HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 1 LT 9
MUNICIPALITY O1: ANCHORAGE
~,~(~ DEPARTMENT OF HEALTFI & ENVIRONMENTAL PROTECTION
ENVIRONMENTAl~ ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPQSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. QF BEDROOMS
Liq. capaciw in gallons Inside length Width Liquid depth
/()D ¢~ IF HOMEMADE:
, ~ ~eH Dwelling PERMIT NO.
O Z ~ Manufacturer ~ Materia~ Liquid capacity in gallons
~2_..~ DISTANCE TO: I~( /~ ¢ Foundation N~are~ lot Ih~e//t PERMIT _~__
~op of ~ile to finish grade ' Mater~'b~e~tile Total effective a~rptiop area
~ CC~ //~ Depth Driller Distance to lot line PERMIT NO.
OTHER ........ i
PIPE MATER eLS ~% 5, ....
INSTALLER ........
72-013 (Rev. 3/78)
i'HK I:::,E!:::'!"H t:)!: l:::l TRE:I~..tL::HCIR PIT ]:El; THEE [:,:I:E;TF:IN(:::ili: E',!::i:IHE:i~:N t"H!: ::::::::::::::::::::::::::::::: CIF FILE:
E!iRC~UN!::) !:::II"ID t'H!ii 12,0'Ft'(::d~'iOF:: FIIEi: E;:)':i(:::Fi',=,'F~T)OI",! ,:::I:t"! i::: E:!:!:T :',.
-il'Iii:RE: :t:'.S i'-.I0 :!2;E:T i,! !: E:' l'l '! FOR
I'HE (:!iR!:::I',?'EL. C'I!.::f::'T'H :t:E; i'HE: t"i!:N:EI"!t.IH E:,E::F'I'H (:iF: (~F:I::i'v'E:i. I~!)E:It,IE~E:i"! ']'FIE: OU!'Ff::!I...t.
!'-!!"![:, 'f~lE: i~OTIC!H OF:' THE: E!:?',C;I::fv'I::IT :[ ()!".I (1:f"! F:'E:Fi: !' :',.
p'F i;?i,! l' 'J' I':iF:'F:'I l' F' '::il'-. r NFl:ii; "i'HK I:;?.E:E;F'ON:!~; :l: ~.. 1. I._ :[ ! 'T' t'C! i NF:Oi:;?H TH £ S; DiEF'FtRTi"IEi;t".tT i:::,1...i!:;: ]: l'q(!i THE!:
iN'L-';!-I:::iULF:IT];L-d'..i ]ii'-!E;F'E)::'f'ilONS; Eft::' FIt"I'-P NEL.L.'.E; Fi', 'F.~IE'.'.!'i"
NIJ!"tE',!!~]I'~: '1::: F;'.ES];DE]?.,ti]:!i]iS !'HF:If- TI.lEi I,~iEL.I. l,J~." t ....
:i:K'P":i<'F r l .... T ,.! ":i '" F I:I!'..!'T~ "': ~'" , I,! ;t: TH()IJT F :!; !'-.!FiI.... . !' I'.,!S;F'!9:YT' ]: ON FII'-,!t)
DE;F:'F::IF?.THF:NT 1,1'1 E;E '!!.El'.!!;: i "1'0
i',ii'N i'i,t, ..... I,t I:::,iE; }'!::!I'-,!i::::F:] E:E:'i'I,!i:i:Ei'.,! :::1 i,iE::f...i.. FIND t::lt",l"r~ CIt'.,F.S f I'I!; S;!:!::I,!F!E?: !::,;l:SF:'O'ii;i:::ll.. '"' :"'':, .,~"::::.
~!;.[. FCi!:;?. I:::i . ,r t[. NEL. i. ~ll,:' 'i.!::,!::~ i-( ;:::'[;:u:;~ ........... I::"EISF F:'i;;:OM I::1 P :: I!:::: t,E~;L.L
I..tF:'CtN "i.tt::' "I'?F:'[~: ::)i::: F:q_tE',L. :[ !:::: I,I :;LI
,,' '1 ,, I ,_ [::' :t: '~;TFIf".!(::E: l:::'L.:c'~l, !:::1 I:::'t:;;: :[ VI::'!'T E: i,IF:..J_.. ']'l:::l I::I Pl?. r VF T ::i' :,[:.!..11': ......... .I ' ...... ~ L,__'.Jl; t' ,:; '~:Ui ~:' ::J' ::i" F:II'-,iD
"rF I::I C;C~H!"IIJi'-,I:!: C.=' '::: :: ,~F'F' L.:t:NE :1:% ';:'Zi I':!~:K'I'.
