The URL can be used to link to this page

Home My WebLink AboutTALUS WEST BLK 1 LT 13 Municipality of Anchorage(~ FLge ~ of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL 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: ~lff./' ~C3 ~. ~ PID Number: ~/~-- ~ I -- ~ ~ Name: ~lZ~k ~ ~ ~ I~A~ ~ Wastewater System: D New ~Upgrade Address: ~ . It~7~ ~,~[e~'~ ~c~ ABSORPTION FIELD Phone: Nc. of B~oms: ~Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION SoJlRating: ~ GPD/Sq. Ft. Total Depth from~ginal grade: Lot: /~ Block: ~ ~L~Subdiv~i°n:~'~ 0epth to pipe bottom from. oriainal~r~d~: Ft. ~ Gravel depth beneath pipe ~ Ft. Township: Range: Section: Fill added above or'g'n~l grade Gravel length: Number of lines: Distance between lin~: WELL: ~ New ~ Upgrade Gravel width: ~ Ft. / ~ Ft. Classification (Private, A,B,C): Total Depth: Ft. Cased TO: Ft. Total~absorption.~/~c~.~area: ~SQ. Ft. Pipe~aterial~(~l. 0 ~ Driller: Date Drilled: StaticWaterLevel:Ft. Installer~ Dateinsta~led: Yield: GPM PumpSetat: Ft. CasingHeightAboveGround:Ft. TANK SEPARATION DISTANCES ~ septic ~ Holding ~'S.T,E,P. TO ~ Septic Absorption Li~ Holding 3ublic/Privat( Manufacturer: Capaci~ in gallons; From Tank Field Station Tank Sewer Lines ~J~C~ ~ ~ Material: , Number of C~a~ments; Su~ce ~ LIFT STATION Water '" Lot Size in gallons: Manufacturer: Foundation b / '~ ~ j "Pump on"~,~z/level at: "Pump~.~o," Ieee at: High water~ala, at: Gu ~ain Pump Make & Model Electrical Inspections pedormed by: 5~ ~ BENOH ~ARK Remarks: J Assumed Elevation: ENGINEER'S SEAL Inspections performed by: ~ Dates: 1st ~ "~:': .... Reviewed and approved b~'~ ~ Date:~-~-°~ :::. ,~,, 72-013 (Rev. 9/91 ) MOA 25 SPURKLAND NO, CE ~5 ,50 Fr. 12~ 150 TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (997) Z79-~1~ LOT 13, BLOCK I TALUS WEST 11875 WILD£RNESS DRIVE MIKE FRIZZEZZ£ SEPTIC SYSTEM AS BUILT DATE: OCL ~ 1995 SHEET: 2/$ GRID: 2758 25 $/16" HOLES @ 12" ABSORPTION TRENCH IC) 5 Ft. of Cover 4" Topsoil 102~ 1-1/4" Discharge 95. I 91.1 d FT. Sewer i-lAd" Distibulion Pipe /dirafi 140 91.1 90.9 no Groundwaler or bedrocfi POMP: MEYE£S SSM4....4/IOHP. BIOCYCLE PLANT BENCH MARK: T~P OF V/ELL CASING ASSUMED ~LEK I00.00 ET, TOBBEfl SPURKLAND P.E. 205 W 15TH. AVENUE AK. 99501 BIOCYC£E AERATED TREATMENT PLANT LOT 15, BLOCK I TALUS WEST 11875 WILDERNEDD DRIVE II SEPtiC SYSTEM AS BUILT DATE: OCT. 5, 1995 SHEET: 5~5 GRID: 2756 PHONff ~1;'846-4080 l,,OTt 1 BLOCK: 9U~VIg~ONI ¢OMMEN~8; TYPB O~ INSF~C~ION: il 3 ~0 NONOOMPLI~N~£ OBBB~VBD ~ 3 WILL BBBXAHIHB A~ NBXT INgP~C~ION NOT ~MOVB ~I.,IIS NO~IC, B MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW950286 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:FRIZZELLE MIKE O OWNER ADDRESS:il875 WILDERNESS DR ANCHORAGE, AK 99516 P.E. (UPGRADE) PERMIT ~f~/%q DATE ISSUED: 9/20/~- ~ EXPIRATION DATE: 9/20/~6- PARCEL ID:01520136 LEGAL DESCRIPTION: TALUS WEST BLK I LT 13 LOT SIZE: 19649 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /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 (18AACS0) . 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: THE WASTEWATER DISPOSAL SYSTEM INSTALLED UNDER THIS PERMIT IS AN ALTERNATIVE SYSTEM UNDERGOING EVALUATION T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Upgrade permit for Septic System Lot 13, Block 1, Talus West July 10, 1995 Gentlemen; The existing system for this lot is not performing satisfactory and must be replaced. ERES ( Lou B utera) investigated the system and the replacement possibilities and concluded that an "innovative" system would be appropriate. Due to the density ofthe wells on the adjoining lots a standard system would not fit. We propose to install a "Biocycle' package plant. The location of the tank and two possibilities for a drainfield are shown on the siteplan. The location based on ERES soil investigation is desirable, because it will cause less disruption to the vegetation on the lot. Both locations will probably require a waiver for proximity to slopes steeper than 25%. The location in the north-east comer of the lot is closer to a steeper bank than the location proposed by ERES. Please review and comment. Yours T~b~b e~'An ~purklAf~~ RECEIVED JUMAt~ (KL A ? l-) / LZT1- 3 I~ I LDT / LD 13 LOT H AVE. ~? 