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HomeMy WebLinkAboutHOMESTEAD HILLS BLK 1 LT 2Homestead Block 1 Lot 2 #015-173-14 ' MUNICIPALITY OF ANCHORAGE f DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTrON ENVIRONMENTAL ENGINEERING DIVISION 0* ' 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ` PHONE �' S [:1 NEW UPGRADE 7"71� MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDR0 MS Well Absorption area I Dwellin PERMIT NQS©O c o % [JJ DISTANCE TO: Uy H 2 Manufacturer Material , No. of compartme is a N ~ Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: .g Well Dwelling PERMIT NO. O y DISTANCE J Ur z O?Q 'aTT Liquicycapaeityil'gal,lops�----"" 2 F Man urer 0 We Foundationr Nearest lot line 't' / l b PERMIT N p a 6 6 0i J DISTANCE TO: w y J LL z No. of lines Length of each lir a Total length of lin Trench widthDistance inches b to lines %f F Q% cc F. Top of the to finish grade r Material beneath the r inches Total effective abscg6 ``--��'' O Length Width Depth - PERMIT NO. LUr7LU Type of crib Crib diameter Crib depth Total effectiv orption a a wilding foundation earest lot line (STANCEClass Depth Driller Distance to lot line PERMIT NO. 'y Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS 3 03 L' � SOIL TEST RATING �q 0 � t Y INSTALLE - REMARKS APPROVED DATE LEGAL TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FTr-'BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 04 + �tl'q Au - THE LENGTH ClIMENSIO4N ISITcHE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). _0*44j" I o o 0 C, S'o 0 F? E-= 114- k_l 31 FR FE L"a !F. E-= F::" _r T ®M _r n r -i F< - T -2! I= — 42f W_9:3"I L 1_-1 r4vll�*t PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — — — _r L-3 C-1 < _=" > T P-4 F=11 F= llz'y I "N F=t F" U. F; -'.'F= 0 u I F;-'.* F= C -N — BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC I -JELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE 15 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F= EEFQ:M I -r F=XF=o I F:lF=!F. C_9F=f_DUM0UFR 3c -1 - -1 =%: f__l I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. !*: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: - ACV�ff EL. Air- I T L8l N/JACK WHITE CO. 1;V4. 0 ISSUED BY- -1 - -----------GATE_ DEPARTMENT HEALTH AND ENVIRONMENTAL DTECTION ln-,Q3-%(n 825 'L' STREET, ANCHORAGE., AK. 99501 264-4720 ID lr-J I -r E: 4T,.F-:-t4F7FR F:lwF­f:;?Nl"lr PERMIT NO. 800607 ELL V&T_ APPLICANT ELIOT LAWSON/JACK WHITE 3201 C. ST. LOCATION TRAPLINE LEGAL L 2 8 1 HQMESTEAD'HILLS LOT SIZE 20000 SQUARE FEET TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FTr-'BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 04 + �tl'q Au - THE LENGTH ClIMENSIO4N ISITcHE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). _0*44j" I o o 0 C, S'o 0 F? E-= 114- k_l 31 FR FE L"a !F. E-= F::" _r T ®M _r n r -i F< - T -2! I= — 42f W_9:3"I L 1_-1 r4vll�*t PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — — — _r L-3 C-1 < _=" > T P-4 F=11 F= llz'y I "N F=t F" U. F; -'.'F= 0 u I F;-'.* F= C -N — BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC I -JELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE 15 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET, OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F= EEFQ:M I -r F=XF=o I F:lF=!F. C_9F=f_DUM0UFR 3c -1 - -1 =%: f__l I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. !*: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: - ACV�ff EL. Air- I T L8l N/JACK WHITE CO. 1;V4. 0 ISSUED BY- -1 - -----------GATE_ GARB -HD -I (T!'_'�TER ANCHORAGE AREA BORC____ •4 !