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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 7 LT 15 kyway Park Estates Block 7 Lot 1 #019-102-01 s1r[A 1 I" E O F n L n S( WALTER J. NICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSSERVAITION ANCHORAGE DISTRICT OFFICE R E C E I VfZ10775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 AUG 3 0 1991 August 27,19,911 ""U.' C"'all,YOf Anchorage zpt. Health & Human Services Ms. Karen Kendall 1511 Woo Blvd. Anchorage, Alaska 99515 Subject: Lot 'I, Block 7, Skyway Park Estatos, Anchorage, Alaska, ADEC Project Numbers 9221 -DW -012 and 9121-DWW-012; Review Dear Ms. Kendall: This is in response to your submittal, received in this office on July 3, 1991, in which you requested a letter of approval for the public water and wastewater disposal systems serving the single family home which will be upgraded to a Bed and Breakfast. The submittal also requested a waiver for the separation distance between the existing source well and septic tank of approximately 90 feet. My review also noted that a waiver for the separation distance between the source well and the soil absorption system of approximately 109 feet would be needed. I have completed my review of the submitted information and have the following comments. Based on the submitted information, it appears that the existing public water system was installed in compliance with the applicable State Regulations at the time of installation, With the upgrade of the water system from a private to public water system due to the change to a Bed and Breakfast, there is the separation distance problems that is noted in your submittal. Since there will not be an increase in the peak flow demand placed on the existing water and wastewater disposal systems resulting in the change and the analytical results for Total Coliform Bacteria and Nitrate (as nitrogen) returned satisfactory, the Class C Public Water System is approved for the concerns of this Department. A Final Operation Certificate, constituting this approval, is enclosed for the existing Class C Public Water System. As a result of my review of the submitted information which includes the fact that there will not be an increase in the peak flow demand placed on the existing water system and in the volume discharged to the existing wastewater disposal system, Department has found the information provided to be satisfactory for allowing a waiver in accordance with 18 AAC 72.035, State Wastewater Disposal Regulations. The separation distance between the existing Class C Public Water System Source Well and the existing septic tank has been waived from 150 feet to approximately 90 feet. pon led on recycled paper by C.D In addition the separation distance between the existing Class C Public Water System Source Well and the existing soil absorption system from 150 feet to 109 feet has been waived. This waiver will remain valid as long as annual analytical results for Total Coliform Bacteria and Nitrate (as nitrogen) are submitted to this Department. it is recommended that the samples are collected during February of each year. Any changes to the existing public water system or the discharge volume increases above that of a two bedroom Bed and Breakfast and a one bedroom single family residence (total of three bedrooms) will invalidate this waiver. Due to the monitoring requirements of the waiver, the following Public Water System