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Home My WebLink AboutHOMESTEAD HILLS BLK 2 LT 5 (2)D MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILING ADDRESS LEGAL DESCRIPTION o.o %oo s LOCATION ~ W~p/;.eI ~ bsorptionarea Dwelling PERMITNO. ~ ~ DISTANCE TO: ~ ~ Manufacturer Material No. of compartments Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. Z ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~. DISTANCE TO: Len~tb~f each line No. offs Total~f lines Tren~w~th Distance between ,ines ~ ~ ~ Top of ~ile~o finis~ade~ .~ Material beneath tile_~ f Total effective absorption area ~ ~ ~ .~ .~/~ inches Length ~ Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth I Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~ SOIL TEST RATING l~_~ L,~ ~ v INSTALLER ~ ~ REMARKS ~ ,I/ - < / LEGAL PERMIT NO, I -- e",, - " ML [-t I ~. I. Ri- I T DEPRRTMENT . HERLTH RND EN',,,'IRONMENTRL ~0TEC. TION 825 "L'" STREET, RNCHORRGE, BK. 264-4728 ~3~4---5 Z TE SE[4E~: F"ER[-1 Z T ,:: 88062~ ) RPPL I CRNT ER I .. --,K RRL .IRE ~_~:i GRRDNER L~.~504 LOCRTION TRRPLINE LEGRL b~&u= B~'~ HOMESTERD :H.!~b~ LOT _,'= I ~E7 ,-~ ' r TYF'E OF 'SOIL RB=.CRFTI~N SYSTEbl : DRRINFIELD 46EI064 SQ.I.JRRE FEET ! BEDRUOM_, = 6 MUM NUMBER OF "- '-- SOIL RRTING (SQ. F'T/BR)= t65 THE RE&]UIRE[:, SIZE OF THE _,CIL 8BSORPTION --,¢_,TEM IS: [:,EPTH=.z-.= 5 I_ENGTH= ::LS-~ ~.3RR%¢EL [;,EP]'H= 1. = THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRYRTION (IN FEET). THE TRE~-~C:H 14IC, TH IS 5. 8E~} FEET. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). c T _ -" '-" _'F,, i.---t ,3RLL ,3 f'lS E:E _F..!Li ! RFD., .::.EP I C TRf-IF-:-: c. I ZE= :z. ,- -_ PERMIT APFLI_.ANT HAS THE REz, FUN_IBILIT~ TO INF~)RM THI_. DEPARTMENT DURING THE INSTALLATION INsPEbTION_ OF ANY WELLS ADJACENT TO THIS PREFERTY RND THE NJMBE~ OF RESIDENCES THRT THE WELL WILL =,ER, E. TI,..tO .~ 2 .'-. ][ i'-t:SPEIST I I.-1. I'-IS RRE RELqL! I E, RL. kFILLIN.~ OF RNY =,~_,TEft WITHOUT FINBL INSPECTION BND RPPROVRL BY THIS DEPRRTMENT WILL BE '-']tJBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND 8NY ON-SITE SENRGE DISPOSRL. SYSTEM IS t00 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER L..INE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQ.UIREMENTS MRY RPPLY. SPECIFICRTIONS 8ND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLL. RTION. PERf'~ I T E,~-¢P I ~.'ES DEE:Ef'IE:EF-: 2::1 .... I CERTIFY THRT 1: IRM FRMILIRR WITH THE REQ.UIREMENTS FOR ON-SITE SEWERS BND WELLS RS SET FORTH 8Y THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~'. I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REC~.UIRE ENLRRGEMENT IF THE F.:ESIDE~~~N~IORE THRN 6 BEDROOMS. SIGNED: .... ~ ~_~.-_.-~L - -- RPPL~CRNT ERIC SKRRLURE ISSUED BY .... D TE___t ...... -Z _0_ ~, SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 7 8 10 ~4 17 18 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN PERFORMED BY: WAS GROUND WATER \! S ENCOUNTERED? ['~:~ L O DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETV~E~EN (minutes/inch) GRE[- R ANCHORAGE AREA BOR?'IGH Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION Traf/, DISTANCE ~ /// FROM WELL ~'/~ :~L MANUFACTURER INSIDE LENGTH INSIDE WIDTH. MATERIAL ~'/-'~'~ ~''' i/~'-~COMPARTMENTsNUMBER OF LIQUI'D DEPTH LIQUID CAPACIT~//~P"/~'~)GALLON$. TILE DRAIN FIELD: DISTANCE FROM WELL//~'~-~''~L FOUNDATION_ NUMBER OF LINES '~" DISTANCE BETWEEN LINES /~'? TRENCH WIDTH~IN. ABSORPTION AREA ~~/..