13 15 LOT L[77 ll 100 150 SCALE: 1~' = lO0 FL UN])EVEL DPE]2 It ~ fffel1 TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 i, OT 13, B£OCK I 11875 WILDERNESS DRIVE MIKE FRIZZELI_E SEPTIC SYSTEM DESIGN DATE: JUNE 12, 1,°,9,5 SHEET: 1/5 GRID: 2758 ~.5 0 £.5 \ \ 50 7.5 ldo SCALE: l" = 50 FT, 51 EN SPURKLA~ No, CE 2225 TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 f907) J J LOT 13, BLOCK 1 TALUS WEST S/D 11875 WILDERNESS DRIVE kflKE ERIZZELLE II SEPTIC SYSTEM DESIGN DATE: JUNE 12, 1995 SHEET: 2/3 ORID: 2736 ABSORPTION TRENCH -0 SECTION A-A 4" Halfpipv 6" LONG 1-I/4 PVC Holes Pointing Up $ Ft. of Cover 4" Topsoil !- I/4" Dischorge -- Sewer Rock OistibuNon Pipe k/irofi 140 BIOCYCLE PLANT BENCH t#ARKL: TOBBEN SPURKLAND P.E. 205 W /5TH, AVENUE ~gNCN AK. 99501 057 279-J916 BIOCYCLE AERATED TREATMENT PLANT LOT 15, BLOCK I TALUS WEST 11875 WILDERNEDD DRIVE SEPTIC SYSTEM DESIGN DATE: JULY 10, 1995 SHEEh J/5 GRID: 2756 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERPORMED POR: LEGAL DESCRIPTION: 10 11 12- 13- 14- 15- 16 17- 18- 19- 20- Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 IF YES, AT WHAT O DEPTH~ p E Depth to Waler After Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~ o ~ I ~ '7 '///~ PERCOLATION RATE /~-~-- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ ET AND 7~/~-~ FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: 1~ ?.,q t, I '7~/~/?x Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 SLOPE SITE PLAN 13 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Ih to Waler After Moniloring? ~ Date: S L O P E Reading Date Gross Net Depth to Net Time Time Water Drop ~'"er~ Z/~'/~;¢- I~,: /~ /¢"-.,.~' :~,~-~ / ~/~"' 14 15- 16- 17- 18- 19- 20- PERCOLATION RATE '/~" (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN .5- FT AND__~ FT COMMENTS PERFORMED BY: ,~r~ 4~-,~ ' ~~~::~ CERIlFY THAT THIS TEST WAS PERFORMED IN ACCOROANCEWITHALLSTATEANDMUNICIPALGUIDELINESIN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85~ Rick Mystrom, Mayor Municipality of A chorag¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Dear Ho~neowner/Prospective B~uyer~' i : The on-site wastewater disposal you are !~terested in purchasing is an "alternative" wastewater disposal system. This system, known as a "Biocycle Aerated Wastewater Treatment System", is undergoing testing within the Municipality of Anchorage under the Altemailve System section of the Wastewater Disposal Regulations (AMC 15.65). There are certain risks involved with the ownership of one of these systetns: This system has been shown to be effective in ofl~er areas..The system is currendy undergoing a two ye. ar, testing period in Anchorage under the guidance of the.D, epartment of Heh!th and Hmn a,. ¢ Service§ (DHHS) and the State of Alaska Department of Enviromnental Conservation (ADEC) to determine its effectiveness in a subamtic enviro~m~ent. Tes~g results on systems installed in 1994 have been very encouraging. Copies of initial test results are available from the DHHS. The Biocycle system has not been tested and approved by the National Smxitalion Fomldation (NSF). Currently, Anchorage Municipal Code for Wastewater Disposal Regulations requires proprietary equipment to have NSF approval. This approval or changes to the Wastewater Disposal Regulations through Municipal Assembly action will be necessary prior to this system being approved as a standard system. The "Biocycle" system for this property may have received vertical separation distance waivers from both State of Alaska and Anchorage Municipal Codes to both ground water and bedrock. These waivers were granted due to the system's expected performance within the site conditions on this property. If file test results do not support these waivers, modification