/ u'..PARTMENT OF ENVIRONMENTAL QUAILi rr 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 lop fNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING %37' NAME®/� ��- ADDRESS �I� ✓®�� %95� PHONE LOCATION 6// SEPTIC TANK: IPTION GUT NUMBER OF DISTANCE FROM WELL Gd/i1/%IU/�/� MATERIAL S�evJ� COMPARTMENTS / % 7L. sTis'c',� _r' -22z_ LIQUID LIQUID CAPACITY Zt-') UO GALLONS. INSIDE LENGTH '� INSIDE WIDTH ` DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: s r NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH— LENGTH — , DEPTH C<%'WZ04 �/ e BUILDING FOUNDATION �s / LINING MATERIAL%�/9W��'� G��«�-°��� .DISTANCE FROM WELL ' NEAREST LOT LINE / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 02'SQ. FT. TILE DRAIN FIELD: /V�i/4 DISTANCE FROM WELL OUNDATIONNEAREST LOT LINE - NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTI AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES , IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM WATER WELL: J f � BUILDING FOUNDATION ` SAMPLE /' NEAREST LOT LINE DISTANCES: Si%uu/iv �- TYPE!n I , DEPTH I— NEAREST C�_ SEPTIC` SEEPAGE v OTHER SEWER LINE TANK SYSTEM--, CESSPOOL , SOURCES y� //moi✓ f!/�iei,/ /Nl1.4�4'. Wit" NoY�' Cc4�%N s�6 ,W..14, ' AlflN1///-� GRLAT'ER ANCHORAGE AREA BOr<uUG 2196 ' DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. r ' 3500 TUDOR ROAD POUCH 6-650 • ANCHORAGE, ALASKA 99502 TELEPHONE 279.8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION L ? LEGAL DESCRIPTION � INSTALLATION OF: SEPTIC TANK -r TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH ` F SOIL TEST RESULTS''° r COMPLETION DATE ANT CIPATED MAILING E PIT PHONE dTt DRAIN FIELD OTHER G / I" TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT YALFD WI HOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE '� �% ( TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ) C' f FOUNDATION TO SEEPAGE PIT DRAIN FIELD f SEPTIC TANK TO SEEPAGE PIT WALL ( ( P SEPTIC TANK . SEEPAGE PIT DRAIN FIELD P-" TO NEAREST LOT LINE. (/ ' WELL TO SEPTIC TANK t SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO. SEPTIC TANK SEEPAGE PIT DRAIN FIELD l SEPTIC TANK, '--✓��, SEEPAGE PIT ; DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. • 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS GRAVEL BACKFILL CONFORM TO BOR GH-Fk9GULATJQNS REGARDING INSTALLATION. HEALT AUTHORITY OR LICENSED DESIGNER TYPE .! -ef"C {�-�-F- , 1 OF SYSTEM q.. 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBIERAYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE >, Municipality of Anchorage „b On -Site Water& Wastewater Program ; ��5# (907)343-7904 s. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-173-14 Expiration Date: - P 1. GENERAL INFORMATION Complete legal description HOMESTEAD HILLS BLOCK 1 LOT 2 Location (site address) 4321 TRAPLINE DRIVE *ANCHORAGE Current Property owner(s) LORETTA ROTH Day phone 346-1358 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) ' PFAR L10.104.12.1 3. NUMBER OF BEDROOMS: -4 SEP 2014 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWA-Tt-R­DL%RQELkL. Individual Well ❑ Individual On-site Individual Water Storage ❑Individual Iiuldin- Community Class Well ® tank Community On-site ❑ ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:J.,� O� UPJL--^r� Distance: Received by: s� Date: . COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment l 7 Receipt Number_ bid G COSA # 022 , I lq � Waiver Fee $ 2t,5 Date of Payment Receipt Number. 61`5bY y Waiver# 504W - 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. 1 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. 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, UD. 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. 