~SQ' FT. ~ENGTH OF EACH LINE ~ i'{'7/O~'~"~ DEPTH OF FILTER DEPTH: TOP OFTILE TO FINISH GRADE ~ATERIAL BENEATH TILE ~ IN, ABOVE TILE NEAREST LOT LINE /~ ''~/' TOTALoF LINEsLENGTH///~ TOTAL EFFECTIVE WELL: TYPE ,;CONSTRUCT,ON DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION___, LOT LINE__ SEWER LINE__, TANK , SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: <~ ~') _~2( SEWER LINE DEPTH: Pipe MATERIAL: LOT SLOPE: C/ REMARKS: DIAGRAM Of SYSTEM ~ ~ G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK PERMIT NO, PHON~ SO,L TEsT RESULTS /~ ~// ~ COMPLETION DATE ANTICIPATED SEEPAGE P~T---Z- ~/~' DRA,N F,ELD OTHER . pF~MTT VAI 1~ ONF YFAR , FINAL INSPECTION= 24 HOUR NOTIC~ REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BESUBJECT TOPROSECUTION. ,EPT,C TANK ~"~~- --' ~1. ' ' ,,?~'~>'"','¢~ r'~ FOUNDATION TO SEEPAGE PIT 20 SEPTIC TANK TD SEEPAGE PIT WALL DIAGRAM OF' SYSTEM '. SEPTIC TANK 5 f~, . SEEPAGE P'T 20 ft* DRAIN FIELD 10 ft. TO NEAREST LOT LINE. / / E AN OSE DRAIN FIEL~ , ALSO CONSIDER AREA WELLS. SEEPAGE PI~ SEPTIC TANK, 25 ft. SEEPAGE PIT 100 ft., DRAIN ~RAVEI. ~AC~ILL o~ , 10 TA)'K- ~0" ~ HOUSE J bnk & fha, should TO I,)'~ 1~0' not exceed ?~. ?~[N.].~ ~ISTU~CED~ [ CASI IRON SIPIION PIPE GREI ir ANCHORAGE AREA BO£" iJGH Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ./ NAME ~'M/lg.~l[,tZ~ ~",,~(.~l//'~T'/l, Jt;. MAILING ADDRESS t~'/ /2/~ ,.~T~, PHONE LOCATION t~/)g.'rr~ 0~1:"* l~l'~/Ze~,/ LEGAL DESCRIPTION ~./:~T '~- ~/~.., Z ~lO,~Te~,~ ~//Z/S SEPTIC TANK: DISTANCE FROM WELL ~ INSIDE LENGTH MANUFACTURER ,(~(::1~ ~(~¢~Z ~ .MATERIAL NUMBER OF COMPARTMENTS INSIDE WIDTH. -- LIQUI'D DEPTH. '~ LIQUI'D CAPACITY/(:]~O GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /~0~'¢~ NUMBER OF LINES ~ ABSORPTION AREA ~/~ depth: tOP Of tile tO fINISh GRAde FOUNDATION ,~ NEAREST LOT LINE /~) TOTAL LENGTH OF LINES /~)<~ DISTANCE BETWEEN LINES TRENCH WlDth~ tN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE 0~4 /3 /~ /~ DEPTH OF FILTER MATERIAL BENEATH TILE ~ IN. ABOVE TILE WELL: TYPE ~/-,z~l(~g/~L -(_!¢hl/)l~g, CONSTRUCTION (~ "OO&'ll~,] /'~ ~L/~l~(~ BUILDING ¢ NEAREST FOUNDATION /0 ~ , LOt LINE CESSPOOL /dO~F OTHER SOURCES APPROVED / DISAPPROVED NEAREST SEPTIC SEWER LINE /0 f'/', TANK REMARKS DEPTH ~ DISTANCE FROM: SEEPAGE SYSTEM /6'0 ~ DISTANCES: INSTALLED BY: ~" IO~--K£~ : ~,/~a~.~L/~ ~xo, SEWER LINE DEPTH: ~qi TO~ PIPE MATERIAL: ~,~T IgO~ i'0 ,~ Io~r~ LOT SLOPE: ~F (~t~.) REMARKS: DIAGRAM Of SYSTEM /lO ~ / / N[~ 1~~' I-~2 ' DATE~/~¢t~_ 2.¢/9')'Z~APPROVED ~)-~/~. (~'!, /~'J~J.~/?/.