i:::i !'HE:F;: [~:E:!]:!t..I [ R!:~:!'~E:i"!'f S l'ti::fT' I ..... ~]~;1'::'[~!::: :i: I::' :[ CI::I !' :[ ONE; FIND .....
f . Id..I _., ].. t~ [:, :[ I:::!(~il:;[~t:::l}"l'.~J;
t:::?,?.::~ .l:::.~:.l:~J '1'(::} ",' ':' :' ' P[~'"'l::'(l:;:
:i: i:::KRT:}:F'V T!IFIT
· i..: :): !:::!H F'F:!M:I:i.]:FIi:;,: !,!i[ i-~I THE I;i~E(;:!LI:!:I~:!i::ME:i'.!I'L'i; FOR Oi'..i--'.E;:I:TF: E;~:i:I,!!!i:F:S FiND NE:I_.I..:!i; i::!~]; :i.:;ii:t'
!::'CIl~:f'li E;'? FILE: Hi .iI"! :i: C; :[ F:'F:tI . :I: T'T' (::!F
;;;!:: ]: Id:l:Ix.. :I:NE;?F:!LL 'I'i"!K S';'r'Ei:TE:!"! :I:N F:!CC;CL.':~:IJ:;,FINC;E: i,i:l:'t!'! TI-tFi: CODE:E;.
:-i:: :1: i..!!",l[:dE:R!i;i'Fff',if:, 'Ft-i!:'!'i' THE Ot"!"-Si]T: 5;E:I,.I&t:;~: :::;?:S-I!3"t !"IR"? i;:I3~:!U:I:I:;i~E: E~i",ILF!I:;i;Ciili~J"tE:!.=iI' :1:i:::' '!HE
I;tE:"ii;:i:,~::'E:NCii:: ]:S; !:~i:!"!O!::)E:!..E:D TO :t:NCI...Lli::,F:: t"t0!;?.i]i: TI'IFIt"I :~;
' C.R ANCHORAGE AREA BG "JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~;~g~)/2 C7~
LOCATION ~//~
MAILING ADDRESS .--~./,~/¢ /:~g'X' ¢/,¢.27 PHONE
LEGAL DESCRIPTION /~'¢" FI /~L-¢.</4 /
SEPTIC TANK:
DISTANCE
FROM WELL ~.0~
INSIDE LENGTH ~
MANUFACTURER --~7-/~¢/4 S2~ MATERIAL
INSIDE WIDTH LIQUID DEPTH __
NUMBER OF
~/~/- ¢¢/~* &-~ 4// COMPARTMENTS
_LIQUID CAPACITY / ~Z) __GALLONS.
SEEPAGE Pit:
NUMBER OF PITS / DIAMETER__
LINING MATERIAL ~'~*~-~ /~1~¢ CRIB SIZE: DIAMETER
BUILDING FOUNDATION~/,¢ NEAREST LOT LINE /¢ !
2. ¢, /.~ 2:,_ ¢ / )/.2 .~,3,-" x" 5 ¢/
OR WIDTH LENGTH
DEPTH //
/
DEPTH ~ DISTANCE FROM:
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
.SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE ~¢~¢d CY/. CONSTRUCTION
BUILDING NEAREST
FOUNDATION_ LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
~/8 / ~& ~F/D DEPTH
NEAREST SEPTIC
SEWER LINE TANK
REMARKS
DISTANCE FROM:
SEEPAGE /.~
SYSTEM ~
DISTANCES:
INSTALLED BY:
PInE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE ~ - /~- ¢'¢ APPROVED ~'~ ~, ~/-~/~g~-'¢'~ '
G.A.A.B.
Form NO, EQ-O31
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
PERMIT NO,
IN STALLATION LOCATION W 1/~ /5i~,'~¥' ~ "~" ~ ~t
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ., DRAIN FIELD ,, OTHER
NOTEI THIS PEr, MIT IS NOT VALID WITHOUT ¢~OIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL, INSPECTION bY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
WELLTO SEPTIC TANK '~0 /'g0 /' 0/~ ~'
FIELD
ALSO CONSIDER AREA WELLS.
SEEPAGE PiT
--., DRAIN FIELD
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 W[TH AIRTIGHT REMOVABLE CAPS ·
I CERTIFY THAT I AM FAMILIAR wI'rH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM I$ IN ACCORDANCE WITH SAID OODE.
