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HomeMy WebLinkAboutMEADOW BROOK BLK 3 LT 13 4UNICIPALITY OF ANCHORAGE Hea, ~ and Environmental Protec on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 ........... ]I~'~ECTION REPORT ON-SITE ,fiEWAOE DISPOSAL - - : ..... 7~ 'r '~ ~LEaAL DESCRIPTION SEPTIC TANK: D~S~,",NCE ,x -- ,,// /~ ,','~' ~ ~ .,~1,~.-~_ ~ NUMbER Of IN%I[)E LE/4(~llt ........ INSIDE WIDllt .~_ LIQUID DEPTH I_IQUID CAPACIT~ GALLONS. TILE DRAIN FIELD: ':K,~ //22 ~'~ y .¢ TOTAL LENGTH D~srAF~C~ ~ I~OM WELL~ "C._FOUNDAI'ION ~_~ ..... NEAREST LOf LINE ....... OF LINE ~ _ TRENCH WIDT~I: ~ IN. TOTAL EFFECTIVE ~ of :Bines ~ _ r}~s r~CE s[_] WEL_N LIliES DEFlJI: ]Gl' el TiLE '10 FlhilSII Gi]ADE _MAFLRIAL BENEATH 'fILE ..... IN. ABOVE TILE IN. SEEPAGE PFf': DIAMETER OR WIDTH ..... LENGTH .... DEPTH Log Crib Rings BUILL~II'~G F©uNL}A-IIO[~ Crib Size: DhqMETE R .... DEPTI4 ....... DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ....... A[~SORPTION AREA (WALL AREA) SQ. Fl'. Pipe Materials: E of Bedrooms: Installer: Remarks: Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: ..... ~. GREA1LR ANCHORAGE AREA BORO .;H ,,, - : Department of Environmental Quality ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION R[pORT ON-SITE SEWAGE DISPOSAL SYSTEM ~ '" - -"PHONE /~'/"$ SEPTIC TANK: DISTANC~ TILE DRAIN FIELD: ~.b DISTANCE FROM WELL_ C~-~ FOUNDATION NUMBER OF LINES__ / __ DISTANCE BETWEEN LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE '~ _ ? TOTAL LENGTH NEAREST LOT LINE /a,- OF LINES ~'~ TRENCH WIDTH ~ /IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE . /' DEPTH OF FILTER MATERIAL BENEATH TILE d'~ IN. ABOVE TILE IN. WELL: TYPE ~.~ ---,.-~.-t ..':~,.-~_. ~. CONST RLICTION BUILDING NEAREST NEAREST SEPTIC FOUNDATION .__ LOT LINE____ SEWER LINE__ TANK CESSPOOL . OTHER SOURCES APPROVED . DISAPPROVED __ REMARKS DEPTH SEEPAGE SYSTEM_ DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: ("~-~ LOT SLOPE: DIAGRAM OF SYSTEM [>l~]::'FIl:;;:'l'l'"l[i!]"~'l" ELF-' I-.IEFII..TII 25:1. O E. T.. TI'iF:; t';':E[.~LI Z RED S i ;:.'~:E OF:' THE SO I L RBSOI:;'.P'I"I O1",1 !SYS"FIEI'I ]: ~.':: THE L. EI',IG'I'H E:' I HENS Z ON ;~ E; THE I...IENG'I'H ':: ~ N FEET ) OF THE "f'~'.IENCI't OR [::,l:;;l:t I NF' :[ El_l>. THE I)EF:'"rH OF R TRENCH O~: F'IT ;[% THE I],IS"FRNE:E BETWEE:N THE SURFRE:E OF' TI.HE GROUI',ID RND THE BOTTEff'I O1::: THE EXCRVRT:I:ON Tt'-IEH:E ]: 2; NO 2;E;'t" [4 1 C, TH FOR TI;;I. ENCI'4ES. THE; CiJ4'.FIVtEL DEP'I"H :[~; THE blL[[.~Ll"'ltJl'"l I],Et::'TH ElF (~:f:tVE[.. BETWEEN 'f'HE OI. JTFRI.J... F'tlx'i!: 1:::11"~[) THE: E:O"FTOFI OF THE IEP:CFIVfTf':[ON <.IN FEET). Eq::tCKF I L.L Z NG OF FIN"r' d;"r'STEM [,.I :[ THCJUT 1::' DEI::'Iql;:TP1ENT WILl.. BE SUBJECT 'FO F'F~OSIECUTZON. I"i :[ hi I MUH E:' ]: S TFINCE BETI.,4EEN fa I.,.IIEL.L. RND RN¥ ON-S Z TE 2;EHR6E E:' I SF'O:~;FII_. S"¢ST[Ef'I :[ S ::t. OE~ FEET FOR'. FI F'I;7.:I:vwrE bJEl..l.. [)R ;;}OO FrEEI' FOR R F'UB[.IC: 14EL. t :t: N 2~;'1" FI L I.... FI T Z O 1'.4. ]: C IF:I:;i:TI F"T' "t"I'~IFI"I' :1.' I I:::IM F:I::IHZI....II~II;->. I.,lI'rH THE F,'EE.!...IREHEIqTS F'OI?. ON-!~,]:.TE :.7:;I!.:.:I,.IEI~?.S FIN[::, t4f;~.t....I...S 1::12; :~i;E:'l' F:'f' 1;:'11..i _:,- TH[i: / Gi~EA[LR Ai,~.~.h.A~,, :,i'.~A tJiJi<bUGii OepartnlenL o'f Environmer, Lal Quality 3330 "C" Street Anchorage, Alaska 99503 SOILS I,OG - PEROI,ATION TEST ' Legal uesc'ri pLi on: 7Xis form reports'. Soils log_ ~_ _. Percolation test 14 - Was ground water encountered? ~ .... If yes, at wigan'depth? _ Net_~Time ~_Depth to Watep Net brop .... mi nute. -~-- -. n FSeld ....... to'pose<, installation:Seepage Pit~5;~;~5 Drait f et . Dept__~'.,~._~_,>i or trench , FiD'TS: .~Ldc~ :.~,~L~::~c--~,-~-~ ........ , , . ./ : / f~ .... ' .' ~ X~ , ,, K':~- ~)z~'~' ~L ';~'/~ ~ ~5':'/ / ', /)" >'~ 'v /'/"' :' ~'- - (;REAILP, ANCiiuid\(;L AgLA UOROUGIi Department of Environment. al Qual 3330 "C" Street Anchorage, Alaska 99503 SOII~S LOG - PEROI,ATION TEST Legal Doscription:_J.=9{, J.t. _~L~//c- ~ This 'Form reports: Soils log ~ _.Date Percolation test Dep th Feet 10- ll - 12- 13- 14- Was ground water encountered? If yes, at wi~at depth?' Reading Date Gross Time Net Time Percolation 'r-~t e '--- ininute. Depth to Water Net Urop Pr: rforn~ed Dy: i~0©v JO.~/4L..L-.E..L~_C<~?. ......... Certi fi ed By .~=z~.~ .... ~: ~--'~-~ .Proposed 'installa't-i-~-n-;' Seepage Pit . Drain Field Dep~ii of Inlet Depth to bottom of pit or trenci~ COMMENTS: MUNICIPALITY OF ANCHORAGE (~ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner "~~r~ Telephone: Home (c) Lending institution Telephone Mailing Address. 1¢2- Business (d) Real Estate Company and Agent '"'~g~:'~'~ ~~.¢~-~-' "~ Address ~,/;~), ~ '"7"~4t¢'7-/~ '~ ~b..~ ,~J"~, Telephone t¢~ ~,¢~ ~ "~.-'"~ ~ (e) Mail the HAA to the followino address: or: Check here,~, if hold for pick up. List contact person and day phone number below. £ &$ ~NGiNEEEiNG 17034 Eagle Ri.vet Loop Road No, 204 Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family~'~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Publi~---- Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~- Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, Page 1 of 2 72-025 fRev 8/861 From ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown beJow, I verify that my investigation of this Health Authority Approval 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 Telephone the date of this inspection. Name of Firm $ & $ F. NGiN~..,-R:~.,,,G Address 1_7034 Eagle Rl~er L~ep Road No. 204 Date Eagle EJyer~ Alm,,ka 99577 ? DHHS APPROVAL Approved for Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 fRev 8/86) 8ack WELL DATA MUNICIPALIfY OF ANCHORAGE ENVIRONMENI'AL SE[,tVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4744 Legal Descrip, tion: ~::~ -1" AUG 1 6 1988 Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample -Fest Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield ~/ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/H~LDtNC~'rANK DATA Date Installed ~ ~ ~"'/""~P Size ~,_ Standpipesd~9'N) _ "-/ _ Air-tight Capsd~'/N) Depression over Tank (Yd~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Hot6?g Tank: To Water-Supply Well ~..,,~<::> To Property Line ~, c::, ~--~ To Water Main/Service Line _ Course \ ¢-~© No. of Compartments "7_.~ Foundation Cleanout(J~4) 7 ~. Date Last Pumped ,~ ~ \tO ~ ~ ; for ' t.,.~/~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field c::~I To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026 fRev 8'861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed ~ ~ \""~ ~ "/~ Length of Field "¢pL¢ ' Width of Field ~ ~ Depth of Field c:~ I ~ ~,¢ I~ ~ravel Bed Thickness Square Feet of Absorption Area Standpipes Present (~kl) Depression over Field (Y/~;) h'5 Date of Last Adequacy Test Results of Last Adequacy Test ~-¢'~1(-~:i¢~6~-~,~ f ~ ~ Separation Distance from Absorption Field: ~ o ) ,-P To Property Line ~. To Existing or Abandoned System on To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ; On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION D ed Size in Gallo~-¢o~ "Pump On" Leve~ High Water Alarm Level at ~ Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ ~.