or replacement of this system may be required. If this system fails to meet the requirements set for it to become a standard, code approved wastewater disposal system, it may have to be removed and replaced by either a holdthg tank or (if possible) other wastewater disposal system that meets Mm~icipality of Anchorage requirements. The cost of any conversions required to meet code requirements will be tile responsibility of th~ homeowner at file time of conversion. I (we) certify that I (we) have read the above statements and mn (are) aware of the risks outlined. I (we) also certify that~re) in file process of purchasing (property legal description): ////~' ~m;) - (Purchaser Name) (Purchaser Signature) (Purchaser Signature) otarize Here PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM Tiffs agreement, dated ~ \ L~ 199 q,~s made between the Muuicipality of Anchorage Dcpartmeut of Health and Human Services (DHHS) and me property owner(s) This agreemeut is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The pruperty owners agree to the ~ollowing: Allow the Nlunicipality of Anchorage the Perpetual right of entry to the property during normal work/ng hours, to 'allow for effluent sampling or evaluating the general state of repair or function of the system. Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement fi'om a registered professional engineer. This k, spection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, aurl that any deficiencies have been repaired and that the system is functioning as deslgnc~. Z~ ,/, /~~~) (Signature) (Printed Name) (Notarize Here) (Printed Name) //lllll,l~~ ~ -~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~d~ ~ SEPTIC ADSORPTION Phone(s~/~ Permit .o. NO. of Bedrooms WELL LEGAL DEeCRIPTION LOT LINE ~ownshJp. Range, Section AS-BUILT DIAGRAM (Show location of well septic system, propedy lines, foundation, TYPE OF SYSTEM / ' Gravel length Gravel w~dth X ~ ~ ~ X Health Depadment Approval: ///~ Date: 72-033 CORWlN & ASSOCIATES, INC. :[000 E. Dimond Blvd. Suite 205 ANCHORAGE, ALASKA 995:15 (907) 522-:[311 FAX (907) 349-2236 / / / SHEET NO OF CALCULATES BY CHECKED BY SCA[F DATE Iff U N J: L; i I:' A L. ;.": 'T Y E! F ~'.~ Ixl C H E! F;: ~ (:i Pea [] N !-;~ ]: 'T E: E~ IE !4 IE R !:::' E! I:R F'I ]: 'J' , ~ .......... dp g r .~!. d ~-~, ~ ~ ].?.?.27. ]..:I:L(~E; CII-RC;LJii: TP, NI'::: :I PI ± r~ have? ,~. t. THE: UF:'E;f:;'.i:~DE ~3Y!~i'f'IE['-'l P![JST B!i~ .~:NE~I~-~!..LE:D Dlf:~.~:!:(aN O[¥i'E:D 7/17/~/C~,, [)EPTH (:IF- THE k!ED THE E~EF"T:[C -H.qql":: P!U(BY :Eg!E EXF'E)E~ED /~}~1[:) F:'/q"I:i:I..Y F/E[Si).)I::IqCE[ EINt..Y~, (.UqD I:~:Xi:::'J:F;;!i~:S i:]ixl fc.,rth l:ly 'Lh~:~ l"lu.i'~:[i::::i.i::ta:L:i.'t.y c)f F~rlc:i'iclr'ad(~.:. (I"iE]{~) and '~'.h~ E;t. at.~:~! (:)~ t ,4:i.:l.l :[ru~i'l:.c~:!.i t.l'l(':e [~rv~i~ct.E~m :in ~::u:::c:c~rda['Ic:(~) ~,,.~:i'!'.l't ali l~'JJ.:J~.l c:(:~c!e)~s and PERFORMED FOR: LEGAL DESCRIPTION: 4- 5- 6- 7 8- 9 10 11 12 13 14 15 16 18- 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 7"'~.~...C ~'~T"ownship, Range, Section: SLOPE SiTE PLAN WAS GROUND WATER ENCOUNTERED? /' Gross Net Depth to .Net Reading Date Time Time Water Drop ~, ~o 7~ ~ la ~//,, ID~ ,,2, ~ o,~ o,~1 PERCOLATION RATE ~/~'~ (mingles/ii, ch) PERC HOLE DIAMETER PERFoRME~ BY:' ~B.~ J ~'~U I //~'~'~//~ ~CERTIF~TH~'IS TEST W~S PERFORMED N ACcoRDANCE'wITH *,L',*TE AND ";.,C ~ALGUIDE~..~ ~ EFFE ON THIS OATE. DAT~' 72~8 (Rev. 4/~) ~N THIS [ : · ' Municipality of Anchorage OEPARYMENT O¢ NEALTH & 825 'U' Street. Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION 5- 6- 7- 8~ 9 12 2O '~J..~ ~'~'~wnship. Range. Section: GREI ANCHORAGE AREA BOR Dop~rtm0nt of Environmental Ouality Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~(~l[[/~O ]~L(~P/~'/~ MAILING ADDRESS-~~, ~' A /~gX LOCATION '~/I.~g ~L~'~ - /L~g~_f.~)%~) A/Z-F/~ LEGAL DESCRIPTION /~)~'1.~ SEPTIC TANK: DISTANCE -- FROM WELL '~) INSIDE LENGTH ~Z MANUFACTURER'--';:~F~-~(~,I~ ~'~-D (~)- MATERIAL NUMBER OF COMPARTMENTS 2 INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY J g20(~) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER ___ OR WIDTH/~.