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HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 5 LT 5n,V 11 y Heights B lock 5 Lot 5 #017-062-44 oGRE 'ER ANCHORAGE AREA BO? ' ;JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME~'~-~ ~/./~/f~/'~'~'~'~'~'~'~'~-~' MAILING ADDRESS~r~./~/-~- _g~" ~'~/~'-/~'/.-~', PHONE3/-~'~--:~/°~~''~, SEPTIC TANK: DISTANCE NUMBER OF FROM WELL~///¢~'-. MANUFACTURER,~'~d~'-~'-~-~z~- MATERIAL ~-~-~----'<-'~-~'-/~- COMPARTMENTS ..22~. INSIDE: LENGTH --- INSIDE WIDTH__ -- LIQUID DEPTH ~ LIQUID CAPACITY/~'~---~'~ GALLONS, SEEPAGE PIt: NUMBFR OF PITS / DIAMETER U'~ OR WlDTFI-~'~d~,~ /LENGTH'''~d'-~', /DEPTH /'/ / LINING MATERIAL ~."¥"~'~- CRIB SIZE: DIAMETER_'~ DEPTH~ DIS-rANCE FROM: WELL ~f/~~~ ~/////' ~'~ / TOTAL EFFECTIVE BUILDING FOUNDATIO~, NEAREST LOT LINE-~~ / ABSORPTION AREA (WALL AREA) ~2gg~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE .~//- ' ¢//'/~//-///'//~ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE TANK SYSTEM , OTHER SOURCES DISAPPROVED__ REMARKS. DISTANCES: INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: ~--~/~ Fo~m N~ EQ-031 DIAGRAM Of SYSTEM DATE APPROVED ~-~".. . . . - G.A.A.B. GREATER ANCHORAGE AREA E3OROUGH SIEWAGI~ DISPOSAL SYSl'£M -- APPLICATION AND PERMIT NAME Of APPLICANT ~ ~/~~ MAILING ADDR~ ~' ~~/PHONE INSTALLATION LOCATION -- ~/~/~ ~~/~ TYPE AND SIZE Gl~ FACILITY TO BE SERVED -- ' '--//~//~ SOIL TEST RESULTS~¢ ~'¢~/~ FOUNDATION TO SEEPAGE PIT ~ SEPTIC TANK ~/ SEEPAGE P¥1' , ., DRAIN FIELD WATER MAIN TO SEP~,TAyK ---~¢ / SEEPAGE PIT CONFORM TO BOROUGH REGULATIONS REGARDING INS'rALLATION. TYPE Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 s r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL�a�j(t� FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-062-44 COSA# 0SG1 q 1. GENERAL INFORMATION Expiration Date: Complete legal description SUN VALLEY HEIGHTS S/D• BLOCK 5 LOT 5 Location (site address) 13421 TAHOE RIDGE CIRCLE * ANCHORAGE AK * 99516 Current Property owner(s) WILLIE EDWARDS Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 13421 TAHOE RIDGE CIRCLE * ANCHORAGE. AK * 99516 _ Day phone rrl «: Cf r -2,w e_ l l Day phone Unless otherwise requested, COSA will be held by DSD for picku . n' 2. NUMBER OF BEDROOMS: 4 JUN 1 2014 3. TYPE OF WATER SUPPLY: individual Well Individual Water Storage Community Class A Well Public Water System i r KbYiII[iril TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site N ❑ Individual Holding tank ❑ 0 Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems 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 structure indicated herein. t 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 installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performarca of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or INOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for _L� _ bedrooms. System #2 Approved for Disapproved. Conditional approval for 0 bedrooms. 337-6179 Date rslr`A ,oP�'.OFA.<i' �4p00 * :.. 4 g , j71 , bedrooms, with the following stipulations: tOF(( V&'i (i/moi ON-SITE WATER AND WASTEWATER 0 ponnRAM 1�?I- Original Certificate Date: t ^ 7 - y The Md*cipa ry XA ge Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Fav 11ms Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SUN VALLEY HTS. B5 L5 A. WELL DATA Well type A Date completed Total depth ft. Date of test Static water level Well oroduction--� Parcel ID: 017-062-44 If A, B, or C provide PWSID# 212005 Well Log (Y/N) Sanitary seal (Y/N)_ Wires properly proms Cased to ft. Casi fight (above ground) in. FROM WELL LOG / AT INSPECTION SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: ug./L. B. SEPTIC/HOLDING TANK DATA M. Nitrate mg./L. Date of sample: Tank Type/Material SEPTIC/STEEL ft. Collected by: a Date installed 10/2/1973 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N)11 NO High water