6. DSD SIGNATURE System #1 Approved for + bedrooms. System #2 Approved for Disapproved. Conditional approval for 10 bedrooms. Phone 337-6179 Date ')S / It bedrooms, with the following stipulations: CE— Ih tOFt(��tiG ON-SITE g WATER AND v WASTEWATER Original Certificate Date: 7 — / <0 —f T Theu rpaht r At dad-, Develop, am( Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon t e represen abons 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) 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: HOMESTEAD HILLS; BLOCK 1, LOT 2 A. WELL DATA Well type Date completed Total depth ft. COMMUNITY WELL If A, B, or C provide PWSID# Sanitary seal (YIN)_ Parcel ID: 015-173-14 Well Log Wires properly Cased to ft. Casing heighUe 15ove ground) in. FROM WELL LOG SPECTION Date of test Static water level ft Well production 9-p M. —9 P.M. WATER SAMPLE RESU Coliform colonies/100 ml. Nitrate mg./L. Collected by: A c: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA *LOCATED IN UTILITY ROOM (SEE ATTACHED RECEIPT FROM ISAACS) Tank Type/Material _ SEPTIC/STEEL 1972 1000 2 Date installed 1980 Tank size 750 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 8/21/2014 Pumper ISAACS PUMPING SERVICE C. ABSORPTION FIELD DATA *BELOW EXISTING GR40E Date installed 10/24/1980 Soil rating (g.p.d./ft2o /bdr 100 System type TRENCH Length 34 ft. Width 3 A. Gravel below pipe 6 ft. Total depth *11.04 ft. Eff. absorption area 408 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/18/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 4_5 in. Water added 812 gal. New depth 23.5 in. Elapsed Time: 231 min. Final fluid depth 8 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump ofr level High water alarm level at Datum ----- I Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES COMMUNITY WELL SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line _ Animal On adjacent On adjacent lots Holding tank Manure/animal excrete storage areas -SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line '�- Absorption field 5'+ Water main 10'+ Water service line 10'+ Sirface water 100'+ Wells on adjacent lots 100'+ PVT; 200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r Properly line ' 7 Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVT; 200'+ PUBLIC F. COMMENTS THE STEEL SEPTIC TANKS (INSTALLED IN 1972 & 1980) ARE APPROACHING THE END OF THEIR USEFUL LIFE. * Wa„^`- RE43i r:T£O 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 `i! S/ If (Rev. 11/05) CE -7W Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program n,e�tr s, Department **** VARIANCE/WAIVER REVIEW **** Waiver#: WR141382 COSA#: osc141468 Permit#: PID#: 015-173.14 Legal Description: Homestead Hills B-1 L-2 Engineer: Garness Engineering Group Applicant: Loretta Roth Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 7.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: x Waiver is not Granted: Date: q A ' � � Approved by: a o wer ..............................................i .. ...................... f Yk GARNESS ENGINEERING GROUP.) Ltd ._. .._,._CIVIL& ENVIRONMENTAL ENGINEERS ,- ---_ September 5, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Homestead Hills; Block 1, Lot 2 To whom it may concern: We request that your department issue a 7 -foot lot line waiver from the west property line to the existing drainfield. The drainfield on Lot 1 does not encroach within l Oft of our drainfield. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any concerns please call Garness Engineering at 337-6179. M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com _ _ 4��c;64t3RRt �dI ;o 7Q i 0 FI Cl co ;4® r �. �' d v' er e dttt!' i i`sew 0 tt`+ 9,0 .0 OF O N \ M t N \ u M M U m M --- 'J G�OJeC � ° a a CD O o O I 5 m / L 29 0 rn r N N b'£5 m mcm0 o o II LL] c In co F Lc) w P°Jew 00 Zn -V'> VI L � O i STN =OjO � r p > m U x M Q '0o it V N- GU40 002 �-i t0'OOZ M„0£,SO.ON �Oda�a°� cn x s y' `' 3 O �j O J 1 O N O T- O N F� 71 O. N C O 4-j C to �" °o-0 O 3 N O C 0 ¢ U Oin i dr N._L,y N O X L fq fA Y O �Z°3 V1 4? V Crc 7654 Old Harbor Ave Anchorage, AK 99504-1930 Off 907-338-5563 Fax 907-338-5564 Loretta Roth 4321 Trapline Dr Anchorage, AK 99516 Invoice Date Invoice # 8/25/2014 13193 P.O. No. Terms Item Quantity Description Rate Amount Camera 1 Camera sewer line from wall clean out in utility room to inlet of 300.00 300.00 septic tank to verify proper main line access and direct shot to inlet of tank. Video from tank to wall clean out. Functional as foundation clean out. Thank you for your business. Total $300.00 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M}�i 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.