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Home My WebLink AboutFORELAND VIEW BLK 1 LT 6Foreland View Block 1 Lot 6 #017-401-47 • MUNICIPALITY OF ANCHORAGE a 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 NAME H• Aql PHONE NEW eine 276-x27 UPGRADE MAILING ADDRESS e2/ Al, S. r&zq '104 AhejotLlo, LEGAL DESCRIPTION II9kck &Peknd i e ty Sm p dlij ij i oN LOCATION NO. OF BEDROOMS ,/ Ift O Well - 1271 Absorption areas! DISTANCE TO: Dwelling _ PERMIT NO. 05_2 Y Z W F V_ Manufacturer Greer Material C pP / J No. of compartments Liq. capacit in gallons IF HOMEMADE: Inside len th g -- Width Liquid depth 1 _10ZDISTANCE TO: Well - Dwelling PERMIT NO. 02.1 ManufacturerMaterial Liquid capacity in gallons w= DISTANCE TO: Well ) ! [�'1 Foundation ? Nearest lot line ♦ PERMIT NO. �Of. 2 u 2 I— w No. of lines / Length of each line77! Total length of lines - r 7 Trench width, Winches Distance between lines �q a C F Q¢ Top of tile to finish grade j � ` / - J l Material beneath the � 2 Total effective absor��n ar� s inches W Length Width Depth , PERMIT NO. 0 i F w ° Type of crib Crib diameter _ Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. _1 W 3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption annals) OTHER Lo l.! fi7 i PIPE MATERIALS C� pUC SOILTESTRATING - _ 20 t OM 2 It � INSTALLER l eneGiicf Canf ruc E -067 REMARKS I nsa[ghipt, IvAl he u e an u �..e a IG ehd ofren . ft L n f PC! en Per Orhf eiv APPROVED DATE LEGAL -1y-83 cof 6 91041 Forelai'd Viet, 5ukcl „o, fl "Ie_ ILITY EBF' P=lNc:F�FcF413E= ,wV E_- DEPARTMENT HEALTH AND ENVIRONMENTAL OTEC:TION 825 'L' STREET: ANCHORAGE: AK. 99501 264-4728 L-JE=L_L_ Rr-A G* RD"—=. I TE !SEL4EFR F'E�r-I I _F PERMIT NO. % 8':0524 ) APPLICANT F. H. HOFHEINS LOCATION LEGAL TYPE OF SOIL ABSOR'P'TION 'SYSTEM IS 821 N ST PLAZA #104 99501 276-5234 TRENCH LOT SIZE 999999 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 4 _,OIL RATING (SL? FTiBR)= 220 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E FEF -r"' -ID e e :aFRH =.- E=L_ E>E=F= -r"= P. THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND FIND THE BOTTOM OF THE EXCAVATION CIN 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 CIN FEET?. F'I-=GU I RE=CD QEF _F I a_- -F"NK :E3 I =E= Av'5C-1 13 F11_L_PDN:S 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. --- -rW+D :2 > 1 r-4f�_F}EC3T I 10r-a'� F4 FRE0U I FRE=E> --- 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 THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'E:FM I T E=-XF} I Fs'E_ E}EIE- EIIE F= F? ::?':JL_ -Soce--:t I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALIT'+7F ANCHORAGE. 2: 1 WILL INSTAL TH AlITINCLUDE EM IN AC'CORDANC:E WITH THE CODES. 3: I UNDERSTRYdDLHjT N -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENC. REF +D L MORE THAN 4 BEDROOMS. SIGNED:--- rA. - -- -- ----------------GAF' LIT HJFHEINS � ISSUED LAY__ --------- / t...."=---_DATE___T V4. 0 • • LY SOILS LOG Q MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 6650, Anchorage, Alaska 99602 276-2221 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: )nV W16-5®tJ DATE PERFORMED: 6/-/0Z LEGAL DESCRIPTION: 2.,170 /a'ue& )40 ® Y/,ew Syewpwy DEPTH SLOPE - SITE PLAN 2- Date 3 Net Time 4 Net Drop rep -L -5 (� 1 C;T 6 , 7 P s M1 S/LTf'- 6&kZ�S - GM 14 15 16 d► � aee aaeeey 17 18 ..0✓6o eMeecu3fl 19i J� HN T. LOVETT I — -- �— -- — WAS GROUND WATER/VVL I _.y_ ENCOUNTERED? P IF YES, AT WHAT El i 6 DEPTH? �_ Reading Date Gross Time Net Time Depth to Water Net Drop Z4 he N g-3-Sz 8to� �5.•,,� 4.4 y ,. el 20 4 pROF sso®4,® PERCOLATION RATE d�o n /17 //fl (minutes/inch) TEST RUN BETWEEN T FT AND s FT COMMENTS �Z�+.