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HomeMy WebLinkAboutT12N R3W SEC 33 LT 10 REMj O U v H W S D O u 0P'LZM „f Z F8&0M ,01 ,5100 A' 3 •z O O N 3 2 2 w O NQ,z-,N f O •+J C N W —o O F- u;- < Q O O � V O2 a O V Q w O W z >a o Hwmo r > J �,z-,zc o in HH z ,n w V~f ONIS- C X M J W K 2 ¢ N W zI zl~-•�2 3 � W O Q C H Q w 3 WaI-K K>O- � J OQJ6 o< Z Q x H J X n w8o o— o ��x n . wt-ar zHa x V Q W H Q ~zwl H. ONHF Q QQmQ N2,OiwO}HF HI-2w� 2 o of o Q1 -,~-,o o"o uq, wx. — aw zoz x S WOOHV,K� u o 0 3 0 K N H wx �- W V ILL J W O o z V H 12/ 1 Q m £ 7 z J l7 O IN -Cl fvLL }H z NOW Z w Q H'J FSO •• W }2 ,--vzwxza¢ Z W m H > Yl LU >oO x i r H Ln Ll = C Q w r 2 r O> w � 2 H W } J Q ~ 3 = 0 tD K o n V=1 0 w u JmV,n 440 imam o Q z OLL Cr Q W W N K w wn. 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ONHF Q QQmQ N2,OiwO}HF HI-2w� 2 o of o Q1 -,~-,o o"o uq, wx. — aw zoz x S WOOHV,K� u o 0 3 0 K N H wx �- W V ILL J W O o z V H 12/ 1 Q m £ 7 z J l7 O IN -Cl fvLL }H z NOW Z w Q H'J FSO •• W }2 ,--vzwxza¢ Floorplans on this page are shown for reference only and represent the existing room configuration and approximate dimensions of the existing area. z O z V_ w m ILS F- 0 �IS) z Z � 0 v DATE: TT A L $,ZS,zozo SCALE: SEP. 2920 Qq Parker SHEET: P-1 70 Floorplans on this page are shown for reference only and represent the proposed 2 — Z Z � H room configuration / usage of the existing area after the new addition is constructed l and bedrooms are relocated into the new space. HALL Iz KITGHEN UP UP 0 OFFICE C cc29'-4" LIVINGIL 2 -11" BATH m BEDROOM � �q 0 a 0 J fD Q � Zj �w N � 7 �w 0 W LEZLiLLJJ c� °o � LL. � N 0 QC v :S v � Q U) o Lm v z O_ Z E— m w ED XN a N z L9 OZ 0 v DATE: 8/25/2020 n16, SHEET: P-2 MUNICIPAIJ'(Y OF ANCHORAGE DEPARTMENT OF I IEAI.TII& ENVIRONMENTAI. PROfECTiON ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl. INSPECTIQN REPORT NAME NEW MAiLiNG ADDRESS~!;0'' I~UPGRADE LEGAL DESCRIPTION LOCATION [ ' /~O ~ IF HOMEMADE: /width .J ~ / ~ ~o. ofl,/~ No. oflines j~Lengtl~ofeaci~e~ ~' Totaltength~hnes '-~ ].~[[,~,tofh~ishgrad~ ¢~ M~terial beneath tile ~ .... inches NO. OF BEDROOMS PERMIT PERMIT NO. PERMIT NO. PERMIT NO. · OTHER PIPE MATERIALS SOIl_ TEST RATING INSTALLER ~EMARKS APPROVED DATE LEGAL 'fiE!: Li!i{i",!(:i!-H Difh'l!i_::NS]:Oi'q :[:ii; ]lie L.ENG'f"II (tN FEE!-) ()F; THE FIlE DE:F'T'H ()I::' !:::! 'FI:~rE!"IC~i (Z)F~: F'iT Z::.i; THE: D!'~i;iI::!IqC:E E',E:I!'.IE[i?',! !'HE 'ii;Ui:;i:FF:!C:r!! OF: -IHE: (]iF;:()I.tN[:, FIND THE: iL?,OTT(:)t'"I CIF 'i"HI!:: !:fl;;;':;C:FI'v'FITZt:CII",I (Z[N FEE;T) -iHEIq:U iS i",!O SET I,t!DT'H !:::'()R TR:E:NCHE::S. -!'HE C!ii:,~:f::IVELL DELI:::'TH I':~; II'IE ?'! ]: N :[ PtLll"1 DEF"IH OF (]Iq:F:I',,,'E[. 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']O I:I'..!C:L!.I[:,E NOR'.C '[Ht::IN ~.]} ~; ~ EiF,!E:E:~ _ ........................................................................ PERFORMED FOR:__ LEGAL DESCRIPTION: SOILS LOG MUNICIPALITY OF ANCHOFI\~I~L~I?ALr~ DEPARTMENT OF HEALTH AND ENVlRONME[~ P, RO~EG'~'I. 