~,~Z-/ ~ ' G.A.A.B. December 8, 1972 ~ir. Den;~y Saxowsky St. Rt. A, Box 30 Anchorage, Alaska Subject: Lot 4, ~31ock 2, Ho~e~tead Hitls Subdivision. ,~r. Saxowsky: On August 25, 1972 this gepartn~ent inspected and approved an on-site sewer s.yste~ for ~ three-bedroo)~ dwelling. Ne si~ce been infor~ied that you, in association with Edwin ~eener, intend to enlarge the present structure an additional three-bedroor~ unit. To t)~crease the present system, you will need a 1,000 gallon septic ta~)k plus absorption sufftcte~)t for ~ three-bedroo:~ dwellings, Additional bedroo~s may not be co~))~ected to the existi n(~ syste~. Prior to construction, please contact this office to arrange for a new inst~llation permit for the seco))d u))it. Failure to cm:Jply with requirements of this bepartme)}t ~ill result In legal actto)t against you. Sincerely, Susan £. Dlckerson Sanitarian cc: Geeater Anchorage Area ~orough Butldin~ Department GREATER ANCHORAGE: AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMit PERMIT NO. - INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO SE SERVED FINANCED THROUGH -,,J SEEPAGE PIT ., DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT ~01L 'TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION= ;1:4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAl. INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. ~/ . __ SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMEHT~ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIt '~ ~ .* DRAIN FIELD / SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ~ / , SEEPAGE Pit . DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK, DRAIN FIELD WATER MAIN TO SEPTIC TANK SEEPAGE Pit ALSO CONSIDER AREA WELLS. SEEPAGE PIT --_. ~''~/ DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S 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 BOROUGH REGULATIONS REGARDING INSTALLATrON, TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~ROUGH ORDINANCE I~O; 2;~§8 AND/~'HAT THE ABOVE Performed For ~-~JF~ ~ Leaal DescrJntion: Lotf/,~o-Block This Form Reoorts Soils Log I:.<EATER ANCHORAGE AREA BOROU~H DEPARTMENT OF ENVIRONHENTAL QUALITY CASE 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Date Performed __Subdivision '/z/~ ~_~e,.~-~ ,=L Percolation Test Deoth Feet 7 8 9 10-- Soil Characteristics Was Ground Water Encountered? If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate ~finute Proposed Installation: Seeoaae Pit Drain Field De~th of Inlet Deoth To Bottom Of Pit Or Trench Test Performed By~ ~~ [)ara Certified By: \ / \ ,/ ¥ \ · · . · .. .-.. . .. .:..~..... .... · Driller . · .. ;.~.~'. ... e . ~- ..... We adze 7ou ~ att, ach ~h~_~ certificate ~ yom-'~lee& .... .' .:;. .~ . ,...-..:.-,-:.: :~:~..-.-.'...,... ;_:_..- :-.;.. ' .... · . , . ' .. · ~,..1.; · ;.. ;' .:v ';. Den'vx Saocowsk-f Well Log Descrintion of For?mtion Top soil Sandy clay Hardpan, yellow clay & gravel Gray clay & sand Sand ( hard ) Sand & clay Gravel, clay & sand Blue clay Clay & pravel _~and & l~ttl. ~ter Hardpan ( tan ) Rock & sand Hmrdpzn ( tan ) Broom sand Hardpan Gra~'el ': little wrater Sandy clay Sand, Cravel ~ 11ttlm ~mter Hardpan ~ne ~r~ve! & little water Hardpan Sand, ~r~vel & ~ittle wm,.er 1;~rdpan Gr~ve!, sa~d f~ lit le ~,~ter S~nd, gravel & ~_itSle water ~a~er, sand & gravel From - TO O- ld. 30 3o- 68 68- 78 78- 98 98 - 105 105 - 112 112 - 127 139 - 160 160 - 175 175 - 2OO 20O - 218 218 - 220 .22o - ~ 221 - 226 23~ - 23~ ~23~ - 23~ 239 - 2~5 2d6 - 251 251 - 257 257 -2~8 t,. · D,,~TI~ RECEIVED " INSPECTION APPOINTMENTS DATE DATE DATE ,NSPECTOR ,NSPEOTOR ,NSPEOTOR DEPT. OF H~ALTH & ~UNIglPALITY OF ANOHO~A~E E~IRONMENTAL p~OTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStreet-Anchorage, Alaska 99501 SEP ~ i 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts ca page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. 1. PRO~ERTYOWNER ~ ~ PHONE MAILING ADDRESS ~ ' PR OPERT~R'Sl DENT ~/~ ~, ~('f di'f~'t fi: above)''~~~/~- ' '' 3, LENDINGINSTITUTIO~ -- ~ PHONE I MAILING ADDRESS 4, REALTOR/AGENT ~ PHONE I MAILING AD~R ESS ~ ' ' 5. LEG~y_/_~SCRIPTION STREET LOC~,T~ O N 6, TYPE OF RESIDENCE [] SINGLE FAMILY [~MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [] Three [] Other 7. WATER SUPPLY [] INDIVIDUAL* ~'~COMMU NITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~INDIVI DUAL/ON-SITE~* [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 1 THIS SIDE FOR OFFICIAL USE ONLY ~ 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions; TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [~...~DISAPPROVED DATE BY ~ ?4- Anchor ge 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENTOF HEALTH AND ENVIRONMENTAL PROTECTION September 17, 1980 Denny/Gail Saxowsky Ed/Martha Keener Box 65 Trapper Creek Alaska 99688 Subject: Lots 4 and 5 Block 2 Homestead Hills Subdivision ApprOval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report be delivered to this department from. Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this department. (3) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S Associate Specialist RCP/lw cc: Alaska Mutual Savings Bank Post Office Box 1120 99510 Nima O'Dell % Dynamic Realty Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ' Date Received August 17, 1976 Time of Inspection //~ ?/77. ~0%~ m%\ Date of Inspection ~ ~(~-., bx ~'~NDIA~{)~)~L SEWER & WATER FACILITIES ^~ ~/- (2'~' .qLo ~,~ //~'~3~' FOR /)'133 1. Approval 'requested by: Hope Cottage ~o Trish e Mailing Address: Property Owner: Mailing Address: 2805 Bering Street, Suite 2A Ed Keener Star Route A Box 1735-~ Phone: Phone: 344-5057 Legal Description: Lots 4 and 5 Block 2 Homestead Hills Subdivision 4. Location: See map 5. Type of facility to be inspected 6, Well Data: ~TId~al C. Construction/~/~/~ 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: No, of bedrooms B. Depth D. Bacterial Analysis Public Supply B, Installer /%//~_ ~.x~m-~/~.~ Size 2. Ma n'u ;ac t u r~f~~~. Absorption Area 2./Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510, East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES FHA. CONV 1. Type of Inspection: CMRO VA 2. Property Owner: Mailing Address: ~_~¥ ['~'~",~ 3. Name of Buyer: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AU6 1. ? 1976 RECEIVED Day Phone:.'~ L~ q- ,~ (~ ~ "~ Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: Phone: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: ~J¢ Phone: Location: Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served No. Bdrms. If Individual, depth of well. Sewage Disposal System Type of System: Public Utility .Individual If Individual, date of installation 72-003(3/76) Page 2 of two pages - Re~. ~st for Approval of Individual er & Water Facilities Legal pescription Lots 4 and 5 Block 2 Homestead Hills Subdizvision Comments Approved~~ Disapproved Date ~-/~ ~ ) ~/ ~pproval ~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 EQ-034 (1/74)