~ng Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA/end HAxA guidelines in effect on Signed '-G Date L,o m Palq~'O34-F.~.¢c Date of PaYment Amount: $ Page 2 of 2 72-026 fBev 8¢861 Back the date of this inspection. APPL, I¢ NT FILLS OUT UPPER HA'~ ONLY ~o er? Owner .... ':-~ ,/' ' ~ ' ' % ' I --? . Phone Buyer }: I/,~-/~/ I ~:%- /~' .' ;:."M-'~-:.~.~ ~ ~:' ~-4"I'~'Z"~ '/ ; ':' "' "- ' ?"(/~ '-' Realty Co. & Agent ' uf ?/ Phone "' : b' / ,, / .... , Street Locati~ . :~ ~.)/(.) :-')/:¢:.(/..:~j:?~%/ Type of Residence '~ Single Family Multiple Family No. of Bedrooms : Other :~di~id,,. ~>~¢.~',':~:.,,, :)-:tq' (~t~,,: ATTACH WELL LOG. A well log is required for all wells drilled since June 1075' ~. uommum[y , . ..' ...... ' t' i ~ ' For wells drilled prior to that date, give well depth (attach log if available). ~ ,.~,v,~u~,.zg.W~.<::~ -TZ~M(~ / ~o~. ,~o,v,~u~, ..~ : - Sewer Disposal ,,~ --./ [~ Public Utility -- When Connected to Public Utility: [~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. 'ime Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector UNICIPALITY OF ANCHORAGE DEPT. OF (' .... ENVIRONMEN',AL PROTECflON Field Notes: RECEIVED ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: ~ Soils Rating Dale ~wer Installed Well To Absorption Area Well Log Received ~). "-'~/~ Well to Tank Septic T~k Size d ( ~ }.~ a c i; l': (; n ',,; o call ~f,~lJ.[.; o:iJJiic(: aL 264-~4720. J: :. 2. :L 9 / ;: j / h I ,iJ.m Robc, r t s EXCAVATION ROBERT A. SHAFER WORK April 10, 1983 CIVIL ENGINEER 694-2979 Nancy Kuzma 3010 Sanctuary Drive Eagle River, Alaska 99577 Dear Mrs. Kuzma, Reference: Lot ].3; Block 3: Meadowbrook Subdivision MUNICIPALITY OF ANCHORAGE DEPT, OF HG".LFH A ENVIRONMENTAL PROTECTION . 0 . Ar I-! f3 !95'3 RECEIVED A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench was 'tested by a continuous flow of water over a period of 48 hours. The average flow during this time exceeded that requirement for a three bedroom residence. There was no adverse effect from the test. It can be concluded from this test that the waste water disposal system serving the three bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. If we may be of further service, please do not hesitate to contact US. ' /RAS/ss I cc: Municipality of Anchorage Department of Health and Environmental Protection SR8 196X EAGLE RIVER,ALASKA I DATE RECEIVED INSPECTION APPOINTMENTS TIM'~ TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECT~ MUNICIPALITY OF ANCHORAGE MUNiCIPALiTY OF ANCHORAGE ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI0r~T. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P~OTECTION ~~ ENVIRONMENTAL SANITATION DlVlSlONTelephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATE. AND S~~~S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please aliow ten (10) days for processing. 1. PRObiTY OWNER PHONB MAILING ADDRESS ,- P~OPE~TY ~E81D~NT {If different from abo~e) PHONE MA~LING ADDRESS / / MAILING ADD~ESS - 5. LEGAL [~E~SCR.[PTION ' STREET LOCATION 6. TYPE OF RESIDENCE ~gl~' SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~B~DROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY F-I INDIVIDUAL* COMMUNITY 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 ~" INDIVIDUAL/ON-SITE** /'72 [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FlEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-elo (Rev. 6/79) 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 I~IlNDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or E~ Ho[ding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTIOn-AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~],.'¢'APP ROV E D FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED BATE BY t",-~) _. ~/""~ ~, I 72-010 {Rev. 6/79) DAVID A. SLENKAMP ROBERT A, SHAFER MECHANICAL ENGINEER 694-9055 October 21, 1980 CIVIL ENGINEER 694-2979 Jack !.'~ite Real%y ATTE!fPION: Doug Anchorage, Alaska Dear Reference: 99503 Mark l~lerson property at 3010 Sanctuary, Lot 13; Block 3; Meadowbrook Shlbdivision At your reouest, a sewer system adequacy test was oerformed on the system located on the referenced property. The septic tank ~.,~as pumped and :in accordance wi'th ~.~nicipality records has a capacity of lO00 ga]7ons. The absorption trench :,m;~ tested f~f a cont:;nuous flow of water in excess of 450 gallons in a 24 hour period without any me~surab]e rise in the ~.mter ]eve]. ~.ntthin the trench. It can be concluded from 'this -test that 'the absorption trench is currently functioning adeouately te serve the three bedroom residence located on this property. Y&m.icipa!ity records also :;n(~ic*'be that the set-~tic -I;~nk is s~lso adeouate. If we ~my be of any further service, p'!ease do not hesitate te c-ll. Sfac o~ly, '} _ Department of He~].th and Env~ornments]. Protection National ~nk of Alaska SRB 196X EAGLE RIVER, ALASKA MECHANICAL ENGINE EFtS STATEMENT DESCRIPTION AMOUNT BALANCE DUE 30 DAYS FROM DATE OF BILLING. 1~% INTEREST PER MONTH ON ACCOUNTS OVER 30 DAYS, DAVID A. SLENI<AMP ROBERT A, SHAFER MECHANICAL ENGINEER 694-9055 October 21~~ 1980 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF i!£!,\L]~i & ENVIRONMEN fAL Jack ~&ite Realty ATTE',fTION: Doug 3201 C. Street Anchorage, Ale ska Dear Doug~ Reference: 99503 RECEIV[L) },~rk Rolerson property at 3010 S~nctuary, Lot 13; Block 3; Meadowbrook Su]~ivision At your request~ a sewer system adequacy test was performed on the system located on 'the referenced property. The septic tank was pumped and in accordance with Municipality records has a capacity of t000 gallons. '~e absorption trench was tested by a coatinuous flow of water in excess of 450 gallons in a 24 hour period without any measurable rise in the Ymter level ¥~ithin the trench. It can be concluded from this test that the absorption trench is currently functioning adequately to serve the three bedroom residence located on this property. ~nicipality records also indicate that the septic tank is also adequate. If we may be of any further service, p]eese do ~ot hesitate to c~ll. Sinc e~r~ly, m'7 ,n .y _ . cc~ ~mnicipali~y of Anchorage Department of Health '~d E~viornmental Protection National Bank of Alaska SRB 196X EAGLE RIVER, ALASKA MUNICIPALITY OF ANCHORAG'- DEPARTME.., OF HEALTH AND ENVIRONMEN, PROTECTION 825 L Street, Anchorac~e, Alask~ 9950i 264-4720 Date Received: ~',.'~['_) 101)k ~2: Time ~3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First Federal Savinqs.and Loan Mailing Address: Post Office Box 4-2200 99509 Phone: 274-6564 2. Property Owner: Robert/Julia Penno Phone: 276-3202 694-3268 Mailing Address: 3010 Sanctuary Road 99577 3. ]legal Description: Lot 13 Block 3 Meadow Brook SubdiwLsion Number of Bedrooms: 4: Single Family Residence:' Multiple Family Residence: ( ) Number of Bedrooms: ???? 7 o Well System: Permit ~ Construction Individual well ( ) CoP~Lmunity/Public System ( ~x Depth of Well Well Log on File ~,,h_, ~., ~ ,~_~..2 Bacterial Analysis {~_ Sewage Disposal System: On-site System ~ Public Utility Septic Tan]{ Size I ~6UC) :[d~ Manufacturer. :~-' Absorption Area .~ ~{~3 ~ Soils Rate / /:,: Material G~:~JI~O:L"'~C :lstances: Well to Septic Tank ~-OD~-~ to Sewer Line _~__~ ... Nearest Lot line to Nearest Lot Line t~I / to Absorption Area ~0~) Absorption Area GREATER ANCHORAGE AREA BOROUGH qc'p Department of Environmental Quality ~,-' 3330 "C" St., Anchorage, Alaska 99503 .- 274-456l REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA 2. Property Owner: _~t~er-_~- T~~_ Mailing Address: 3. Name of Buyer: o Mailing Address: Name of Lending Institution: FHA CONV .P ..... Name of Realtor or Agent: Mailing Address: ~--~-'~ .. ['~)c~ ~_a _ D ~.S' Phone Day Phone Mailing Address: ~=~t-~,~UioLL-- ~/)~ Phone Legal Description: Location: 7. l'ype of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility o No. Bdrms. 2~ Individual If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation If Individual, number of dwellings presently served Individual (on-site)r/~ 7/w EQ-037 (1/74) Page Pwo Department of Healhh and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Coll~nent s: Affadavit Attached: ( ) Letter Attached: ( ) Approved: Disapproved Date: Date: Department Worksheet: 1. Approval requested by: Mailing Address: 645 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received September 23, 1976 Time Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR of Inspection Conv. United BAnk Alaska G Street R.D. Cousineau/James Davis Phone: 278-9526 Phone: 276-7777 2810 c Street Lot 13 Block 3 Meadowbrook Subdivision Single Family No. of bedrooms 2 Public Utility 5. Type of facility to be 'inspected 6. Well Data: A. Type C. Construction 7. Sewage Disposal System: A. Installed 1976 C. Septic Tank: 1. Size D. Seepage Pit: E. Disposal Field: 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank 1. Absorption Area Total length of lines B. Depth D. Bacterial Analysis On-site system B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination ., Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Ret st for Approval of Individual .~ .~r & Water Facilities £egal Description Lot 13 Block 3 Meadowbrook Subdivision Comments Approved ~.~ ~ Disapproved 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) 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 1. Type of Inspection: CMRO.. VA FHA CONV.. Mailing Address' ~,(° / (~ '~ " ~:~'L4~-(' Dav Phone: Mailing Address: ~ ~ ~-~ ~ay Phone:~ 4. Name of Lending Institution: ~J ./~/~', ~,~ ~. Mailing Address: Phone: Mailing Address: ~'(¢ ~ ,~-~ Phone(~ 6. Legal Description:_ ~ /,7 ~~ ~ 7. Type of Facility to be Inspected:__ ~ ~ /~ 8. Water Supply Type of Supply: Public Utility No. Bdrms. ~)~- Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site). 72-003(3/76) MOENING-GREY & ASSOCIATES, INC. GEOLOGISTS AND ENGINEERS 715 L STREET, SUITE 8 ANCHORAGE, ALASKA TELEPHONE 274.2314 June 15, 1976 Municipality of Anchorage Dept of Environmental Quality 3330 "C" Street Anchorage Alaska 99503 Attention Rolf Strickland, Chief Sanitarian Gentlemen The soils log for Lot 13, Block 3, Meadowbrook Subdivision dated June 3rd, had an erroneous Lot No. This should have read Lot 14 instead of Lot 13. A corrected copy of the subject log has been enclosed for your files. Also, a separate log has been prepared for Lot 13 per the attached copy. This inspection was completed June 14, 1976. Please advise if you have any questions. Yours truly, ~--~ MOEJ~%NG-~-GREYJ& ASSOC~IAT_~, INC. Enclosures