~,/ LENGTH4-~: DEPTH ~,~ ' LINING MATERIAL~- f~Y~¢T~ C~R~ SIZE: DIAMETER ~ DEPTH~ ~(Z- DISTANCE FROM: BUILDING FOUNDATIOM ~0/~ NEAREST LOT LINE ~ ~. TOTAL EFFECTIVE WELL (~ / ABSORPTION AREA (WALL AREA) ~-~) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE il~ll)ll/ll3l"~ CONSTRUCTION BUILDING /(~ f,/_ NEAREST~ I NEAREST /~) /~ SEPTIC FOUNDATION LOT LINE eJ SEWER LINE TANK CESSPOOL tOL~IO~Z OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM f~g~ ! DISTANCES: PIPE MATERIAL: LOT SLOPE: ~}¢~F~L REMARKS: DIAGRAM OF SYSTEM DATE,<~~. APPROVED G.A.A.B. Form PW-026 GREATER ANCHORAGE AREA BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AHD PERMIT I=INAL INSPEC¥1ON~ 24 HOUR NOTICE REQUIRED. BACKFILLII~G HE&I. TH DEPA~'rMENT AUTHORITY WILL BE SUBJECT TO PRO.LC TO NEAREST LOT LINE, WATER MAIN TO SEPTIC TANK . ~ / SE~IC TANK, ~ , SEEPAGE PIT ~.~, DRAIN FIELD 70 RIVER, LAKE, STREAM, 4 INCH DIAMETER CAST lEON SIPHON PIPES ON SEPTIC TANK ANC~ SEEPAGE PDT FITfED WITH AIRTIGHT REMOVABLE GRAVEl.. BACKFILL, 9 -21 -'/2 ORGANICS ORGANIC SILT SANDY GRAVEL (SW-GM) TRACE SILT SiLT / WITH SOME SAND, SOME GRAVEL Med. Dense (SM-GM) 0.0~ 1.01 SAND ( S P) i~O_ SILTY SANDY GRAVEL gl W / COBBLES (G M) No Water Table Note: Hole excavation with Engineering ~ Geological Consultant8 DATE 9-:50-72 !$,CALE I"= 2' IOWN eY G.A.W. 15.0' tractor mounted backhoe. Howard Nugent Property LOG OF TEST BORINGS Anchorage Alaska , JCHXD ~¥ W.E.D. JPROJ. NO. 26540'5~ DWG NO. A-OI 'September 22, 1972 SOILS TESTS RESULTS, R & M ENGINEERING Howard Nugent Lot 13, Block l, Talus W~t Subdivision O-l.O: organics 1.0-2.0: organic silt 2.0-3.5: Sandy. gravel with 3.5-8.0: Silt with 8.0-9.0: sand, trace of silt, 9.0-15.0: Silty sandy gravel some silt. fine sand, some§ravel, medium grain, with cobbles, S.W.-G.M./t¢~p~ medium-dense. medium - dense. G.M. NO WATER TABLE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of EnvironmenTal Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519~6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A S INGLE FAMILY DWELLING Parcel I.D.# et ,~' --~-ol - '5 (~'-~ 1. GENERAL INFORMATION Complete legal description LO'i- ECEIVED APR 2 4 /~UNICIPALITY OF ANCHORAGJ~ I:NVII~ON/~NTAL 8~RVI~$ DIVISION 13 Location (site address or directions) I! ~ 7 S"- P~'oPerty owner-. .~ ,, ~;"~M'a~ili r~g address. .,"'l'en~Jing agency ?:Ma ng address Dayphone ~ ¥5- -¢3 ~ Day phone Agent Address Day phone Unless otherwise ~equested, HAA will be held for pickup. NUMBER OF BEDROO MS: TYPE OF WATER SUPPLY: Individual welt 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 O F WASTEWATER DISPOSAL: Individual on-site NOTE: Holding tank Community on-site Public sewer tf community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-o25(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. Name of Firm $ & S ENGINEERING 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 EngineeCssignature --1¢/~//F~ Phone G ~l.'~ - ~-0/7ff Date DHHS SIGNATURE Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 engin;3e~r registered in the State of Alaska, The DH HS does this as a courtesy to pu mhasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employess 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. Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVlC~ C E IV E D Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907~3R3~r41998 · . .Municipality of Ancho"age Health Authority Approval CnecK i~&pt. Health & Human Services / '7-,¢~.~.,5' J,,~'7- ~,~//~ParcelI.D.: 0 A. WELL DATA Well type _,4 ~ Log present (Y& ,~ o Date completed Totaldepth ~j~/~ ('¢'44 '~.o. 4.F,L~s/)3asedto Sanitary seal 0/N) '¥ FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number i ~/ "7 ~._ Casing height (above ground) Wires properly protected (~?N) AT INSPECTION Date of test Static water level ~/'" g,p.m. Well production WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: B..~-D-T4CM.~DLD,"NG-TANK DATA Date installed ci/a"7 /~'~-- Tanksize /6°0 (; .7 -¢ g.p.m. Collected by: Number of Compadments __ Other bacteria 0 S & S ENGINEERING 17034 Eagle i'dver Loop ~,oaa No. Esgle River, Alaska ~9577 z;} Cleanouts (~N) ,v,~ ~/ Founda!!? cleanout .~)/N) ¥ r~ ..~ Depression (Y/[~ /'''0 High water alarm ~N) ~ ~ Date of pUmping ~ / ~ :; Pumper -- C. ABsoRPTION FIELD DATA ~ 7/t~,4 ,~'~ ~/~7 /~7 b/4~ ~ Dateinstafled ~/~9~?~-- Soiirating (g.p.d./ff'o~. /%O Systemtype Length &~6 '/~ Width ~ ~ Gravel thickness below pipe O, &" Tota depth ~' Effective absorption area ~?~ er ~ Monitoring Tube present ~N) )'4J Depression over field (Y~ ~¢ O of te.t .or .e ,oom. Fluid depth in absorption field before test (in.); ~% Y Immediately after ~'¢~gaL water added (in.): ~ Fluid depth D~ y (ins) Minutes ater: ~ ~ Absorption rate = ~ 0 0 ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~& ~0,¢~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION C/'~/O Date installed c//~-'7 / ~ ~ Manhole/Access ~/N) '¥~- $ High water alarm level at* ;~ ;~ '/~-" Cycles tested ,~ / 4 Size in gallons "Pump on" level at* *Datum 7-o :~ )6oo "Pump off" level at* k' E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots /0o V-~ ) O0 '~)- ~ / ,,l Public eewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~'~ -3- Property line $' ¥ ~Absorption field Water main/service line )0-,~- .Surlacewateddrainage /'0o '~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line )O /_,L ' · Building foundation / 0 Wells on adjacent lots Water main/service line Surface water ./o 0 -/- Driveway, parking/vehicle storage area Curtain drain /,J 0,~ ~ k,,.'o w /,..., Wells on adjacent lots /oo ENGINEER'S CERTIFICATION In conformance with MOA 12iA,~ g~Jidelines in effect on this date. En ineer's Name ,~0,3 ~./Z~-- ~" /"~^, ,,.~ · , i~.~;t~ :.~t ~ ~ow^ HAA Fee $ Date of Payment Receipt Number ~ ,,~? 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ...... .. ~ .......... ... BIOCYCLE.,ALASKA. ..s~.:[o~-.:::[~.?: ~}UARTERLY MAINTENANCE REPOR~ '" D~gof.i,his$c~ice:'/'~..~ Tim~: __-- ,ANAEROBIC CHAMBER I C&ARIFICATIO.,N TANK . · :":.' ; . . AretheOverflowlunctionsClcar'/(~ AnyU~aoc~.ptableOdoura? .[~ ' ~*eChlofincC,.nisl*~Cl.n.and'a~t? ~ Ar;lhcChlo~oC~nid.tLi~0On? ~ .. · * T~k Cl~O~ . ~ thc Liquid Colour Cl~m? Commm~ . . , ;...~ . .';.''' .,. ~GAT[O$ SYSI~ AN~YSE~ ~t~ :" .~j/M~W-23-~.9~? 12:~5 CT?/E ES1 RNCHOR~6E CT&E Client Name Proj ~'t Name/// Client Samplu ED Matrix I~WSID Sample P.~m~rks; Client PC~ 41491 Printed Dat, edTime 05/23/97 10:46 Collected DatedTime C~/12/97 00:00 Received DntefT'une 05/12/97 t6:15 Technic.~l Director:. Steph~m C. Ede 2,00 II'~/L EPA 40s.1 ROBERT C. COWAN, P.E. May5,1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLA.NS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS MUNICIPALITY OF ANCHORAGE Dept. of Health and Human Services Attn: Dan Roth P.O. Box 196650 Anchorage, AK 99519-6650 REFERENCE: Lot 13; Block 1; Talus West Dear Mr. Roth, This is to provide additional information on the referenced property for the purpose of obtaining a Health Authority Approval. The trench was found saturated with 4' of water in the monitoring tube (no sludge) on March 24, 1998. Snow was melting at the time. Additional monitoring until April 22, 1998 found the water level remaining at 4':~-2''. A test hole was excavated on 4/22/98 on the uphill side on the trench about 10 ' away (see attached soils log). No ground water was found. However, a small water seep entered the perc hole and therefore a percolation test was not performed. This water seep is believed to be residual snow melt. The pm-existing bed was tested on 4/22/98 and passed the adequacy test. The trench was discom~ected and the bed colmected to the discbarge line from the BioCycle. Discussions with the owner have revealed the likelihood of high water use. This couple has three daughters. Additionally, a leaking toilet may have gone uarepaired for over one year. We