Loading...
HomeMy WebLinkAboutSHELL #1 LT 105 14eLL. MUNICIPALITY OF ANCHORAGE DI 1TMENT OF HEALTH AND HUMAN SEF, Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES TO FAONI SEPTIC TANK ABSORPTION FIELD WELL nddress /G 6 10 Ta ti<, e /`cam �,, 4,4 AK ?h/( WELL p'3 y j0 new Phones) 3'f6 33 `i`/ Permit No. �yoz4�— No. of Bedrooms LOT LINE - ----- 10 /1! W / 5, ®� LEGAL DESCRIPTION _ Lot 10 __ Block ,i+ —_ Subdivision _I) e ! if FOUNDATION L 3 X13 L� e a llF''' _ AS -BUILT DIAGRAM ISbow location of well, septic system, property lines'. loundalmn, driveway. water bodies, etc.) -- Township, Range. Section Se c. [S'" 'T !2 /V 2 3 L✓" — TANKS ❑ SEPTIC ❑ HOLDING -- — — Manulacllner — _i-- Ca,u y m gallol s Material No. of 'c iparlments -- /Ve iv 1r -- TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN O OTHER Depth to pipe bottom from original grade /, _ y FT blit depth Iron oriade ginal gr..%. FT w ! E - — 41 RII added above aigmal grade Gravel length-------------- 5 FT Gravel depth beneath pipe FT Gravel width FT Total absorption area >1 /� SQ FT Distance between lines rA J2 b e, Id FT — Ff k1 _ Numr of belines Son rabn9 SQ FT Pipe mammal Installer A F C_ Dale Installed 9 -31 It — --- WELLS ❑ PRIVATE ❑ OTHER (Identity) Class h cation (A, B, C) _ �L Installei �~ l I Total Depth Cased to `1rsT.IledFT FT Date — REMARKS: .�4_,Cl rtvd OVC/rte rc% _ ..:/ "s c:"i Y .i lfafJ DSC — lr�5 ;ck1•/ v,r 6C'tf .74IL11 S'U, l a e.— u<% [ •1 v. r'q n 8! S v ��•cif.— �. � h ° �"�"r �r'T� Scale: i rs orm Inspections Performed by: /I— ( � S ENGINEER'S SEAL /� y — �7 0( V Sar�o2.. - )ate, Date. r, 3 l a •1Cc, l d t - cerlily thal (his inspection was perlonned according to all I-1 L� • L (r Municipal and Slate guid fines in el(ecl on This date: Health Department Approvaly�\\\✓+J1��,...-1-�� Date: 113 (:3/6b) ' 8z^^0 x~�� I J TW TQ 1%J pit 11-4111, w out 19 R? DEPARTMENT OF HEAL|H HND ENVIRUNMENTAL PROTECTlON 825 L STREET, ANCHORAGE, AK 99501 264^4720 oERM[T NO: 0ATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: oil A I ksrp I 11i:::- IF 11 Jf:`� 8�0247 07/29/86 BARBARA SANTORO 10610 TAHNEETA DR, ANCHORAGE� AK 99516 346~3399 ME .,- � /0 0/ LEGAL DESCRIP: SUBDIVISION: SHELL LO[: #1Cl 8LOCK: NA SECTlON: 15 TOWNSHIP: 12N RANGE: 3W LO[ SlZ£: 19000 (SQ,FT. OH ACRES) MAX 8EDROOMS: 2 Listed below are the options available to you in designing your septic system. Choose the option thaL best [its your site^ 11 'A:'4!��K�k��U DEPlH TD PIPE 1301 TIM (FT,) 4"0 4.0 4'0 GRAVEL DEPTH (FT.> 4"0 05 3"0 TOTAL DEPTH (FT"> 8.0 45 7.0 GRAVEL WIDTH (FT.) 2.5 18"O 5.0 GRAVEL LENGlH (FT.) 52^0 34"0 49"0 GRAVE|VOLUME (LAW YDS") 21"7 22.7 31,8 TANK �]ZE (GALS) 1,00)"0 ** 1,000,0 ** 1,000"0 ** SO[L RAlING 011A^11T`/1111) 206 201 206 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certiIy thaL: 1. I am [amiliar with the requirements for on~site sewers and wells as set forth by the Municipality o[ Anchorage (MOA) and the State of Alaska, 2^ I will instal1 the sysLem in accordance with all MUA codes and regulations, and in compliance with the design criteria o[ this permit" 3. I will adhere to all MOA and State o[ Alaska requirements hor the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4, I understand that this permit is valid [op a maximum o[ 2 bedrooms and any enlargement will repuire an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDIN8 CDDES� THEN (1> AN ELECTRICAL PERMIT AND INSPECTION MUST 8E OBTAINED; (2) ASBUILTS WlLL NDT BE APPROVED WITHOUT AN ELECTRlCAL INSPECTION REPORT; ANO (3) THE ELECTRICAL WORK MUM BE DONE BY A LICENSED ELECTRICIAN. SIBNED DATE: ' APPLICANlSANTORO � 60317 ALASKA � IOIROnm WL COnTROL SCiJHS, IN. Engineerinq & 6ironmental Studies HAP SANTORO 10610 TAHNEETA DRIVE ANCHORAGE ALASKA 99516 SELLER—SAME LEGAL:SHELL #1 BLOCK 0 LOT 10 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE—JUNG 23 1986 JULY 24 1.986 HAP SANTORO 10610 TAHNEETA DRIVE ANCHORAGE ALASKA 99516 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 500 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 300 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 299 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS, SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT HAS NOT BEEN PUMPED WITHIN THE PAST YEAR. THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE—.TUNE 23 1986 A FLOW TEST WAS PERFORMED ON THE WELL, 459 GALLONS OF WATER WAS PUMPED AT A RATE OF 2.7 GPM OVER A DURATION OF 2.8 HOURS. THE DRAWDOWN WAS 17 ' WITH A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL WAS 216.15 FEET. THE WELL IS A _ ,&/pTE�FOR THIS 3 BEDROOM HOME. y 1200lest 33rd Auenue. Suite B • Anchorage, Aloska 99503 • (907) 561-5040 ALASKA ENVIRON'°SNTAL CONTROL SERVI( INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907)561.5040 JOB Sl)eti P I L,� 10 �-k P!6' SHEET NO. •T� - OF- CALCULATED F CALCULATED BYu a�"� DATE- Z___ 3 3kl' CHECKED BY DATE Gr.Ai F VL h%IO/)JS: %/tale SS(pl'�c y/-`�C//t� V/P 7, neic/,r'a't ,ul -fm, �i..� /`:'r8' ra ecA' Z- x/ ZU6'= [7 ._�� L.%' n/o Su, fl�'u e) argc, . _T!)c e {cre .n�aKe ryfit.. `a _ `Z fee t /o,_y (S -2_x L/ 'F 2 W6 D / Loi Lo 1� Ar � 0.•°6•e •.°� Y _ (OWtvd b'I Lot 2) _ Ar �g�+•� • •go Ip•••:•• •r._o sus•9000 000, •• *• -_® A Area af Lot 25 " i ISR Y C. RIM, JR, E•2 51 i7 'N77 •� ea Q -c s. PoreA ,$-2'(/ Vit? 10 Lot Z.r Tan Areas of Scp-t k LBf 3 . _ _ �, sysicMs 1 _Lot 9 A/orFS Tl rs ,'ilyly.�tfs TliGt a7 u�,gr /�L/ se/ f'c ��s �� r 6e�'Om+S cr., .',�sJ��t=.(/rte(. .o,., Lu Y- /O 4VA"lf �na•�ifa.'->./'rte. cr„lC _ �Pqur�P//i f«.,,c :, Psy��..'-Ay Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOO a PERCOLATION TEST PERFORMED FOR: 5,qfu u TO R O � DATE PERFORMED:_ / ,3 (J B7 LEGAL DESCRIPTION: `i I�f_',II L) / Township, Range, Section:7-eit,4,(c DEPTH SLOPE SITE PLA `2--- 17 H WAS GROUND WATER ENCOUNTERED? - N S IF YES, AT WHAT L DEPTH? O P cE Jil�lj Depth to Water Alter Monitoring? [l� Date: 1■�■■VI■ Depth to Water Net Drop 9: 55 AO; o p 6 a444- v HXO O f6 51C■��■... I o �. I� 1�■ir�.z ME �[[ � PERCOLATI N RATE 46ules/ nch) PERC HOL DI R + � in �I �%�■■■10 Vol■ IOU ■■■ ■ Reading Date Gross Net Time Time Depth to Water Net Drop 9: 55 AO; o p 6 a444- v HXO O f6 . I o �. .o, v �[[ PERCOLATI N RATE 46ules/ nch) PERC HOL DI R + � n P TEST RUN BETWEEN Szi- D FT AND .h ( FT COMMENTS iTa/+:9 -SOI/ -IZ AU S' /'I r-Gf'cr6e -06 J' ZZ/uYdp S'kZ PERFORMED BY: rn a �a VA G 1 Y CERTIFYTHATTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: </ Z� 72-008 (Rev. 4/85) / / oui6 (HeV. si rtsl MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HF:AI._TH & ENVIRONMENTAL_ PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 87.5 L Street - Anchorage, Alaska 09501 Telephone .7.64-4720 ON-SITE SEWAGE DISPOSAL- SYSTEM ANLL/OR WELL INSPECTION REPORT fVAMF_.^�, XNFW ©�/ I 1����� /(1Cs _ T �I 4J[(•' ❑ UPGRADE MAILINGA KESS ~� _ < LEGAL DESCRIPTION, A LOCATI //�� _ NO. OF BEDROOMS Well Absorption area DwellJ'ng L) 1, DISTANCE TO: rll�t" inr��C7��/ r �c _ OT- ��'CCg J c �r PERMIT N0. P z Nf� Manufacturer _(moi Material No. of compartments Liq. ca achy in yallons �2) IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. CZ Manufacturer Material Liquid capacity in gallons �= DISTANCE TO: Welgtj�o� / Fou tdation X /.'��/"J2,60d��aZ Nearest lot line / PERMIT NO. CY tu No.oflines Lenof—each line y�r Total length of lines ©� Trench width ^Z inches Distance between lines p Top of tile to finish grade (/ „ Material beneath tile Total effective absorption ar Z inches l>� w Length Width Depth - PERMIT NO. Q F- a� LU Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line .j Class Depth Driller Distance to lot line PERMIT NO. a LU DISTANCE T0: Building foundation Sewer line Septic tank Absorption — area(s)-OTHER — PIPE MATERIALS : R ?11C, ASTM 113[i37 SOIL TEST RATING TJ r0o!)► — INSTALLER AT ) &W- e -C REMARKS i I APPROVED DATE LEGAL S_— A /,3 - z S'4 49`/ L o i oui6 (HeV. si rtsl DEPHRTMENT � HEALTH HD ENVIRONMENTHi 9OTECTIGN 825 STREET/ HNCHORHGE, HK9.�01 264-4720 PERMIT NO ( 820176 ) HPPLICHNT TOM WESTERHOF SRH 2146 99507 I49-5]67 LOCHTION OFF OMHLLEY LEGHL L18 SHELL ��/ LOT SIZE i... 000 SQURRE FEET TYPE OF SOIL HBSORPTION SYSTEM I5� TRENCH MHXIMUM NUMBER OF BEDROOMS 4 SOIL RHTING (SQ FT/BR)� 125 THE RL HBSORPTION SYSTEM J. � )������� ��...... ��� ����.� � PERM[T RPPLICHNT HHS THE RESPONSIBILIT9 TO INFORM TH-S DEP�RTMENT DURIHG THE INSTRLLRTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE BHCKFILLING OF HNY SYSTEM NITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEP8RTMENT WILL BE SUBJECT TO PROSECUTIUN MINIMUM DISTHNCE BETWEEN H WELL HND HNY OH~SITE S�QHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE HELL OR 1�0 TO 200 FEET FROM H PUBLIC WELL DEP�NDING UPOM THE TYPE OF PUBLIC NELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FE�T NELL LOGS HRE REQUIRED RND MUST BE RETURNED TQ THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION OTHER REQUIREMENTS MRY HPPLY SPECIFICHTIONS HND CONSTRUCTION DIHSRHMS HRE HYHILH8LE TO INSURE PROPER 'IL NSTHLLHTIOM ������....... ..... � I CERTIFY THHT 1� I HM FAMILIHR WITH THE REQUI�EMENTS FOR ON�SITE SEHERS RND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN RCCORDHNCE NITH THE CODES ]� I UNDERSTHND THHT THE ON~SITE SENER SYSTEM MHY RE8UIRE ENLHRGEMENT RES SIG 7 7SSUED BY ' Y40 �.vnliaur',t t:.nClneera 6L ASSOCIU10S 212 ..t International Airport Rd, -' Suite 204 ANCHORAGE, ALASKA 99502 • (_ (907) 278.3773 — SOILS LOG — PERCOLATION TEST V\ SOILS LOG ❑ PERCOLATION TEST 3ERFORMED FOR:1 p WASTE `—yV01P�� DATE PERFORMED: LEGAL DESCRIPTION: �J+ S ��� ` SU I ITI PIT SLOPE SITE PLAN— — — 1 2 10 , 11 12 13 SAN'b-Sw Nb �l�TEIZ_ 17 OF A .41 20 Sr Ralph 8. J . o r 9 - �;n'., NG. t1099 c=r,I?6r(COLATION RATE (minutus/Inch) ®.' ' TEST RUN BETWEEN FT AND FT C i�1 h r1i lti\• A'! COMMENTS 7a�Pli l«�s.. DATE:9_ 7 _ F'i Z PERFORMED BY:. CERTIFIED BY: I WAS GROUND WATER ,`u L ENCOUNTERED? l�1 0 P IF YES, AT WHAT E DEPTH? Reading .