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HomeMy WebLinkAboutROBIN HILL #2 BLK 4 LT 4Robin Hill #2 Block 4 Lot 4 017-393-02 Not eligible for Certificate of On - Site Systems Approval because final Inspection Paperwork is needed! Municipality of P.O. Ikxx 11XHM • .lnc6nnige, Alaslui $Y9519-&;50 • Telephone (!X)71343-SU)l • Fax (!X)7) 343-KNX) 4700 M gaw sthel • :tnchorogc, Alaska 4X65(17 mm.muni.org Mayor Mark Begich Iluilclitlg Safety Division 22 Jun 05 Ken Peterson 13101 Floral Lane Anchorage, AK 99516-3142 Subject: Expired On -Site Water and/or Wastewater Permit Permit Number: SW030399 Legal Description: Robin Hill #2 Block 4 Lot 4 Dear Mr. Peterson: This letter is to inform you that your permit SW030399 expired on 25 Sep 04. Our records indicate that a house was built on this property. To date we have not received a final Inspection Report for the installation of the on-site wastewater disposal and/or the water supply system. Please be aware that you will not be able to receive a Certificate of On -Site Systems Approval at the time of any transfer of title. If you have any questions, please call this office at 343-7904. Sincerely, Kathleen Maricle Permit Clerk On -Site Water and Wastewater Program Enc: Copy of permit Coiilinuitity, Security, Prosperity Municipality, of.Anehorage o 4( \ - , .. P.(). N)x 19;67A) • Anchoragc, Alaska JD.919-WZ0 • Tcicphonc (907) W -M01 • Fax (007) 313.82 MI 47(X) Bragmv Strcc( • Anchomgq Alaska 91M07 Mayor Mark Begich August 16, 2004 Ken Peterson 13101 Floral Lane Anchorage, AK 99516 u1% 1v.m1ml.0 r9 Buildhifir Safety Division Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW030399 Legal Description: Robin Hill 92 Block 4 Lot 4 Dear Mr. Peterson: An On -Site Water/Wastewater Permit, number SW030399, issued by this office for a single-family system, %gill expire on September 25, 2004. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincerely, �� / !_/ `��/7 ��" c1 Daniel J. Roth Program Manager On -Site Water and Wastewater Program Enc: Copy of permit Community, Security, Prosperity MUNICIPALITY OFANCHORAGE 2"'r h/alc Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 26, 2003 Expiration Date: Sep 25, 2004 Permit Number: SW030399 Parcel ID: 017-393-02 Legal Description: JROBIN HILT: #2 BLK —4 LT -4F Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 013101 FLORAL LN Owner Name: Ken Peterson Lot Size: 56989 SO. FT. Owner Address: 13101 FLORAL LN Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-3142 This permit is for the construction of: ❑,/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. Received By. Issued By Date: 29 Date:LZ 6 03 Municipality of Anchorage 41—, -. Development Services Department Building Safety Division 3z• 1 '�' !; On -Site Water and Wastewater Program .. ... 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343 7904 ON-SITE SEWER/WELL-REERMIT APPLICATION - - FOR A SINGLE FAMILY DWELLING Parcel I.D. ('21'1 Permit Number SW 030399 Property owners) I Lr ✓� Y �T r S u ✓1 Day phone Mailing address (1) 121 r%I nYr� � (LIQ nC. s -,AC Mailing address Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Ngsq Lot Size Acres q.Ft. Zip Code L� afIf— 4 K'dnrn Ft'I(s i/ -Z 13101P-adl 0 -'no - Number of Bedrooms �_ 3 THIS APPLICATION IS FOR: SOnly K Well Only Elewer Sewer and Well Cl Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: %{ 01CD Waiver Fees: 17 Date of Payment: 'l 7(Cr-2 — Date of Payment: Receipt Number: 2 OReceipt Number: (Rev. 12/00) Michael N. Anderson, P.E. Civil/Structural Engineering and Excavation 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 September 18, 2003 Municipality of Anchorage Department of Health and Iluman Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 4 Block 4 Robin Hills #2 S/D To Whom It May Concern: This is a request for a new septic permit due to the existing system failing. The ground over the existing tank has started to collapse, thus the system needs to be replaced. A new test hole has been completed on the east side of the old trench, the soils consist of silty sands with some gravel SM. The depth of the test hole was 18 feet with no