundation ' ~ · To Disposal Field To Stream. Pond, Lake. or Major Drainage Comments Page I of 2 72-026(11,84) ABSORPTION FIELD DATA 5CHALE. ITEI~ Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y.~) Results of Last Adequacy Test Separation Distance Irom Ab~eld: To Water-Supply Well ~ //7 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 ~ 0 / Depth of Field [0 / Gravel Bed Thickness ~ · Standpipes Present {~N) Date of Last Adequacy Test To Property Line ,,~" To Existing or Abandoned System on ; On Adjoining Lots To Cutbank {it present) tOO"t D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions J Manho~N) ' po,,"Leve, at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request **' I certify t h a t I/.,h a ~ef,c~..k e,d .~ r i f i ed. or conformed to all MOA and HAA guidelines in effect on the date of lhis inspection. Signed ~J~ ~l/~,.~ Date Z.//~ ~ / ~:::~ ~ ~1,,s - - '1 t __ Company ~EC,~ I J~C. MOA No. ~O~""O2~'~ ' ' Receipt No. -'-'-'-'-'-'-'-'-'~'") ~ ~' ~' ~) Date of Payment ~ ~ I~" ~:~(f3 Amount: $ ~ ~ ~-'~'--- Page 2 of 2 ALASKA ,,UIROFII 613TAL CORTROL S6 IC6S, IRC. BRt.EE HAN~ 10211 EVER~2~FFN t~O~RAGE ALA~ 99516 ERUC~ HANN3N 10211 EVER~FFN 99516 601~6 LEC,~L:DAZEL 5OHNEITER BI. OCK 2 ~ 17 ADE(~IJJL-'Y TEST F~ SE~ER SYSTE~I ABEQU,~"Y 'lEST DATE-Oq/It~/g6 THE TYPE Ow ,~f3SClqPTION SYSTEVI IS A ~ WITH AN AREA CF 360 SO:rT. THE SYSTEM IS CAPABLE CF ,~CF_.PTING 450 C,~.LONS CI:r ~l~u~ PI~ DAY. THE S. JR~ CAPACITY CF THE SYSTE~I IS 717 CALLONS. BASED ~ 'I~ TEST DATA THE SYSTEM IS ACEEPTABLE FER A /VIUNICIPALII~ OF ANCHORAGE DEPL OF HEALTH & ENVIRONMENTAL PROTECTION , PR 18Lo8 RECEIVED SEPTIC TAI',K ABF.,C~U, SL'Y THE EXISTING SEPTIC TAI~K V~ CF' 1250 IS ABF..C~IATE ~ THIS 3 ~ I-EUSE. THE SEPTIC TAbK/P~ PI.~NT ~ R.I~ED ON 08119/85 . FI.O,V 1EST ~ ~:~ ~ ~I, FH. FLO.V I~TE-0q/lt~/S6 A FLO, Y TEST WAS PERF.'rED CN THE ~i. 717 G/~J.,QNS CF' WAllra~. WAS ~ AT A~ 8.9 ~A~TI~ 1.3 ~. ~ ~~ 6.5 ' ~ A~YTI~ 10 ~ ~ ~ ~ATIC~A~ ~W~ 20 F~. ~H. IS ~A~ ~ ~IS ~ B~~. 1200 UJest 33rd ~uenu¢. ~uit¢ ~ .Anchoro§¢. Alodca 99503.[907) 561-5040 t' . f DATE RECEIVED "* INSPECTION APPOINTMENTS TIME TIME TIME )ATE DATE DATE MUNICIPALITY OF ANCHORAGE -- DE~. OF HEAL~ & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~' jRO~E~A[~ PROTE~ION 825 L Strut · A~ho~a~, Al~a ~1 8 1979 ENVIRONMENTAL SANITATION DIVISION RECEIVED REOUEST FOR APPROVAL OF INDIVIDUAL WATE~ AND SEWER FAOILITIES MAILING ADDRESS 2. BUYER PHONE MAILING ADDRESS MAILING ADDRESS PHONE ' LEGA"OESCR O"7 /'7 STREET LOCATION 6. TYPE OF RESIDENCE [~*'*'~SI NG LE FAMILY r'l MULTIPLE FAMILY NUMBER OF~BEDROOMS ~--I One [--I Four [--I Other r-'l Two I'-I Five ~ Three [] Six 7. WATER SUPPLY ~'INDIVIDUAL* * A3-TACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISIN3~AL SYSTEM [~"'~DIVIDUAL/ON-SITE°° J~?~' YEAR ON-SITE SYSTEM W.~S INSTALLED.. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I-'l SINGLE FAMILY r-'l ONE r-1 THREE I-'1 FIVE [] OTHER r-] MULTIPLE FAMILY [] T~NO [] FOUR I--I SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMM~JNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER r'-~Septic Tank or [-1Holding Tank Size: /t°~'~O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ~. 4. DISTANCES SepticlHold~ng Tank I Absorption Area ISewer Line I Nearest Lot Line I I WELLTO: Absorption Area to nearest Lot Line 5, COMMENTS [~ APPROVED FOR ~:) BEDROOMS i--'l CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)