`p Date Gross Time Net Time Depth to Water Net Drop WATER WELL RECORD MUNICIPALITY OF ANCHORAGE STATE OF ALASKA ENVIr I G J DEPARTMENT OF NATURAL RESOURES Division of Geological Q Geophysical Surveys 9 R82 RECEIVED Drilling Permit No. LOCATION OF WELL (Please complete either to, Ib or Ic.) _ A.D.L. Do Borou�gh ^S_uDdiviaion Lopt� Blojck Ib. I/n giro. Section No. rorrnahipN❑ Range E❑ Meridian Wo Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS �TIII 3. OWNER OF WELL: Address: Street Address and Arca of Well Location , -- Feet Below 2. WELL LOG Surface 4. WELL DEPTH: (flnoll 5. DATE OF COMPLETION / el? M aterlal Type Top Bottom � I G, ®Cable tool [j Rotary ❑ Driven ❑Dug /> r 1 7 �� ❑ Auger ❑ Jat led L] Bored E]Other ] {I '� % 7. USE: Uornoafic ❑ Public Supply _]Industry " 1 '� le v 1 '� (% ❑ Irrigation ❑ Recharge ❑ Commaricol ❑ Toaf Wall ❑ Olher:--- -- 1 � .Nr' (r � •I 4• ' 4 Q� S. CASING ❑ 'fhr/e od od Welded 7 <j ��i �Ft-(%l� dlam._�1_—In. to z/`Ly;L fl. Depth Y/oight._Ibs.�ft. _J(?Q (2\1 rl 0 diam. in. to _ , ft. Depth Stickup — __ It. r ( I i J -_J—L l_ 9. FINISH{ OF WELL: -- — -- Type: 1 L. -� I �i,. Slot/tjesh size Lo ngth: �A; ,•, !Jv,J Q, U/ c Sot between fl, and fl. Backfilling �.--- _ — Gravel pock 10, STATIC WATER LEVEL://J fl. r" % � .V �(^ �I ( I Data ❑ Abovo or Bolove land sur (a co Equipment used: _ 71 16. WATER WELL CONTRACTORS CERTIFICATION: II . PUMPING LEVEL below 7land surface and YIELD z�[n ft. otter / hrs. puinpIngL! q.p.m. ft. after hrs. pumping L q. p. M. 12. GRO U T I NG Wall Grouled: ❑ Yes ❑ No Motorial: ❑ Neat coment ❑ Other: _ 16, PUMP: (if available) HP IZL Length of Drop Pipe 2 'j r—fl. capacity _k_ q. p.m Lnl Subm. ❑ Jot ❑ Contrifical ❑ Other 14. REMARKS 15. Water Temperature .__—° ❑ F ❑ C This well was drillgd unitr my ju sdiction and this report is true to the best of my knowledge and belief{ Registered Busine s_s amo Contract License Number (1) ;I - I __I/ cQ 11 Address: Signed : Authorized Representative Dale: (Form 02-WWR (II/81) Copy Distribution: WHITE-Stato DGGS, PINK -Driller, CANA RY_0 ustomer r , MUNICIPAu'ry OF ANCHOnAGE D €>AnTNIE'aT QF- t -11-A;_. T H AND E,NVI[ION MENTAL PRO I-XTION DIVISION OF LNVIRONMIM01'i AL I;I�l1�iN CERTIFICATE OI INSPECTION FOR I IEAL-I-1-1 AUTHORITY APPROVAL OF ON SITE SEWER AND WATER FACII_I'I Y 2.64-472() Application Date I. GENERAL iNFORIVIA ION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Telephone: Home F,u. mess (b) Applicant Name -- --- ----- p-- — — r -- ----- Applicant Address (c) Applicant is (check one): Lending Institution - Owner builder LI ; Buyer h.l Other U (explain); ----------------- --- (d) [-.ending Institution — rlliL—__--------------- - telephone Address - - -- --- -- --- - - ----------- -- (e) Real F_si, Company and Agent - "^ �)=_------------.