Identification (PWSID) Number is assigned to this Public Water System, ��. Please remember that the PWSID Number assigned to your public water system will need to be on all analytical data submitted to this Department so that the waiver will remain valid and the results will be properly filed. In regards to the use of the existing wastewater disposal system, it appears that the system was installed substantially in accordance with State regulations and guidelines at the time. The results of the recent adequacy test, also verifies that on the day of the adequacy test was performed, the wastewater disposal system was accepting the necessary flows. In addition, there will not be an increase in the volume of wastewater being treated and disposed by the existing wastewater disposal system due to the change from a single family residence to a bed and breakfast. Therefore, the wastewater disposal system is also approved for the concerns of this Department. 'The enclosed signed "Approval of On -Site Residential Water and Sewer Systems" constituting this approval, is enclosed for the existing wastewater disposal system. Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to contact me. (14,e4— el , Keven K: Kleweno Environmental Engineer Enclosure: As Stated cc: John Smith, DHHS, w/o Enc. SKIh Consultants, w/o Enc. KKK/pf . GRE'9'ER ANCHORAGE AREA B0I""UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 IN,SPEC/T�IO(�N� REPORT ON-SITE SEWAGE` DISPOSAL SYSTEM NAME - L� MAILING ADDRESS-A(o.)- Z_ a.1.69 ,Aan.. _ PHONE,),) _" /'� r� r p p LOCATION ) �� J .' .(W e' c =LEGAL DESCRIPTION -4 �j7_--- SEPTIC TANK:—\—�1 DISTANCE n I1rl NUMBER OF FROM WELLMANUFACTURER ��- ��r- MATERIAL"—QA, 11 __COMPARTMENTS -2--- INSIDE LENGTH --INSIDE WIDTH _LIQUID DEPTH _LIQUID CAPACITY -1_0( ( GALLONS. SEEPAGE PIT: � I NUMBER OF PITS —� DIAMETER – OR WIDTH II , LENGTH,!- L., DEPTH (3 LINING MATERIAL j2-01 CRIB SIZE: DIAMETER --DEPTH-- DISTANCE FROM: WELL V _ ( TOTAL EFFECTIVE /�� BUILDING FOUNDATION, NEAREST LOT LINE "1`.1i) ABSORPTION AREA (WALL AREA) // `0 SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED_ _DISAPPROVED DISTANCES: INSTALLED BY: PE�PE MATERIAL:alo�� .^ C LOT SLOPE: ��- REMARKS: Form No. EQ -031 NEAREST SEWER LINE REMAR c ?, A� F_ .4 R• DATE DEPTH _ DISTANCE FROM: SEPTIC SEEPAGE TANK. SYSTEM_ DIAGRAM OF SYSTEM APPROVED t._ 'a. G.A.A.B. �7fet r�t�-✓)f..t=.J CLW' /9 %17, GREATER ANOFIORAGE. AI;?G:A F30ROLJGI-I ,�� j'T •��'F___-- IIL.III $ DEPARTMENT OF' [ENVIRONMENTAL QUALITY PERMIT N O. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL. SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION l4lat`_ LEGAL DESCRIPTION -_ C1 -t / -��Z ` INSTALLATION OF: SEPTIC TANK _Ll_� TYPE AND SIZE OF FACILITY TO BE SERVED LING ADDRESS Z�ZZ '/6 4 " � _ PHONE 41-7 Y SEEPAGE PIT n FIELD-, O'FHER FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS -.._ NOTIE: THIS PERMIT IS NOT VALID WITHOU'P SOIL TEST COMPLETION DATE AN"FICIPATEI> FINAL. INSPECTION' 24 HOUR NOTICE REQUIRED. BACKFILLING OF' ANY .SYSTEM WITHOUT PIPIAL. INSPF.CTION HY 'EHE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL. BE SUF33ECT TO PROSECUTION. SEPTIC TANK SIZE _ /6'�O __- TYPE .J(�ed MINIMUM DISPANC:F_S, REQUIRF.ME:NTS FOUNDATION To SEPTIC TANK _- Z�, FOUNDATION TO SEEPAGE PIT ______C__, DRAIN FIELD SEPTIC "TANK TO SEEPAGE PIT WALL SEEPAGE AREA :iIZE ✓_.—.` yfx 2,24i SEPTIC TANK SEEPAGE PIT O DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK -4-0 r-- SEEPAGE PIT-_-.-, DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN 'FO SEPTIC TANK SEEPAGE PIT __- DRAIN FIELD _. SEPTIC TANK, 1-00-f---, SEEPAGE PIT Loo_-._. DRAIN FIELD "FO RIVER. LAKE, STREAM. N_ INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF ON 5 FEET INTO UNDISTURBED SOIL. A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS__ _-- GRAVEL BACKFILL CONFORM TO BOROUGH ftEGL LATIONS REGARDING INSTALLATION, G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCRIB/EED� SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE _/�/-_- APPLICANT'S SIGf•IATU RE FORM NO. EQ 016 I AREA BOROUGH ORDINANCF_NO. 28-68 AND THAT "FHE ABOVE BECEIVEI) GREATI:R ANCHORAGE AREA BOROUGH 00.1 1�/� �WARTMENT OF ENVTRONMFNTAL QUALITY Case 11 3330 "C" Street GREATER ANOIORAOL AREA BOROUGH ANCHORAGE, ALASKA 99503 DEPT. OF ENVIRONMENTAL QUALITY Performed For xersk Kendall Dated Performed 09/28/73 Legal Description: Lot_I Block 7 _Subdivision Sky Way Park Estates ^ This Form Reports Soils Log__ X ``Percolation Test—___-__ - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics _.- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Brown organics Date Gross 'Time Net Time Depth to 1120 Net Drop Brown silty sand _ Brown silty sandy gravel - m- (GM) with gray sandy J gravel seams (GW) - - - _ interlayered Was Ground Water Encountered? No If Yes, At What Depth? Reading Date Gross 'Time Net Time Depth to 1120 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit x Drain Field Depth of Inlet Depth to Bottom ofiuPit or Trench --- COMMENTS: 170 sq. ft. of drainage area is required per bedroom. Test Performed BY Carlisle Date Certified BY: ALASKA MINERAL & MATERIALS LAB Date: 09 28 73 Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL bllct-00-o1 Parcel I. D. — Expiration Date: — 1. GENERAL INFORMATION Complete legal description SKYWAY PARK ESTATES S/D; BLOCK 7, LOT 1 Location (site address) 1511 WOO BLVD, ANCHORAGE, AK, 99515 Current Property owner(s) RONALD HOSKINS Day phone C/O AGENT Mailing address 1511 WOO BLVD, ANCHORAGE, AK, 99515 Real Estate Agent MARY JO CUNIFF W/ KELLER WILLIAMS Day phone 317-3187 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 Received by: �i Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `l l O Waiver Fee $ Date of Payment �� �7I I a (���� Date of Payment Receipt Number Receipt Number COSA # 0SCCI a t Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER 2 As certified by my seal affixed hereto and as of the validation date shown below, 1 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. /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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious 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 sails 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 Y System #1 Approved for _ bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: AN ON-SITE WATER AND WASTEWATER PROGRAM The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory V Nitrate Advisory Arsenic Advisory Other gy; cr l Original Certificate Date: (Rev. 11!05) 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: SKYWAY PARK ESTATES S/D; BLOCK 7, LOT 1 A. WELL DATA *ASSUMED Well type PRIVATE If A. B. or C provide PWSID# N/A Date completed PRE 4/12/78 Sanitary seal (Y/N) YES Total depth 64-66 ft. Cased to *40'+ ft. FROM WELL LOG Date of test NO WELL LOG Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform () colonies/100 ml. Arseni,'.54. i ug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments _ Foundation cleanout (YIN) _ Depression over tank (Y/N) u1cl-/ Parcel ID: G44-2L&4­� Well Log (Y/N) NO Wires properly protected (YIN) G S Casing height (above ground) 12+ in. AT INSPECTION 11/16/2012 48 ft. 5.52+ g.p.m, Nitra4J_2 mg./L. Date of sample: 11/16/2012 PUBLIC SEWER Date of pumping C. ABSORPTION FIELD DATA Date installed Length ft. Total depth ft. Eff. Pumper. Soil rating (g.p.d./ft'��ft. Width Collected by: GEG. Ltd. Date installed Cleanouts (YIN) High water alarm ft Monitoring tube Date of adequacy test Results (Pass/Fail) _ Fluid depth in a�'n before test _ in. Water added Elapsed Ti —min. Final fluid depth in. rejuvenation treatment (past 12 mo.) (Y/N & type) System type Gravel below pipe Depression over field ft. For bedrooms _gal. New depth in. Absorption rate >= g.p.d. - If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YM "Pump on" level at in. "Pump off" level atm I . High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main Sewer /septic service line Animal containment areas 50'+ Public sewer manholetcleanout 100'+ Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption Water main Wells on adjacent lots Water service line Surface SEPARATION DISTANCE FROM ABSORPTION Property line . Water service Curtan drain F. COMMENTS G. ENGINEER'S CERTIFICATION TO: Water main Surface water Driveway, parking/vehicle storage Wells on adjacent lots 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date ! -1,/ -z— (Rev. (am. 11/05) Municipality of Anchorage Community Development Department Development Services Division a FET. On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 01910201 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 7, Lot 1 of Skyway Park Estates Subdivision. This inspection revealed an arsenic concentration of 57.1 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. AAROW PUMP & WER SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 a Fax (907) 345-0202 Eagle River: (907) 622-9335 JOB SITE No. 9636 INVOICE DATE CUSTOMFH 9VJL (HLgINATPC PUMP DEP ,/ SALESPEftON ^ QUANTITY DESCRIPTION PRICE AMOUNT r, JOB SITE No. 9636 INVOICE DATE WELL DFPiE{ 9VJL (HLgINATPC PUMP DEP ,/ SALESPEftON ^ QUANTITY DESCRIPTION PRICE AMOUNT LABOR HounS RATE AMOt1NT TOTAL MATERIAL TOTAL LABOR r' WORK ORDERED UY DATE COPAR TOTAL LA[30R _ PAY THIS AMOUNTn r� n_ SIGNATURE Q Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree fhat if above work is not paid for in 90 days 1 agree to allow Aarow Pnmp & Well Service, LLC. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. LU � 3 4oi�ia�.W i ci N • �' 31^® 8I1 Q S IZ �s L FW e 106 p>1/� e � a d j � s 6E19 0 i • ��•. IOLI � ¢ A Yl (B i9d g, s, lae6 far er � ad � .. a ti.. m Y De _ ae r �s Cdr ss' off_ "_ 's rs ios Ton m m ✓' s � ' i co s d m & N 3s e N o H dor zQe .Q `° o -o .�. •,.. 'v awe'�. _. auu Buuoi�$a nrcrwr»�3z°n Cf) E C7 g ¢a uuu �uougnnnrcrc¢�r»33z. DAIt SGHEODt.ED 1J TIME INSPECTOR - StlGT ;VISION SKYNlA7PARK ESTATES BLKILTtTRACT BL.K 7L 9 k INDICATE NORTH , 1 j i E E 3 <i 7 fl AT PROP INE': SIZE MAIN: TYPE MAIN: DEPT AT MAIN: CONNECT LOCATION: r \Aa 13 I COMMENTS u h'se _.. t �{��, 2.2 INSPECTED BY a DATE SCHEDULED 1 7 TIME SU8DIVJ=N SKYWAY PARK ESTATES INSPECTOR BLKILTITRACT BLK 7 LT 1 �7A 1'Z kS2(P,FEs Al ",kctj -TAP vi i Got 30' �t�AiJ )Ip CL -50 END 30' BLVD. 3or SIZE MAIN: �j 1i TYPE MAIN Dip. DEFT AT MAIN: fZ 5 AT PROP. LINE- fQ CONNECT LOCATION: 15s, OT� -r HE COMMENTS 4II ©_c,:P INSPECTED #3Y'.