believe the premature failure of the trench is explained by tbe high water use and leaking toilet coupled xvith the small trench size (approved with an application rate factor 4 gpd/ft2 which is no longer allowed for the BioCycle). There is no evidence to suggest the BioCycle was not performing up to expectations and the trench does not appear to be encroaching ground water. q[he trench should be suitable for future use after a drying out period. Request you approve the Health Authority request. Robert C. Cowau, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP SUITE 204 · EAGLE RIVER, ALASKA 99577 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 ~_(~)\---~_~(~D NAA# ~:~:'0 L~L.[.~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) \~ ~- ~ ~(~1 ~-'~¢~-~L%'~.,-.,-.,-.,-.,-.,-%_~. ~)~L Property owner Mailing address Lending agency Mailing address Day phone Day phone ~ "';,Day phone .,,_ ,._ - i_i ( ,: Unless otherwise requested, HAA will be held for pickup. ./ NUMBER OF BEDROOMS: q TYPE OF WATER SUPPLY: NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Individual well Community well Public water If community well system, provide written confirmation from ing to the legality and status of system. Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q325 (Rev 1/91) Front MOA #21 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. Name of Firm ! · .!..., ,~, ~.~, I. Phone / ~ / ~' Address ~" ~'" Engineer's signature Date DHHS SIGNATURE y. Approved for /~, Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: 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 DNHS do not conduct inspections or analyze data before a certificste is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1/91) Bauk MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SEI~J~IIY OF ANCHOkA(~F- ~ Environmental Services Division Ei-~I~6'~;3~TAL SERVICES DIVI$1ON~ 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-.4744 OCT 0 5 1995 Health Authority Approval Checklist LegalDescription: ~-~'1~ 13, 81/L{ 'Tac~z~g~.*,~- ParcelI.D.: A. WELL DATA Well type ~ RECEIVED ~15- ~2o l- %/o If A, B, or C, attach ADEC letter. ADEC water system nnmber Log present (Y/N) bi Date completed Total depth '~ '7 t) ~ Cased to ~'7 '7 E> t Sanitary seal (Y/N) 7 FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Colifonn Date of sample: . iq7,2 Casing height (above ground) ) ~fl-~ '~ Wires properly protected (Y/N) \/ t AT INSPECTION g.p.m. ~ ~/f P'O' g.p.m. Nitrate Collected by: ~ --% B. SEPTIC/HOLDING TANK DATA Date installed ~/~7/z~ ,~ Foundation cleanout (Y/N) Date of Pumping ~/fi3t Zaoksize /~ Number of Cmllpartnlents -// Cleanouts(Y/N)~ Depression (Y/N) N High water alarm (Y/N) _ ~/Pumper C. ABSORPTION FIELD DATA Date iustalled /r9 ?/4,~ S°il rating (g.p.d./fi2 or ft2/bdnn)~ System b,pe Length ,~ ,~9 Width ?. Gravel thickness below pipe ~ Total depth 8 Effective absorption area &~.~{.~<~MonitoringTubepresent(Y/N) '~'/ Depression over field (Y/N) Date of adequacy test p.l//&X Results (Pass/Fail) '7 For /7/ bedrooms Fluiddepthinabsorptionfieldbeforetest(in.); P'///~ hnmediatelyafter ~gal. wateradded (ill.): Peroxide treatment (past 12 months) (Y/N) 1~ If yes, give date LIi~ STATION '~ / 0 ~ y( L ]~ Date installed ~/~7/t] ~ Size in galloos Manhole/Access (Y~) '~/ '%m~p on' level at* High water alarm level at*[ ~,~ 7~ *Datum Cycles tested E. SEPARATION DISTANCES ~?ulnp ofF' level at* Absorption field on lot Peblic sewer nlai~ Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /~9 / ; On adjacent lots ; On adjacent lots Public sewer manhole/clcanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building fourldation ~ [' PropeO. y line ~ / L~ I Absmgtior~ field Water main/service line ~ ¢Q~ff Surface water/drainage _~ lO Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ,'~ ~3 Water main/service line Snrface water N ] 1~) Drive'way, parking/vehicle storage area > ~- Ceriain drain M I (') Wells ou adjacent lets '~ / ~ / Property line F. ENGINEER'S CERTIFICATION 1 certiJj;' ' that I I ave determined thru,field inspections and review of Municipal records, that the above systems, are in confi~rmance with MOA [MA guidelines in ~[fect on this date. Engineer'sNanle ] O~ G~q¢~~ ~ ElYgil~ngSealHere~ HAA Fee $ ,~0, Date o£ Paynlent Receipt Number Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk,doc 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. # ~'2~ - ¢~C't\ - .~¢31~ HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include i0t, block, subdivision, section, township, range) Location (address or directions) Mailing Address (c) Lending Institution Telephone: (home) -//~//~ Business Telephone /4~z4 Mailing Address (d) Real Estate Company and Agent _ Address Telephone (e) Mail the HAA to the following address: (or check here/~f hold for pick up.) List contact person and day phone number below: / 2. TYPE OF RESIDENCE ~ Single-Family~ Number of bedrooms --- 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/~ 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. 7/8§) 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, functional and adequate for the number of bedrooms and type of structure indicated herein. [ 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. / Address PC~ ~CJ/~ ~-30~,~'9 ~ Engineer's Seal 6. DHHS APPROVAL Approved forfl&~'(~)bedrooms by Approved ~' Disapproved Terms of Conditional Approval Conditional Date 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)Beck Page 2 of 2 MI.~ I~J~F'I~ OF ANCHORAGE (MOA) S~laflhl:llt~lt~ity Approval (HAA) CHECKLIST - FEBRUARY 1984 1990 343-4744 Legal Description: RECEIVED A. WELL DATA Well Classification ~ P~-~/{/'~ ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) /4V¢ Date Completed /~----~7~ Yield '7/~/']~ · 1 '- / . /C/' - TotalDepth /d~20 Cased to ~;;~ Depth of Grouting ~/3~"¥////,~f¢¢') Stat c Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~'/¢Z2E'2 t ; On Adjoining Lots To Nearest Public Sewer Line /(-/,/~/~- · To Nearest Sewer Service Line on ~_ot ~'~,~ / Water Sample Collected by. Water Sample Test Results Comments To Nearest Public Sewer Cleanout/Manhole Date B. SEPTIC/HOLDING T.~/~NI¢~dI~ ,A, TA Datelnstalled J¢~-~-~lTze ¢¢~C'~C-'~ No. of Compartments ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ FOundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped ~;~ Pumping/Maintenance Contact on File (Y/N) ~ ;for ~ Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ J~.)L"~-~ / TO Building Foundation To Disposal Field To Property Line To Water Main/Service Line ~,~0 j To Stream, Pond, Lake or Major Drainage Course Comments '~-J~ ~.JS'/:~_ '~-. 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed 7/~/~> Width of Field /.~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~"~:~. Depth of Field Gravel Bed Thickness (~ / Statndpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot ~'~/~'~ / ',~ SEPARATION DISTANCE FROM ABSORPTION FIELD: TO Property Line ~ /f~') //:-'/- ~ _ ,~r"/./-//__ TO Existing or Abandoned System on ; On Adjoining Lots ~,~/~C~ / To Water Main/Service Line ~' ~'~) / To Cutback (if present) /~////dr- _ To Stream, Pond, Lake, or Major Drainage Course To Driveway, .P, arking Area, or Vehicle Storage Area / D. LIFT STATION ~ Date Installed Dimensions Size in Gallons Manhole) "Pump On" Level at ..........~m p Off" Level at High Water Alarm Level at )~/ ~/ Vent (Y/N) _ Tested for _J./~ Pumping Cycles during Adequacy Test. ~:emt~eMnOtsA Electrical O~ /-'1' **Check Permitted Bedroom Rating Against HAA Request** I certify that I ~ .checked, ¢¢(ff~d, or conformed to all MOA and HAA c inspection. //////////~// . Signed ////(L~-~'/~///~ --- MOA NO. ~ ~ ~ Receipt No Date of Payment Amount: $ 72 026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 effect on the date of this Engineer's Seal PROJECT: -LOCATION OF ~IEL[ (Legal Oesc~ priori):_ ~IELL DEPTH:~F~F~_W. lO0 FT. CASING: . STATIC wATER LEV[t (To0 of rosin9): ORILLER: F T El~psea .rime Sincel [ Clock pumping-StatE,d/ J Depth Co