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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 9 LT 10\© ~--- MunicipaLity of Anchorage Page __ of ___ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMEN]'AL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~u¢ ~',.~ ~,1 /-4~ PID Number: ____OI Name: ~New ...... ~ ~._~'~o~ Wastewater System: grade ,, Address: /~ ~~ ~, ABSORPTION FIELD Phone ~ No of Bedrooms ~ ~ Deep Trench ~ Shallow Trench ~Bed [~ Mound ~Other LEGAL DESCRIPTION Soil Raling: Tolal Deplh from original grade: ~, ~ GPD/Sq. Ft ..-~ Lek Block Subdivision: Depth to pipe bottom from original grade Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel lenglh: ~ ~ ~ FI ~ ~ Ft.  Gravel width: Number 01 lines: Distance belween lines: WELL: D New D Upgrade % ~ ' FL ~ ~ Ft. Classilicalion (Privae. A,B.C): Tolal Depth: Cased To: Total absorption area: Pipe material: ~/~ ....... ~ ~ /~ ~ SQ. ~. ~o~ ~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM Pump Set at Ft Casing Heighl Above Ground:Fl TAN K SEPARATION DISTANCES ~eptic ~ Holding [] S.T E.P TO Sephc Absorption Ldt Nolding Pubhc/Private Manufaclurer: Cap~city iR gallons From Tank F,eld Slahon Tank Sewer L,nes / ~ Surface ~ ~ Water /~ t~ LIFT STATION Lot Size in gallons: Manufacturer: ~ /1 ~ ..... Line ~ Foundation ~"t ~ / "Pump on" level at "Pump off" level at' High water alarm Curtain ~/, ~/~ I Pump Make& Model Eleclrical Inspections perlormed by Remarks: A~¢~ ~ ~~- BENCH MARK Location and Descriplion: Assumed Elevation ENGINEER'S SEAL Inspections performed by: s. ~ ,~¢~ ¢ Dates: 1st ~/~/~3./' Department of Health and Human Services approval '.,~ ,, 0 '~,'. . , ...... . , "(1~ l ' 72-013 (Rev 9/91) MOA 25 / / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930149 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:MASHBURN GARY C & OWNER ADDRESS:12800 ALPINE DR ANCHORAGE, ALASKA 99516 PARCEL ID:01739146 PAGE 1 OF DATE ISSUED: 6/10/93 EXPIRATION DATE: 6/10/94 LEGAL DESCRIPTION: MOUNTAIN PARK ESTATES BLK LT 10 LOT SIZE: 27200 (SQ. ]FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAl, PROVISIONS. SPECIAL PROVISIONS: EXISTING SEPTIC TANK MAY BE REUSED ONLY IF IT IS EXPOSED AND RECEIVED BY: DATE: June 8, 1992 Department of Health and Human Services Anchorage, Alaska Re: Onsite Sewer system design for the Gary Mashburn residence Mountain Park Estates Lot 10, Block 9 Dear DHHS, This is a request for an onsite sewer permit for a existing residence located at the above address. The existing seepage pit system has failed and therefore needs a new absorption field. The existing tank is concrete and will not need replacing. Two test holes were done with the second test showing the best results next to the house. From the asbuilt we don't have much room in this area and will need to encroach (5 feet) on the 10 foot offset from the house and not the lot line (see asbuilt). The invert out of the existing tank is at elevation 4 feet and the system is designed as a bed at elevation 4.5 feet. The foot print of the bed is 20 feet wide by 60 feet long and parallel to the property line. The elevation of the house footing is at 4 feet and the bed is at 4.5 feet. All work on the bed excavation will be done outside the perimeter and not on the actual bed layer. No impacts to the surrounding properties are foreseen except the adjoining lot 9 for future well locations, but the 100 foot radius will be easy to obtain, given the lot size. Ail other neighboring lots have onsite systems (except lot 9) already and appear to be performing adequately. The required 10 foot set-back from the house can not be used due to the 30 foot test hole radius and the existing lot configuration (existing well, existing seepage pit, home, property line, etc.). The topography of the area is approx, flat with the ground just outside the lot area sloping approx. 