----- Address ------ -Telephone -- - ------ ---— ------------ -- (f) IVlail the HAA to the following acidress: Single Familyj{ -, N`Ulti-Family Cl Other _---------- ---- -- ---- --- Number of Redroorns----'_------ _--- 3. WA T hn SUPPLY Individual Wel(�7- ' Community F-1 Public h7 Note: If community well system, must have written confirmation from the State Department of Invironmontal Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Cl ' ' Public (=1 Community El Holding Tank F-1 Note: If community well systern, roust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. �zozs n r oat Page 1 of 2 61c -f1 "1 5. ENGINFEMVI a FlHPJ1 PnOVIDINk- 111SPEC I IONS, i C.S I , FILE SEAHC i, DA AND INFORMATION /:- 7 /r, As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this i-lealtiI Authority Approval shows that the on-sito 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. Name of firm _ f' c -._.S —-------------- Telephone ..-- --'' ri ------- -- _, r; Address — ------="--- G Date------------------- r G�OU00 AR a0 G00 >OjoC04G� f � if p�c�a o ]c •',;, ;l F> 6 E+;.P APf3110VnL Approved for beclroorns by - --- Date --- -- — Approved _--—,-_---- Disapproved ___-_-- —_ _ -_ Conditional -- Terms of Conditional Approval --- GAV IO1.1 The Muncipality of Anchorage Department of 1-lealih and Envirorunontal Protection (DHEP) issues 1-11ealth Authority Approval certificates based solely upon the representations given in paragraph `i above by an independent professional engineer registered in the State of Alaska. The DI -IEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain foderal and state requirements. Fmployecs 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 (11,64) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: S Ael * / 17-N23&,r' A. WELL DATA r,;ut•,iaPALm/ OF ANCHORAG;! MI'L OF HEALTH & 1:NVIf,ONiME ITAL I'P.OTCCI'ION Well Classification P" ` If A, B, C, D.E.C. Approved (Y/N) IV it Well Log Present Y 1) Date Completed —,? . 31 - $ ;- — Yield y C P M Total Depth Cased to 2 L46 Depth of Grouting Static Water Level z00 Pump Set At J 2 Sanitary Seal on Casing 1��) Casing Height Above Ground Electrical Wiring in ConduitA/N) Depression Around Wellhead (Y/a Separation Distances from Well: To Septic/Holding Tank on Lot eo 3 On Adjoining Lots 6T /00 To Nearest Edge of Absorption Field on �c.v. CT Lot //8 � ; On Adjoining Lotsio p. To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole � To Nearest Sewer Service Line on Lot 81 Water Sample Collected by Je rf ACs Date 5'- z3�f3� Water Sample Test Results S«fi-s Comments B. SEPTIC/HOLDING TANK DATA 12 Date Installed / 8 Size / Z S d No. of Compartments Standpipes l) Air -tight Caps C/1V) Foundation Cleanout&' N) Depression over Tank (Y/0 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N ; for Holding Tank High -Water Alarm (Y/N) N n Temporary Holding Tank Permit (Y/N) NM Separation Distances from Septic/Holding Tank: To Water -Supply Well 103 To Building Foundation Z 3 To Property Line To Disposal Field ZS- p To Water Main/Service Line C;T z S" To Stream, Pond, Lake, or Major Drainage C' T- tvv Course Comments Page 1 of 2 72-026111/841 