ATE APPL,CANT'S S--AT--
"One teil is worlh a Ihousa~d opbllons"
!Ir rforme(!, F'i)'r Date ~ mm
r Glaoisr Excavating PerformedL~.22L:7~
J:'OesYri'~:tion: Lot 9 Block 1 Subdivision Skyranoh~
or~s Soils Log ~em Percolation Test
Oe n ¢ h
Feet
Soil Characteristics
Silty Gravely Sand SM-2~O
Silty Sand, some gravel SM-2~O
16 fi, bottom of test hole
Was Ground Water Eacountered?_=~
t~ . ,~0,0o
If Yes, At what Depth?
Readinfl
Date
Gross Time
Net Time
Depth to Ii20
Net Droo
Percolation Rate Hinute
Proposed Insta--~lation: Seenaoe Pit yes Drain Field
I)eoth of Inlet. Depth To Bottom Of Pit Or Trench
C n..4~,,~ E N 'r S. ;~ ~,
· __...~ oq. ft. draS. na~e area required:per bedroom
No bedrock' or wa~er table 4- lb. below intended seepage ~i~~
~est Performed ~W~~t Data Certified By: Cons~ructi~'n T~
"0.~ ~est ts ~vortJ~ a tt~ousa,~
Performed For Olaci~ Excavating Co Date Performed.
Legal Oescrintion:
7his ~orm Re~orts
Soils Lda ye ~ Percolation Test
Deoth
Feet Soil Characteristics
~ ]:rD_et
3--
4--
5--
lC--
to Seepage Pit
Silty Sand SM-2~O
Silty Gravel Layer -14 to 1~ ft.
feet bottom of Test Pit
~Was
Ground Water Encountered? No ~/o^
IF Yes, At what Depth?
Readinq Date Gross Time Net Time Depth to H20 Net Droo
Percolation Rate ~linute
Proposed Installation: Seeoaae Pit yes Drain Field
Death of Inlet Depth To Bottom Of Pit Or Trench__
CnM!~ENTS: 23~ sq. ft. drai~,~go area
No bedroo~ or water table ~ ft. below intended seepage pit.
rl,,.s,L ~. ~ '-, Data Certified B~/:Construction m~¢,r, l~
Lab Manager Date: ~-25-7/F._ ............
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 SINGLE FAMILY DWELLING
Parcel I.D. # ~ \4 - _~ -\~
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing.address
Lending agency
Mailing address_
Agent /",('//'J"
Address "%¢//~-
~-----~ i.' ~'T"b~- %T~u-Y"' Day phone
/~[A Day phone ,~"/,4-
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well ~
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA
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.
NameofFirm A~-~c~A ~'~A-~ ~ C¢'~P~/'~/~/'4'~''''~-~' SvC$, Phone ~'-~f~
Address,
Engineer s signature ~~~ Dato ~
/---~/~¢(/2¢/3bed rooms'
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
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 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.
72~25 (Rev. 1/91} BaCK MOA #21
Municipality of Anchorage ~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAl,. CHECKLIST
Legal Description: .%1~-2~(' /~¢4-~ -~-q ¢¢' 2 Parcel I.D. o/~/~Z-- - -,~),~. "7/~/
A. WELL DATA
Well type ¢-~'I'~,P1, If~, or
Log present (Y/N)
Total depth /'¢/./~
Sanitary seal (Y/N)
C, attach ADEC letter.
Date completed
Cased to /¢//~
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot ~//3-
Public sewer main
Sewer service line ~/,/~
ADEC water system number
/~ (//4 Driller
Casing height
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots _ /¢~F
Public sewer manhole/cleanout ,A///'¢,
Petroleum tank ,/'///~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
/v ~,,g- Other bacteria ,tv'?/'~
Collected by: /"//,~
B. SEPTIC/HOLDING TANK DATA
Date in stalled" ? ¢//,,~/~+ Tank s ze /~20 ~ Compartments '7
Cleanout¢ (y/~N~'. .,' '..~'. . .:"~°undat on c eanout (Y/N) Y~ Depression(Y/N)
H~gh w~ter alar~ (~N) ,;',' ¢ .., ,-¢. Alarm tested (Y/N)
Date of:~mpin~ ....... ~~ ~/~ ~ Pumper
SEPARAT!ONDISTANCE¢'.¢R~M SEPTIC/HOLDING TANK TO
Well(s) on lot "',~;~; .. */~' On adjacent lots ~
Topropertyline~ ~,~'~"r'~bsorptionfield [j~,~4qOuo~J
Surface water/drainage No~ O g~'CC'.,V,~Z)
Foundation
Water main/service line
72-026 (Rev. 7/91 ) Front
'2 · [')f--J?-,- ~-/~ V/.~ 'T- 7/~./c~ ~. CONTINUED ON BACK PAGE
C. LIFT STATION
Vent (Y/N) ~evel at
Manufacturer
Manhole/Access (Y/N) ~
~' level at
,.-/~Cy~les tested
High water alarm level
Meets MOA electrical codes (Y/N) .---/ ~
We.l. lc~rtflot On adjacent lots Surlier..