•1 PERFORMED BY: 7 'y) W/LS/Jl✓ C CERTIFIED BY: ;%!G DA 72-008 (7/76) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys DrillingPermit No. `•LOCATION OF. WELL (Please complete either to, It, or Ic.) A.D.L. No. NAn Borough' Subdivision Lot Block Ib. I/4gtrs. Section No. Township. Range E0 Meridian h. oreland Vi w 6 1 —0}—pf—of— s❑ w❑ DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Hal Hoffhein Address Street Address and Area of Well Location 2, WELL LOG - Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Surface rpt ' Material Type - Tap 9ottom �v'. it. � — —al— — —8'— 0 14 e, Cable tool ®Rotary Driven C] Dug cQuags gritivel y/ fatrmaks of sand. 14 32 Auger - Odetted ❑ Spred Other: streaks32 45 7. USE: 11 Domestic 0 Public Supply ❑ Industry O 0 Irrigation C] Recharge El commerical of.rock. approx. 2 SpA 45 57 ❑ Test well ❑ Omer: .Wp4thiargud rack 5 88 B. CASING: C] Threaded ® Welded bedrock. blk. rock: water a 110' diem. 6 In. to ff, Depth Weight 17 i. lbs./ft. 88 110 dram, in. to ft. Depth Stickup It. S: FINISH OF WELL: Type:oRan bottom Diameter SlotMesh Size: Length: Set between ft. and ft. Bpekflllinq Gravel Rack - - 10. STATIC WATER LEVEL: 401 ft C3 Above , or ISM Below land surface Date, Equipment used: II. RUMPING LEVEL below land surface and YIELD - - 1t. after hrs, pumping_g.p.m. ft. after _hrs. pumping �_ g.p.m.: 12.GROUTING Well Grouted: ❑ Yet [M No Material Neat Cement 0 Other: 13, PUMP: (if available) - HP Length of Drop Pipe" ft. capacity O.P.M. O Subm. C] Jet 0 Centrifital O other - 14,REMARKSr Air development for 1 hour @ 6+ gpm. IB. WATER WELL CONTRACTORS CERTIFICATION: I 15. Water 'Temperature _° Q F � C This wall Was drilled under my jurisdtollon and this report is true to the best of my knowledge and belief; Da ten Drilling AA0512 Registered Business Name _ Contract License Number Address I - signed: .Dote' - -- Authorized ReprdbOntative - For.62 ■ �W.WR (11/GI Copy Distribution: WHITE- Stale 0968, PINK,- Driller, CANARY' Customer NAn Borough' Subdivision Lot Block Ib. I/4gtrs. Section No. Township. Range E0 Meridian h. oreland Vi w 6 1 —0}—pf—of— s❑ w❑ DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: Hal Hoffhein Address Street Address and Area of Well Location 2, WELL LOG - Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Surface rpt ' Material Type - Tap 9ottom �v'. it. � — —al— — —8'— 0 14 e, Cable tool ®Rotary Driven C] Dug cQuags gritivel y/ fatrmaks of sand. 14 32 Auger - Odetted ❑ Spred Other: streaks32 45 7. USE: 11 Domestic 0 Public Supply ❑ Industry O 0 Irrigation C] Recharge El commerical of.rock. approx. 2 SpA 45 57 ❑ Test well ❑ Omer: .Wp4thiargud rack 5 88 B. CASING: C] Threaded ® Welded bedrock. blk. rock: water a 110' diem. 6 In. to ff, Depth Weight 17 i. lbs./ft. 88 110 dram, in. to ft. Depth Stickup It. S: FINISH OF WELL: Type:oRan bottom Diameter SlotMesh Size: Length: Set between ft. and ft. Bpekflllinq Gravel Rack - - 10. STATIC WATER LEVEL: 401 ft C3 Above , or ISM Below land surface Date, Equipment used: II. RUMPING LEVEL below land surface and YIELD - - 1t. after hrs, pumping_g.p.m. ft. after _hrs. pumping �_ g.p.m.: 12.GROUTING Well Grouted: ❑ Yet [M No Material Neat Cement 0 Other: 13, PUMP: (if available) - HP Length of Drop Pipe" ft. capacity O.P.M. O Subm. C] Jet 0 Centrifital O other - 14,REMARKSr Air development for 1 hour @ 6+ gpm. IB. WATER WELL CONTRACTORS CERTIFICATION: I 15. Water 'Temperature _° Q F � C This wall Was drilled under my jurisdtollon and this report is true to the best of my knowledge and belief; Da ten Drilling AA0512 Registered Business Name _ Contract License Number Address I - signed: .Dote' - -- Authorized ReprdbOntative - For.62 ■ 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 HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# Lit_t1-�4-i HAA# tA t-, GENERAL INFORMATION Complete legal description �, � 81 Location (site address or directions) c,Z.1 Property owner ` 4: %o A' _ Day phone Mailing address Lending agency Mailing address. Agent (( 1 Address J�� Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone Z z- 4 1� 1 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (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 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 forthe numberof bedrooms and type of structure indicated herein. I furtherverifythat 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, andregulationsin effect on the date of/this inspection. Name of Firm .Jct /%7G-`� /7G/C� f!/y�� Phone Address G !�jl� Engineer's signature Date 19 j�rf19z 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments M 111TICI bedrooms, with the following stipulations: Date The Municipality of Anchorage 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. 7M25(R..1/91) Beck MOA421 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �(0 faf?1( Parcel I.D. �l7 iso/ --Z17 A. WELL DATA Well type If J ��fc If A, B, or C, attach ADEC letter. ADEC water system nurrtbEr Log present (Y/N) 7' Date completed Dr�iller3 &JnE&e J?4 )i q Total depth `�eD / — Casedto 4-c/ Casing height— Sanitary eight Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test12 Static water level /� ( J I'lr'f rn v n oa Well flow g.p.m. �) g.p.m. 00 y Pump level 1 O o r.n N SEPARATION DISTANCES FROM WELL TO: g Septic/holding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main IW4 Public sewer manhole/clear Public sewer service line / Petroleum tank WATER SAMPLE RESULTS: Coliform O — art 5 Nitrate -4`� JP�0 ( Other bacteria `S a� 5 Date of sample: -� ✓ Collected by: v O Meir, 4urf, n� T459t B. SEPTIC/HOLDING TANK DAT Date installed 71IY 3 Tank sizepp'�l10 ( Compartments Cleanouts (Y/N) y Foundation cleanout (Y/N) Depression (Y/N High We ter alarm (Y/N) / v 4 Alarm tested (Y/N) Date of pumping 7— Z�-22_ SEPARATION DIS OM SEPTIC/HOLDING TANK TO: O j � �1 � Wei I(a)onlot !! // ((�J On adjacent lots /o ! Foundation l s' To property line Absorption field Water main/service line Surface water/drainage IV 0 0 L24zfd 72-026(Rev. WI) Fmnt MOA 21 - -..«. '.' , CONTINUED'ON BACK PAGE.' C. LIFT STATION Date installed Size in gallons Vent(Y/N) "Pi High water alarm level Meets MOA electrical codes (Y SEPARATION DISTAN0t FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots DR %/Access "Pump off" level at Cycles tested Surface water _ fl Date installed y$oil rating p` �4 System type s C r� (� —1 6( i ( Length WidthO/�q Gavel thickness / �— Total depth Total absorption area � /0� 12� Cleanouts present (Y/N) Depression over field (Y/N) `v Date of adequacy test'— Results (pass/fail) pa ,�,,5 for 4 bedrooms Peroxide treatment (Past 12 months) (Y/N) Nelle h oLZq— If yes, give date SEPARATION iD�ISTA f EOM ABSORPTION FIELD TO: Well on lot / %4^ f (P FOn adjacent lots � [06 � Property line �o 7 To building foundation -5 s22 To existing or abandoned system on lot A,101? 6 Onadjacentlots P9O Cutbank Water main/service line -VOZZe Surface water _L on.—ye Driveway, parking/vehicle storage area lD Curtain drain h on c MoA� �-S � l�1 e�S, E. ENGINEER'S CERTI�CATION I certify that i have checked, verified, or conformed to all MOA and HAA guidelines in effect on the -date of this inspection. P ,� �� OF q,( 11 Signature j �� `46q� y� * s Engineer's Name-A6/nee EE V� �� Y �'� • • u �I a. Date ` . James F. Sizemore =� �,1517 HAA Fee $ Date of Payment ,/ Receipt Number 406 7- C'koy2 11 72-020 (Rev. 3/01) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 0 6 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 2//O /b(,- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L I !—or (c Vie +O SSS 1 A) R3 Location (address or directions) (b) Applicant Name u� � lY 0 Telephone: Home 2)4= ;_ 702 D Business 2 7 e 3 6 95 Applicant Address A tin ✓v (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Rr; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-FamilyP'�Multi-Family❑ Other Number of Bedrooms 3. WATER SUPPLY Telephone Individual Welhq Community ❑ Public ❑ Note: If community well system, must have written corifirrnstioh from the State Department of Environmental Conservation attesting to the legality and status. 4. 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 (11/84) 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 investigation 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NHAWyHOP.N - 19INceFING Name of Firm 7127 Old Seward Higily✓ay Telephone Address Date WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long tern) adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval Inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. 