(�% DATE: r JJr� F 30' 1 �7 W t�. 4 �t�AiJ )Ip CL -50 END 30' BLVD. 3or SIZE MAIN: �j 1i TYPE MAIN Dip. DEFT AT MAIN: fZ 5 AT PROP. LINE- fQ CONNECT LOCATION: 15s, OT� -r HE COMMENTS 4II ©_c,:P INSPECTED #3Y'.(�% DATE: r JJr� d *4�API ASBUILT SURVEY. P' =30' yppp G�1 NO COPNFAS SEi TNBDPIE 'q. SNANEA. VOLS Yfj HBY CERTIFY ASURVEY OFTHEFOLLOWING DESCRIBED CRIBEDPROPERTY LOT 1, BLOCK ], SKYWAY PARK ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE THE xlsarsMAnLN HEaEorvls foR THF vsE of LEwzNSlrvsnnTxaEz sPEafzuuv ro VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN sHrnvnNv co�Lzns efTWEEIJ EXLSTW6smvrnaEs aNprl.aTrED LOT Lafs aup/oR FASEMErvrs aNDlsTHE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS NOT TO BE VSEp fO0.PO5IIIgJ1N6 npMRONnl51RV[SURF; TMpROVFMENT5, 0.Q fFNCFLINES. 1 EXIST OTHER THAN NOTED. EASEMENTS OF RFCPID. OTHER TNPN i1.Osf appFaPIN60N THE RfLORO haT,ARF NOT jHOWN HEREON(1FxE55 xrvDlcnreDl DATED AT ANCHORAGE,ALASKA THIS _9TH_ DAY OF NOIP:FFV(ELTNES TN.ITMRY APPEAP ON iMS WAWIN6 APE NOT TO BE VSEp TO DETERMNE NOVEMBER 2012. PRWEPry11NFS OR POSIttgJ applT[ONnLIMpROYEMEMS, A1IV PAVIN65HOWN NERE(NJM4Y RE APPROXIMAIF DVE TO E%LE35IYESWW.1Np/giI[F. HOLT LANA SV0.VEYING WHI6A.El p101 j lIOti6 FB 156-39 ANLHWA6E,nC 99515 3a65513 MUNICIPALITY OF ANCHOR A(;[ �. DEPARTMEN JP HEALTH AND ENVIRMft- PROTECTION 825 L Street., Anchoraan, Alaska 99501 264-4720 Date Received: April 7, 1978 #1.: Time 11:15 a.m. #2: Time #3: Time, Date 4-10--78 Monday Date Date Insp Pratt In sp Insp REQUEST FOR APPROVAL, OI? INDIVIDUAL SEWER AN WATER FACILITIES 1. Lending Institution Request: Mailing Address: � � _ Phone: _ 2. Property Owner: Hershel L. Kendall__ Phone: 344-•4116 --_ Mailing Address: Star Route A Box 192A 99507 ____�__________ 3. Legal Description: Lot 1 Block 7 Skyway Park Psstates__ 4: Single Pam:ily Residence: (x) Number of Bedrooms: Three_ Multiple Family Residence: ( ) Number of. Bedrooms: 5. Well System: Individual Well (x) Community/I?ublic System ( ) Permit # __� Depth of Well 64-66' y Well Log on File ( ) Construction Bacterial Analysis — 6. Sewage Disposal System: On -sate System (x) Public utility Permit # ^��_ Installed 1974� Installer Septic Tan], Size a o Manufacturer; 6 ` `-_� Absorption Area Soils, Rate- ) Materiah 7. Distances: Well to Septic Tank __ to Absorption Area -qvMr#- t.o Sewer. Line Nearest _Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 1 Block 7.Sk w Park ]Estates Subdivision Continents: Aff.adavi.t Attached, ) Letter Attached: ( ) Approved: - ✓_--- Date: _L{_ -- Disapproved: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection \1 825 L Street, Anchorage, Alaska 99501 L\ Sc[ 264-4720 \��--i%quest for Approval of Individual Sewer and Water Facilities l 2 3 112 5 6 Property Owner: /DRL/- Mailing Address: �%� I�Q�� �4 �_/j_Phone:�l�p Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Mailing Address: Legal Description: Street Location: Single Family Residence: Multiple Family Residence Phone: Phone: Phone: (Number of Bedrooms: ( ) Number of Bedrooms: 7. Water Supply:,. *Individua.l Well (/�i/) Public/Community System ( ) If Individual Well, well depth �i 6 6 j% If Community System, name of system 8. Sewage Disposal System: *'On-site System If On-site System, date of installation: o Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77