water observed during the excavation or during the seven day monitoring period. The perc was 24 minutes per inch, the new system is deep trench with #'feet of effective depth for total length of 63 feet. 9- The lot slopes gently to the south east at about I to 3 percent. The lot will not encroach any neighboring lots for future development due to the large lot size and existing systems. The existing tank will be demolished and the new tank installed in its place, sec the plan. If you have any question please call me at 345-3377 SincercLv Michael N. Anderson, P.E. DESIGN CRITERIA: 3 BDRM X 150 = 450 GPD APPLICATION RATE: 0.6 GPD/SQ. FT. 2.0' WIDE TRENCH 450/0.6 = 750 SO. FT. REQURIED 750/14 = 54' REQUIRED TRENCH TRENCH: 10.0' DEEP 7.0' EFFECTIVE 2.0' WIDE (1) 54' LONG EXISTING WELL 100' RADIUS MOUND OVE (THI1) o GRADE FILTER FABRIC SM -2.0 2' INSULATION IF REQUIRED 4'0 PIPE SEWER ROCK -18.0 -9.0 2.0' R EXISTING HOUSE,-- 1 w I TANK AND / v w CLEANOUTSI a I J OPOSEh TIC SYSZEM n. EXISTING ERTIC Z a J — ~ o: o~ -- EXISTING SEPTIC = EXISTING SEPTIC o J I I I i � PO � � O O� P R� Septic Design Prepared For ' BOB BURGESS &KEN PETERSON OF Al1 LOT 4, BLOCK 4 ,-1P,.•• �:QSIt ROBIN HILLS #2 SUBDIVISION Prepared By 00* • 49T�Hsy�'. •••� y� �, MICHAEL N. ANDERSON, P.E.i�!/J .. ..... 4640 SHOSHON1 DRIVE •�„ MICHAEL N. ANDERSON (907) 345-3377 / FAX (907) 345-1391 �,•. �C,Ej9 69 ;�� SCALE: 1"=200' SEPTEMBER 15, 2003 11, p ..... y�� Q WELL 2-37. DRop`( -------------- NEW 1000 GALLON TANK 2-37/ DOUBLE GO VALVE �C� r— .0 1 6.0 1 1 1 1 1 1 EXISTING DRNI Septic Design Prepared For BOB BURGESS & KEN PETERSON LOT 4, BLOCK 4 ROBIN HILLS #2 SUBDIVISION Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' 1 1 1 1 1 1 I 1 I 1 1 i i i -100' EXISTING WELL RADIUS 54.0 10.0 i SEPTEMBER 15, 2003 I I E z-,S7�1 i OF Al • X91 ry' • rl *:*49T"* .* 0 M40.00.0 .MAI . MA... fs • MICHAEL N. ANDERSCN :4k - CE 4'CE 94 9 j e Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: I-r-r*r �4rr'g D n DATE PER 2 /� 11 --0 Ti LEGAL DESCRIPTION: Lrf t4 61/c y Po6 n Al), Township, Range, Section: DEPTH . SLOPE (FEET) p+a/or(r i F-7—T—T-1 r_T- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18• 19 20 COMMENTS (rgrvf O t' pian A�o1 lqd�' u4c­- 'A','n t WAS GROUND WATER .._L!y ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water Mer Monitoring? M u. c Date: _-4m) ) 11 •.r+ vv. .�.r.......... P MICHAEL N. ANDERSON * L4 Reading Date Gross Net Time rime Depth Wu Water Net Drop `i e3 rt ser , n �S�r *:49TH.�' *+I •,!A,r.•7:...�I.JJJ.4•..a..� •.r+ vv. .�.r.......... P MICHAEL N. ANDERSON * L4 Reading Date Gross Net Time rime Depth Wu Water Net Drop `i e3 rt ser , n �S�r 3nm, .r ✓/• o Of N. 7 5" z f PERCOLATION RATE 711_ (minutes/inch) PERC HOLE DIAMETER TESTRUNBETWEEN 610 FTAND A3"5- FT I 1 PERFORMED BY: Ms Ae e'/A I An i KA in I CERTIFY THA THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE. '�7,0 3 72-008 (Rev. 4/85) GREr!R ANCHORAGE AREA BOF"IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON -SITES SEWAGE DISPOSAL SYSTEM NAME '-5 ' 6 ,J�..//LLI_� MAILING ADDRESS ": 0V 1✓'Vk''' `- 3Z- - PHO/N/E - �Gr LOCATION 0/ III" � LEGAL DESCRIPTION/// 2��, /J' ��f v SEPTIC TANK:/ f,h/ /hJ 4olol ,% DISTANCE WGrah �� �k �jATER1ALNUMBER OF —COMPARTMENTS— FROM WELL MANUFACTURER/ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/ -4LGALLONS. TILE DRAIN FIELD: �pp L f � �, i�. TOTAL LENG�Tn / DISTANCE FROM WELL FOUNDATION . 1 NEAREST LOT LINE 210 LINES NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTIiTI'k IN. TOTAL EFFECTIVE ABSORPTION AREA 46" It SQ. FT. LENGTH OF EACH LINE / DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE/,o-2-12-IN. ABOVE TILE IN. WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE'S: DIAGRAM OF SYSTEM • le INSTALLED BY: Ctr LJ04 d SEWER LINE DEPTH: / lR� po v / f PIPE MATERIAL//:C.3�VN LOT SLOPE: ';;:40/'PL✓ roll" REMARKS: - 'o r' DATLO � � APPROVED At 2033-1 • GREj"^:R ANCHORAGE AREA BO' ,JGH ,4 DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3370 "C" STREET ANCHORAGE, ALASKA 99303 TELEPHONE 274.4791 Vj�YYYY ONONONON� lY,. SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF A PPLICANT• />-, /•/�P MAILING ADDRESS �./17--PHONE 3'06 / f INSTALLATION LOCATION ` �s �u �"'-' L• J LEGAL DESCRIPTION INSTALLATION OF, SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER ri11�` TYPE AND SIZE OF FACILITY TO BE SERVED ,(�' FINANCED THROUGH ten/ _ TO BE INSTALLED BY M / • ` Y- ' r e -,e Q /Sy 1-2:"-,:✓� SOIL TEST RESULTS `�� r U NOTE, THIS rERMIT 15 NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OP ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE I &-C�e TYPE MINIMUM DISTANCES, REQUIREMENTS/ Sr I NK $REPACK AREA SIZE FOUNDATION TO SEPT C TA FOUNDATION TO SEEPAGE PIT � G DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /J /14 AX �/[� / /I �� / s / SEPTIC TANK `� 0 8[fPAGC PIT 1La�. DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK /�`� 1.. SEEPAGE PIT � 0 DRAIN FIELD / `' /� , ALSO CONSIDER ARCA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, � SICPAOC IIT �/ DRAIN FIELD /Q � .` TO RIVER. LAKE. STREAM. \. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING OAP OP EXCAVATION B FEET INTO UNOISTURGED SOIL. \ 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT` FITTED WITH AIRTIGHT REMOVABLE CAPS. eJ•//%eeA e df //'.,Aq NY v� T/71r/fir �\ GRAVEL BACKFILL a ya I 141 CONFORM TO BOROUGH REGULATIONS REGARDING ARDING INSTALLATION. \ G.AA.S. OR LIC CNSRO D$f,GN$R I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATCR AyIC DESCRIBED SYSTEM I IN ACCORDANCE WITH SAID CODE. .f"�J' DATE APPLICANT'S SIGNATURE � FORM NO. CO -416 TYPE DIAGRAM OF SYSTEM BOROUGH ORDINANCE NO. 28.88 AND THAT THE ABOVE C6 lilmMI CNMI 1111111 BOROUGH ORDINANCE NO. 28.88 AND THAT THE ABOVE INC.Fa .n:Nlcw 244 EAST SIST AVENUE P.O. BOX 6017 • ANCHORAGE. 'ALASKA 09303 • TELEPHONE 907-279.0453 • TELEX 090.33619 May 15, 1975 Rat No. 562031 • Sebring Builders Box. 1540 C Star Rt. A •. Anchorage, Alaska .. RE: Test Hole and Soil Log Report for Sanitary..System Lot 4 Block 4-Robin Mils.Subdivision; Dear Mr. Sebring: . We are submitting herewith the test boring results and our comments regarding soil conditions encountered at-the subject site. - This investigation was'performed in accordance with your request'of ttay 12, 1975, and those procedures outlined in a letter dated December 19, 19741: by Mr. Rolf Strickland of.the Greater Anchorage Area Borough Department of Environmental Quality. A single.test hole was put down within.the Lot 4 area for the-purpose ' Of defining general subsurface soil conditions for 'the proposed sanitary system. Excavation was accomplished with an auger type drilling 'rig and the test hole was extended to a total depth of 20.0 feet below ground surface. One sample was recovered•from the test hole and retained for grain size analysis. The results of this sample are' enclosed. The final log prepared for the test.hole has been'included in Drawing A-01: Ground water was not encountered in-the test hole: We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, . R &-M CQNSULTANTS,_IM, James W. Rooney - Vice -President Encl_ . s NOTE: Tast hole extended with auger type drilling unit. Log Represents ..Lot 4 Block 4 Robin Hills Subdivision Sebring Builders Xoy'of.Tcst hole ., •• Anc;orage,. Alaska R Engineering eA Geological Consultants Inc. y ANCIMRACE IAIH9AN%S ALASKA JUNEAU t LABORATORY TEST .REPORT TEST ON Tnsitu Material RAM PROJECT NO. 562031 PROJECT NO PROJECT NAME Sebring Builders LAB NO. 75A-753 SAMPLED FROM Test Hole No. 1 SUBMITTED BY "Jackson FIELD NO. 1 SOURCE Lot- 4 Dlock 4. Robin Hills Subdivision DATE REPORTED 5-15-75 LOCATION Anchorage, Alaska DEPTH 7-81 DATE SAMPLED 5=13-75 DATE RECEIVED 5-13-75 GRAIN SIZE DISTRIBUTION CLASSIFICATION 95 LL aro' .BS PL 04 ' .COMPACTION ' ' PASSING SINE As SPEC RECEIVED UNVI[D AA3H0 FAA SN 410 •58 REMARR3 ,uta Classification S' 9•' i 10 ' ,FRO OPTIMUM MOISTURE .. �" %+3 3` % GRAVEL % SAND I.IFt� % SILT 1" 100' .7. CLAY 3/4. 99 Fsv V2" 95 LL aro' .BS PL 04 71 PI ' ,ya CLASS SN 410 •58 REMARR3 ,uta Classification ,FED Based on/ ,FRO Gradation 040 47 41so .