Orawdown/ Pumping J Remarks Tine Scooped, liin_ ~a~er fr. Recovery Race, GP$4 o J (s~l) 0 0 J S~ar: I 5 I b8~ o J 10 1 g6' o " I j 15 I ~' o u I I 2o i ~' I o ,, I 313 35 qO '45 50 '5S '. '60 (I. .120 (2 houcS)i 150 180 (3 hours 210 2qO (4 hours RECOVERY 10 t5 ,I 20 25 I ~ 2,5' 40 45 I 60 (t hour) ] I, : I o 0 J /~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERALTAX I.D. #92-0040440 ANALYSIS REPORT BY SA~{PAE fo~ Work Orde~ ~ 25239 Date Report Printed: JUL 10 90 ~ 10:51 Client Sample ID:L13 B1 TALUS ~EST PWSID :UA Collected JUL 3 90 0 16:00 hts. Received ~UL 3 90 @ 16:20 h~s. Preserved with :AS REQUIRED Client Name : CORWIN & ASSOC. Client A¢ct : CORWINP P.O.~ NONE RECEIVED Rea ~ Ordered By : BRUCE CORWIN Analysis Completed :JUL 4 90 Send Reports to: Laboratory Supervi$o~ :$T~EPNEN C. ED~E~ 1)CORWIN a ASSOC. Released By: 2) Special Chemlab Ref {: 902234 Lab Smpl ID: 1 Matrix: WATER Allowable Paramete: Tested Result Unit~ Method Limits NITRATE-N 0.68 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SA}dFLE COLLBCTBD BY BJC. i Testa ?erfozmed * See Special Instructions Above UA-Unavailable ND- None Detected "See Sample RemaYks Above HA- Not Analyzed LT-6es~ Than. OT-Gzeater Than ~GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "¢" Street, Anchorage, Alaska 99503 274-4561 Date Received July 30, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1976 1. Approval requested by: Cony. National Bank of Alaska % Marva Goodson Mailing Address: 630 East 5th Avenue Phone: 279-2506 2. Property Owner: Ticor Relocation Management Co. Phone: 279-7611 Mailing Address: % Dynomic Realty Jim Boudreaux 3. Legal Description: Lot 13 Block 1 Talus West Subdivision 4. Location: Corner of Wilderness Lane &Outcrop Lane 5. Type of facility to be inspected 6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Single Family No. of bedrooms 3 B. Depth D. Bacterial Analysis System: On-site System 1973 B. Installer 1. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines 98' , Absorption area , Other contamination , Absorption area Sewer Lines __ C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Req it for Approval of Individual S ,r & Water Facilities Page 2 of two pages - Legal D~scription Lot 13 Block 1 Talus West Subdivision Comments Approved ~-~ ~. '~ Disapproved Date ~l~'/h~ I Approval Valid for one year fro~ date signed Greater Anchorage Area Borougn, Department of Environmental 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) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV __ Mailing Address: Name of Suyer:~'~ Mailing Address: Day Phone 4. Name of Lending Institution: Mailing Address: ~ ~¢ ~'. 5. Nameof Realtor or Agent, DV/~J~J~I~, Mailing Address: ,~0 / ~lJ, Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served l~)~J~' If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation S/~ ~/~ m~,~ ~it~ /1~ I'"/3 EQ-037 (1/74) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3.3~0 "C" Street, Anchorage, Alaska 99503 274-4561j~ ~ Date Received Time of Inspection Date of Inspection ? REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Legal Description: o 5. Type of facility to be inspected 6. Well Data:/~ ~/~ f ~c~_~ B. Depth A. Type ~- ~uC~ ~ C. Construction Phone: No. of bedrooms D. Bacterial Analysis Sewage Disposal System: C. Septic Tank: 1. Size |~ d) 2. Manufacturer~-~-~r~ D. Seepage Pit: 1. Absorption Area ~/~ £~' 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank~~~, Absorption area Nearest lot line _~ ~ , Other contamination B. Foundation to septic tank C. Absorption area to nearest lot line , Sewer Lines , Absorption area EQ-034 (1/74) Page 1 of two pages Page 2 of two pages- Req~t~ for Approval of Individual S~,_~.r & Water Facilities ~ Le~gal Description ~~~~~-~ Comments Approve ///~//~ (~~aX~~o~ .... v e d'~v~ ~' D a t e~-~/~:/% ~ Approval Valid for one year from date signed ~ Greater Anchorage Area Borough, Department of Environmental 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 E~-034 (]/74)