5, A cit &-1 Kofi /o C. ABSORPTION FIELD DATA 12.5-(01<1syfk� 26G(1re4 e of System Design c- Soils Rating in Absorption Strata yZl Yp re i Y 9 Date Installed —13-821fd) �" 31- 6 �)e / Length of Field S D (al�� 5S Width of Field Z6-2e'�o /d) 3 (nP % Depth of Field �� �`/d� �i'P•�) Gravel Bed Thickness ��� ' `n ew� Square Feet of Absorption Area X0661'44 yY04Standpipes Presentdl A) Depression over Field (Y/ J Date of Last Adequacy Test A(11 i3h ! aseet� � / H fe /eno 7`Li«„ :Z eee(rrnrr/s' , encs vp� . A-1 Results of Last Adequacy Test was ne czvs-y Separation Distance from Absorption Field: r To Water -Supply Well (I S �� ` To Property Line sys{ wesf L4 To Building Foundation 36 6'O) To Existing or Abandoned System on Lot (,;7 ' 6e4-wev„ old /r ec l ; On Adjoining Lots 67- 30 To Cutbank if resent N A To Water Main/Service Line � i Z s ( present) To Stream/Pond/Lake/or Major Drainage Course C, T /O o To Driveway, Parking Area, or Vehicle Storage Area y 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 i Dimensions Manhole/AEess (Y/N) mp Off' Level at _ Vent(Y/N) ing Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request 1 certify that I v checked, erified, or conformed to all MOA and HAA guidelines in effect on the datis®Fpe-4t �© Signed Date 6 /fK� Ky't /fir 0000 ee•e•...eee a ® Company /![ c S MOA No. S T �'6 azo %e*�..9T.f... ....•®0 Receipt No. ^7 000f • •onewneoe eeee o. LE Y C. R JD, R. Date of Payment f` �. C 29�� p� t� r'sFSeal- Amount: $ �� •.e.e e � Page 2 of 2 72-828 (11/84) ff CONTROL SEFtvIGts, fNcSuite. 1200 Wes 33rd Avenue, ANCHORALASKA 995036�— (907) 561-5040 Y CHECKED By LD�A'T^�E ^ l?%I/JNJ NEibHE�RS __ W. LL 33 EPTiL / Hoof i I, iANl� Sip WEST' LOT Lir�E z94: '5� C/o -� 3.� f6� iANl� Sip WEST' LOT Lir�E z94: '5� C -PL t )1.a—AA- Time APPLK NT FILLS OUT UPPER HAI ONLY Property Owner Time Phone Mailing Address �` '1y %/�( ! /.;�y-- Zip Code { ,- - I-. Date Date Buyer `j�si f fy l' Date Address Inspector Zip Code Lending Institution Inspector Inspector Phone Address Zip Code n' Field Notes: MUNICIPALITY OF ANCHORAGE Phone Realty Co. & Agent Address Zip Code Legal Description Street Location &'ri RECEIVED Type of Residence - Single Family ❑ Multiple Family No. of Bedrooms ❑ Other DATE Water Supply (\�� ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ,z Individual l.�C'SY ` C_�Y\ `�-�--Q For wells drilled prior to that date, give well depth (attach log if available). El Community Well Log Received Septic Tank Size ❑ Public Utility 4 Well to Tank Sewer Disposal Year Individual Installed: ,O Individual ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. C -PL t )1.a—AA- Time Time Time Time I-. Date Date Date Date pp q-Q-9� A Inspector Inspector Inspector Inspector n' Field Notes: MUNICIPALITY OF ANCHORAGE ENVY -. V :I .. <.. i .0 f' 'I _ . I RECEIVED ( "APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size 4 Well to Tank 72023 101821 zs) 5oaz. c. c ::�15- l ll'22 (REVBRSEd 9Al /CCE8RL 51-4./7-) /6• /19. • +4 # yj (03- 298) 8-23- 8 3 5.112.4;2e43 (0 2r38) 4 /7,62 4-/8-73 !11-13 Thru 19 11-25.70 34 -fAru,39 //-/3.70 0/S— A/ — /! ry 12 /..5. 7n 0 LOU \� Ad;o,rJng Page No. Adjoining Tax Boon No. 0