alarm (Y/N) N/A Date of pumping �— Pumper -00 C Stplp 5ei u 't f c C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 10/2/1973 Soil rating (g.p.d./ft`or /bdrm 200 System type SEEPAGE PIT Length 28 ft. Width 28 ft. Gravel below pipe 9 ft. Total depth 12.41 ft. Eff. absorption area1048 ft2 Monitoring tube *YES Depression over field NO Date of adequacy test 06/16/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 65 in. Water added 1645 gal. New depth 75 in. Elapsed Time: 120 min. Final fluid depth 72 in. Absorption rate >= 600+ g,p.d_ Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — *MONITORING TUBE ONLY EXTENDS 8.5' INTO EFFECTIVE D. LIFT STATION Date installed "Pump on" level at n. E. SEPARATION DISTANCES Size in gallons "Pump off" Manhole/Access water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot On adjacent Absorption field on lot On Public sewer main Sewer /septic service Public sewer manhole/cleanout Holding tank Animmment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Propertyline 5'+ Absorption field 5'+ Building foundation Water main 10+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PRIVATE/*80+ COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 9 10'+ Building foundation 10'+ Water main 10+ r�� 10'+ Water service line **UNK'OWN Surfacewater 100'+ Driveway, parkingtvehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/*120'+ COMMUNITY F. COMMENTS *ADEC APPROVED AT TIME OF CONSTRUCTION. SEE 1971 WATER SYSTEM AS—BUILT DRAWING. **SEE LETTER ON FILE WITH MOA 7/12Z2 G. ENGINEER'S CERTIFICATION I certify that I have deteimined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (.rl$lr`g (Rev. 11/05) M n K 10' 47°W 120.56 . J p O U N NO6° N o N6 C5 Rt0_ GE CiT2C1 m , C YN ro TAHOE CIRCLE) ---- (TAHOE 9 6z QQ N J l\\\�4 o .eeeee so44 0 r�;e•.. o •. 1y.� m "• mem w 0 g 6�z S1q°4T M��No o xgF z \ • gw 9 / /ti .. d = o J �• tii cD � - w ilk, ` J t-io zoo ti w oint, M29�q[ 0,0. J~ W K2zZ KUU t° / r �= mw '&'o1 MR: w eys d y § & }) Uw O I •SZ o a ...®® z z c 14w N� b ro J Z e .moi W Z O :n W J tai o ti Y VI M � H d M N W K W 2 n 'W'^^ Vf m W Q vi Y U) O � `�'v-.Ly z h.. OU F o g rc b © /.�My�� � m C6 � y O 0 e W x t Q Z z w Cl) K 10' 47°W 120.56 . J p O U N NO6° N o N6 C5 Rt0_ GE CiT2C1 m , C YN ro TAHOE CIRCLE) ---- (TAHOE QQ N J l\\\�4 o .eeeee so44 r�;e•.. •. 1y.� m "• mem w o go M��No o xgF z \ • gw z / /ti .. d = o J �• tii cD � - w ilk, ` J t-io zoo ti w n 6� `•. •...••�'+r Z>�°~' ,t 1 A\ia:0eeee z IL oz =� III Municipality of Anchorage Development Services Department Building Safety Division1 71 On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 . Anchorage, AK 99519-6650 Yv"ww.munl.or glonsite (907) 343-7904 0 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-062-44 COSA# C"T) 1. GENERAL INFORMATION Expiration Date: Complete legal description SUN VALLEY HEIGHTS S/D; BLOCK 5 LOT 5 Location (site address) 13421 TAHOE RIDGE CIRCLE * ANCHORAGE, AK * 99516 Current Property owner(s) WILLIE EDWARDS Day phone Mailing address Lending agency Mailing address Real Estate Agent 13421 TAHOE RIDGE CIRCLE * ANCHORAGE AK * 99516 Day phone JOE BELL W/ KELLER WILLIAMS Day phone 350-4047 Mailing address 101 W. BENSON BLVD, #503 * ANCHORAGE AK * 99503 Unless otherwise requested, COSA "will be held by DSD for pickup. 2.NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF II'SPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. l verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shoves that the on-site water supply and%r wastewater disposal system is (are) safe, fffnctiona! and ader"ltate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained fromi 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 installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Enaineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the. water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _4Z Approved for bedrooms. Disapproved. Phone 337-6179 Date ! Itt o" .