HomeMy WebLinkAboutANGELA HEIGHTS LT 6Angela Heights
Lot 6
#050-283-42
DRILLING
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
OWNER OF LAND
ADDRESS
,j o blrv 'J b ,'~ E S
LEGAL DESCRIPTION /-
DATE-Started ~b',.
PERMIT NUMBER
DEPT. OF WELL /~? ? 0~
STATIC LEVEL OF WATER FT.
/
DRAW DOWN FT. [ ~'
GALS. PER HR /o~OO
KIND OF FORMATION:
From ~ Ft. to ,~ Ft. O(-d~/~O~O~''~'~''d
From. c~ Ft. to P Ft. ~'dP'U~.~ 6~dO~'Z
From 00 Et. to c~O Ft. ff/,,9
From 20 Ft. to~,~_Ft. 5~~ ~' g&gd'i~d~'~-
From 2~" Ft. to ~ ~ Ft. ~ ~,~ ~t ~-~//j]Og:"~.
From
From
From
From
From ~5 Ft. to -~Ft. 5~[~-~,/O ~Ot~, ~ L~od~g'ro~m'3~
From. ~0 Ft. to 7~ Ft. Sd~o/O From__
From c~P Ft. to [ ~Ft. C~ ~'~' ~d~tc/c7~ From__
From [~)~ Et. to /'~OFt.
From Ft. to.__.Ft, From
From__Ft. to Ft. From
From__Ft. to Ft. From__
From__ Ft. to Ft. From
From Ft. to Ft, From
From__ Ft. to__Ft. From__
From Ft. to Ft. From__
From Ft. to Ft From
Ft. to__Ft.
Ft. to_ __Ft.
Ft. to Ft.
Ft. to Ft
Ft. to__Ft.
__Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft.
Ft. to__Ft.
Ft. to__Ft.
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to__Ft
MISCL. INFORMATION:
DRILLER'S
NAME
PERMIT NO.
[.li_i~-J I C: I ~'RLIT'T' £1F Rr~C:H,JF:R~3E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 E. TUDOR
276-222~
F~ELL PEE:£'I IT
( 76277 )
APPLICANT
LOCATION
LEGAL
JOHN JAMES
L6 ANGELA HGTS
P 0 BOX 755 E, R.
LOT SIZE
688-2450
li000 SQUARE FEET
MINIMUM DISTANCE BETWEEN A NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 50 DAYS
OF 'THE NELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
F"ER~'I I 1"' ".,,,.'RLI C:. F~]R C~I'-,IE '"r'ERR F'RO~'I I S5~LIE
I CERTIFY THAT
i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2' I WILL I - c ~ ' 'ORDRNCE WITH THE CODES.
Municipality of Anchorage
Development Services Department
Building Safety Div{sion
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0~O "~,83 -52
HAA #
Expiration Date: ~- tiC- - O /
1. GENERAL INFORMATION
Completelegal'description I, ot 6, An,~ela tlei~:ht:s SubdivJ. sion
Location (site address or directions) 10123 Chickaloon Street
Current Propertyowner(s) Richard & Zlarge L'~,;".: Dayphone
Mailing address
694-4494
10123 Chickaloon Street, Eagle River, AK 99577-~3~
Lending agency
Day phone
Mailing address
Real Estate Agent Remax/Debbie Lewis
Mailing Address
Un/ess otherwise requested. HAA wi//be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
16601Centerfield Dr.,
Dayphone 694-4200
Ste 200, Ea~le River, Ak 99577
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
[] Community On-site
[] Public Sev/er []
The Municipality of Anchorage Deve!opment Services Department (DSD) issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professlonal civil
engineer registered in the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of
titIe (except betv;een spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue fcr properties served by a private er Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Cedificates are valid for cne year for properties served by Class A or B wells or a public
water system. The Municipality ol' Anchorage is net responsible for errors or omissions in the professional
engineer's work.
4. 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,
based on procedures outlined in the Health Authorify Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of sb'ucture 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(are} in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of instalIation.
$ & $ ENGINEERING
Phone
17034 Eagle River Loop Roa,4 No. 204
Name of Firm
Address
Engineer's Printed Nar~e m Robert C nn~.~n, ?.~.
5. DSD SIGNATURE
% X Approved for 4 bedrooms.
Disapproved.
Conditional approval for .~
Date '3,./~'/¢ /
.,. ;.% .~..~ .......,v ~'_ ,~
~t2<~.,'. ..............
bedrooms, with the follow ng stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory .
Well Flow Advisory
X
,/
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Mpnicipality of Anchorage
Development Services Department
BuOdtng Safety Division
On-Site Water & Westewatar Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.us
(907) 343-79O4
Legal Descrtptlon:
A. WELL DATA
HEALTH AUTHORITY APPROVAL CHECKLIST
Well type If A, B, or C provide PWSID # '""'
d.pth/5 . ' .. cos. ta
FROM WELL LOG
Static water level
Well production
WATER SAMPLE RESULTS:
Well Log (Y/N)
Casing height (above around) I Z'~ln.
AT INSPECTION
Coliform _.O .colonies/100 mi. Nitrate ;3. et" mg.A. Other bacteria O~ colonies/100 mi.
Date of sample: ~ Collected by: ~','~'. ~' ~ ~'1 ~J~.....~...I ~'J ~'
B. SEFrFIC/HOLDING TANK DATA
Tank size __ gal,. Number of C(N~partments __
Foundation cteanout t'Y/N) Y/N)
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
ABSORPTION FIEU) DATA
Date Insi~ii~t~ .... ~.~il
Length fl.
Total depth -- ft.
Date of adequacy
Fluid depth in ~
(g.p.d./ft~ or ~/bdrm)
Width fl.
~ Monitoring tube --
Results (Pess/Fail)
mfore test in. Water added
Final fluid depth in.
System type
Gravel below pipe
Depression over field
For bedrooms
gal. Now depth in.
Absorption rate >= g.p.d.
An~ (past 12 mo.) (Y/N & typa) If yes, give data
D. UFT STATION
Date installed ~ ~xf Size in gallons -
on" level at~f'~. 'Pump off' level et
'Pump
Datum ~" Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alam~ & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WE~J~' ON LOT T0:~ '! lots ~//////'V/~r
Septic tanldlift station on lot NXA - : - On adjacent lots ,,~ ~'
Absorption field on lot /~ On adjacent
/
Publlo sewer main / ~O V- Public sewer manhole/oleanout / ~ If..
Sewer/septic senace line. ~' ~- ~ Holding tank - ~//~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line ~ Absorption field
Water main __ L W~ · Surface water
Wells
on
adjacent
lots
SEPARATION DISTANC~,F~OM ABSORPTION FIELD ON LOT TO:
Property line /"' Building foundation _ Water main ~
Water Se~/je~ne Surface water ~ Driveway, paddng/vehicle storage
Curt~ drain. . Wells on adjacent lots
COMMENTS
G, ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance wfth MOA HAA guidelines in effect on this date.
Engineer's Printed Name
Date
Waiver Fee $
Date of Payment
Receipt Number
FE~-14-L:~01 09:~ ~ ENGIta:.~..~ItIG ~ Gc~.l !.211
,~__ CT&E Environmental ServFcee Inc.
2.08
O..~O0 mg/L ~EPA 'l~o.o I0 rr~x 02,/O?JO I S;C3.
¢~d/lOOmL SMIB 922Z8
02~7/01 YAP
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
GENERAL INFORMATION
Complete legal description
Lot 6; Angela H~ights Subdivision;
Location (site address or directions)
10123 Chick~oon Street, Eagle River
Property owner
Mailing address
Du Pon~ Relocation Company
Day phone
Lending agency
Mailing address
Day phone
JACK W~_'/TF
AgentKa~hi 0P_m.x_ *_ead
Address 10928 Eagle River Road, Eagle River, Ak.
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Day phone
99577
694-5500
Individual well X×
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
NOTE:
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 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.
$ & $ ENGI~F.~!NG
Name of Firm ,?n-~4 =,.?. ~,,~? L=o~ i~o=,~ ~,~,, ~.,, · Phone
Eagle River, Alaska 29577
Address
Engineer's signature
DHHS SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bed rooms.
bedrooms, with the following stipulations:
Additional Comments
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.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKMST
Legal Description: ~ /~, /~'-t~C'--L~' ~'~. ~t~' Parcel I.D.
WELL DATA
Well type '~¢-~',~
Log present
motaldepth
Sanitary seal ~N)
If A, B, or C, attach ADEC letter.
R[CI VEL:
ADEC water system number
Date completed (~ - / '~- 7 L,, Driller ~ ?:
Cased to ,~'C) ' ~" Casing height I Z.
