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Home My WebLink AboutKASILOF HILLS BLK 7 LT 15 Municipality of Anchorage Page t of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Waste)water Disposal System and/or Well Inspection Report ~ - ~ ~Upgrade . ~~ ~, ~~ Wastewater System: ~ New Address: ~o~~ .~. ABSORPTION F~ELD Phon~ ~ -- [~ ~ No. or,rooms: i CDeep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION sci, Rating: ,~14~ GPD/Sq. Ft. Total Depth from ori~inal grade: Subdivision: ~epth to pipe bottom from original, e: Gravel depth beneath pipe = '~ Fill added above origina grade: ~ Gravellength: ¢ Gravel~ ¢- J Numberof nes: D stance between nes WELL: D New U Upgrade i ~¢'~' ~ Ft. ~ h C)' Ft. Driller: Date Drilled: Static Water Level: Igs~ller:, . . Date installed~ Yield: ~ Pump Set at: Casing H.~h~ A~ove ~.ou.d~ TAN K GPMj Ft. Ft. SEPARATION DISTANCES ~s.pti~ ~ Ho~di.~ a s.r.~... TO Seplic Absorption Ld[ ~ Holding ~ublic/Private Manufacturer: __~ . Capacity in gallons: Mate~. ~ Number of Compartments: Surface ~1~ W~t~r ~ [ 4 / ,~ ~ LIFT STATION Lot I I Size in gallons: ~ ~ ~ "Pump on" level al:~~t~ater alarm at: Foundation .¢~11 .~ / / Remarks: ~t~[t.~ ¢~h~' '~~ BENCH ~ARK ~~>~ ~ ~~, L°cati°n and Descripti°n~x~ ~ ' ~ ~ ¢ ~ . . ] I Assumed Elevation: Insnections nerformed by' ~7;3~;;;;;i:;;;;1' R°ad N°~s' 1st cl~[~-'~[ Department of Health and Human Serwces approval ~, ~.. ..... . ,¢,~ 72-013 (1/91) MOA 25 Permit No. ~.JC~ ~(~;~ Page. Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well, Inspection Report 72.013 A (2191) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910201 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:DORRIS FLORENCE M OWNER ADDRESS:10301 STROGANOF DR ANCHORAGE, AK 99516 DATE ISSUED: 7/17/91 EXPIRATION DATE: 7/17/92 PARCEL ID:01513220 LEGAL DESCRIPTION: KASILOF HILLS BLK 7 LT 15 SEC 13, T12N, R3W, SM LOT SIZE: 30000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (ISAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: VERIFY THAT PEAT LAYERS ARE NOT PRESENT IN TRENCH LOCATION. IF PEAT IS ENCOUNTERED THE SYSTEM MUST BE RELOCATED WITH NEW SOILS/PERCOLATION TESTS AND REDESIGNED. NOTIFY DHHS PRIOR TO INSTAL]~A~ION F~R INFIELD VERIFICATION. RECEIVED BY: ~ DATE: July 8, 1991 ROBERT SHAFER, P.E. ROGER SHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER OISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 15; Block 7; Kasilof Hills Subdivision; PER~IT REQUEST NARRATIVE Request you issue a permit to upgrade the septic system on the referenced property. An adequacy test was performed on the existing system on June 17, 1991. The absorption capacity of the existing syst~l is adequate for one bedroom. The existing system serves a three (31 bedroom house. The existing tank was found to be of poor integrity. A test hole was excavated in the area of the proposed upgrade. The soils are a SM material with 2 veins of peat approximately one ft. deep each from 74' to 84' and from 94' to 104'. The SM soils h~ve a percolation rate of 40 min/inch. We foresee no negativeimpact of the development of adjacent properties by the installation of the proposed upgrade. If you have any questions review, please contact us. A. SHAFER, P.E. or require additional information for your 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 / = / ? / SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE 1 2 3 4 5 6 7 9 11 12 13 14 15 17, 19- 20- WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Deplh to Waler Alter/ ~oniloring? ~1 ¢'C[ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop I ". ~" PERCOLATION RATE _/'~ ?,,...) Im,nutes/inch) PERC HOLE DIAMETER ~ PERFORMED ~(~le River, Ai~a 99~ // /~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN~F~CT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GREA 'R ANCHORAGE AREA BOR( ~ rr ~ r',~~ '-.Si' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPI.:CTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE / NUMBER MANUFACTURER )1~"¢-'¢-"4"" M A T E R I A L ~_-~..