5% on the Northwest side. The lot footprint is a triangle shape with the well on one end and the septic on the other end of the lot. Sincerely Steven R. Pannone P.E. PLOT PLAN I Hereby certify that I have surveyed the following described property: Lot I0., Block ~) , juo~r~ ~ ?.~,..~__m~-~rt~Z~.~_~.i.U~s~k~ _ _~~ Recording District, Alaska, and that thc improvements situated thereon are within thc property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission l[nes or other viMblc easements on said property except as indicated hereon. Dated this the ~Day of_.~, 19~_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat, ASBUILT SCALE [";4-o' GRID ~,'~-5~ JOBNo. 1731 George Bell Circle Ga L~l]~g9 L,.~*. Anchorage, Alaksa 99515 (907)345-6476 Municipality gl Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST PERFORMED FOR: ~Od",.~ (k'/~CfG~ ~f"y'~ DATE PERF( LEGAL DESCRIPTION: /~c'~'d'~r't I~)o,/' (~2-- ~"~ (--~e-~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18- 19 20 3OMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Oepth I° Water AfteF'l ~,~'~. 2/~........¢ Monitoring? \"" ¢~ Dale: , / N ? ? ? Reading Date Gross Net Depth to Net Time (../~,l~1'~ Time (h,11%~ Water Drop j IO IO ,o 7 ~o /o PERCOLATION RATE__/~' (m~nules/mch) PERC HOLE DIAMETER TEST RUN BETWEEN __-~- FT AND .,~, 5'- ET PERFORMED BY: /'"/(,_¢ (Ac E'(/ /~¢\ 4. ,~(-'~¢.~ I '~ (~-ev~__~ (2, i¢2,,.H ~.¢~_. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/'~4'~'-/~,~ 72-008 (Rev. 4/85) GRE ANCHORAGE AREA BO' U6H O Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ~//~Z'- ~Z~/-~"- LEGAL DESCRIPTION ~,~~'7J LOCATION ~ NUMBER OF SEPTIC TANK: /D~./ -/¢7//v~.,/.z~.~_-~) . . .-- _~ /'~,~ cOMPARTMENTS ' :' ¢/~/~[):/: MATERIAL E'~'/¢¢ ANCE FROM WEL~/~/ ' INSIDE LENGTH~INSIDE WIDTH ~LIQUID DEPTH~LIQUID CAPACITY /~2~GALLONS. SEEPAGE PiT: /z A'/~"/-~ .F,--'~ ~ , ~ NUMBER OF PITS ~. DIAMETER / OR WIDTH ~, LENGTH~, DEPTH /~[¢~¢~,~.-z4, - ~C~ ~. ~/~ ~//"~ DIAMETER ~DEPTH ~ DISTANCE FROM: LINING MATERIAL ~~ - CRIB sIZE: ~' ~ _SQ. FT. / TOTAL EFFECTIVE " BUILDING FOUNDATION~ ~/~ NEAREST LOT LIN~'; · ABSORPTION AREA (WALL AREA) ~-- ADDITIONAL ABSORPTION ~~~ WELL: ,~./F'~O/~ ' z'~'-~ TYPE /~-~/'//'~¢'"'~- CONSTRUCTION -- NEAREST BUILDING LOT LINE ~, FOUNDATION ~' OTHER sOURCES CESSPOOL ~ ' APPROVED ___ DISAPPROVED ~ REMA RI&S DISTANCE FROM: DEPTH -- sEPTIC SEEPAGE TAN F. ~, sYSTEM NEAREST SEWER LINE/' DISTANCES: -~C/'~ ~ ;~z'/'~/ -- iNSTALLED BY: PIPE MATERIAL: LOT SLOPE: DIAGRAM OF SYSTEM d o J~ ~ ~4 GREAT'ER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4§61 SEWAGE DISPOSAL SYSTEM .... APPLICATION AND PF. RMIT pERMIT NO. SEEPAGE pit DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED . ~2. -. ] so,L TEST .ESDLTS .J¢¢ ¢¢ PHONE OTHER FINAL INSPECTION: 2.4 FLOUR NOTICE REQUIRED. BACKFILLING OF ANY sYSTEM WITIqOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SE SubJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANR FOUNDATION TO SEEPAGE PIT __-V* O / DRAIN FIELD DRAIN FIELD ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEEPAGE -- DRAIN FIELD TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON piPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. DIAGRAM OF 5Y.~TEM GRAVEL BAC:KFI LL CONFORM TO ~OROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR With THE REQUIREMENTS OF G~NCH/C~GE AREA ~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBEDSYSTEM ISIN ACCORDANCE W TH SAID CODE / } //(/"~/I~''/'~~ DATE '¢ 9'____ ARPLICAN"'S S'GNATUR GREATER ANCHORAGE AR!:A BOROUGH DEPARTMENT OF ENV!RON,~iENTA!_ QUA!_ITY 3330 "C" Street ANCltORAGE, ALASKA 99503 Case # Performed For ~'~i: ~'~'~~rF~ Legal Description: Lot !'~ Block This Form Reports Soils Log - Soil Test Must Be Logged To 4 Depth Feet Soil Cl~aracteristicq Dated Performed 14- l¢.- Was Ground Water Encountered? If Yes, At What Depth? ..... ~_:~: Percolation Test__N Be'iow Proposed Seepage System l I t I I L__L_] [_]__J I ~ Reading Date ! Gross Time Net Time Depth to H20 I Net Drop Percolation Rate MinuLe Proposed Ins~t~-'l~'~F: See aec' Pit c~ Drain Field 1 t n , r~ ., Test Performed I~Y 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ' 1. GENERAL INFORMATION Complete legal description Lo'T- /~,, '-~_~,cl4 c)., .~,~L~'z-g,.~ -PAP_F.. ~m,~'-r'-~...~. Location (site address or directions)' /'~ ¢ ~,~ ,q L~ ~ "~. Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATEFI SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025 (Rev. 1t91) Front MOA 1~21 .J. .STAI=EMEN'F OF INSPECTION B'r' ENGINEEIq As cerl. ified by rny seal affixed b, oreio and as of the validation date si~own below, J verify thai my invostigal~on of ibis Health Auti~o~ib/ Approval application shows Ina[ tile el',, s~to water supply, and/m wastowater disposal system ~s sale, functional and adequa[e fo~ the Qumbor of bedrooms and b/pe of structure indicated hereto. I fu~therverifythat based on the inio~mation obtained from the Murficipality el Anchorage files arid fi'om my investigauon and insf)ect~or~, lbo on-s~te, wa'ret supply and/or wastewator disposal s'./slem is in comphance wlib all Ivlunicqp(ti and .%lale codes, ordinances, and regu/aUons ~n eflecl on lhe (late of tins inspection. Name of FiFP,,,1 Phone x ,',. .~ .: ,~ </ LDato DIdHS SIGNATURE /N Approved Io~ .... J~ bed Disapproved. CondiHonai approval lei isedrooms, with tlqe foilowitlg st~pulation.'-u Addifional Corxxnents Date -fl;e Mumc~pality of Anchorage Departmenl el t leatth and Human Sepaces (Dit~IS) ~ssu,.;s ~fiealth /\uil]ol~ty /\pproval Certificates based only upon till} rf}pCesentahons giver] u~ paragraph 5 above by ap mdependem professional engineer registered in lbo St;Mo el Alaska. FI and their If}riding inst~tulions u] (\der lo satisf..:er tam federal and slate ~ uflLurements tlmplo,/of}s et DHPtS (!,;) not col]Guct inspections or analyze data bf}fo~ a cf}rtificate iespol~sible for ei rots or o~lSSiOnS ~n lbo pn. ,;sslonat engineer's work Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L/o~ 'T& ?/ /vi%:,~F~rzv.. ~s"r~"F¢,~ Parcel I.D. c:~I:F-SD/¢/~ A. WELL DATA Well type'-T'¢~ t u'A''~-¢ Log present (Y/N) Total depth Sanitary seal (Y/N) h" ~.~, If A, B, or C, attach ADEC letter. Date completed Cased to ~ 1'- FROM WELL LOG Date of test -~ Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot / Public sewer main Sewer service line ADEC water system number Driller Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout g.p.m. ~/~ Petroleum tank WATER SAMPLE RESULTS: Coliform -- (;~ -- Date of sample: l I - ~ Nitrate Other bacteria ~ c.~ -- Collected by: ,/kPo/L-C~E:~'z.~¢ '~"¢ ~ ¢,~ B. SEPTIC/HOLDING TANK DATA Date installed g%ok.~o,,~,~.