Wires properly protected Q/N)
FROM WELL LOG AT INSPECTION
Date of test ~ -' I ~ - 7 ~, ~, - / ~. - '~ /
Static water level / D / ' /~ I '
Well flow /~ ~',~/~ g.p.m. __~..~ 4- g.p.m.
Pump level /~ /.J~
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot '~/~
Absorption field on lot
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform C
Nitrate
Date of sample:
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size
Compartments
Cleanouts (Y/N) Foundation cleanout (Y/N) Depre~
High water alarm (Y/N)
Date of pumping
SEPARATION DISTANCES_ER'Old'SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ On adjacent lots Foundation
To pr~ Absorption field Water main/service line
72_0~J.~e water/drainage
- 26 (Rev. 3/91) Front MOA21
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level ~
Meets MOA~es (Y/N)
SE.~ION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Manufacturer
"Pump off" level at
Cycles tested
Surface water
Date installed Soil rating System type
Length Width
Total absorption area
Depression over field (Y/N)
Gravel thickness
Cleanouts present (y/N)
Total depth
bedrooms
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N) ~
·
SEPARATION DISTANCE FROM A~N FIELD TO:
Well on lot ,-~ On adjacent lots
To building found~
On adjace~s~
~~r~ti~r
fo~ate o~
If yes, give date
Property !ine
To existing or abandoned system on lot
Cutbank 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.
Signature
Engineer's Name
Date
~70~ ~ E~t~ P. iw~r Loop Road No. 204
Eagle River~Alaska.. ~5_7_.~
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev, 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
ANALISIS REPORT BI $~J~LE £oz Ig)RKozdezt 35214
Date Report ?zinted: 3U~ 1S 91 e 12:SS
FAX: (907) 561-5301
Client Sample ID:L6 ANGELA H~S. Client Name :S & S ENGINEERING
PWSlD :UA Client Acct :SNSENGP
Collected JUN 12 9i { 20:00 hrs. BPO ! PO { NONE RECEIVED
Received JUl{ 13 gl ~ 15:00 hrs. Req t
Preserved with :AS REQUIRED Orde{ed By :R. SHAFER
A~lyets Completed :SUN 14 gl Ser~] Reports to:
Laboratory Supex_v~so~J.'E?HEN C. EDE i)S ~ S ENGINEERING
Released 2)
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmNmNmmNmmem · mmmm mmmmmmmNmNNNmmmmm{ · mmmmmmmmNmmNmNmmmmmm m mmmmmmmmmmmmmmmmmsmmm
Chemlab Ref t: 912716 Lab Smpl ID: 1 Matrix: WATER
Allowable
Parameter Tested Result Units Method Limits
NITRATE-N 1.6 mR/1 EPA 353.2 10
Sample ROUTINE SAMPLE COLLECTED BY: RAY.
Remarks:
I Tests Performed * See Special Instructions Above UA-Unavailable
ND- None Detected "See Sample Remarks Above
NA- Not Analyzed LT-Less Y~n, GT-Greater Than
~,~SGS Member of the SGS Group (Socidtd Gdndrale de Surveillance)
MUNICIPALIT~ OF ANCI~ORAGI~
DIVISION OF ENVIRONMENTAL HEALTH
DEPAKTHENT OF ~_.4LTH AND Ehw~IROh~NT~ P~OTECTION
APPLICATION FOR ~ALTH AUTHOKIT~ APPROVAL CERTIFICATE
General Information
Application Date
(a) Legal, Description (i~nclude lot, block, subdivisiou~..section, township, range)
Location (a~dress or directions)
Applicants Address (L~.//'?9'h ~/
Telepho.ne - Home Business
(c) Applic_a'nt is (check on.e) Lending Institution ~-~ ; Owner/builder
Buyer ~--~ ; Other ~ (explain);
Telephone
(f) ~I =h~ ~ =o ~h~ follo~u~ ~dr~ss=
2. Type of Residence
Single-Family,.~.,
Number of Bedrooms
Multi-Family ~
Other (dascribe)
3. Water Supply
Individual Well ~ Community ~--~ Pubiic ~
Note: If community well system, must have written confirmation from the State
Department of ~nvironmental Conservation attesting to the legality and status.
4. Sewage Disposal (C '"'~ q'Z','<4- )
Mote: 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]
Firm Providing Insp~ct.ions~ Tests~ File Search~ Data ~nd InformaCiom
certified by my seal affixed hereto and as of the validation date shown below, I
that my investigation of this Health Authority Approval shows that the on-site
.water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein.. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
Address
Date .- ~'-
DHEP Approval
Approved for ~/-?~/./i' bedrooms
Approved .~,~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPKESEKr-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN II;DEPEKOENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
Ra4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUI~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF /-,NCHORAGF:
DEPT. OF HFALT'I &
ENVIRONM~F~ TAL F';:~
1985
RECEIVED
Legal Description: /_~-- /~
If A, B, c= C, D.w..C. A~oved~/~)
Well Classification
Well Log P~esent ~/~)
Total Depth /,~:~' "~ '~ Cased to
Static Water Level , /~gf ~
Casing Height Above Ground /~..~'~-.
Electrical Wiring in Conduit ~/~! . .
Separation Distances f~cm Well:
To Septic/Holding Tank cn LOt .... ./~/~
To Nearest Edge of Absc~ption Field on LOt
To Nearest Public Sewer Line ~--, z-
· ~
D~pth of G~outing ~ ....
Sanitary Seal on Casing ~/~)
De[z.~essio~ Around Wellhead ~f~
Date Completsd
/%4//~,~,; On Adjoining LOtS
/
To Nearest Public Sewer
Cleancut/Manhole /~.' ~- To Nearest Sewer Service Line on Lot
Water Sample Test Results
Cc~ents
B. S.E~IC/HOLDING TANK DATA
Date Installed Size
Standpipes (Y/N) Air-tight Caps (Y/N)
Depression over Tank (Y/N) Date Last P~
Pumping/Maintenat7 Contmact on File (Y/~) . /
To Water-Supply Well
To Property Line
To Water Main/Se=vice Line
Course
Com~nts
No. of Ccmpartments, .
Foundation Cleanout (Y/N)
Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To St=earn, Pond, Lake, c~ Major Drainage
Receipt %
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed
Width of Field
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Dep=ession over Field (Y/N) ~ ~te~/~st Adequacy Test
#
Results of Last Adequacy Te~st. ./V /f/
Separation Distance f~n Absc~ptio~/FiWld:/
To Water-Supply W~ll 'To P=operty Line
To Building Foundation To Existing ct' Abandoned System cn
Lot ; On Adjoining Lots
To Water Main/Service Line To Cutbank(if present) ..
To St=earn/Pond/Lake/c= Majo= Drainage Course
To Driveway, Parkin~ A~ea, c~ Vehicle Stc=age A=ea
Comments
D. LIFT STATION
Date Instailed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
· Manh/ / o ss (Y/N)
les du~ing Adequacy Test.
M~ets MOA
Comments
on the date of this inspection.
'** Check Pem~itted Bedrocm Rating A~ainst HAA Request
I certify that I have checked, verified, c~ confomned to all MOA HAA Guidelines in effect
Signed
Company
,: .. .8RB 196X
..... ·
KB1/d5/s
Date -~-~-~ ~
MOA No. ~
[Page 2 of 2]
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
1. Type of Inspection:
2. Property Owner: --_.~0
Mailing Address:
3. Name of Buyer:
CMRO VA FHA CONV.
Mailing Address:.
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description: (~,0~- (/o
Location:
Day Phone:
Phone:
Phone:
U
Y
Type of Facility to be Inspected:
Water Supply
Type of Supply:
Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
If Individual, date of installation
No. Bdrms. ~
.Individual
Individual (on-site)
72-003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department qfEnvironmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Eagle River A~e~gm~
Date Received December 8, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
%:~p.m.
12-9-/~6 Thrusday
Jke~n%dy
Cony.
Approval requested by:
Mail ing Addre'§s:
Phone:
2. Property Owner: John & Virgina James
Phone: 688-2430
Mailing Address: Post Office Box 733 Eagle River 99577
3. Legal Description: Lot 6 Angela Heights Subdivision
.4. Location: Chickaloon Street off of Eagle River Road
~5. Type of facility to be inspected Single Family No. of bedrooms 3
Well Data:
A. Type
C., Construction
Individual
B. Depth ~ ., ~ ~'.t38'
D. Ba.~'t%rlal~ Analysis
7. Sewage Disposal System: Public utility
A. Install'~ed
B. 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
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Req for Approval of Individual S~ r & Water Facilities
Legal Description Lot 6 Anqela Heiqhts Subdivison
f l']fl -.'. ' . . .~/ -
Approval ,~d for one ye~ rom 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
EQ-034 (1/74)