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TES1 LoT · SLOPE PERCOLATION TEST SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 13 14 15 16- 17- 18 19 20 COMMENTS ~25-E 1971 WAS GROUND WATER ENCOUNTERED? N 0 S iF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE _ /60/ TEST RUN BETWEEN FT AND -- FT PERFORMED BY:. 72-008 (6179) EPiAJS MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval 1 Parcel I.D. 018-191-10 Expiration Date: `- 1 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 33 LOT 10 REM Location (site address) 3230 DE ARMOUN ROAD,ANCHORAGE,AK 99516 Current property owner(s) MICHAEL&SARAH REILLY Day phone Mailing address 3230 DE ARMOUN ROAD,ANCHORAGE,AK 99516 Real estate agent _ Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex E Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer [[ Waiver request for: _ Distance: Received by: Date: _ COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ _ 550 Waiver Fee $ Date of Payment 5ag �� Date of Payment Receipt Number 6,3t//On Receipt Number COSA# 0 5 e 9/1(43 Waiver# 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, 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. 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 installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 5/22/2019 oFl/t/tioo, 4.,4. * :•49 "6. DSD SIGNATURE / i1 System #1 Approved for J bedrooms 111 No. N. CB 0469 4N. 69 .•�'� System #2 Approved for bedrooms 1t /22/.1.9.. '/ Disapproved \���i Conditional approval for bedrooms, with the following stipulations: �llllll(((((fAU T "1/4 "CR Y F s-o pA`Sr/ihF�qHO c 1 �p``• 1�VICES \��`5��� By: k (-vv. Original Certificate Date: 6.- S / -w' l The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA)based only upon the representations 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: T12N R3W SEC 33 LOT 10 REM Parcel ID: 018-191-10 If more than 1 septic system on lot: COSA Checklist# of_ Structure served by this system A. WELL DATA f� Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm Date drilled 1971 Water storage tank volume NA gallons Total depth *65+ ft Well disinfected for coliform test? ❑ Yes ® No Cased to *40+ ft ® Coliform bacteria is Negative Z Sanitary seal is functioning correctly Nitrate N D _ mg/L ❑ Nitrate less than MRL (ND) Z Wires are properly protected Arsenic ND ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by FWCS Date of flow test for COSA 5/16/2019 Date of Sample 5/17/2019 Static water level at beginning of test 44 ft. Comments *Based on acoustic readings & MOA record docs. B. TANK DATA—8/20/2009 - 1500-gal C. LIFT STATION - NA Age of tank(s) 10 years ❑ Required maintenance completed Tank type/material SEPTIC /STEEL Age of lift station years Measured operating fluid level in septic tank 49.5" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 5/15/2019 D. ABSORPTION FIELD DATA— 105'L x 2'W x 6'ED — 0.6 GPD/SF = 1260 SF Which system tested (date installed) 8/21/2009 Adequacy test date 5/16/2019 ® *ALL standpipes present per record drawing Results El Pass For 5 bedrooms Total measured depth from grade 13 ft (max) Fluid depth prior to test 16 in Measured depth to pipe invert from grade 7 ft(min) Water added 950 gal ❑ N/A— pressurized field New depth 31 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1320 min depth into effective Z Code-required soil cover over field Final fluid depth 15 in ® System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced 1500 gallons If yes, enter date Comments/Deficiencies: *Original '82 system only visible standpipe was a cleanout and lateral was full of liquid. Presoaked 2009 system and switched diverter to 2009 field. MT will need to be found or installed in '82 field if to be tested in the future. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100' Z Yes if No _ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Z Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below Surface Water > 100' ® Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Z Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS 41P-. , AT G. ENGINEER'S CERTIFICATION ;:(s.....,(S...... . . �s' I certify that I have determined through field inspections and review I*�49 TH/\ * r of Municipal records that the above systems are in conformance / with MOA COSA guidelines in effect on this date. I r MICHAEL N. ANDERSON. . No. CE 9469 4v / COSA Checklist.docx 15/22/l9 4 A4OFESSIOt= 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 I"'~ \ ~t~ -- ~c~. \~ \1~ HAA# ~. GENERAL INFORMATION Complete legal description Location (site add'ress or directions) Property owner Mailing address Lending agency Mailing address Agent Day phone Day phone Day phone Address Unless otherwise requested, HAA will be heJd for pickup. ' .... NUMBER OF BEDROOMS: ..~' ",4 ' 3, 'TYPE OF WATER 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 Public sewer NOTE: ,X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, s~:uewwoo leUOp,!ppv :suo!~elndils 8U!MOIIOJ eql ql!M 'swooJpeq '9uuooJpeq Jo,L leAoJdde :!euoqlpuoo 'pe^oJddes!(3 ~ ._ Joj pe^o4ddv ~ =lblr~JJCNglS SHHO "9 U~aNI~DN::I ,AB NOIIO~]dSNI ..40 .LN:Ii~:~/VJ.S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LO-i-' ID -~Q ~;~,TI2N~t¢/ Parcel I.D. A. WELL DATA Well type ~ ~.S, Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. b,,/ Date completed I ~L.~ Cased to I 50 ADEC water system number Driller Casing height Wires properly protected (Y/N) Date of test Static water level FROM WELL LOG AT INSPECTION MUNICIPALITY OF ANCHORAGE SIP '1 7 99t Well flow Pump level g.p.m. L EIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RE~'5'M~TS: Coliform '"% _ Nitrate Date of sample: ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria El. SEPTIC/HOLDING TANK DATA Date installed (¢/,~1] ocz- Tank size /.~ ¢~'~ Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ High water alarm (Y/N) ~/~ Date of pumping ~/1~/~ I t'¢ Depression (Y/N) Alarm tested (Y/N) Compartments SEPARATION DIS'rANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To propertyline_ Surface water/drainage On adjacent lots >/t.~'~-~ _Foundation Absorption field ~Water main/serwce line h//A 72-0261Rev. 3/91) F¢ont MOA21 CONTINUED ON BACK PAGE C. LIFT STATION ~J/.z~" Date installed 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 ~ Width_ Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /-'~ System type Gravel thickness ~' Total depth Cleanouts present (Y/N) Date of adequacy test for ~r-'~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //.~ On adjacent lots ,~ /¢..~¢2 Property line To building foundation On adjacent lots Surface water Curtain drain To existing or abandoned system on lot t'///~ Cutbank ~'-///'/:k- 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 ef(e.cton the date of this inspection, Engineer's Name Date HAA Fee $ ,///,,,2,,~. Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 205 NEST I511h AVENUE SUITE ANCHORAGE, ALASKA 99502-7904 (907) 279-79t& RESIDENTIAL WELL INSPECTION LEGAL: [.crt. 10,~ Sectiorl 33 T12N,) R3W LOCAT I ON: 3230 DeArmc:)un Road OWNER: Bruce Ayer TYPE OF WELL: Pr:i. vat:e.~ SJ. ngle I::'amily WELL LOG AVAILABLE: No INSTALI_ATION REQIJIREMENTS MET:Yes WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: 5.5 Gal ].c)ns per M:i.r'lu't:.e DATE OF INSPECTION: Sep'l:.,. 3~ 1991 TEST PROCEDURE: Well was pumped at a cons'LarrY, rate while 't:he probe. Ak the bec. l:i. nn:i.r-,g fD'f t'.he test water level was fOLU"td at 3.6 · f:eet bet f::lw top o't: cas:i, ng. At: a pumpirlg rat. e of ,5.5 gal ] OhS per m:il'tU'L:e the wa'l:(,)r ].ev6)], dr(:)pped tc:) 57 .t:eet. a.f't:er ~¢ hours [:)~ pt..mil:) :i.i~:],, A '~:ol:a]. c:)F 750 ga:l, lf:]ns were pumped,, The rocc:)very ~as mc)ni't.'.ored for 75 m:i. nut. es, ~}LU'Jl](] '(:hJ.s 'U.~.f~e '~.h(a TEST FOR E.COLi AND TOTAL NITROGEN: Water was '[:es'l:.ed -For E.Cc)l:i. E,,Co] :i 0,, Total Ni'Erc)(Je[~ ND (Non(z, DetecEecl) Max,, a].]c)wab].e Total. Nitl"ogen 1() m(;~/]., TEST RESULTS: Thi s ~.~el ] ine~etc, 'Lhe r'eqLt:i, r emelrLs o',r' the t~lt..u):[ c:i. pal :i. I:.y o'f: TGIS WELL .W_ILI_ PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE T_HAN F_OUR HOURS ,::/ss~:.~sm(,;,nL o'F bl'lr~ condit:i.c}r~ o-F the ~e].]. app].ies c:)r'~].y to 'l/.l~e c:or~d:it:i.(::)rts as (::)f the day tes~tod. The 'f].c)w rate may clqange duct 203 WES'[ 15VH, AVENUE SUITE 20& ANCHORAGE, ALASKA 9V502-Jq04 (907) 279-3~16 SEPTIC SYSTEM ADEQUACY TEST LEGAL: I...o~: 10 Sect:i. on 33 TJ2n R3W LOCATION: 3230 DeArmoun Road OWNER: Bruce A y ~:,r RESIDENCE: S:J. ngle F'ami]y~ 5 Bedrooms WELL: F::'r':i. vate~ On Site SEPTIC SYSTEM: F:'RSM MLIIqIC:PAL RECORDS: 5 Bedroom System ]'ANK~ Grce~r Steol 1500 Gal. Two Cc~mparts. ABSORF:'] I ON SYS]EM: ABSCIRPTION ARI:::A: 756 Sq. Ft,, SO ]: I. RAF I NG ',', :1. 5C) I NSTALJ...A-I' I [JN DA']'I: ~ 6/2:1/82 DATE OF LAST PUMPING: Anch.. []ess F'ool Sept. 10, 1991 DATE OF TEST: Sept. ember :i3~ J. 99:1. ]'EST PROCEDURE: Sys'E<?m was :i. nspected and measured. 'Tank was · ~ound with 4 Feet o'~ cover and with a ].iquid level o'~ :1.5 :i.n(:::hes. Tr e~:ch (:..]. can OLd: was zl. 5 ~:eeE deep and dr"y. 'l"r'er'~ch mc>n:i. I::or 'Eul:)e was 9.,5 'F(z,,eE de)el:) with 47 inches o'f water,, :1.280 gal. ] ohs (:~-~ c] c~an watc.~r was adcied ~c:} Ehe b.r'c:er~czlq whJ. ] e Ehe water lc)vels in the I:ank and the monitor rude W~::re morl:Ltor-ed. The) wa~:c,.)r ]eve]. :i.n t:he ['.alfl<: d:i.d not. change~ whJ].e 'Eke l(...)ve]. :in the · For 5 I"~our's,. DLH"J.I"H;) Lb:is k~me 'El'it:, water' lev(Il :i.n El'to.i, mc]n:i.l:or' Izub[e dr'opped 5 :[l'~C:hes.~ :Lr~dic:at:Lng {:hat :~R:t() ga:l.:l, ons o.f wal::el" had [:)e:en TEST RESULT: Department the Health and Soo:iai. Services 'l':he Mun i c i pa:L :i. ty oF Ai](::hoi"Ar.:jt:~. NOTE The operational :l.:i.-Fe o'f ail septic sysEems:> depends Ol't the :L oc:al sol ]. (:(:3i'~(::1 :i. {::i. 01'~ :: ~ gl~'(]l.{ll CJWTI'{: E2r 1 e,.)vc~ ]. E~ th&v{] fllay .[ ]. estimate o'f how lc)rig th:is system wi:t:L ~l:rlC:]:iOI] sak:i.s;Eactor-Y 'f:or CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANAEYSIS REPORT BY SAMPLE for WORRorder$ 37882 Date Report Printed: REP 7 91 @ 11:56 FAX: (907) 561-5301 Client Sample ID:3230 DE ARffOUN RD. PWSID :UA Collected REP 3 91 @ 13:06 hrs. Received REP 4 91 ~ Il:SO hrs. Preserved with :AS REQUIRED Client Name :TOBBEN SPURKEAND, Client Acct :TORRENS Req ~ Ordered By :TOBBEN SPURKLAND Analysis Completed :REP 6 91 Send Reports to: Laboratory Supervisoi :~T_gP~tEN C. I)TOBBEN SPURKLAND, P.E. Released By : ~~ E~___~_/ 2) Chemlab Ref ~: 914565 Lab Srapl ID: I ~atrlx: WATER Allo}lable Parameter Tested Result Unit~ Method Eimits NITRATE-N ND(O.IO) ms/1 EPA 353.2 10 Sample ROUTINE SAHPLE C0[J. ECTED BY: STUART. Remarks: I Testa Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "See Sample Remarks Above }IA; }lot Analyzed ET=Less Than, GT=Greater Than ~G-~ Member of the SGS Group (SockRt* G~n~rale de Surveillance) / tt[~ALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAl. SYSTEM ~ARY I.~.YO I~ CO~PL~?~ BY ~IA ~chorage , / .__j~!cl~0~'_~g~_ A]-~i?..~ The l~irs t National Bank of [I 11-011427-203 t.~oa~Aoo~ o~ s~o~so~ ........................ ~o~f~d~ Bruce E. Ayer Jr. & Julia K. Ayer j~eA~mun Rd. Anchorage 99502 Sec~ 33, T12N., R3W., SM / 10 15 I.l Public system ~ Community system ~ Individual' 5 [(Ti Yes [~ No ,,o o,,i,~o, of t~,e [] S,~t~ Iii Co,,~, El ~ocal Department of Health that this individual water-supply system ]~j] is nor satisfactory asa domestic water supply for d,e subject prol~rly. C,,n he expected to function satisfactorily, mM [] Onnot be expected to function satisfactorily not likely to create an insanitm~ condition 6/b/72 .... Env~ : GREATER ANCHOF~G~ AReA BOROUGH Department of ~.kw'Jrenmental qtality 3500 Tuc]or Road, hnc'orage~, Alaska 99507 279~8686 Type of Facility to be Number of Bedrooms: ~" Seepage Pit: ]. Size ~ t;~', 2. Disposal F~e]d; Total Length of Lines Distances: A, We]]. To: Soptic Tank ............ , Absorpi;ton Area~_~_~___, Sewer Lines , Nearest I,ot l.lne _~-~'? , Other Contamination /~ Foundation to Septic Tank %0' ~> Absorptien Area ~d) ---~. Absorption Area to Nearest Lot Line ~ ~ ~ Request for Approval of L ~vfdual Sower & tNatey Fact].it;t6 Page Two Aoorove ~sapproved Dar / ~p~rova] Valid for One Year l~rom Da%e Signed ~r A~ago Area Borouf~h, Department" of ~nv:i. ronmenfial Qualify DIAGNAM Ot: SYSTEM :[ cerf, iCy ~ha~ fihe informa~;~on conf, ained in ~his reques'c far approval 'co be a t;rue arid accurate represe¥~at~on of the subject sewer and water ¢aci].tf, ies