6. DHEP APPROVAL_ k� Approved for /,in/ -i 2 bedrooms lb)4:7h�� Approved '— Disapproved Conditional Terms of Conditional Approval CAUTION ..., ' NEIL ii'r"f`li+'::2 �`• `G^ :�' CE-426ti The Muncipality of Anchorage Department of Health al`4Environmental 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 (1 V84) MUNICIPALITY OF ANCHORAGE (MOA) MUNKIPAUTY OF Atm AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ggyIROWAENTAL PROTECTION 264-4720 SEP 1 8M Legal Description: �1lEEfJG/.US L-� f / PCE&I49P JZ[e&J A. WELL DATA RECEIVED 1525 7-1;t- ^) Q3(A) Well Classification PR I>W/& If A, B, C, D.E.C. Approved (Y/N) � Well Log Present (Y/N) )_e. S Date Completed C®'Z� G3 yield 614n ,� Total Depth Zed Cased to �% Depth of Grouting—r Static Water Level Pump Set At UAA-' XIewN Casing Height Above Ground f�Sanitary Seal on Casing (Y/N) Yds Electrical Wiring in Conduit (Y/N) /BS Depression Around Wellhead (Y/N) o!20 Separation Distances from Well:. To Septic/Holding Tank on Lot On Adjoining Lots AV' r To Nearest Edge of Absorption Field on Lot /SC2 ; On Adjoining Lots To Nearest Public Sewer Line 9 To Nearest Public Sewer Cleanout/Manhole �y To Nearest Sewer Service Line on Lot &P Water Sample Collected by /1� ;Date n'g -g4 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7-19-9-3 Size2.2 No. of Compartments Z. Standpipes (Y/N) &_-5 Air -tight Caps (Y/N) Yes Foundation Cleanout (Y/N) Y= Depression over Tank (Y/N) IICD Date Last Pumped E%-9 Ar Pumping/Maintenance Contract on File (Y/N) for IiC�i4 Holding Tank High -Water Alarm (Y/N) Tempotary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well Aa 7 / To Property Line x6C /j To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field _) To Stream, Pond, Lake, or Major Drainage r C. ABSORPTION FIELD DATA • Soils Rating in Absorption Strata 242 I` Type of System Design Date Installed -83 Length of Field Width of Field �� Depth of Field Gravel Bed Thickness %Z Square Feet of Absorption Area 7dU Standpipes Present (Y/N)` Depression over Field (Y/N) Date of Last Adequacy Test !2:AF � Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /VZ/ To Property Line a To Building Foundation 3.3 To Existing or Abandoned System on Lot X// � ; On Adjoining Lots �n To Water Main/Service Line .173� y To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course O To Driveway, Parking Area, or Vehicle Storage Area .2>i )� Comments 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 Manhole/Access (Y/N) — 'Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h e q c ed, v rled, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date -9 /10 /96 Company MOA No. y2 9' �® ®@ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) CE -4369 Time PPLN@NT FILLS OUT UPPER HAI* ONLY Property Owner - I ✓��J - Phone v i1 t Date Inspector - Mailing Address G c- Zip Cotle C LI a 6 �� Buyer Address OF ANCHORAGE Zip Code Lending Institution � �G�% �j 7 jai Phone Address - ENVIRONMENTAL PROTECTION Zip Code Realty Co. & Agenf - _ - - Phone Address - - Zip Code Legal Descriptio /0 - �' T'_g3 Street Location DATE Type of Residence Soffs Rating_ �gle Family Well To Absorption Area Well Log Received Multiple. Family No. of Bedroom--4-- edrooms❑ Well to Tank � 1 7 0Other Water Supply - > ►fdual _ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Tj- Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility - Sewer.Dlsposat- '46idual - Year Individual Installed: _ ❑ Public Utility When Connected to Public Utility ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time _ Time Time Date - Date Date - - Date Inspector - Inspector Inspector - Inspector MUNICIPALITY OF ANCHORAGE Fi Field Notes: JJ �F2 - ENVIRONMENTAL PROTECTION LLDvL.LG OCT 27 k RECEIVED -( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' /0 - �' T'_g3 DATE BY: t - Soffs Rating_ Date Sewer Installed - Well To Absorption Area Well Log Received Well to Tank � 1 7 Septic Tank Size