~_ __ OF -- COMPARTMENTS FROM WELL /O-~ INSIDE LENGTH_~~' / TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES INSIDE WIDTH__ LIQUID DEPTH LIQUID CAPACITY/~'IC~GALLONS. -- -. / ~"_ ~ TOTAL LENGTN z~FOUNDATION__. NEAREST LOT LINE ~'~ "1~. OF LINES ., DISTANC~ BETWEEN LINES TRENCH WIDTH ~ IN. TOTA~ ABSORPTION AREA -~/'"-~"~ ~1~""~' SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE ~ WELL: LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE ~::~ ~l~. ABOVE TILE TYPE ~ BUILDING FOUNDATION IN. NEAREST /' NEAREST LOT LINE /~'/"'" , SEWER LINE,~'-'"',/ _ DEPTH .... DISTANCE FROM: SEPTIC Z SEEPAGE TANK-/~'~, SYSTEM '/3/ CESSPOOL OTHER SOURCES APPROVED ......... DISAPPROVED REMARKS DISTANCES: DIAGRAM OF'- SYSTEM INSTALLED BY: "~ f~-?J/~ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: Form EQ-032 FROM : ALASKA WATER ~ WASTEWATER PHONE NO. : 907~385246 Jun. 25 1998 11:25AM P1 $ " It :'~' ~: ' ~ ~' ' '.' '. ~; ' 4' ~ _~..~"" ,'. ,.- ~..,. ~ ': ~:~¢ ~j . v. ' ~ " . ~ ' ' .... . ". .... ' , '. ~...; , '.~ · ,.~. O- ~ * ' ' ': '~ ...."",' 'B'"' , "'"" GREA R ANCHORAGE-"' AREA BOR IGH DEPARTMENT OF ENVIRONMENTAL QUALITY ' ¢~ 3330 "C" STREET ANCHORAGE, ALASKA 99503 ~.d~J~- TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AN[) PERMIT INSTALLATION OF, SEPTIC TANK / -- S;E~AGE PI" , D~R~IN~'dEf~I~- ~''~/~ ,~CC, C~;HER / ' , TYPE AND SIZE OF FAC/L/TY ,O BE SERVED SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT 8OIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING Ct'~ ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL i3E SUBJECT TO PROSECUTION. SePtiC TANK SIZE /~ TYPE SEEPAGE ARea ~ZE/'~ f~¢~/~-- ~///C~ ~/~ ~)e~ MINIMUM DISTANCES, REQUIREMENT~ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALt. SEPTIC TANK TO NEAREST LOt LINE. WELL TO SEPTIC TANK SEPTIC TANK. f~¢ , DRAIN FIELD SEEPaGe PIt ALSO CONS]DER AREA WELLS. , 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 ~"~ /.~ I CERTIFY THAT I AM FAMILIAR WITH TME REQUIREMENTS OF GREATER ANCHORADE AREA BOROn' ~CE NO. 28-68 AND THAT THE ABOVE GREATER ANCIIOkA(;[ Uepartlnent of Lnvi ronlneliLa] Elua] 3330 "C' SLreet Anchorage, A1 as ka 9~b03 ~ -- S()[hS 1,()(; PEROI,ATION TEST Del; th Feet ']- 13- ~o~ .o~ '-'4 T~?o' ,~t4.ote.. Was ground water encoum:ered? ./~_.0__ If yes, at wi~a~ de$~th? ................... Reading [)ate Gross Time Net l'ime Depth to Water Net uro? Percol ali on rate mi nute, ~Proposed installatio-nT--$b-e-p~-.qe Pit [)rain Field DepU~ of Inlet Depth to bo[tom oF pi t or trench COMMEN'FS: ._/~ ~ 2~ ~'77~.~1~_~ .... ~ te8_ _ R~/~.e~l~l~7~.] 7 7 :::'~ 77:: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTI4 & IdUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLII~G 01 5-1 32'- 20 HAA :/~'~~_h (~) \ ((-~'"') ~- 1. GENERAL INFORMATION Complete legal description LoL 15; Bloc]< 7; Kasilof Hills Location (site address or directions) 10301 Stroganoff Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address May Dorris 16518 Oranqe Blossom Rd. Day phone_ Oak Dalef CA Day phone_ 95361 Agent Address Jill Hoelting/ Dynamic Prooerties Day phone 261-7663 _ Unless otherwise requested, HAA will be held for pickup. NtJ~IB[-';R OF FJEDROOM$: 3 TVPE OF WATER SUPPLY: XXX Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWA'i'ER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 #21 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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. £~[.,~j~~:/~d~.u~ t~~.~.~..._ Phone 337 - 61 79 Name of Fi ri 7320 E~mt,~esteL, I ~ ts.tC]~ cie Enginee,"ssignature . .~;~. ~/.( l,~, :)~ Date .... ~?/'zT- ~ ALASKA WATER & WASTEWATER SHALL BE PAID $1100.00 AT CLOSING FOR TIlE ENGINEERING SERVICES PROVIDED. INVOICE /~'; SUBMITTED TO JILL HOELTING/DYNAMIC PROPERTIES DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with ihe following stipulations: Additional Comments By: ~'. '~"" ' ~ Date 4 ' '''? ~ / 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. 72d~25 (Roy. 1191) Back MOA t~21 RECEIVED Municipality of Anchorage ~1~ DEPARTMENT OF HEALTH & HUMAN SERVICES`JUN 2 4 1998 Environmental Services Division MUNICIPALI'IY OF ANCHORA 825 L Street, Room 502 · Anchorage, Alaska 99501 · ~/:)~r-~tf~cEs DiWSlON Health Authority Approval Checklist LegaIDescription: /~(~/~ /-~-¢ J'3/~'/;'- ~/. ,/C"4~,;¢/c*¢/~//SParcelI.D.: A. WELL DATA Well type Log present (Y/N) Total depth /"/~ ~ Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'"¢~ Cased to ~ Casing height (above ground) / ~// F--~' Wires properly protected (YIN) FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~ , ~, I ¢~¢'J~' Other bacteria Collected by: g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed ¢~ Foundation cleanout (Y/N) Date of Pumping Tanksize /, ~-,~o Number of Compartments ~- Cleanouts (Y/N) . y Depression (Y/N) /~ High water alarm (Y/N) Pumper /~ ~'-~'~ [ X C, ABSORPTION FIELD DATA Date installed ~/¢ 1~'¢~7 Length ,¢?,¢' ! Width Effective absorption area ¢/~ ,¢ Date of adequacy test ~, ~ <? ~ ~7 ~ J.