# C) l S- I-13- IL( HAA# 0(�)w r','�(�(q 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LoT y Bina / A;Ve.,f Location (address or directions) y-3zl T�Mr.��%E (b) Property owner 7>hyl- A)MNtj`q Telephone: (home) 3 ' "/3�� Business Mailing Address ¢3a/ 7-944U//6 *a t4Z (c) Lending Institution Al R A Telephone Mailing Address (d) Real Estate Company and Agent ��Ta�� y/ Address Telephone 562. - &03 (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'K Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community's 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. nee) Page 1 of 2 Z ;o Z a6Ed HORe (eeiL ASH) szo-ZL .ilaom s,aaauibue leuolssa;oad ay; ul suoissiwo ao saoaaa ao; alglsuodsaa IOU si a6eaoyouy;o AllledlolunN ayl ,penssi sl Oleo!;llaao a aao;aq elep ozAleue ao suolloadsul lonpuoo lou op SHHa;o sa9Aoldw3 -sluawaalnbaa alEls pup leaapa; uie;aao Aslles olaapio ul suolln3!lsui buipual alayl puE sawoy ;o siaseyoind of Aselinoo a SE Slyl saop SHHQ ayl 'E�isely ;O alelS ayl ul paaals1691 ,laaul6ua leuolsse;oad luapuadepul up Aq anoge g ydea6eaed ul Uanlb suoilpluasaadaa ayl uodn Aluo paseq paleol;!aao lenoaddy Allaoylny 431eaH sanssl (SHHa) saolAJOS uewnH puE yllpaH;o luewlaEda4 a6Eaoyouy;o Al!IEdlolunyq ayl lenoaddy ILuoll!puoO;o swial leuol3!PUOo panoaddEsia panoaddy alE(] Aq swooapaq "-,wny JO; panoaddy 1VA0addV SHHa '9 leaS s,aeau16u3 ssaaPP`d euoydelal / wal3;o OWEN uolloadsu! sly! ;o alpp ayl uo loa;;a ui suolleinbei pue 'seoueulpjo 'sapoo alplS pue ledlownW Ile yl!m eouplldwoo ui si walsAs lesodslp aalEmalsem ao/pue AIddns jalem 91!s -UO ayl 'uolloadsul puE uollE6lls9nul Aw ww; puE salt; a6Eaoyouy ;o A3!ledlolunjN ayl woa; peulelgo uollewao;ul ayl uo paseq ley! A;uaA aaylan; I •ulaaay paleolpul ainlonils;o adl�l pue swooapaq;o jagwnu ayl ao; alenbepe puE leuolloun; 'a;Es sl walsAs lEsodslp JalemalSem Jo/pue AlddnS jejEM 9jjs-UO ayl lEyl SM04S lenoaddy Al!aoylny ylleaH slyl;o uollE6llsanul Aw leyl A;!aaA ! 'molaq UMoys alEp uo!lep!leA ayl;o se pue olaaay pax!;;e leas Aw Aq pal;!!aao sy N011VWH0ANI 4NV V1Va `HOHV3S 311d `S1S31 `SNOI,L33dSNl DNIaiAOdd WHId E)NId33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) rFIEIfI ISS - FEBRUARY 1984 Legal Description: L y 8�7iu A. WELL DATA,,/ �1�? Well Classification if If A, B, C, D.E.C. Approved Y/ ) Present(Y/N) Total Depths Cased to Static Water Level Casing Height Above Electrical Wiring in Conduit (Y. Date Completed Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Yield Pump Set At e Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest ; On Adjoining Lots ; On Adjoining Lots Date r Cleanout/Manhole B. SEPTIC/HOLDIyG Aly DATAJk �� Z Date InstaliedoOd-74 8' Size 'Sa No. of Compartments Standpipe (Y/ ) Air -tight Caps &) Foundation Cleanout (Y' 1 Depression over Tank (Y N) Date Last Pumpedof " Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N)� Temporary Holding Tank Permit (Y/N), SEPARATION DISTANCES FPOM FTIC/HOLDING TANK: H1 a�fi�'S To Water Supply Well To Building Foundation r To Property Line To Disposal Field To Water Main/Service Line r To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1. of 2 L 2.51 MONAlro'd M4,1-7 C. ABSORPTION FIELD DATA /I Soils Rating in Absorption Strata /� Type of System Design 6N�ti O-Z,Y -cord r Date Installed � Length of Field 3 Width of Field Depth of Field /a r Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present((Y N) Depression over Field (1 Date of Last Adequacy Test Results of Last Adequacy Test �DEQU�F%E SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 2&0- To Property Line /U To Building Foundation To Existing or Abandoned System on s Lot A0 ; On Adjoining Lots w -10-- To Water Main/Service Line /d t To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course X07) 4 - To Driveway, Parking Area, or Vehicle Storage Area /d 't" Comments D. LIFT STATION Da stalled Size in Ga "Pump On" Level a High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ""Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.