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HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 2 LT 14 Municipality of AnchoragePage DEPARTMENT OF HEALTH' AND HUMAN SERVICES ENV RONMENTAL 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: ~ ~j ~ r.= o I~,~ PID Number: Name: ~-../k.~ ~- ~S~ ~P Wastewater System: c New ~ Upgrade. Address: Phone: ~ -- ~Z~ No. of~ ooms: ~ Deep ' - ed D Mound ~Other Soil Rating: Total Depth from original gr~ LEGAL DESCRI PTION GPD/Sq. Ft. Lot: Block: Subdiv~ion: Depth to pipe boEom from original grade: Gravel depth bene~pe Township: ~ J Range: ~ Section: ~ Fill added above orig{nal grade: Gr~: I Ft, Ft. WELL: ~ D New D Upg~ Gravelwidth: ~ ~umber of lines: Distance be~een lines: Classification (Private, A,B,C): ~ Cased To: Total absorp~ Pipe matedsh Driller: ~ Date Drilled: Static Water Level: Inst~ll~r~ Date installed: TAN K ' : Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES s Septic ~ Holaing ~ S.T.E.P. To Septic Absorption Lift Holding =ublic/PrivateManufacturer: Capacity in gallons: From Tank F[e~d Station Tank Sewer Lines ~K~G~ Number of Compa~ments: S~,ace LIFT STATION Water ldo ~+ } oo~ .... Lot Size in gall°ns: I Manufacturer: Line ~ ~ ~ ~ ~ ~ "Pump on' level at: ~ "Pump~: High water alarm at: Foundation ~o ~ Cudai~ Pum~ Electrical Inspections pedormed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspections performed Dy' , ........ tes' 1st 7- z -~ Department of Health and Human Se~ices approval ~: ............... ;.., ,.,~ Reviewed and approved by: ~~ ~ Date: 7-~-~ Permit No. SW96Ol 64- Page 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION of 2 P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LegalDescription: LOT 14, BLOCK 2, PROSPECT HEIGHTS S/D PIDNo.: 015-091-12 ST1 ST2 ~ / / A B FCO 19' 27' ~' ~gw ~ ST1 40.5' 56' 88'8'-/ ~500 GAL ~88.6' ~ST2 50' 45.5' S.T. DBL1 50' 48.5' :XISTING CRlf~ DBL2 49.5' 49' 72-013 A (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:SW960164 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:WILSON BRADLEY J REV TRUST 50% OWNER ADDRESS:9700 PROSPECT DR ANCHORAGE, ALASKA 99516 PARCEL ID:01509112 LEGAL DESCRIPTION: PROSPECT HEIGHTS BLK 2 LT 14. LOT SIZE: 94400 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 PAGE 1 OF DATE ISSUED: 7/02/96 EXPIRATION DATE: 7/02/97 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK 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 (ISAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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 RECEIVED BY: _ DATE: ROBERT C. COWAN, RE. ROBERTA. SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITEPLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHAN[CAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN July 1, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 14, Block 2, Prospect Heights S/D Request you issue a permit to replace the septic tanks serving the existing four bedroom house on the referenced property. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. The proposed 1500 gallon septic tank is to be placed outside the well protective radius. Attached is a site plan which depicts the location of the proposed tank. If you require additional information, please contact us. Sincerely, ~rt~ .~, P. E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AI,.ASKA 99577 =' 60' SITE PLAN / / DESIGN zo f-- a.~F~ z ROBERT C, COWAN, RE. ROBERTA, SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELLINSPECT[ON & FLOW TEST SITE PLANS ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONS]TE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 rEFERENCE: Lot 14, Block 2, Prospect Heights S/D July 1, 1996 3ENERAL: 1. Se Se The scope of this project includes the intallation of a 1500 gallon septic tank outside the 100' well protective radius to serve the four bedroom residence located on the referenced property. The existing 1000 gallon concrete septic tank and the existing 500 gallon septic tank are to be excavated, pumped,. crushed, and abandoned in place. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. ,EPTIC TANK INSTALLATION: A septic 'tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Se All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP" SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 14, Block 2, Prospect Heights S/D July 1, 1996 e Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. e The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: TyDe of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). ~ '~Page Three Lot ].4, Block 2, Prospect Heights S/D July 1, 1996 INSPECTIONS= Typically there will be a minimum _of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the tank has been set; lines, cleanouts, standpipes, and insulation are in place; and prior to backfilling. 2. The final inspection is to occur upon final grading of the property. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. pe~it. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents° S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER · 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 PHONE ~J UPGRADE MAI LING ADDRESS 'r& LEGAL DESCRIPTION ~ DISTANCE TO: Well Absor6tion area Dwelling PERMIT~o~~O. Material No, of compartments ~Z Manufacturer ~~ ~~  Liq, capacity in gallons Inside length Width Liquid depth ~ IF HOME.DE: ~ ~ Well DwelJing PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO:  Z No. of lines Length of each line Total length of lines Trench width Distance between Hnes inches ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area O inches Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic'tank Absorption area(s) OTHER ~ PIPE MATERIALS ~ ~ ~ SOl L TEST RATING REMARKS Fi!'"iO :~i; F!FF'F T H,E N:!ii: LT ::!..d. ES::. ;2 !:::'Fi:CP~;F'EC:T I'"FT'.i~; "'" .... t" .. "i"!:;;:E N C H T'T'F:'E OF::' '/:~;O.TL Ffi32;OI:.;:Ei:T.T. 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"[' '"l .[ NI'" OF::H "r' , Z I'.,I:E;'T'F:tL..L!:::IT T q;.l :[ ?.P.::i F'.~: Z T .T 7 i'.P}.:: '.31::' F:l?'l~'r' I,.tE'! .I._'.:S FIE:'.:[F!C:[~::NT 'T'O TH 'X '.~: F:'i;i:OF:'E:I:;~:T"r' FINE:' 'T'HlJi[ t'-,I1 il"lF:fl::'i:;;' O.f'::' f~:E:E: '.' I'DF:Z."~ ';: E:~: "f'HF:!T THE: ['.E:L..L. [4 :[ LL -'*'" "" '"" E:l:::i-':'l:cJ;i L[[N2i '.~q:::' !::iN'T~ '.~;"r~:~:JTE?'t I-,.I'J;"I"HI;;IIJT FZN!:::IL.. ][[",I~.:;PECT].Cti",I FIN[;:* lfl'"!'-'!"::U"/l:::l! ...... 'T'H;t'~i~; DE::F'i::ff-:::TMENT 14 :[ !....L. E:FZ .f,'JE:J F'..J ~ TO F'F~:CC:;EC:UT :.' '" !'q :[ N I HUH D ]: :.:?['F:!I".IC:E E';ETt.,!EEN Fi !.,iELL.. F:iND I:::IN,'T' ON'"".:}; :[ "f'E: :E;EP.lf:IGE L':' :[ ::~;F:',':)E;FI!... :E;"r'~S"['E['I ;i: E; JJZiEI I:::EZET F:OF:: Fl F:'f:::I"/FFf'IE !.'.IELL.; OF;: :tSEi 'T'O ;T'."-.:~iEI FEET FF?.OH F! I:::'!JIF]:L:[C ['.[EL..L. E:'E!:':'E:ND]:NEi LIF'ON THE: T"?!:::'E: OF' I::'iJE~L. IC O'THE:I:~: F]:EI]:!i..J t F:'.'E!'"!E:i",IT'.'~!; !"IF!";' FIPI::'L"/. '.'~;F'E:C: ;.I: F' ]: CF:IT ]; I[)I",!:L:; .I::II-~,.F.) CCLN:~?I'F?.UC:T t ON F'I'v'FI t LFiE:!...E~ TO ]; [",!'.:.;;U!::"::E F'I:~'.OF:'E:I:;?. ! i",!'::;TFtLI...FiT :.[ ON. GREI' ",:'-R ANCHORAGE AREA Q Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /~//-/~;;////~ ~-~/O.~ MAILING ADDRESS LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~//~(J/~-~/~ MATERIAL 4,'/_ :~/Z~ 7/-/9 INSIDE WIDTH LIQUID DEPTH NUMBER OF ~/~--~ COMPARTMENTS LIQUID CAPACITY //~)O ~GALLONS. SEEPAGE Pit: NUMBER OF Pits / DIAMETER or WIDTH ~), LENGTH ~2~, DEPTH g LINING MATERIAL /~)¢/~ CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM: WELL / ~! / ~OTAL EFFECTIVE BUILDING FOUNDATION,~~ , NEAREST LOT LINE'A/Urn°//UABSORPTION AREA (WALL AREA) ¢~ sq. Ft. ADDITIONAL ABSORPTION WELL: TYPE ~ // BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION DEPTH DISTANCE FROM: NEAREST ~(~% S NEAREST SEPTIC / SEEPAGE / LOT LINE , SEWER LINE TANK /~) , SYSTEM /'"'~--~'~ OTHER SOURCES DISAPPROVED REMARKS DISTANCES: INSTALLED BY: LOt SLOPe: ~ ,t,'-)~/ REMARKS: ~:7r , I .. / DIAGRAM OF SYSTEM DATE '::~/~//7--~' APPROVED G.A.A.B. / GREATER ANCHORAGE AREA BorOUGh DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 '~/t.,~ TELEPHONE 27~-456, ~!