-.....~ Fluid depth in absorption field before test (in.); Fluid depth -~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g,p.d./ft2 or ft2/bdrm) Gravel thickness below pipe Monitoring Tube present (Y/N) y' Results (Pass/Fail) ~E -~ -'-~ ¢' */~ System type J~-¢-¢~' Total depth /~2, · Depression over field (Y/N) For -~ bedrooms Absorption rate = If yes, give date / ¢'--5~ '* Immediately after 4/,¢E gal. water added (in.): /~,~O 4' g.p.d. 72-026 (Rev. 3/96)* D. LIFT STATION Date installed ~ Size in gall. pR~j'' , C..y~ e~s tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / g70/¢' Absorption field on lot / OeP f4 Public sewer main /~//~ Sewer/septic service line 2--,'~ / ¢ On adjacent lotS On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ~ Foundation 2.. ¢// Water main/service line Property line O,O ' Surface water/drainage / co o/¥ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain AbsorPtion field ~;' / '/- Wells; on adjacent lets Building foundation ENGINEER'S CERTIFICATION //l I ca, ify that i "lCfA J],bidelin~,s in in conformanc~ Signature Engineer's Name Date ~/~/~, *-/P / Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lets / g~¢'¢/¢ FIAAFee $ '~00.00 Date of Payment Receipt Number inspections effect on this date. Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Al[ale]kal Water 7320 East Chester Heights Circle ~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Eagineers June 16, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reft Well and Septic System Inspection at Lot 15, Bk 7, KasilofHills S/D. To whom it may concern: The subject property has a 3 bedroom house on it that is served by a private well and septic system. A well and septic system evaluation were performed as a condition of the sale. The results of the field investigation and adequacy tests are summarized as follows: A. WELL: On the day of our inspection (6/5/98) the static level was 48 feet below the top of the casing (BTC). Some water was used by the septic tank pumper prior to the test which caused the water level to drop to 57 feet BTC. Water was initial pumped at a rate of .64 gpm for a period of 240 minutes, which resulted in a drawdown of roughly 10 feet. The flow rate was increased to 1.92 gpm for 158 minutes (304 gallons), which caused the level to quickly drop (within about 32 minutes) to 122 feet BTC, and stabilize near that level throughout the rest of the pumping period. A copy of the field notes is attached. Based upon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 3 bedroom house (0.31 gallons per minute). It should be noted that, according to the tenants/buyers, wi~en the neighbors on the adjacent properties watered their lawns, all three wells ran out of water. In short, extensive watering of the lawn may not be possible. B. DEPTH OF WELL CASING UNKNOWN: There is no well log on file at the MOA, and the State of Alaska Department of Natural Resources (DNR) did not have a copy of the well log either. The static water level is 48 feet below the top of the casing which is a good indication that the water source is not shallower than 40 feet. Attached is a copy of several of the well logs for adjacent properties. Lot 26 is cased to 40 feet (seated in bedrock) and has a static water level of 40 feet. Lot 16 is cased to 36 feet (seated in bedrock) and has a static level of 25 feet. Lot 14's casing depth is unknown (copy on file is poor), but bedrock was encountered at a depth of 38 feet. Based upon these logs it is reasonable to assume the casing depth for the well on Lot 15 is between 36 and 40 feet, and is seated into bedrock. If your department feels that a more thorough evaluation is necessary, please contact us. C. SEPTIC SYSTEM ADEQUACY TEST: According to the M.O.A records, the absorption trench was installed in August of 1991, and is 58 feet long, 3 feet wide, and has an effective depth of 8 feet (96 inches). Prior to beginning the test, the