��— Signed Company�i Date �$ y+ Engineer's Seal MOA No. D Receipt No. _�2 / e l� l �el Date of Payment 7— ` �` � Amount: $ f ;7b, 0-} Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 *� OkillF T" f STATE OF ALASKA � DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE x ALASYfor - PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT / / Plans for the construction or modification of t public water system located In Aor C 11 99 G [[ Alaska, submitted in accordance with 18 AAC 80.100 by fl �,�Az Ly,k/`eMc•/1 / k / //o J epi! ce J have been reviewed and are Q approved. conditionally approved (see attached conditions). �J_ /�J""��/ By TITLE _ DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. a 6. APPROVED Change (contract order no. or descriptive reference) % Approvedby /by Date 7 / ,c) IGs,c�/a ro/^rio,h J ld) V��^ i�c�•�l /�,J C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water Is made available to the public. The construction of the 1-7h°y< </ uU / er- public water system was completed on 1 ,9 '7 Z -(date). The system is hereby granted interim approval to operate for go days following the completion date. BY - - TITLE DATE _ As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. . C i� JavCX /'L.�v;�i� e.,�o <'y..�ter/ 2 BY TITLE DATE 18-0407 (Rev. 111831 DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEERIMUNI-BOROUGH (Complete Section q 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: August 14, 1989 PWSID: 211669 To Whom It May Concern: 563-6775 According to the records on file in this office, the Homestead Hills S/D Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Cindy Thomas Environmental Engineer APPLIC''AT FILLS OUT UPPER HAL"NLY Time Property Owneryr���ysff�`�7 li�- ( ��, Phone 9D7 Madtng Address -. r- LA ,T � S "kin- — Zip Code -!"�' Date Buyer RaLXAC. .7 ^20 Date d\i(ziPCode Inspector Address Inspector LendingInstitution ( a —r Phone Address �-' �- -.. ',..)fF ,... ..� j"tii�;'�r'C�'._ Zip Code Realty Co. & Agent Phone (APPROVED BEDROOMS Zip Code Address ( �) DISAPPROVED { C' Legal Description} `i { } ` .,},t'tj^iiti..''..1 /- t..l: -.•4 ( ) CONDITIONAL APPROVAL' ^ OGG Street Location DAT Type of Residence 31l- Ingle Family -t" BY: ❑ Multiple Family No. of Bedrooms Soils Rating ❑ Other Well To Absorption Area Water Supply 1:1 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. SQeGommunity For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility �j Sewer Disposal --y 1 '""' ( f '(�r8 C%( k` ❑ Individual Year Individual Installed: / 1'` 1- c� O0 ❑ Public Utility When Connected to. Public Utility: [;*Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Tim— Date Date Date Date Inspector Inspector Inspector Inspect Field Notes: i (APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( �) DISAPPROVED ( ) CONDITIONAL APPROVAL' ^ OGG DAT BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank ENGINEERING INNOVATION IN THE FAR NORTH ARCTIC ENGINEERS, INC. ENGINEERING STUDIES a DESIGN - C'sONSTRUG110N MANAGEMENT « SURVEYING January 31, 1984 Vicky Smith SRA Box 1735H 4321 Trapline Drive Anchorage, Alaska 99516 LEGAL: OWNER: HOUSE TYPE: WATER: SEPTIC SYSTEM: TEST DATE: AEI# 84-003-02 SEPTIC SYSTEM ADEOUACY TEST Lot 2, Block 1, Homestead Hills Subdivision Vicky Smith 4 -Bedroom, 2 -Story, Community System 4- - Single Family Home Tank: 1-750 gal. steel, 1-1000 gal. steel Absorption System: Trench