• #so 0100 40200 36 STATIC IMMERSION BRAND 0%—I/2%— ' y- 006 .Oz MM .00SMM DELETERIOUS MATERIAL MINUS 10 200' ME$" SOFT FRAGMENTS COAL 0 LIG. OR LT. WT. PART. CLAY LUMPS 3TICX3 0 ROOTS FRIABLE PARTICLES SPECIFIC GRAVITY ABSORPTION FINENESS NODULUS SULFATE SOUNON99S FREEZE -THAW RATIO L.A. 'ADRASION LOSS— DEGRAOATION VALUE_ THIN -ELONGATED __ OR'.ANIC COLOR GRADE i �nglnnUring aGaologlcol Conaulloni-t MAX. WET DENSITY MAX. DRY DENSITY CORK MAX. DRY DENSITY % FRACTURE METHOD NATURAL DENSITY NATURAL MOISTURE WEIGHT LOOSE WEIGHT RODDED MOISTURE - PERCENT No. 1 ' 5-13-75 0.0' ORGANIC MATERIAL (Peat), N 1.51 . ' 471.T _ Tra ro CanA (MT.1 ' LABORATORY TEST REPORT TEST ON Insitu Material %+10 RBM PROJECT NO. 562031 PROJECT N0. PROJECT NAME , -LAB NO. Y % GRAVEL Bole No. 1 2" Jackson .FIE LD % SAND LABORATORY TEST REPORT TEST ON Insitu Material %+10 RBM PROJECT NO. 562031 PROJECT N0. PROJECT NAME Sabring Builders -LAB NO. 75A-753 . % GRAVEL Bole No. 1 2" Jackson .FIE LD % SAND SOURCE Lot 4 Block 4 Robin hills Subdivision DATE REPORTED 5-15-75 LOCATION Anchorage, Alaska DEPTH 7 -BI DATE SAMPLED 5-13-75 DATE RECEIVED 5-13-75 GRAIN SIZE DISTRIBUTION CLASSIFICATION FSY • COMPACTION.' . ' SPEC. ' UNIFIED AASHO FAA y %+10 1" %+S % GRAVEL . 2" % SAND 11/2". % SILT . I" 100 % CLAY 3H" 99 FSY ' 1/2" 95 LL 3/5" BB PL ..#4 71 PI ' * a CLASS SM *10 4015 58 REMARKS Classification 020 Based on 0 30 Gradation /40 • 47 050 0410 *100 41200 .02 N M 003MMIL 36 STATIC IMMERSION BRAND—. O^/°_I/2°/.— ly,_1v2%_2%_ u o_ DELETERIOUS MATERIAL MINUS 4# 200 ME3N SOFT FRAGMENTS COAL B LIG. OR LT. WT. PART. CLAY LUMPS STICKS a ROOTS FRIABLE PARTICLES SPECIFIC GRAVITY ABSORPTION FINENESS MODULUS SULFATE SOUNONE33 FREEZE -THAW RATIO L.A. ABRASION LOSS .GRADE DEGRADATION VALUE THIN -ELONGATED ORGANIC COLOR' EnginooTing rat Oaological. Consultants ANCrow AAs PAIANANR\ ALASKA'+u NAwu OPTIMU/A MOISTURE MAX. WET DENSITY MAX. DRY DENSITY CORR. MAX. DAY DENSITY FRACTURE METHOD NATURAL DENSITY NATURAL MOISTURE WEIGHT LOOSE WEIGHT RODDED .MOISTURE - PERCENT 7; i' i' eM ix i'C1 iH N y !w'� !" tM!v k is 6 idD :m E n !N n In E p y !y E `; E N `' to Zi j' tn :1 �? n o Pei r S � E i3 E O t11ppo^r'r : A a 1 ? E ! O O O O < pr 10y 0 0 x 3 0000 i 1 1 ! ? 1 EID ? i t I I i i C• ?m {V iMM t L : w ?o : j wo is s rt f� H �1eeJ� H t1y H w� H �rr� H M �rJ H H H H H H H H H i' i' eM ix i'C1 iH N y !w'� !" tM!v k is 6 idD :m E n !N n In E p y !y E `; E N `' to Zi j' tn :1 �? n o •yt r M O w M A a pr 10y 0 0 x 3 0000 o 0 r r EID 1 N ? r r i C• ?m {V ? to r?N L : w ?o : j wo O f� H �1eeJ� H t1y H w� H �rr� H M �rJ H H H H H H H H H 0 0 0 0 o p o 1N !T 2 ? to !A F+1 i co 1 i V i i' i' eM ix i'C1 iH N y !w'� !" tM!v k is 6 idD :m E n !N n In E p y !y E `; E N `' to Zi j' tn :1 �? n o •yt r M O w M A pr 10y P i i 1 tD r EID 1 N ? i m 09 m 6 e a Pr N 'rC p m � r r r .r N _ Z i\ J l�,x� wa.gt'S (171/ MUNICIPALITY OF ANCHORAGE • -7 DEPARTMENT OF HEALTH E HUMAN SERVICES (V �� DIVISION OF ENVIRONMENTAL SERVICES n CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264.4744 Application Date 91S / e 7 1. 'GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot block, subdivision, section, township, range) I rt4-4 'l kck.q 'Pnb,-n Hills SJbdlvtsr4n�fla Location (address or directions) I X101 PIofa1L Lo,n. (b) Property Owner Home 34S-650) Business 426i430A Mailing Address "51 L11 r•' "".Q.— (c) Lending Institution AlaQlu- USA � CRS �� Ii elephone ?86 --.'' sly �Z>o : $r enenk Mailing Address Po.lox 1966 (3iUU in i9&ata-• 'FIMY-66/3 (d) Real Estate Company and Agent B, Address Telephone /Aodyr p4E✓4 O'G—O�a roc. (e) LMail ist contact person anld day phone number below ere �, if hold for pick up. d /o lo*, $tcnno,.nr, i A•io.oka-�, USA ±� PhMC 2. TYPEOFRESIDENCE Single -Family 10 Number of Bedrooms 3. WATER SUPPLY Individual Well JO Community D Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite PublicE3 Community O Holding Tank O 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 72.073 IRw SMI nmI "13 isms "UP WWI i to Z a6ed 'YllOm s,laau!6ua Ieuo!ssalold aql u! suo!es!wo to s!olla lol elglsuodsoi lou sl a6ejogouV to Apted!o!unlry aql •ponssl sl eleolyllao a alolaq slop ezAleue to suo!loodsui tonpuoa lou op SHHO to saaAoldw3 sluawaiinbai mels pue Ieiapa/ u!uUao Als!les of laplo u! suollnipsu! Bwpuelnagl pue sawoq 10 slasegolnd of Asaunoo a se $141 50017 SHHO aql TISUIV to 9le1S OLD u! paials!6a! JaauBua leuo!ssalad luepuadapu! us Aq aAOge g ydel6eled ui uaA16 suo!leluasaldai eql uodn Aluo paseq saleolpliao lenoaddV Agloglny y11901-1 sanss! (SHHO) SaolAlaS uewnH pull ggeaH 10 wawlledso e6el0g3uV to Atlled!o!unyy eql oleo NounvO lenolddy leuog!puoO to swlal Ieu0111pu00 panaddesro' — panolddV Aq swoapaq m 77- !ol panwddy IVAOilddV SHHa '9 4861 i oleo I S66 '1 ; ai y ' 3 0 1 ssaippy s! –3'p r euogdalal .. Ap :° y y wJ w!!d to eweN vo!loadsur s!ql to slop eql uo baps ur suo!lelnBei pus 'seouewplo'sspoo 61e1S pue ledlo!unlry Ile Ul!m eaue!ldwoa ui si walsAs lesods!p lalemalsem jo/pue Alddns jotem el!s-uo 9141 'uopoadsul pue uo!1e61js0nul Aw wojl pue sal!l e6eloyouy to Alrledlo!unyy eqi wojl pawelgo uorlewlolui eqt uo paseq legl AluaA lagllnl l u!alaq poleo!put amlonils to adAl pue swoolpeq to lagwnu eql lol elenbape pue leuoltounl'ales sl waisAs lesods!p jelemelsemlo/pue Alddns lalem a1!s-u0 agllsgi smogs lenolddy Aluoytny gtleal.i S1141 to u011e611SOAu! Aw tegl AlueA I Imolaq umogs slop uo!teplleA eg110 se pue ote,eq pexllle!eas Aw Aq paipliao sy NOIlVWUOdNI CNV VIVO'HOHV3S 31ld'S1S31'SN01103dSNI ONI01AOU WHId ONIH33NION3 'S CIAI'L MUtytCtpgllTY Of An010mm MUNICIPALITY OF ANCHORAGE (MOA). EtyytROw tENTAL5E6v;CE3 DIVISION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 ScP ] o 1987 264.4720 Legal Description: P� C �v �� Atwb H,//, .S2bdrvur� k1•,2 A. WELL DATA Well Classification Pr va ife If A, B, C, D.E.C. Approved (Y/N) ti, A. Well Log Present (Y/N) 1^ Date Completed _0/9 / 7S Yield 36p- 0eer Total Depth le Y2 Cased to le 'It Depth of Grouting N•A• Static Water Level _P 2 i Pump Set At '--M P23 Casing Height Above Ground 3 f Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot Ito, -- ;On Adjoining Lots > 100' To Nearest Edge of Absorption Field on Lot 1-311 : On Adjoining Lots r CAO' To Nearest Public Sewer Line N.A. To Nearest Public Sewer Cleanout/Manhole M A. To Nearest Sewer Service Line on Lot N•A Water Sample Collected by T 1`n ; Date %/ t/ 6 7 Water Sampie Test Resulis c:_t• Ac 0 ce1(4 15'cp � 1 1 V 0'e: nLle- Kf' bWk -N B. SEPTIC/HOLDING TANK DATA Date Installed/ZC 7f Sizef 0 00 Ufa, No. of Compartments / Standpipes (Y/N) r Air -tight Caps (Y/N) r Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) Date Last Pumped 8 / zd' / a7 yt Mpr•AL�sd Pumping/Maintenance Contract on File (Y/N) R.A. ; for tit Holding Tank High -Water Alarm (Y/N) 1v,A - -- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well lieu S-ftM c. o, To Building Foundation 111F, P. �a ' To Disposal Field 20 To Properly Line P To Water MaiNService Line A'A' To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating In Absorption Strata '25V r7' /R dr,.. Type of System Design —2CrP 7-rrirC6 Date Installed 0'r Zo / Length of Field MO Width of Field ?d. Depth of Field 167 r Gravel Bed Thickness yZA',.it - Yn o, Square Feet of Absorption Area Xco `- Standpipes Present (Y/N) r Depression over Field (Y/N) N Date of Last Adequacy Test 9 / Z 67 " Results of Last Adequacy Test Aof'•4aater' r 3 b.o[rvow� Separation Distance from Absorption Field: To Water -Supply Well 1 fir' S+o� �• •• To Property Line d 0 To Building Foundation H7ROM C. o To Existing or Abandoned System on Lot -N•A . ; On Adjoining Lots To Water Main/Service Line 1'1. O. To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course root To Driveway, Parking Area, or Vehiyle Storage Area f62 Comments 'v`• Ar?. D. LIFT STATION 1.(A 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 .. Check Permitted Bedroom Rating Against HAA Request .6 Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA certi fy that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this inspection. Signed ! -5 Date Srpf9. 160 Z Company/�P T cA _ C oer MOA No. 87-QCF- ReceiptNo. 01q_001 _01W / �� Date of Payment Y 7 OF A/ 0 o w •( 0 Amount:$ ��`� g,`Q`,.•' Engineer's Seat Page 2 of 2 ?2.020 111/8I) CO... 49TN� •"r� d ..........................d �Tf1EODORC F. MOORS �� 17 CE"3589 • . Df...; RECEIVED r INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR LN PEL`TOI� ❑ Two ❑ Five MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONENVIRONMENTAL fl%OTECTION 825 L Street -Anchorage, Alaska 88501 *ATTACH WELL LOG. Awell log is required for all welts drilled • SEP 17 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 2644720 R 4 L � E D S REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAC L I DIRECTIONS: Complete all parts at page 1. incomplete toques" will not be processed. Please allow ton (10) days for processing. 1. PROPERTY OWNER ❑ PUBLICUTILITY PHONE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEDL MAILINGADDRESS 73 2 / .ncho/QGE . filQS 1 PHONE PROPERTY R SI DENIM differentfrom�abov V 2. SIAER `�"�� 9144 x 3D MAI ING OR SS � . 3.ENDING INSTITUTION PHONE AleuskQ_, OSA Aid l MAILING ADDRESS r 4. REALTOR! GENT PHONE MAILING ADDRESS e ea^ 5. LEOA/LDESCRIPT ON F STREET LOCATION if N N Al F- 6. TYPE OF RESIDENCE NU41BER OF BEDROOMS FAMILY ❑ One ❑ Four ED Other SINGLE ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY % INDIVIDUAL' *ATTACH WELL LOG. Awell log is required for all welts drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log If available.) S. SEWAGE DISPOSAL SYSTEM INDIVIDUAIJON-SITE** 'p �/ ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEDL 72.010 (RW. 6179) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE. ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON•SITE ❑PUBLICUTILITY Connection Verified PERMIT NUMBER DATEINSTALLED r _j INSTALLER ❑Septi a or ❑FloldingTank Size: If Tank is homemade give dimensions: SOILSRATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: SeptiolHoldinq Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS U - APPROVED FORBEDROOMS ❑ CONDITIONAL APPROVAL (letter mus ccompany certificate) ❑ DISAPPROVED DATE rr i` B Ralall, r1 NEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID N 920040440 rft!.15c' REPORT N S611PLE "::eot YOl : VU(BAL ken 9: :iie:It Dqui 10: L4, 04 BOBIR HILLS rig 5'Aplt^ kec•a : SBP o f!' Orcerec 07 : TED WiRle 1£c IMM'. 5Ek9icz 145 a ECIC) 5T AIi0 01?AOa, fit. 94b!6 SilP:lat i i:J'fur t: bort Urcer No. : 2&1 client Acco3nt : FLA:M Vat: Leport Printed: SEP 9 67 a 0:1s ^:leaned EY = �« Reports Acdrens 92 4(Kms ' Pec V: '55�j Lar 6:111:1 IN I Ratrix: hater Al lu',4nir( ;,ae aralxr r ssteu kesu!t:Units Ne:rod Lren:: _._..._...__.--------------------- ----------------- .------- --I- NI RMP -ii 0.60 Ira i) CG!1V'ai): YA-0' I t? •� � :oa7 S'cfP1iC!1 c. Elly l' r- LAiil �1v..YY.,.. )S:1{: �j��:•'!." I�,LC.-�� 1 Yest6 Vortorsed ► Sea ;3peclal lastractlnns hwvo ?ti - !.c:x 9Y2n;e0 *4 Sec 6m:ple Pcoacks Ar,•o.", V11- Nut e6aIY:e0 1.14,e33 lh,n, 61 O'ioter Titan \ ; I . I•� n i } C.J �I 1 q., CHEMICAL & GEOLOGICAL LAhO.�RATORIES OFALASKA, INC. 5033 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 582.2343 FEDERAL TAX ID k 92.0040440 Olin t IT;} : VEdi'L !J. 84 BILL.) 4it b'at?Ic Frc . �Et t tl% . ilydered 8v : TEo NOARE JG 1:1 Heont is 'ix 1:A1 aUP "!°Cn;Il1: �L S%!RVICY. 145-')'o ECMO S r rUlCBvt:AGF', AC. 49b1tr Speclai irsuast: mw;:;Alao Nci a: 7):d Ub S`rol lD: 2 rareceier Tcsten 'N AL CUL!lti4:! r�1;rtiJ I e PeKZrl.y: 1 NiALYSIS RRIP" BY 5 w`!?EC •. 'sx�c ir, oer1Co;. • • : z62! theht hccaLel : tiP, dU't Date Report ?r!ntcn: SiT 14? u9:r! Release(! E<l' P.enorts Adoress a2 llatrlx: Vater AI Irvab le Re 4tNrllta tethad Llur!t. V colilUC>ul Y`I lcsts Pedorend + Ste Special instruction:+ Anaee &U, None letected +.e See Saeple Remarks Above ai;= Not Anaiysed LY -Less Yvan, Of-trnter _man Tobben Spurkland P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Mrs. W. Troyer SRA Box 373-Z Anchorage, Alaska 99507 MUNICIPALITY OF ANCHORAGE DEPT. OF HG'dril 4 FNVIRONMENTAL PLOTLcnON Oct. OCT 12 1981 RECEIVED S E VIER$ KDE(4UJLC Y TES T Legal Lot 49 Block4j Robin Hills s/D Location On Floral Lane, Two blocks off DeArmon Owner Will Troyer Residence Two Storeyq Three Bedrooms Water On site well Sewer System From Municipal Records: 12* 1981 Tank 1000 gal Sunset Plastic One Compartment Absorption System 40 feet long trench with 10 feet of gravel Absorption Area 800 sqj, ft. Soil Rating 250 Installation Date June 1976 Date of Test Oct. 10g 1981 Test Procedure System was inspected on Sept. 29. On that day the clean out for the trench was found to be 6 feet below ground and containing no water. The sump was found to have a total depth of 18 feet with 15 inches of pipe sticking up above ground. Liquid level was found 71-71' below top of pipe. TAnk was 10 feet deep with a liquid depth of 44 inches. Tank was pumped ozi Oct. 8. On Oct. 10 water was added to the sump. A total of 150 gal was added at which time water was heard entering the tank and the filling stopped. Prior to filling the liquid levels in the tank and sump were checked and fount to be 24 inches and 71-8" respoctivety. Test Result The absorption system had not absorbed any measurable amount of water 1n the 48 hours between pumping of the tank and test The actual depth of liquid in the sump was found to be more than 10 feet prior to toot• indicating that the trench was OF Aja\%j full of water. The test substantiated this indication. Only p�;e.••"'••q.C,F1( 150 gal was needed to surcharge the trench and cause backflow into the tank. ''his system does not meet the criteria of the r *: q9Ui FAk * to Municipal Codet which requires an absorption rate of 150 gal • •••••• •• •••� per bedroom per 24 hour period. ,•. o. 222571 '�/ �- w / (� JUNE 25. 1971 ; ��,�� C I fti-c-�wl�. l ,MUNICIPALITY OF ANCHORAGE Department( '� Health and Environmenta�-)rotection 825 '1;" Street, Anchorage, AK. y9501 20 4A.q►►►b� * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT .pplicant: Mailing Address: S. A- bob_ -L32-- vocation: -1 &a C ' /J _ Phone} Number: 3 SIJ = / 4-f 5� aegal Description: L ; / Z/pww0 Lot ��G •c 'ype of Soil Absorption System Is: S {a Trench: r/" Drainfield: _ _ Seepage Bed: Holding Tank: laximum Number of Bedrooms: Soil Rating (sq. f t/br) The Required Size of the Soil Absorption System Is: DEPTH 1�T _ LENGTH GRAVEL DEPTH S WIDTH The len4f-i dimension is t o 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 .rmit applicant has the responsibility to inform his department during the :stallation inspections of any wells adjacent to this property and the number residences that the well will serve. * *.* TWO M INSPECTIONS ARE REQUIRED :ckfilling of any system without final inspection and approval by this departme .11 be subject to prosecution. .nimum distance between a well and any on-site sewage disposal system is 100 fe >r a private well or 150 to 200 feet from a public well depending upon the type public well. Minimum distance from a private well to a private sewer line 25 feet and to a community sewer line is 75 feet. Well logs are required id must be returned to this department within 30 days of the well completion. :her requirements may apply. Specifications and construction diagrams are railable to insure proper installation. * * * PERMIT EXPIRES'DECEMBER 31, 1 9 3 1 I certify that: (1) 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 res dente is remodeled to include more that 3 bedrooms. Signed: kIssu6d by: -� tip✓ App'li ant Date: 14 --•r 3-- 8r SWP/024(1/81) �1 Municipality .1l1 !1' t i !,& a .0 ,1 y .. 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264.4111 GI:OHGV M. SULLIVAN. MAYOn DEPARTMENT of IIEALTII AND ENV IHONMEN7 AL P170TECTION October 13, 1981 Will/LuRue Troyer Star Route A Box 373-Z Anchorage, Alaska 99507 Subject: Lot 4 Block 4 Robin Hills Subdivision $2 The adequacy test performed on the on-site sewer system indicated the system is not functioning properly according to National Standards for a three(3) bedroom single family dwelling. Therefore, before approval may be granted to the lending agency, an upgrade will be necessary. Prior to the upgrade, a permit will need to be issued by this department. The upgrade would include; 55 feet of trench with 5 feet of gravel backfill. The existing trench must be utilized. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Alaska USA Federal Credit Union 2600 De Barr Road 99504 Municipality ®2 825 "L" S7 R E ['r ANCHORAGE, ALASKA 99501 (907) 2134 4111 M 01t/:F M. HILI IVA Y, MAY011 DEPAHTMEN'r OF HEALTII AND ENVIHONhWNT A I. PROTECTION September 23, 1981 Will/Lu Rue Troyer Star Route A Box 373-Z Anchorage, Alaska 99507 Subject: Lot 4 Block 4 Robin IIills Subdivision 42 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: 1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office for our review. (3) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to tlational Standards. A listing 'of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R:S. Associate Specialist RCP/ljw cc: Alaska USA Federal Credit Union 2600 De Barr Road 99504 Tobben Spurk(and P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Mrs. W. Troyer Oct. 289 1981 SRA BOX 373-Z MUNICIPALITY OF AN'C'HORAGE Anchorage, Alaska 99507 czar. c!". -U" G ENV1201vd:NLu r:.�TLCTION 01"T 2 a Sa81 S E V E R Il RECEIVED Legal Lot 49 Block 4, Robin Hills 8/D Amendment to sewer adequacy test conducted Oct, 10, 1981 On October 109 1981 I conducted a test on subject system. The test indicated that the system was failing and had to be upgraded. I retested the system on Oct. 27, 1981 on the assumption that the sump could have been installed with only a weephole instead of beeing fully perforated, as is the practice to day. Also in 1976 is was fairly common to install the drain with the holes up. I added 466 gal of water to the septic tank at a steady rate of 6.66 gal per min. beery ten minuits I checked the liquid depth in the tank. The water level did not rise. It reained stationary at 4834 in throughout the test. Since there is no way of actually measuring the water depth in the treneht one can only conclude that the system is acceptable if it can receive 450 gal within a 24 hour period with out any signs of disteess. This system reseived 466 gal in less than 90 min. and no signs of disstress or surcharging was observed* This system therefore meets the Municipal requirements. n r, Municipality of Anchorage MEMORANDUM DATE: October 29, 1981 TO: Laura Crow FROM: Senior Office Assistant Sewer and water Program SUBJECT; Request for Refund - Account #2460 Please make arrangements for the following refund. The upgrading of the on-site sewer system was not needed at this time and the permit has been voided. Permit # 811130 Receipt 0161468 Amount: $20.00 LuRue Troyer 9009 Honeysuckle Anchorage, Alaska 99502 Note: this is a new address, do not send to address on the receipt. Thank you. LAura J. ward Senior Office Assistant attachments e MR GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 ffi4-4561 Date Received I(,) -An -()5 Time of Inspection q•.(D0Qrr -9MAA Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: • Phone: 2. Property Owner: egn c i)dP,-ir n CA_�V-_ _ —Phone: ,. tAtt-' Z�Ao9 Mailing Address: Rte, IF u' �O-A 3. Legal Description: 9A )-► . (n��� �? 14 2m%. ,. k�i � 0s X1,0 4. Location: _nP ('T%rrM, M tan n,v+i []S QICS06 a &U -m- 5. Type of facility to be inspected Ln_c). No. of bedrooms nhs a� 6. Well Data: A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. InstalledB. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line F0434 fl/741 pano 1 of +u,,, nanae Page 2 of two pages - RE. ist for Approval of Individual pier & Water Facilities Legal Description Comments:. Approved Disapproved Date �/ r ApprovalkValid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request Tor approval to De a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date MSV Un ��CGREATER ANCHORAGE AREA BOROUG11_.. V Department of Environmental QualityA •v3330 "C" St., Anchorage, Alaska 99503 - 274-4561 C� REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Z fllll�& /0. Py. ie n Y t 8 Mailing Address: '7 e_ S Day done/41d& 3. Name of Buyer: Mailing Address: Day Phon/e,���lf03�^ 4. Name of Lending Institution: Mailing Address: Phone 5. Name of Realtor or.Agent: Mailing Address: Phone 6. Legal Description: • _&O.J7 a Location: 4.;Cr jo r_ jjjfj�ff4i or Flo rd 1 / L 4,v 7. Type of Facility to be.inspected: 8. Water Supply Type of Supply: Public Utility �e31 t,VG�z No.. Bdrms. 13 Individual K If Individual, number of -dwellings -presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation EQ -037 !?/74)