sump had 19.5 inches of liquid in it, indicating that the system was approximately 20% full. Nine-hundred & fifty (950) gallons was added to the trench, via a pump truck, which caused the liquid level to rise 30.75 inches, corresponding to 30.9 gallons/inch. The recovery was monitored 420 minutes later and the level had dropped 15.25 inches, indicating that greater than 450 gallons had been absorbed. Based upon this data, it was determined that the absorption rate of the trench exceeds 450 gallons per day, as required for a 3 bedroom house. NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (,frequency of septic tank pumping, usage of biological additives), condition qf type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee ia' made regarding the future performance of this well or septic system CLOSING: If you have any questions, please contact me at 337-6179, or 244-9612. ~cer~~M.S. June 5, 1998 Lot 15, Block 7, Kasilof Hills Adequacy/well flow test. No documentation on well; record shows depth at 170'. Renters admit that when neighbors on either side watered new lawns mid-summer, all three ran out of water. Renters ran out on another occasion. t.Wellis located at fence in front yard. The seal should be replaced; gasket to the isn't seated he casing, a well plug is missing, and the conduit isn't properly threaded to the seal. System consists of an older trench which apparently failed, and a newer trench. Trench #1 has no monitoring pipe, but cleanouts at either end. First of these has 4" standing water, but south end is dry. Trench//2 tied to//1 at midpoint. Tr//2 has cleanouts either end, MT near south end. Additional pipe~ited just upslope from Tr #1; it is dry and appears to have been added when upgrade was matte. It is dry and remained dry during testing. There is new excavation between ST and Tr#1; and between Tr//1 and #2. Both ST risers have been crushed and need to be replaced. Well static was 48'; well was run at 1+ gpm during first portion of test, then run down to 120q-, then stabilized at that zone for remainder of testing. Flow fluctuated slightly, but averaged about 1.5 gpm. I~'The first 154 gallons were injected into Tr//1 at the south end. This caused no rise in the MT in//2. The hose was moved to inject into south end of Tr//2 and remaining 304 gallons placed in Tr #2. Water rose from 28" to 36". Water drop after cessation of flow was slight. I t'7 / :~ ~t 19--~ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received /~-\/~ Time of!Inspection Date of Inspection .~~2~_~2 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR F 1. Approval requested by: ~L~.!~ ¢-~'~e~_~ ~¢~,~),r~_ ~.,',,c'~'W~/-~t Mailing Address: ~r~×_ ~_~0~ Phone: _~,~[-~ ~ 2. Property Owner: .. ~o~o~ ~.~. ~f~,.~ Phone: .~LIc~q _. Mailing Address: ~,~ 3. Legal Description: ~Q¢31( 4. Location: ~¢¢~ k'~)'~'/o, _ 5. Type of facility to be inspected&LL]~Oa 6. Well Data: A. Type~z_E~Lzz~ C. Construction 7. Sewage Disposal System: A. Installed ~/-~. B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Be Distances: A. Well to: Septic tank Nearest lot line No. of bedrooms B. Depth D. Bacterial Analysis ~~~_~. 2. Manufacturer 2. Material , Absorption area , Other contamination , Sewer Lines , B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALI1Y OF ANCHORAQ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEC 1 6 1975 RECEIVED I. Type of Inspection: CMRO 2. ropert Owner: Mai,ng Address: ~_P-A 3. Name of Buyer: VA FHA CONV Day Phone ,~F'~I '~'~ Mailing Address: ~, Name of Lending Institution: __~l_~ rV 'l .5. Name of Realtor or Agent: ~ Day Phone Phone Mailing Address: Phone Legal Description: L.~]~' I~, BIE "l , Type of Facility to be inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings pFesently seFved If Individual, depth of well Sewage Disposal System Type of SysLem: Public Utility If Individual, date of installation ~/.~1./"]~'"~. No. Bdrms. .~"~ Individual Individual (on-site) EQ-037 (1/74) Page 2 of two pages - Rec~ Legal Description ,~? for Approval of Individual S ~r & Water Facilities Comments Approved (x~~~9 Disapproved Date / ApProval ~Valid for one year from date signed Greater AnChorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request~for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. ~ SIGNED Date EQ-034 (1/74)