Absorption Area: 408 sq. ft. Approval Date: Original 1972, Upgrade 1980 January 31, 1984 PROCEDURE: House water use was kept at a minimum on January 31, prior to the adequacy test, which was started at 10 a.m. Water from a tank truck was dumped into the trench in 100 gallon increments with liquid rise in the sump measured after each increment. When 1000 gallons had been added, water level in the sump had risen 10 inches. At that time, addition of water was halted and the septic tank was pumped. ENGINEERS,ARCTIC '2,901 PATRICIA .,ANE x ANCHORACe, ALASK.n. 99504 a 907/333-9428 (AccOUNTING� I Absorption monitoring was carried out for 30 minutes after pumping the septic tank. In that time, water level in the trench dropped to the initial level measured at the start of the test. RESULTS: The absorption system functioned very well. The adequacy test revealed an absorption capacity in excess of 600 gallons per day, the minimum requirement for a 4 -bedroom house. The system conforms with Municipality of Anchorage requirements. .� -oF At�'l�a AV y43®D•• •A•46µ <IDD.�DDXJ0ry.9•.• a YDD _d fr.. ......••9Ys•••Y• ••B o9 •e David S. Ya oshok "°✓ s �9 ••D+. Y•DYYD• p1,�.ta ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 CUSTOMER'S ORDER NO, PHONE ATF. + NAME /i 7 ADDRESS CASH 0.9.0, CHA ON ACCT: I MDSE.RETO PAID OUT �1� t I I P l`x7I TAX I S Y RECEIVED By TOTAL j lel' J Ali claims and returned goods mus I de accompanied by this bill. 1441 'k`�'°" PAOo0C1609[Neels Ina, Cmmn. Marv. 01471. February 3, 1984 ENGINEERING INNOVATION IN THE FAF1 NORTH ARCTIC ENGINEERS, INC. ENGMC-ERING STUUiES a DESIGN s CONSTRUCTION S`ViANAGEWNT A SURVEYING Municipality of Anchorage Dept. of Health & Environmental Protection 825 "L" Street Anchorage, Alaska 99501 Dear Health Officials: AEI# 84-003-02 we inspected Lot 2, Block 1, Homestead Hills Subdivision during the performance of a adequacy test on January 31, 1984. All necessary standpipes were in place and capped with rubber caps. U 5. LEGAL DESCRIPTION DATERECEIVED INSPECTION APPOINTMENTS Hills Subdivision TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO16EPT. OF I'� ACfi-i & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL i4lC'f ECTION'. • ENVIRONMENTAL SANITATION DIVISION NA)Y -221 i@80 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEAjX9262C &/IEED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER �C.�U�P.i.� PHONE =rPl4jt7Mgt. Inc. (Graham) call R.E.Agent 8. SEWAGE DISPOSAL SYSTEM - MAILING ADDRESS contact R.E. Agent if needed PROPERTY RESIDENT (If different from above) PHONE Vacant 2. BUYER PHONE Just listing property ... no buyer yet MAILING ADDRESS n/a 3. LENDING INSTITUTION PHONE No lending institution yet... just listing property MAILING ADDRESS 4. REALTOR/AGENT PHONE Jack White Company / Elliot C. Lawson 243-4175 MAI LING ADDRESS 3201 C Street, Anchorage, AK 99503 5. LEGAL DESCRIPTION Lot 2... Block 1...Homestead Hills Subdivision STREET LOCATION (No house number) Trapline Drive (O'Malley, So. on Braga 2 mi. to Trapline) 6. TYPE OF RESIDENCE NUMBER OF,BED RO .D�t SINGLE FAMILY ❑ One Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ee ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - INDIVIDUAL/ON-SITE** L YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)0197 %n.✓ (�; THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE E:1 PUBLIC UTILITY'—� Connection Verified PERMIT NUMBER DATE INSTALLED % INSTALLER ❑Septic Tan �C or ED Holding Tank Size: jj�68 If Tank is homemade give dimensions: SOILS RATING TYPE OFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank A ion Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 344.0114 14 0Z lbiwk`You SERIES 609 JACK WHITE COMPANY THE ATTACHED CHECK 18 IN FULL. DETACH AND RETAIN THIG REAL ESTATE - - - PAYMENT OF THE FOLLOWING - PORTION FOR YOUR RECORDG ter' DATE D E 5 C R 1 P T 1 0 N AMOUNT 5-22-80 