D. ABSORPTION FIELD DATA
Date installed
Length "'~0 / I(~ Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Soil rating
FT
Gravelthickness 7 / ~.System type
Total depth
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO'
//~ i q O
Well on lot /'q '" "
On adjacentlots ~ ~,~v~ Propertyline
To building foundation O~4,~ov~ ~ \ To existing or abandoned system on lot
On adjacent lots"r~ ~/" ¢¢~ "'¢ ~'/~Cutbank ~/,A Water main/serviceline
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area 1-~.~4
I certify that I have checked, verified, or,C'onformed to all MOA and HAA guidelines in effect oQ .Lha~l~te. of this inspection.
Signature tx,.._./~~¢,~.,"~,' ,/~1~,' ;.~'~'iJ
Date ~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
Alaska Water & Wastewater Services
"Preserving the Last Frontier"
1992
Municipality of Anchorage
Department of Health add Human Services
Division of Environmental Services
On--Site Services Section
P.0. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
OOT 7 19,02.
M.J'dolp:jity c,f Anchorage
Ref: Health Authority Approval (HAA) Applicatioli for Lot
Block 1, Sky Ranch Estates
To ~hom it may concern:
1. SEPTIC SYSTEM ADEQUACY: Attached is the HAA application
for the subject lot. An adequacy test was cur on the septic
,~rsystem by introducing 6.7 GPN~ for' a total of 70 minutes,
into the sump located at the end ef the trench. 'Fhs total
volume i~tcoducBd ~as 469 gallons, ced the liquid level in
the sump rose a total of 14~5 inches. The recovery of
~systmm was monitored for 110 minutes after the watec was
shut off, and the results were plotted on log vs.. log
Based upon this [)~ot ~ th8 system will absopb 505
Cons8quBntly~ the systmm is adequate fep a thp8e b~dpoom
house (450 qPD),
2., STRUCTURAL INTEGRITY OF SEPTIC -r~NK: The exist.~ng septic
tank was installed in June of 1974~ making it approximately
18 years old. During my site visit, the septic tank was not
expesed and visually inspected for structural integrity.
However, there was not any noticeable depression oven the
septic tank, ~hich if p~esent ~ould indicate that it
structurally failed at ~his time. Regardless, because of
its age, it is reasonable to assume that it is reaching the
end ef its useful life. Consequently, the ne~ homeowner
sheuld anticipate replacing it within the next five years.
SEPARATION DISTANCE FROM SEPTIC TANK TO ABSORPTION
FIELD: The subject separation distance is unknown because
the initial inspection report (8/12/82) did not state the
distance and, furthermore, there is no clean-out designating
where the trench begins so that it can be physically located
at this time.
Telephone - Fax 338-3246 · 8471 Brookridge Drive ® Anchorage, Alaska 99504
4. SEPARATION DISTANCE TO CLASS "A" WELL: There is a Class
"A" well located on Lot 11, Block J., Sky Ranch Estates ~2
Subdivision. The separation distance 'from the septic system
to this well is approximately 190 feet. Attached is a
waiver of the 200 'foot separation distance 'from ADEC.
If you have any questions, please call me at 357-6179. If
all gees well, please send the HAA be the homeowner. Thank
you.
Sincerely,
;;fAG/jag
Stout2.wps
,ant
P.E., M.S. .
WALTER J, HICKEL, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION~
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
September 24, 1992
Jeffrey A. Garness, P.E., M.S.
Alaska Water and Wastewater Services
8471 Brookridge Drive
Anchorage, Alaska 99504
Subject:
Lot 9, Block 1, Sky Ranch Estates #2, Anchorage, AK
ADEC Project 9231-WV-011, Review
Dear Mr. Garness:
This is in response to your submittal, received in this office on July 24, 1992, in which you
requested that the Department waive the separation distance between a Class A Public
Water System Source Well serving Sky Ranch Estates #2 and a wastewater disposal
system located on Lot 9, Block 1, Sky Ranch Estates #2, from 200 feet to approximately
190 feet. I have completed my review of the submitted information, this office's file on Sky
Ranch Estates, and other pertinent information. Based on the results of this review, I
have the following comments.