~ Tank size Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Compartments Foundation cleanout (Y/N) '-/'¢"~. Depression (Y/N) /'//A Alarm tested (Y/N) Pumper /~'1- ~o/~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / 'P--:g To property line Surface water/drainage On adjacent lots /c,o -1- Foundation Absorption field -~o ~ Water main/service line 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed /tJ/¢~ Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ o Width ~o Total absorption area /~,~ 5¢ Depression over field (Y/N) ~o Results (pass/fail) q:~ ¢~.s_~ Peroxide treatment (past 12 months) (Y/N) Soil rating O-S' 4~-/$F/~ System type ,~ ~----~-~ Gravel thickness /2" Total depth .-~-/ Cleanouts present (Y/N) ~.~ Date of adequacy test for /-'// bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~ To building foundation ~-~ On adjacent lots Surface water ' Curtain drain On adjacent lots /¢o T- Property line To existing or abandoned system on lot ~..-~--/ Cutbank -'~-~/~A Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signatur~ Engineer's Name Date ('/~/~_c~ Waiver Fee: $ Date of Payment Receipt Number HAA Fee $ ,,J~"¢ Date of Payment ,//"--/',,/~,.~ Receipt Number ,~K' HOM[::- ~c_4EIq,~"l('~t:-~ INC, '~ 2216 Wilderness Anchorage, AMska 995~ 6 345 · 1890 CUgTOME~ E, tock Lei ........ P OOO REMARKS .~dL-eacn A;ea ___ Hold,'~9 Tank pFIOBLEM AREA - CALL FOR MORE INFORMATION NF_.,~DS TO I_'~E DONE AGAIN IN 6 MONTHS Good Shape Ji~n cap missi~ needs Standpipes Floater on top Needs Septictqne INVOICE GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Streets Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. Date Received December 29, 1_976 Time of Inspection Date of Inspection _/-/~-77- 1. Approval requested by: First Nationa]L Bank of Anchorage Phone: 274-1521 Mailing Address: Post Office Box .4-2090 Phone: 2. Property Owner: Patrick/Katherine Pourchot 3. Legal Description: Lot 10 Block 9 Mountain Park Estates SW corner of Alpine & Beverly Drive 4. Location: 5. Type of facility to be inspected Single Family No. of bedrooms 4 6. Well Data: ~ A. Type Individual B. Depth D. Bacterial Analysis C. Construction 7. Sewage Disposal System: On-site system A. Installed.~/~j-/~ ~l B. Installer C. Septic T. ank: l. Si.ze .... /.~?~c~,~c~. ManufactUre~ D. Seepage Pit: 1 Absorption, Area ~_~_~ 2. Material E. Disposal Field: Total length ot m~nes 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area Other contamination , Absorption area , Sewer Lines , C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Ret it for Approval of Individual S Jr & Water Facilities Legal Description Lot ].0 Block 0 Mountain Park Estates Comments Approved _ ~ fi~ ~approved Approval Va~l'id for one year from date signed Date Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained 'in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~:'R~lLr-a~:71r~Jf~rXpl~'Jfl, Anchorage, Alaska ~ ~7:~-3J~: 825 L Street 99501 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA. 2. Property Owner:. Patrick and Katherine Pourchot CONV. xx Mailing Address: (out of state-contact realtor) Name of Buyer: Gary C. and Suzette Mashburn Mailing Address: 1200 W. Dimond Blvd. #403 Day Phone: Day Phone: 344-5629 4. Name of Lending Institution: First National Bank of Anchorage Mailing Address: P. o. Box 4-2090 (99509,~' Phone:, 274-1521 5. Name of Realtor or Agent: Harston Real Estate-Ella Mae Warren Mailing Address: 2804 Northern Lights Phone:, 277-3511 6. Legal Description: Lot 10, Block 9, Mountain Park Estates Location: SW corner of Alpine and Beverly Drive 7. Type of Facility to be Inspected: SFD 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. 