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Home My WebLink AboutT14N R2W SEC 12 LT 1 OF 11TI4N R2W 12 Lot I of 11 050- 273 -09 GREA,-ER ANCHORAGE AREA BOk,..dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOS. AL SYSTEM SEPTIC TANK: DISTANCE FROM WELL,.~? INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY / ~ GALLONS. LINING MATERIALC/~/~//I~': CRIB SIZE: .UlLDING FOUNDATION '~/, DIAMETER DEPTH DrSTANCE FROM: WELL NEAREST LOT LiNE /0 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~' SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: DIAGRAM OF SYSTEM LOT SLOPE: REMARKS: 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PERMIT NO. DEPARTMENT ' HERLTH AIN[:, ENVIRONMENTRL ROTEI]:TION 825 '"L" STREET, ANCHORRGE, RK. 9;~501. ~PPLIC:FINT L. OCR]"ION L. EG~L LESTER SMITH. FOOTHILL [:,R L.i OF Lil SEC ±2 T:t4N E:O'X 83 E. R. LOT SIZE 694-23:69 ]:4225 SQI.JRRE FEET '¥"¢PE OF SOIL flBSORBTION SVSTEM IS: TRENCH NUMBER OF' BEDROOMS = ~: SOIL RRTING (SQ FT/BR)= i50 THE REQUIRED SIZE OF THE SOIL RBSORPTION S'¢STEM IS: THE LENG]'H DIMENSION IS THE L. ENGTH (IN FEET) OF 7'PIE TRENCH OR DRRINFtELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE Ek.',CR'v'RTION (IN FEET). ]"HERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFRLL PIPE FIND THE BOTTOM OF THE E'XCRVRTION (IN FEET). 6'RE:KFILLING OF RN9 SVSTEM WITHOUT FINRL INSPECTION RND RPPRO'v'RL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMIJM L I=1'MNLE BETblEEN A WELL FIND AN"r' ON-SITE SEb. IRGE DISP]SflL z,r.z, TEM IS :L00 FEET FOR R PRIVRTE WELL OR 200 FEET FOR A PUBLIE: WELL. SPEC]:FICRTIONS RIND CONSTRUCTION DIRGRRt'IS ARE RVFtIL.RBLE TO INSURE PROPER INSTALLATION. t ±: FOR]'H B"r' THE MUNICIPRLIT"r" OF RNCHORRGE. 2: I WILL INSTRLL THE S"r'STEM IN FICCORDRNCE WITH THE CODES. 2;: t UNDERSTRND THRT THE ON-SITE SEWEF:: S"r'STEM MR? REt.]UIRE RES I[:,ENCE~EMODELE[:, TO I NCLU[:'E MORE THFtN ]: E:E[?ROOMS. RPPL I CRNT LESTER SMITH i _,_,UE.[ ............. DflTE ......... CERTIFV THR]' I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET' ENLFtI~'.GEI'dEI'.,IT IF TIdE 08-E Russe# OVster 694 2774 Soils ~ Foundations Performed for: GEO'~ ~'CHNI CAL Er DEVEL~- PMENT CO. Box 90, Davis St, Eagle River, Alaska 99577 694-2774 or 688 P~2_80 SOIL LOG Ear/£///s 688-2280 Land Development Tel. No.~ Soil Cha~rac_ _~ Yes_ ._~ No~ If yes, what depth_~ i6 Ground Water Encountered: Proposed Installation: Seepage Pit _~Drain Field~_ Comments: '~"~-~' . , ~".,. k,.'~e ~',J. ~ ~ CERT Municipality of Anchorage 'Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 BEagaw, S~e~t P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 FICATE OF ON-SITE SYSTEMS FOR A SINGLE FAMILY Parcel I.D. 05027`309 1. GENERAL INFORMATION APPROVAL DWELLING ffctr~c,.~ O~P 1017-q7 COSA# 05CiOl~-~ff Expiration Date: 2 - 1-// Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent , Mailing address T14N, R2W, SEC12, LOT 1 OF 11 17122 FOOTHILL * EAGLE.RI~/ER, AK * 995.77 ............... MICHELLE SCHILLING Day phone 696-4410 17122 FOOTHILL * EAGLE RIVER, AK * 99577 Day phone VICTORIA BRINK W/ KELLER WILLIAMS Day phone 551-94,34- 101 W BENSON BLVB. SUITE 50`3 *ANCHORAGE, AK 9950`3 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] 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 INSPECTION BY ENGINEER As cerlified by my seal affixed hereto and as of the validation date shown below, t 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 t,~e 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 337-6179 Address .5701 E. TUDOR ROAD, SUITE.101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineerin~j'bnMySis.of the system in accbrdance 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. DSD SIGNATURE ~Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. Arsenic Advisow Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite CERTIFICATE OF 0N-S1-¢ 7: S APPROVAL Legal Description: WELL DATA Well type PRIVATE Date completed Total depth i20 T14N, R2W, SEC 12, LOT 1 OF 11 6/18/86 ff. IfA, B, or C provide PWSID# N/A SanitarY seal (Y/N) YES Cased to FROM WELL LOG Date of test 6/18/86 Static water level 80 Well production 10 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. 120 ft. g.p.m. Nitrate 0.126 mg./L. Date of sample: 10/5/2010 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal, Number of Compartments Foundation cleanout (Y/N) YES Date of pumping I 0 J /5 ]! o CHECKLIST Parcel ID: 05027309 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 10/6/2010 · 69 .ft. 5.03 g.p.m. YES YES 12+ in. Other bacteria 0 colonies/100 mi. Collected by: GE(;; Ltd. Date installed **'7/12/77 2 Cleanouts (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Pumper JR'S PUMPING ABSORPTION FIELD DATA Date installed **'7/:12/77 Length 20+30=50 .ft. Total depth*17/17.8 ft. Eft. absorption area 800 ft2 Monitoring tube YES Date of adequacy test: *'10/6/2010 Results (Pass/Fail) PASS ISOUTH/NORTH TRENCHI I'BELOW EXISTING GRADE TO Bo'FrOM OF WHAT ARE ASSUMED TO BE SUMPS I Soil rating (g.p.d./ft2o~, 150 System type DUAL DEEP TRENCHES Width 3. ft. Gravel below pipe 8 ft. 'Depression over field NO For 3 bedrooms Fluid depth in absorption field before test 10 in. Elapsed Time.: 225 min. Final fluid depth 10 Any rejuvenation treatment (past 12 mo.) (YIN & type) **SOUTH TRENCH TESTED. Water added 655 gal. New depth 1 6 in. in. Absorption rate >= 450+ g.p.d. NONE KNOWN If yes, give date - PRESOAKED WITH 2210 GALLON OF WATER ON. 10 0. D. LIFT STATION Date installed "Pump on" level at Datum ~ E. in. Size in gallons Manhole/Access (Y__~_) ~ "Pump off" leveL.aL-------inT-'"-- High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: '79'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ ,in. On adjacent lots *96'+ On adjacent lots '79'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ Water service line Curtain drain NONE COMMENTS SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'.+ 10'+ KNOWN *SEE ATTACHED Absorption field 5'+ Surface water. 100'+ NORTH TRENCH/SOUTH TRENCH Building foundation **UNKNOWN Water main N/A Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots. '93'+ 1'+ WAIVER REQUEST. **RELATION OF SOUTH TRENCH TO GARAGE SLAB UNKNOWN. 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 with MOA ,COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fees Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number AS-BUILT I hereby certify that I have s~eyed the folloveln§ described property,:, iL, o ?' ~' ~ "' '~'" "~ ' ' :',.-,i :, ~ ..,,.. ,; ~,,.. .~? , :,,, .... .: i .... . ,.e..... J'7-.-.: "i"! ~..~, ;l,j' . . . . ,, x. k-"' ..?/':';'~ AneZorage Reco. rding Precinct, Alaaka, and that the imp. rove- om~m? ~itua~ed me?on .? within ~he F~ope._n~ lines and ~io not ~ap or en~oacn on me property Iy~g adjacent thereto, that onn° .,m~prove-m. en~ on pro. p~ 1.y~g adjacent thereto enctbach nrne premises m quesaon and [hat there am rte roadways, transmission tines or other v~ible easeme_~ts on said ~xcept as indicated hereon. Dated ~t Eagle River, AlasI~ ROBERT C, }OHNSON : ...... . SCALE: Registered Ln_nd Smvevo~ No. I~80-LS i" = .~. ~' BOx 77-0456, Eagle R~v&r, Alaska 99577 Phone (907) 694-2543 SGS ReL# 1105359001 Client Name Garness Engineering Group, Ltd Printed Date/Time 10/08/2010. 16:44 Project Name/# T14N,R2W,SEC12,L1 OF 11 Collected Date/Time 10/05/2010 11:45 Client Sample ID T14N,R2W,SEC12,L1 OF 11 Received Date/Time 10/05/2010 12:45 Matrix Drinking Water , Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/05/10 10/06/10 KDC Waters Department TotalNitrate/Nitrite-N 0.126 0.100 mg/L SM20 4500NO3-F B (<I0) 10/05/10 AYC Microbiology Laboratory E. Coli Ne~;ative I 100mL SM20 9223B A 10/05/10 DLC Total Coliform Negative I 100mL SM20 9223B A 10/05/10 DLC ARCTIC PUMP & WELL INC. Jim Sullivan, CPI PO Box 770197 Eagle River, AK 99577 (907) 658-2510 (907) 258-2510 apw~gci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: Legal Description: T 14N R2W S12 Lot: 1 of 11 Block: Property Owner Name & Address: Michelle Schilling 10023 Chandalar St l~'~ol~ Rix~r AI~ Pump Installation Date: 10/14/2010 Pump Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Pump Size: Pump Model: hp Pitless Adapter Burial Depth: Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Arctic Pump & Well, Inc. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Well permanently decommissioned by procedurel 5.55.060L. c. Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 o fl Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchora,qe, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 http:llwww.muni.or,qlOnsite Development Services Department On-Site Water and Wastewater Pro.qram partment **** VARIANCE/WAIVER REVIEW **** WR#: OSP101247 HAft: OSi:::101265 PIDft: 050-273-09. Legal Description: T14N R2W Sec12 Lot I of 11 Engineer: GEG Permit/C: Applicant: David Schilling Your request for multiple waivers regarding the subject property's well and septic system has been approved. The waivers are approved as detailed below. 1. 79 foot separation distance from the subject property's well to subject property's septic tank. 2. 79 foot separation distance from the subject property's well to the drainfield on Smart Lot 1. 3. 96 foot separation distance from the subject property's well to the septic tank on Smart Lot 1. 4. 93 foot separation distance from the subject property's drainfield to the well on T14N R2W Sec. 12 Lot 4 of 11. This waiver approval applies to the specific separation distances as detailed above. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: 1.~1~1~ App db eY' '~ 'Sf Reviewer Recft: 090976 Amount: $1050 Date Paid: 10/22/10 **** VARIANCE/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS :,,~:::~ :~;', ,, ~ October 22, 2010 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Multiple Waiver Requests for T14N, R2W, Sec 12, Lot 1 of 11, To whom it may concern: Properties Well to Properties Septic Tank: The existing 3 bedroom house is served by a private well and septic system. During our site investigation work to obtain a COSA, we discovered that the well on the subject proPerty is only 79 feet away from the existing 1000 gallon septic tank on the subject property. We request you grant an-8-1-~ot separation distance waiver from the well on the referenced property to the septic tank. The following items are justification for the waiver: · The well and septic system are on opposite sides of the house. If effluent were to surface, it would be unable to travel towards the well head. · The existing encroachment has existed for over 24 years. · Attached is the well log for the referenced property. The well depth is 120 feet. The soil appears to be variations of clay, gravel, & sand. · The lawn is neatly groomed, so if the tank were to overflow, the effluent would be obvious and the problem would be addressed immediately. · We are only asking for a 21% variance. · Recent water samples results indicated no bacteria present and nitrate levels to be 0.126 mg./L. In short, the water quality is within MOA, state, and EPA requirements. Properties Well to Adjacent ProperW (Stuart Lot 1) Absorption Field & Septic Tank: The existing 3 bedroom house is served by a private well and septic system. During our site investigation work to obtain a COSA, we discovered that the well on the subject property is only 79 feet away from the absorption field & 96 feet away from the septic tank located on the adjacent property (Stuart Lot 1). We request you grant a 79 foot & 96 foot separation distance waivers from the well on the referenced property to the absorption field & septic tank on the adjacent lot. The following items are justification for the waiver: · The existing encroachments have existed for over 24 years. · Attached is the well log for the referenced property. The well depth is 120 feet. The soil appears to be variations of clay, gravel, & sand. · The lawn is neatly groomed, so if the tank and/or drainfield were to overflow, the effluent would be 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com obvious and the problem would be addressed immediately. .We are only asking for a 21% variance & a 4% variance.. *Recent water samples results indicated no bacteria present and nitrate levels to be 0.126 mg./L. In short, the water quality has not been adversely impaired by this encroachment. Properties Absorption Field to Adjacent Properties Well (T14N R2W Sec 12 Lot 4): The existing 3 bedroom house is served by a private well and septic syStem. During our site investigation work to obtain a COSA, we discovered that the well on the subject property is only 93 foot away from the absorption field on the adjacent property (T14N, R2W, Sec 12, Lot 4). We request you grant a 93 foot separation distance waiver from the well on the referenced property to the absorption field on the adjacent lot. The following items are justification for the waiver: *The well and septic system are on opposite sides of the driveway. If effluent were to surface, it wou very obvious to the homeowners and they would be able to address the problem immediately. .The existing encroachment has existed for over 24 years. *We were unable to locate any other well logs except for the one for our referenced lot (T14N, R2W 12, lot 1 of 11) which is attached to this waiver request. The well depth is 120 feet. The soil appears variations of clay, gravel, & sand. '.The lawn is neatly groomed, so if effluent were to overflow, the effluent would be obvious an, problem would be addresSed immediately. *We are only asking for a 7% variance. *Recent water samples results indicated no bacteria present and nitrate levels to be 1.48 mg./L. In the water quality has not been adversely impaired by this encroachment. We are unaware qf any adverse impacts this would have on adjacent wells or septic systems fro~ granting of these x~aivers. If you have any questions, please contact us at 337-6179. Thank you for assistance. i x~f~f ~ ~.~G'~,l~essi P.E., M.S. mre~/t7 ~ ld be , Sec to be the lOrt, the 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com - F o o~-h-TL~--A v e n u e I ~ / T14N R2W SEC 12 I ~T 1 ~TUART LOT J , ~ SCALE: ~GLE RIVER RO~ MICHELLE SCHILLING 276-4665 I 1 or 1 ~¢'..~e~freyA. G~,' WAIVER REQUEST 10/19/2010 (Rev. 01/05) // .- GREATER ANCHORAGE AREA BOROUGH '3330 "C" Street., Anchorage, Alaska 99503 274-4561 ~ / j~ ~~ Date Received June 21, 1976 u ..... -J~ '. Time of Inspection 2:30 p.m. ~ Date of Inspection ?-Z-?6 ~e~Ze REQUEST FOR APPROVAL OF Thursday INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: 3, 4. .5. '6. Mailing Address: Property Owner: Mailing Address: Area Inc. % Myrna Johnston Post Office Box 249, Ea~e River Phone: 694-9555 Lester L. Smith Phone: 694-2369 Post Office Box 83 Legal Description: T14N R2W Section 12 Lot 1 of 11 Location: Type of facility to be inspected Single Family Well Data: Individual A. Type C. Construction Sewage Disposal System: A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines ~eet Myrna at the Area Realty Ea~le River office. No. of bedrooms , Absorption area Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank .C. Absorption area to nearest lotline B. Depth D. Bacterial Analysis , Other contamination , Absorption area , Sewer Lines EQ-034 (1/74) Page 1 of two pages 1 2. 333p Department of Envi ronme~.tal qual i t~UNIClPALITY 'C" St.~ Anchorage Alaska 99503 27aDq)~(~HEA~TH& ~ ENViRONmeNTAL PROTECTION; REOUEST FOR APP2OVAL OF ]~I~FJ~L×~WATER' FACILITIES Type of Ins'pectio.~: JUN 3 1 1976 VA FHA CONV Propewty Owner: ~$~ ~.0. ~o× 83 Mailing Address: ~agle ~lver, ~ 99577 3. Name of Buyer: ~/~ NailipQ Address: ~. 2ame of Lending Institution: ~/A Da.y Phone 694-2369 e Day Phone -, Mailing Address: Name of Realtor or Agent: Phone ,Myrna Johnston, Area, Inc. Realtors 'Mailing Address: P.O. Box 249 Eagle River, AK Legal Description:' - T14N Location: Approximately Phone 694-9555 99577 R2W Sec 12 Lot 1 of 11 1 mile E.R. Rd. turn"l.eft one street short of .Genora St. whit~ w/qreen trim Type of Facility to be inspect'ed: ~later Supplyi, .(only) Type '~f S~pply: PuSli'c -2nd house on riqht. -'. ,.' .- N01 Bd~msl Individual x ' ....... ' Utility dWelli'ngS, pre'sexily se~ed 1 ' If' Individual','number of If Individual, depth of well Sewage Disposal'System Type,of S~stem: Public Utility '~ndividual (on-site) _.If..Ind~v'idual, date of installation Rea~to~ will have key page 2 of two pages - Re~-~t for Approval of Individual .?-Aer & Water Facilities 'Legal Description T14N R2W Section 12 Lot 1 of tl Comments: Approved Disapproved Date ~l~,~i Approval~Valid for one year from date signed Greater Anchorage Ar~a 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)