~_~{ ~ ' SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: GEPTIC TANK ~ J SEEPAGE Pit ~ , DRAIN FIELD FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS NOTE1 THI~ PERMIT FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE MINIMUM DI*"~TANCE$, REQUIREMENTB ., DRAIN FIELD . . SEEPAGE Pit ALSO CONSIDER· Area WELLS. · SEEPAGE Pit / ~ /Db~/~RalN PIELD FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT ~ ~ SEPTIC TANK TO SEePaGE PIt WALl /~ SEPTIC TANK ~ j , SEEPAGE Pit DBAIN FIELD ~ WATEr MaIN TO SEPTIC TANK /D DRAIN FIELD GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT IAM FAMILIAR V/ITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROU~RDINANCE NO. 28-68 AND THAT THE ABOVE DATE ~ ~ APPLICANT'S SIGNATURE - R&M ENGJ , EERING & GEOLOGIC, t. CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087-- ANCHORAGE, ALASKA 99503 TELEPHONE 907--279-0483 TELEX 090-35419 Civi/ Engineers . Geologists Land Surveyors JAMES W. ROONEY, P. Eo MALCOLM A° MENZIES, P.E., L.S. .lAMES H. WELLMAN, P.E. July 26, 1973 AUU 1973 (~RE,~,TER ANCHORAGE AREA [~OROUGH DEPT. OF ENVIRONM6NTAL QUAklT¥ R & M Project No. 36639 RALPH R. MIGLIACCIO I~ngineerirlg Geologist Kincaid & Son Construction 7801 Jodphurst Anchorage, AK 99502 Re: Test Hole and Soil Log Report for Sanitary System Lot 14, Block 2, Prospect Heights Subdivision Dear Mr. Kincaid: We are submitting hereQith 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 July 26, 1973, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environ- mental Quality. A single test hole was put down within the Lot 14 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 14.5 feet below ground surface. 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 ENGINEERING & GEOLOGICAL CONSULTANTS ~James W. Rooney JWR: ph xc: GAAB w/ T.H.-I 7 SANDY SILTs WITH SOME SAND AND GRAVEL TRACE ORGANICS (SM) 2.0' GRAVELLY SAND WITH TRACE TO SOME SILT AND COBBLES (SP-GM) No Weter Table 14-.5' T.D, Engineering Geological Consultants ANC~O~AO~ ~'A~neAN~e, ALASKA UUN~AU Note : Test hole excavated with tractor mounted backhoe. Kincdid And Son ConstruCtion LOGS OF TEST BORINGS Anchorage Alasko ICH~D BY W F n IPROJ. NO. 36639 ~lowe NO. Z~ September time, t~at it ~s ~v~t eco~i'~icatl~ feas-ibl~ ~,~r ~.~e iFdiv'bj~:l };omc own-. ers ia t~is lock, Ii L:'/ L<;, esta~>tish f~ubtic or co~L~uMty water or sewer dis~ posal facilities. 'Th~: ~$6row~l~ ~s, at tMs tt~>~e, ~$roJectin~ sewer inte S i :)cere 1 y, Chi;~f SaM tarian cc: i~aviJ Kie, caid 'e 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 Parcel I.D.# OI 5' -o~t--I~ 1. GENERAL INFORMATION Complete legal description Lot 14: Block 2: Pros?=ct R~ghta Location ,(site address or directions) · ProPer(y owner '- B~ad & n±sa W±lson ~- Mailing address ..... 'P,.O~. Box 112495 Park City, ' Lending agency Mailing address ' Agent George Stadnicky/ First Choice Realty 9700 Prospect Drive Anchorage, AK Utah, Day phone 84062 Day phone Day phone 345-2322 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~/ TYPE OF WATER SUPPLY: Individual well xxx Community welt 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 Public sewer NOTE: xxx 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 for the number of bedrooms and type of structure indicated herein. I further verifythat 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. S & S ENGINEERING Name of Firm i70.~,~ I=agJe River Loop Road No.-~i Eagle River, A~sk~a ~9577 Engineer's signature . _ . Phone Date DHHS SIGNATURE -,/ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.78 mg/1. EPA maximum concentration is 10.0 mg/1. More information on nitratcc i~ available fr~m th~ ~n-gqc~ ~o~r~r~ Pr~g~mm; DHH~, 3~3X4744.. Addmona~ uomments By: ~ ~ 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. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: Lot ~q 8~ a P;3~',~,-7- ~rj ParcelI.D.: A. WELL DATA Well type (3 Log present 8) Total depth Sanitary seal Date completed Cased to I '7 If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly prot~bted (~/N) FROM WELL LOG AT INSPECTION Dateoftest ~/~'(/7~ ~/ I;3 Static water level ! ~ ~) ~ Well production ~"" g.p.m, r~ ' ~ g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Dateofsample:7/~-:~/g? ~ ~(' ~[R~7 Collected by: ,S-, 7 ¢ Other bacteria S & S ENGINEERING Eagle River, Alaska ~577 Number of compartments ~ Cleanoutsl~N).__ High water alarm (Y~ B. SEPTIC/HOLDING TANK DATA Date installed '7/~,/~0 Tanksize ) Foundation clear, out ~lbl) ~r~J Depression (YI~ Date of pu~nP'i~g C. ABSORPTION FIELD DATA "~ Date ihs~alled '~ / el' / -7 ~ ::Soil rating (g.p.d./fF o;ff~-~.r~ ' Length" ~ 3. Width ~,'1 Gravel thickness below pipe. Effective absgrpti°n area ~ O0 ,~' Monitoring Tube present ~/N)¥ ~$ Depression over field (Y,~ __ Date of adequacy test G/~O/ ~/G Results(Pass/Fail) Fluid depth in absorption field before test (in.); Fluid depth z./ ¢/~" (ins) Minutes later: / ¢ ~ For ~ bedrooms Immediately afterlOOO gal. water added (in.): Absorption rate = ~ '~ O '+ g.p.d. Peroxide treatment (past 12 months) (Y/N) ,~ ~ ,v 4- /,~,v ¢ ~ ,,/ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons · Manhole/Access (Y/N) "Pump on" level at* .~'~~'~"~mp off" level at* High water alarm level at* .__.--~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ! o o / + Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ! Foundation ~" -j'- Property line Water main/service line 30 '-f Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! Pr°pertyline !0 -~ BUilding foundation ) o --~ Absorption field Wells on adjacent lots Water main/service line Surface water ! o 0 "/- Driveway, parking/vehicle storage area ~ O '~/ Curtain drain iu ~/v .,~ /'C ~ ~ ~,. ~ Wells on adjacent lots / ENGINEER'S CERTIFICATION . ~'~ I ce~ify that l have determined thru field inspections and review of Municipal rec~~ems are in conformance wit¢ ~OA H~guideEnes in effect on this date. ~' Signature Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Drinking Water Analysis Report for Total Coliform Bacteria 200 w. Potter Orive Anchorage, AK 99518-1605 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Tel: (907) 562-2343 MUST BE COMPLETED BY WATER SUPPLIER Fax: (907) 561-5301 TO BE COMPLETED BY LABORATORY  shows Ibis Water SAMPLE to be; isfactory ~ SendInvolce ~,~,. ~,~.~_-,~. _?;!_- m,,.., ~ geed No. 204 Eagle River, Alaska 99~77 -0 Send Result~ 0 Send invnice Month Day Year SAMPLE TYPE: ~l[ Routine D Treated Water ~ Repeat Sample ~o_r routine sample ~ Untreated Water with lab ref. no.Cq'7, t.lO~,,1-~. ) [] Special Purpose SAMPLE LOCATION Time Collected Collected By Please P~nl O Unsatisfactory O Sample over 30 hours old, results may be unreliable O Sample too long in transit'; sample should . .~o! be over 48 hours old at examination to indicate fellable resultS. Please send new sample via s~cial delivery mail. Date Received ., Time Received Analysis Began Analytical Method: ~'~Mcmbrane Filtcr o MMO-MUG * Number of colonies/100 mi. ~ .~. o~* &~ Result* Analyst 97.4322~ ~ ~ Anch Fbks Jun Date: .. Time: Client notified of unsatisfactory results: Phoned Spoke with Date: ~~ Time: BACTERIOLOGICAL WATER ANALYSIS RECORD ]omments: MMO-MUG Result: Total Coliform Memhrnne. Filter: Direct Count · . VeriffCnti0~-...L.~ Fecal Coliform Confirmation Final Membrane Filter Results BGB ' - - E. Co# Colonies/100 mi Faxed Faxed COI,~IFII{~{~ '- - ....'T~Z'(.' = rtn Ntttnetollr r~ C~unt Coliform/lO0 mi Time_ t-Td© brs CT&E Environmental Services Inc. CT&E Ref.# 974022002 Client Name S & S Engineering Project Name/# N/A Client Sample lD Lot 14 Blk 2 Prospect Heights Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: Client PO# Printed Date/Time 07/25/97 10:36 Collected Date/Time 07/23/97 09:45 Received Date/Time 07/23/97 16:00 Technical Director: Stephen C. Ede Parameter Results PQL Units Method Allowable Prep Analysis Limits Date Date Init Nitrate-N Total Coliform 5.78 0.500 mg/L -6f-OB'd~h/O-eOL-t~ /~$~,~p~p SM18 4500-NO3F 10 max SM18 9222B 07/24/97 JRJ 07/23/97 TMW MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 015-091-12 HAA# HA900102 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 14 Block 2 Prospect Heiqhts Subdivision Location (address or directions) 9700 Prospect Drive, Anchorage, Alaska (b) Property owner Jerry Clough Telephone: (home) Business Mailing Address 9800 Prospect Drive, Anchoraqe, Alaska 99516 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here rq, if hold for pick up.) List contact person and day phone number below: S & S Enqineerinq 17034 Eagle River Loop Road S~ue ~u~ Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family~ Numberofbedrooms four(4) 3. WATER SUPPLY Individual WellX~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site []x Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 end 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. NameofFirm S & S Enqineerinq Telephone 694-2979 Address 17034 Eagle River Loop Road, ~204, Eagle River, Alaska 99577 Date Engineer's Seal 6. DHHS APPROVAL Approved forf°ur (4)bedrooms by Approved ;~_~ Disapproved Terms of Conditional Approval Conditional Date This office has received written C0nfi~mati~ of the'-test boring of the property as required under th~' Conditional Approval of March 27, 1990. This property now meets with the MOA codes and requirements. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-o25 (~ev. ?/88) Back Page 2 of 2 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANO REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER June 18, 1990 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 MuNICiPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL pROTECl'ION Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED REFERENCE: Lot 14; Block 2; Prospect H~ights #I; As a result of a conditional Health Authority Approval issued for the referenced property on March 27, 1990, a test hole was drilled near the septic leachfield on June 13, 1990 to verify the bedrock depth. The test hole was drilled to 20 ft. below the ground surface (7 ft. b~low the bottom of the leachfield) and no bedrock was encountered. Therefore, we request you issue an unconditional Health Authority Approval for the referenced property. If you have any questions, please contact us. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot ~4~ Block 2... Prospect H&ight~ __ Location (address or directions) 9700 Prospect Drive (b) Property owner Mailing Address (c) Lending Institution Mailing Address Telephone:(home) A~ohn~ag~: A~a~ 99514 Telephone Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List Contact person and day phone number below: $ & $ E;~GiNEERi~NG 17034 Eagle Ri~er Loop Roa~! No. 204 Eagle River, Alaska 2. TYPE OF RESIDENCE Number of bedrooms Single-Family [~X 3. WATER SUPPLY Individual Well Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th 'legality and status. 4. SEWAGE DISPOSAL On-site J~( 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. 72-025 (Rev. 7/88) Page 1 of 2 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 th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functiona 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 Telephone~'/'~/? ' ~ zNr~IIaEF'R;"IC No. -004 . . , ~a~le Rix, e,r k~op Road Address :~ -~~ Date ': 6. DHHS APPROVAL · ApProved for .~- _bedrooms by The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88)Back Page 2 of 2 A. WELL We~ssification Well Log Present ~/N) ~L Date completed Total Depth'~Z.~' Cased to ~'~ Depth of Grouting Static Water Level ~ i Casing Height Above Ground Electrical Wiring in Conduit~..~/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authorily Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: L--._..~-%-~ \,d~ li~=~L.,~ if A, B, C, D.E.C. Approved (Y/N) Yield / _-- SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Pump Set At Sanitary Seal on Casing ~N) "/ Depression Around Wellhead (Y/~;) To Nearest Edge of Absorption Fiel~o~ Lot To Nearest pUblic Sewer Line ; On Adjoining Lots ; On Adjoining Lots To Nearest Sewer Service Line on Lot To Nearest Public Sewer Cleanout/Manhole ~/,~ Water Sample Collected by ~,~-~ ~¢'~ ; Date Water Sample Test Results Comments "~ SEPm C/.OL. .e T^.K.^TA Datelnstalled '? ~'/'~ ~/¢S?ze ~,~-~0 No. of Compartments Standpipes(~/N) ,./ Air-tight Caps((~/N) Depression over Tank (Y/~) Pumping/Maintenance Contact on File Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line Foundation Cleanout ~[~N) ~ Date Last Pumped (,¢2 ~ ~/.~' ; for -- Temporary Holding Tank Permit To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026(Rev. 7/88) Front Page 1 of 2 i C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 9/'7 Width of Field ,~.'7~' Square Feet of Absortion Area '~'/r-~z~'~ Type of System Desig~n Length of Field ~ Depth of Field ~ Gravel Bed Thickness ~'~ Statndpipes Present ~N) DePression over Field (Y~[~ ~.5 Date of Last Adequacy Test ~ - ~r'-~ o Results of Last Adequacy Test ~c_~/s.~:~:/~~. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well I ~c::~ t.¥. To Property Line ~'~ To Existing or Abandoned System on To Building Foundation, Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots ~-~='[ ~ ~ ,~- t.~ To Cutback (if present) \ o,c:) Comments D. LIFT STATION Date Installed Size in G~~ "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments. Dimensions Manhole/Access (Y/N) . "Pump Off" Level at ~ __ _ Vent (Y/N) uring Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA auidelines in eJf?~;.j~.,tbe date 5f!~,his inspection. ~'~.. Signed _ S & S ENGINEERING 11034 Eagle Ri~er L~p Road NO. ~ 49 . . a~ Company _ ~.~ ......... -- Receipt No._ Date of Payment_ ..~ -- ~/~,¢ O Waiver Fee: $ AmOunt: $ /~'~ ~, ¢ ¢ Date of Payment 72-026 IRev. 7/88) Back Page 2 of 2 TO REPLY SIGNED DATE / SEND PARTS 1 AND 3 INTACT - POLY PAK (50 SETS) 4P472 ~® 4S 472 PART 3 WILL BE RETURNED WITH REPLY.~ ~ ~~~:~ ' ~0 ' .:..~::::::';-:-:: :.-:-. ...... .-.: -r: .:~?:::;?.z::::>:.:.::::.':~,'::~.:· .-.'. ,'.' ~ ' - ~'.':- '> .:~'~'~ ~'~':' ...z'.'::~'~:~;:.::::~:~::~9~z::~::-· -: :' ~:~ .,. ............................................. .~0 :-~ : CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~.~;.~ §033 FEDERAL TAX ID # 02-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 20413 Date Report Printed: MAR 16 90 ~ 09:41 Clisnt Sample ID:L14, E2; PROSPECT HEIGHTS PWSID :UA Collected ]UR 13 90 @ 16:00 hrs. Received ~R 14 90 @ 13:00 hrs. Preserved with :AS REQUIRED Client Name : S ~ S ENGR Client Acct: SNSENGP P.O.$ NONE RECEIVED Req ~ Ordered By : R. S}tAFER Analysis Completed :~R 14 90 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S & S ENGR Special Instruct: Chemlab Ref ~: 900452 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 3.1 mR/1 EPA 353.2 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RDJ. ============================================================ ..... == .... 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected '* See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. .TELEPHONE (907) 562-2343 .'~ 5633 B Street ,-~.... L ' Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PRIVATE WATER SYSTEM Name Phone NO. $ & $ ENGINEERING Mailing Address 17034 Eagle River Loop Road No, 20~. Eagle River, Alaska 99577 City State Zip Code Mo. Day Year SAMPLE TYPE: Routine Cheek Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE Time Collected NO. LOCATION ~ 2 I I 31 I 4 I I 5 I TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: satis shows this Water SAMPLE to be: isfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Membrane Filter * No. of colonies/100 mi. - Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filler: Direct Count ~.) Verification: LTB BGB Final Membrane Filter Results Reported BY--ate Time: TNTC = Too Numberous To Count OB -- Other Bacteria Collform/100ml Collform/100ml a.m. p.m. PART ONE OF TWO REMAINDER TO FOI.LOW #1: Time #2: In sp '~UNICIPALITY OF ANCHORAGE ~ DEPARTMEN% dF HEALTH AND ENVIRONMENTAL .PROTECTION 825 L Street, Anchoraa~. Alaska 99501 264-4720 Date Received: Time ,. ~ #3: Time Date .