3 Individual. XX Individual (on-site) 72-003(3/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DEC 2 9 1976 RECEIVED 1. Type of Inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: Gary C. and Suzett~ Mailing Address: 1200 W. 4. Name of Lending Institution: First Nati~ Mailing Address: P, O, Box 4-2~ 5. Name of Realtor or Agent: Mailing Ad d r~ .'.~'_.x280~ 6. Legal Description/ Lot 10 Location: [ SW corner 7. Type of Facility t~_~e, lnsF 8. Water Supply Type of Supply: P lic Utility. If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation CMRO VA FHA Patrick and Katherine Pourchot No. Bdrms._ CONV ×x Dimond Blvd #403 ,Individual XX Estate-E1 ~ren Mountain Pa Estates Individual (on-site) 72-003(3/76) 4. 5. 6. o ~ GREATERANCHORAGE AREA BOROUG uepartment of Environmental 3330 "C" Street, Anchorage, Alaska 99503 27q=456~ Date Received .. ~ ........ ~ ,-~ ~.~ , -/ Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF ~ INDIVIDUAL SEWER & WATER FACILITIES "F . ) FOR Approval requested by: ~f~/~, ~_~_~s4~l ,=/~/ Mailing Address: ~,.~ 7. ~/ ~ ~w'~ /,.~ Phone: Property Owner: _ ~ ¢ -:~ ($~ ~":'~' ~ )~./ Phone: Mailing Address: ~. ~.,-~/~, zJ..-~o-/ Legal Description: ~ ,,~ /O.E, x/; ~1 )l~.'t Location: _~.~//tJ '/':' ' ~ ' ~ ' Type of facility to be inspected m~~,~.</ No. of bedrooms Well Data: S .... ,.&( ---x-..:t , ;~, .~,_.4. V,,,,//~ , ,,,1,~ {,4 ' ', ; ' /.. · A T e / ' / // - ' YP ~" /' ~' /~' ~-' B. Depth /~ C Construction C',;,, .... ~';~"*f ....D. Bacterial Analysis A. Installed $. Installer /~ , dj_. ~ ~ C. Septic Tank: 1. Size ~~<~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area jB/~zzl/ 2. Material E. O~sposa] F~e]d: Total length of ]~nes 8. Distances: A. Well to: Septic tank //w */ , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank .? ~A , Absorption area C. Absorption area to nearest lot line ~,~, Sewer Lines EQ.-034 (1/74) Page 1 of two pages GREATER ANCiiORAGE ARb,', BOROUGH Department of Environmental Quality "C" St., Anchorage, Alaska 99503 274--.4561 REQUI!ST FOR APPROVAL OF INI)iVIDUAI. SEWER & WATER FACILIi'IES 1. Type of Inspection: ' CMRO VA 2. Property Owner: ,]ames A. Brown Mailing Address: P.O. Box 4-207, Anchorage 3. Name of Buyer: Gary M. & Nancy J. Matlock FHA C 0,~,I V x .__Da__zy Phone 344-132n ,, Nailing Address: 1441 E. 12th St., 99501 DaZ Phone 277-2n23 Name of Lending Institution: Alaska Hational P, ank Mailing Address: Pouch 7-010, 99510 Phone 277-~511 5. Name of Realtor or Agent: P, owden Co. (Larry Luedke) Mailing Address: 907 t.I. ~!orthern Lts., 99504. Phone 277-la.q2 6. Legal Description: Lot 10, [~lock 9, Mountain Park Estates Location: I,IIIN Alpine Drive, Anchorage, Alaska 7. Type of Facility to be inspected: Home 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 247 ft. 9. Sea/age Disposal'System Type .of S~stem: Public Utility If Individual, date of installation No. Bdrms. ~ Individual (on-site) x Jul~ 1974 Page 2 of two pages - Req~, c for Approval of Individual SE ,' & Water Facilities Legal Description ~-A .'" /~,,.~,. ~ ~ ~- .~, ~, .~.~ Comments Approved ~ ']'.~,~i ,Disapproved Date ~/'--~, Approval~Valid '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 for approval to be a true and accurate representation of the subject sewer and wa~er facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)