I #128 ER (Graham) Lot 2, Block 1, Homestead Hills Sub. $25.00 r Mumicipality of May 30, 1980 825 "L" STREET ANCHORAGE, ALASKA 99501 (907)264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Elliot C. Lawson % Jack White Company 3201 C Street Anchorage, Alaska 99503 Subject: Lot 2 Block 1 Homestead Hills Subdivision (Equitable Relocation Mgt. Inc. (Graham)) Approval for the individual sewer and water facilities can not be granted until the following items have been completed: A- 41) The septic tank pumped with a receipt submitted to this department. (2) An adequacy st be performed the existing leaching area. This e wi. 1 -deter e stem is adequate acc dii�g N do 1 oto d S. A listing of private fi , s r ing e N is nc sed. This report nee, s t be submit ehis epartment for our review._ If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw IT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 STRE T LOCATION ENVIRONMENTAL ENGINEERING DIVISION NUMBER OF BEDROOMS Telephone 264-4720 SINGLE FAMILY ❑ Two ❑ Five REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES Three ❑ Six DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. AI t 4)" A 1. PROPERTY OWNER i r� P E COMMUNITY MAILING ADDRESS 50 1735-ff ❑ PUBLIC UTI LITY depth (attach log if available.) PROPERTY RE IDENT (I different from abo%te) ��ic PHONE INDIVIDUAL/ON **If individual/on-site, give installation dated If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. YER 's PHONE c s�, ay�._pa� MAI ING ADORE .� 7, 50 3. LENDING INSTITPHONE �. WN LING ADDRESS 4. FEALT R AGENT PHONW MAD�N DDRES$ C 6 5. LEGAL DESCRIPTION �, STRE T LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM �j INDIVIDUAL/ON **If individual/on-site, give installation dated If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. iz-uIuls/1d) 7/ THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED '- TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ INGLE FAMILY [� MULTIPLE FAMILY NUMBER OF BEDROOMS F-1ONE ❑ THREE [__1FIVE ElOTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Sizer If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS -�y-7 M'J APPROVED FOR DROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED DATE ^ BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) eonstruct;on gest c9al "ONE TEST IS WORTH A THOUSAND OPINIONS" 2204 CLEVELAND AVENUE • ANCHORAGE, ALASKA 99503 • 277-0231 August 24, 1978 Mr. Harmon Sheets SRA 1735 H Anchorage, AK 99507 RE: Lot 2 Block 1 Homestead Hills Subdivision Dear Mr. Sheets: This is to certify that the existing septic system percolated at the rate of 1000 gallons per day when tested according to the Municipality of Anchorage procedure. Very truly yours, CONSTRUCTION TEST LAB w 1 ".V%; r11 •4 Ileal A. Ha <cm , USS E Neal Hausam, P.E., L.S. NH/ j a GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDI IDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Phone: 2. Property Owner:-�Z,&c-�_ Phone:, �Z��-— Mailing Address:,Yf� C 3. Legal Description: 4. Location://�,����ny`�� 5. Type of facility to be inspected, 1._ No. of bedrooms 6. Well Data: A. Type ���'.y Vie" C. Construction 7. Sewage Disposal System: B. Depth D. Bacterial Analysis _LD r A. Installed /�� �, B. Installer f-..�/C. Septic Septic Tank: I.- Size l .i c 2. Manufacturer -C d/'5 a D. Seepage Pit: 1. Absorption Area2-�7�Y 2. Material/)/() E. Disposal Field: Total length of lines 8. Distances: �T) A. Wel to: Septic tank f Absorption area >>% t , Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank „`) , Absorption area C. Absorption area to nearest lot line EO -034 (1/74) Paqe 1 of two pages -,ge 2 of two pages - Re,,_,ast for Approval of Individual -,,ver & Water Facilities b / ,Legal Description Comments A isapproveb /C)4pproval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM i 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 `-;A i ir