~-[-~,"~/_.z,~'~ [...0~i0[ ,,~' Date Insp~, ~,/,~ Insp April 13, 1978 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Area Inc, Realtors % Joe Babka Mailing Address: 3300 C Street 99503 Phone: 278-2~25 2. Property Owner: Amos Mathews Phone: Mailing Address: 344-4788 ~-/~a/~.~. NHN Prospect Heights 3. Legal Description: Lot 14 Block 2 Prospect Heights Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System:' Permit # Construction Individual Well (x) Community/Public System ( ) Depth of Well 225' Well Log on File ( ) Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System Sx) Public Utility ( ) Installed 1974 Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Page,Two[ Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 14 Block 2 Prospect Heights Subdivision Comments: Affadavit Attached: Approved: ~~_~ Disapproved: Letter Attached: ( ) Date: Date: ~/~ i' Department of Health and Environmental Protection //~~./ 825 L Street, Anchorage, Alaska 99501 ~"' ~'quest for ApproVal of Individual Sewer and Water Facilifiies 1. Property Owner: ,/P~O~ ~~o~ Mailing Address: 2~ Name of Buyer: Mailing Address: Phone: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: 5. Legal Description: Phone: Phone: 22.7~-,.q3 db Street Location: 6. Single Family Residence: (~ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:. *Individual Well (X) Public/Community System / If Individual Wellf well depth ~L~ ~/ If Community System, name of system ( ) 8. Sewage Disposal System: *~n-site System (~) Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. *~ If on-site sewer system is over two(2) years old, an adequacy .test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 e o 4, 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~-~ ~' /q iZu~/fC Date Received ~) ~/ ~0°~ Time of Inspection ~ N~ Date of Inspection  REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval 'requested by: ~-/~. ~ ~~ --~~ Mailing Address: ...... ~ . .- ~ ,~ Property Owner: ~~ ~- ~ Phone: ~7V- ~-// Type of facility to be inspected~ ~~_ No. of bedrooms Well Data: A. Type C. Construction B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed / C. Septic Tank: 1. Size D. Seepage Pit: B. Installer X~'//~v ~/;~ /~'~)0 2. Manufacturer ~z~O/~ 1. Absorption Area ~ ~' 2. Material E. Disposal Field: Total length of lines o Distances: / A. Well to: Septic tank /30 , Absorption area Nearest lot line ~© /~Z~S, Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line Sewer Lines ~ FN_Nq2 Jl/7~ PaoR 1 of two oaoes ,Page 2 ~f two pages - Req~.~.st for Approval of Individual S. ~r & Water Facilities Lega~ Description Approved Disapproved Date ~ ~/~-w~ ~proval 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 water facilities and these facilities are operating satisfactorily. SIGNED Date GREATER ANCHORAGE ARL:/, BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA xx FHA 2. Property Owner: Amos C. Mathews P.O. Box 979 Mail ing Address: ~nalqnr~e: All.lea 9951Q_, 3. Name nf Buyer: Amos C. Mathews Day Phone 274-8511 Mailing Address: same as above Day Phone same as above Name of Lending Institution: ALASKA BANK OF COMM]~RC]~ Pouch 7012 ~ Attention: Phone Mailing Address: Anchorage~ Alaska 99510 Anita Cook 279-5641 Ex. 121 5. Name of Realtor or Agent: None Mailing Address: Phone Legal Description: Lot 14, Block 2, Prospect Heights Subdivision Location: Prospect Drive & Upper O'~alley Road 7. .Tyoe of Facility to be inspected: Single Fam_ ~.¥ Home NO. Bdrms. 8. Mater Supply Type of Supply: Public Utility Individual xx If Individual, number of dwellings presently served 1 If Individual, depth of well 225 ft. 9. Sewage Disposal System Type .of S~stem: Public Utility If Individual, date of installation Individual (on-site) xx August ~ 1973