- .. .. ....... ....... f r A. 1 • ar ss. QP CE -79P 4 9s •' p ' � •�c�G 0fessionoo Conditional approval for bedrooms, with the following stipulations: .-r•`.ttac i±i3erits: COSA CheCrlist Septic System Advisory Well Flow Advisory Nitrate Advisoiy Arsenic- Advisory Maintenance Agreements Supplemental Engineer's Report Other (tfl(IN If(/t� ly `�� �G • 0 ON-SITE ••, 'ATERAND •. C'= y T8 ER ; PROGRAM s 1 By: Original Certificate Date:— 1 � , (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division 5 F. ; c T V On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFI,ICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SUN VALLEY HEIGHTS S/D; BLOCK 5, LOT 5 Parcel ID: 017-062-44 A. WELL DATA Well type COMMUNIN I A� B, or C provide PWSID# 212005 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N Total depth ft. Cased to ft. Casing height (abo round) Date of test Static water level Well production WATER SAMPLE Coliform FROM WELL LOG lonies/100 ml. Nitrate mg./L. Am-enic: ug.'�/L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material) SEPTIC/STEEL Tank size 1250 Foundation cleanc Date of pumping _ C. ABSORPTION FII Number of Compartments 2 I_�ilvI ii iX449101 ft. 9.p -m. Collected by: Date installed 10/2/1973 Cleanouts (Y/N) YES (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A 7/6/2011 Pumper, IDATA FB - ONE STOP SERVICES Date installed 10/2/1973 Soil rating (g.p.d./Wo %dr 200 System type SEEPAGE PIT in. Length 28 ft. Width 28 ft. Gravel below pipe 9 ft. Total depth *13.,1 ft. Eff. absorption area 1008 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **7/7/2011 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absojrption field before test fi8 in. Water added 1170 gal. New depth 84 in. Elapsed Time: 120 min. Final fluid depth 78 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE—SOAKED WITH 1560 GALLONS ON 7/6/2011. 15001 GALLON PRE—SOAK APPROVED PER JEFF POET (7/6/11). D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service On adjacent On adjacent lots Holding tank manhole/cleanout AR4nat ontainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ 10'+ Property line 5'+ Absorption field 5'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PRIVATE/*80'+ COMMUNITY SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line **UNKNOWN Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/*120'+ COMMUNITY F. COMMENTS *ADEC APPROVED AT TIME OF CONSTRUCTION. SEE 1971 WATER SYSTEM AS—BUILT DRAWING. **SEE ATTACHED LETTER. G. ENGINEER'S CERTIFICATION o OF A ©o ,� ... . S�4pl I certify that 1 have determined through field inspections and Q * 9 H review of Municipal records that the above systems are in �' ' ' ' ' ' ' ' ' .. ' ' ' ' ' ' ' ' ' . ' ' • . ' . conformance with MOA COSA guidelines in effect on this date. J fr Garne Engineer's Printed Name JEFFREY A. GARNESS �Qo�9� E— ]3 cm�G Date 7 1 1S I 1 4@y —T i�f to f ession o� COSA Fee Waiver Fee $ Date of Payment Date of Payment Receipt Number 6'� �J �� Receipt Number (Rev. 11/05) r -R71F1 — 0 7. 'a �4 , L.T e m'. wa":&. w J.I heroby, certUy that T have surveyed the following described property-'---L Anchorage *cording F i�ci, �a and that the TT21 tiS E"nts situated 9LS�"[Jt1 3�GP i�Fi�CI3�S ';lie :j?IK?�fel -oach on the property do not rlap or enc. d •',va�� �tk a'�k wemuwc e, a � la thtua�a is �� � � ce�rt� lyar� �e�t t`�ss�ttr aaa� as the gasa�es op ��' �c iia�est as d ttxat thexe a ria xaarlays, tri slz� . ; z�, ��� tom". ms�s�.w ��� � • (?t£� '77»�"i�' f:''d5�'.T�.�` A�'A .At� �'A�,'C}�PE"��' e�� i •� rJS Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALAT A & ASSOCLA.TES PLAT ARE NOT SHOVVN HEREON- Ingineers aixd Suri eyon ...,, ...... _ .. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS July 12, 2011 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road, P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Sun Valley Heights S/D; Block 5, Lot 5, Water Line Separation Distance, To whom it may concern: During our initial inspection, the distance between the seepage pit and the water line could not be verified. There are no previous C.O.S.A.'s or H.A.A.'s for the property and the distance is not listed on the original inspection report. We retained One Stop Services LLC. to professionally locate the water service line so the distance could be measured. According to the locator's markings, the water line meets 10' separation to the tank. However, the distance from the closest locate mark to the seepage pit cleanout was found to be 17.8'. Because we cannot be sure of the configuration of the seepage pit below grade, the exact distance from the water line to the pit is unknown. If you have any questions, please contact us at 337-6179. Thank you for your assistance. i Sincerely, d i� effrey ss,P.E., M.S. Presi t 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com One Stop Services, INC 7654 Old Harbor Ave Anchorage, AK 99504-1930 Off 907-338-5563 Fax 907-339-5564 Garness Engineering 3701 E Tudor Rd, Ste 101 Anchorage, AK 99507 Fax = 338-3246 Invoice Date Invoice # 7/6/2011 3675 P.O_ No. Terms I, -d %M r. d8Z:60 I, I. 90 If 0 Due on receipt Item Quantity Description Rate Amount pump truck 1 Job Site: 13421 Tahoe Ridge pump septic GUR-T£�2 Li NE Lo C14 � 175.00 aS4 °� 175.00 Thank you for your business. Total ,� o a s. I, -d %M r. d8Z:60 I, I. 90 If 0 �L.Ik--,}v.,I J;y. t ri-a 1 I�t ILI I ia Lu w _ rl -1 �Ih a v � -I f 171 I I I I -- -------��---- `~ �h Ii I , I _ z' I� s 1 I, I Q W `L �l Q U _ QI r, +I ,.'..I w ..... Zj14 JSP z i I I I rr I r. I r I I i \ rlr{IL I� IL I. r n NN Iii �' Ill T'ifr -,1T �'11 C2C 'fl r I1 t ilI i'YY �I I, '� III Tp ll'' I'�jf'� ooN I i;r ��li N ,Ili.l I II I I I I; �a aF I,I -I I 7'` f I III i II I liltl tt, 1 °1 ---�, G` iT o I I I I .I'. I I i, I A}}�li "C�\ I , �I or I -I 71 -r- • �' 3. w \ I I 1 ,�I+, i .��,'n r rl I ,{ ;Nl i �r�, i.. � I II II I 1I NII � ( I �I� � I if I ,I� 11� r �II I II I I� L,IrI'T' III, ItIII .�4I GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Tim(! of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: Mailing Address: _]? ~-~'~ 2. Property Owner: ~-~' //,~/--'~m-~ Phone: Mailing Address: 3. Legal Description: 5. Type of facility to be inspected 6. Well Data: C. Construction Sewage Disposal System: A. Installed D. Bacterial Analysis I~. Installer ___/x~ C. Septic Tank: 1. Size/~?~//.w~/ 2. Manufacturer_u'~.~rc~-x~ ~. D. Seepage Pit: 1. Absorption Area~~,~2. Material ~-<~-~-~ E. Disposal Field: Total length of lines ?~_~//m,~~- Distances: A. Well to: Septic tank ~//~-, Absorption area Nearest lot line~--, Other contamination B. C. Absorption area to nearest lot 'line ~ ~-, Sewer Lines /-~//~'/~/~-- J/--'--A/~[~/4 Foundation to septic tank ///~- , Absorption area EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re ~st for Approval of Individual ~er & Water Facilities Legal Description Comments Approved Approval Valid for one year from (late signed Greater Anchorage Area Borough, Department of Environmental Date 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) GREATER ANCHORAGE AREA BOROUGH. Department of Environmental Quality "C' St., Anchora§e, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Inspection: CMRO VA FHA _ __ ___ D_9~v Phone ~-: ~-~. ~. D_ay Phone 1. Type of 2. Property Mai-ling Address: 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: CONV Mailing Address: Phone 5. Name of Realtor or Agent: Mailing Address: Phone Legal Description: Location: Type of Facility to be inspected: /~:~, '--4~-<.M' No. Water Supply ~ Type of Supply: Public U~lity Individual Bdrms If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site)~ If Individual, date of installation /~:~~ Eq-037 (1/74)