From the submitted information, it appears that the wastewater disposal system was
incorrectly installed in regards to separation distances that existed at that time. However,
the monitoring data tends to indicate that the aquifer and source well are not being
directly influenced by improperly treated wastewater from the wastewater disposal system
~,-, ,~ ~ ~ o,,~- ~ ~ ~, a ' ~,' ~ ,~ Cv r ,,o ofth¢'
,n ques,.~n, n,~r f, om .he other ,,~,,tem~ tha, are lo~ate., wit. ,~n th.. pr~.~c.~ e ad ..,~ v~
~'existing Class A Public Water System Source Well. Thus, it appears that there is existing/
I evidence in support of the requested waiver without all the information required in 18 AAC_..J
~80.030 (b) being provided to this office.
Therefore, in accordance with the provisions of 18 AAC 80.030 the separation distance
between the Class A Public Water System Source Well for Sky Ranch Estates #2 and the
wastewater disposal system located on Lot 9, Block 1, has been waived from a minimum
2f~._2_0~___:f.~¢._.t.o_.~ 9_.0..f_.e.._e_t~ This waiver will remain valid until t~ wastewater disposal system
on Lot 9, Block 1, Sky Ranch Estates #2 fails, requires upgrading, is modified, or the
operator(s)/owner(s) of the Public Water System object to this waiver. At that time,
either existing separation distances will need to be met or another waiver request will
need to be submitted to this office.
Jeffrey A. Garness 2 September 24, 1992
Thank you for your coordination with this Department. If you have any questions, please
do not hesitate to contact me.
Sincerely,
Keven K. Kleweno
District Engineer
KKK/cf
cc: John Smith, MOA DHHS
Tony Wilson, Sky Ranch Estates
MUNICIPALITY OF ANCHORAGE
DEPARYMEI OF HEALTH AND ENVIRONMENT PROTECTION
825 L Street, Anchorage, Alas 99501
' 279-.2511, ext. 224 or 225
,' ,,~, Date ~eceived: M:~ 11, 1977
#2: Time ~3: Time
Date Date
Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska National Bank of the North
Mailing Address: Pouch 7-010 99510 Phone: 27~-4581
2. Property Owner: Claude E/Marilyn R Hoff
Mailing Address: Star'Route A Box 1619H 99507
Phone: 344-8982
3. Legal Description: Lot 9 Block 1 Sky Ranch Estates ~1 Subdivision
Single FamJ_ly Residence: ~ Number of Bedrooms: 4
Multiple Family Residence: ( ) Number of Bedrooms: ~
We3.]. System:
Permit #
Construction
Individual Well ( ) Conm~unity/Public System (x~
Depth of Well Well Log on File
Bacterial Analysis
( )
6. Sewage Disposal
Permit It
Septic Tank Size /gQfD~ Manufacturer
Absorption Area _~_~_ ~_~_'_D~Soils Rate
7. Distances: Well to Septic
System: On-site System (xk Public Utility ( )
Installed .~:~.~?_:~_~_.y~ Installer
Material ~ ~ //.~
Tank ~/~' to Absorption Area
to Sewer Line
Nearest Lot line
Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
DEPAR'rMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 I, Street, Anchorage, Alaska 99501
279-25].1, ex~. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
Type of Inspection: VA____FHA__
Property Owner: .... ~_0_FF~ Claude E. & Marily~t R.
Mailing Address: SRA Box 1619H Anch. Ak. 99507 Day Phone: 344-8982
3. Name of Buyer: HOFF, Claude E. & Marilyne R.
Mailing Address:. SANg AS ABOVE
Day Phone:, 344-8982
4, Name of Lending Institution: ALASKA NATIONAL BANK
Mailing Address:_ _P~ouc_h 7-010 /anchorage, Ak.
99510
5. Name of Realtor or Agent: N/A
Phone: 278-4581
Mailing Address: - Phone:_ -
Legal Descr ption:_ L~o_t 9__~Block 1 Sky Ranch Estates #1
Location:___ NHN Whi__spering Spruce Drive Anchorage, Alaska
99507
7, Type of Facility to be Inspected:__ Single Family DwellinA
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation ____
No. Bdrms. 4
Individual Community
Individual (on-site) XXX
72-003(3/76)
P'age Two
Department of
Request for Approval
Health and Environmental Protection
of Individual Sewer and Water Facilities
Legal Description: Lot 9 Block 1 Sky Ranch Estates ~1 Subdivision
Comments:
Affadavit Attached: (i) Letter Attached: ( )
Approved:
Disappr oved :~/~
Date:
D~partment Worksheet: