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HomeMy WebLinkAboutHIGHLAND HILLS #3 BLK 2 LT 16NAME GRE '.,LER ANCHORAGE AREA BOR,. i'GH :~,,_. "~" Department of Environmental Quality ~' 3330 C Street Anchorage, Alaska 99503 (.'~ ' : INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTE/~ LOCATION SEPTIC TANK: DISTANCE ~") FROM WELL~' INSIDE LENGTH MANUFACTURER INSIDE WIDTH LIQUID DEPTH ---- LIQUID CAPACITY /([:)~GALLONS. TILE DRAIN FIELD: '~"-0 - (' TOTAL LENGTh-, DISTANCE FROM WELL ¢O~--~L FOUNDATION -'~ NEAREST LOT LINE ~') ........ OF LINES /~ / ABSORPTION AREA (/,3~0 SQ. FT. LENGTH OF EACH LINE ...... / [ DEPTH OF FILTER (-/ DEPT.: TOP OF TILE TO FINISH GRADE ~/ MATERIA[_ BENEATH TILE ~'¢4"-;~ _IN. ABOVE TILE ':~ IN. WELL: ,D ~. TYPE _/'/'~ ~ ~r,; LC'(~:~,~ONST,RUCTION BUILDING FOUNDATION CESSPOOl APPROVED _ NEAREST LOT LINE_ OTHER SOURCES DISAPPROVED NEAREST SEWER LINE DEPTH SEPTIC SEEPAGE , TANK , SYSTEM REMAR~-<.S DISTANCE FROM: DrSTANCES: DIAGRAM OF SYSTEM INST(~LE~: , SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: 'J'"r'l:::'!:] (1)l::' %() ]] !, J::tJJ:ii 'ii ] J;;~]l:;'J ] I" I",1 ?'r".?t"l:ii.H ]i ]!i I'il:::l;:.::'i;l"itil'"l !'.,]t. lt'lliill!iiZl:;i; Ol:: i:::F:I':,I:;? 'n'3i'i:i:i; ::: THliii; t ti2-,l(ii i'i..I [:, ;1; I'"l E !'.,l ':i; Zl; 01",! ]( :ii; i"HE 'l'!..lli!i; Dt~T:'Ti'I Cfi::: I::I TI;;;'.!iiZi",lC:l'~! (]i:;;: I;::']Z'l (iil:;?.Ol. lt',!D I:::11",t!) 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A-18072 Mr. Don Leach P.O. Box 988 Anchorage, AK 99510 Subject: Subsurface Investigation for Septic System Lot 16, Bl~ck,3~?~Highland Hills SubdiQision, Unit No./4'' ~ r Dear Mr. Leach: Enclosed J.s the log for the test hole placed on 'the above lot. Also enclosed are graduations of the materials en- countered: 1.5' to 5.5' (Sheet 1) , 5.5' to 10.0' (Sheet 2). No water table was encountered. Sincerely, ALASKA TESTLAB ~l Melvin R. Nichols, P.E. Laboratory Manager MRN:rb Enclosures Test Hole Location Lot 16, Block 3 Table A VO ~iA-IGuT£ Date: .",{a},: ]7, 1977 Depth in Feet From To 0.0' - 0.5' 0.5' - 1 .5' 1.5' - 5.5' 5.5' - 10.0' Soil Descr:Lpk}_q{L ..................................... Peat, P'L. F-2, brown Silt_~ Sand, SM, with roots and organics. F-2, brown Silty Gravellx Sand, SM~ damp, particles to 5", rating 150 sq. ft./bedroo?'t. NFS, brown Sandy Gravel, GP, damp, der, se, rating 100 sq. ~t./bedroom. BoLt:om of Test Hole: Frosh Line: Free Water Level: 10.0' None Observed None Observ 1 1 . 0' 2 3.0' 3 7.0' Type of Dry Sample Strength Group Unified G SM G GP Remarks: I . Type of Scmple, G=Grab, SP = Standard Penetration, U =:' Undistu:d'~ed. Dry Streng6h, N=None~ .=Low, M=Medium, H=High. Group refers 'LO simi!~ .' material, this study only. General In:~ormation, ~ ~e Sheet 1. Frost and Textural LI~ ~sification, see Sheet 2. unified Ciassificatior, see Sheet 3. by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ,,....,;~ ~-.? /~.:'/)c ,?'/ DEPTH OF WELL [ 'i,'~' ADDRESS I'~ (% i.~c::;~ "' ~;~ ~) STATIC LEVEL OF WATER FT. '' "' " t (~ ~ ,:gz.l~ i~IL~*v~9 I~~z~ DRAW DOWN FT. ~) LEGAL DESC I N . ~"/ / ~ h //~JZ ? GA~.PERHR ~'~ ~" DATE-Started ://~/ Z / Ended ~_ PERMIT NUMBER ~ ~2- ¥ () KIND OF CASING (, 2~L~' KIND OF FORMATION: From From '; Ft. to J ii:' Ft. From ~ 6 Ft. to ' ,':.:~t Ft. From )' )~ Ft. to_ -~'(~ _Ft. From From /}b_Ft. to From / ) Ft. to ·" Ft. From (7i) Ft. to /Q49 Ft. From____Ft. to__Ft. From__Ft. to___Ft From__Ft. to___Ft From Ft. to Ft From__Ft. to__Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From____Ft. to__Ft Ft. c~','t':',?'~; ,~.C 0~.:-",2' From Ft. to____Ft. ..~,/'/-o~.:';' ,.~ ~:.~/:';Z~9("(. From Ft. to .... Ft ,t~/,~,.,~q,.) From Ft. to _~ Ft .~/:~/rO.~) .(- (~'/C)t~(,.'~ From Ft. to Ft Ft. ~" /q ~) ~'/:"~'L JL: ¢, ~.~ ( ~ From From Ft. to .... FL Ft. to Ft. From Ft. to Ft From Ft. to Ft From__Ft, to Ft From____Ft. to Ft. From Ft. to .... Ft From Ft. to_____Ft, From Ft. to Ft, From Ft. to_ _Ft Frmn Ft. to Ft. From Ft. to Ft. From Ft. to i Ft MISCL. INFORMATION: / / DRILLER'S NAME ]; E:lii;I;;i:"l' ]; I:::'"r' -I" H I:::l"l" :;L: ;t: F::II"'I F;'I:::II'"I ]: L.. ]; FIt;;: I.,.I:I:T,L"I "I'HIE I:;i:I!EQI..I];I:;dEI'"IENT:5 FOR I:::'OI:;.'.'TH Ii;?¢ THE I'll..IN :[ E: ]; F'FII.. ]; 'I'~'r' CII::* 2: ~: I.'.1:1: L.I... ]: N:i~;'f'FIl..I... 'T'HE: '_:i;"r".!!;-J"lEl"l ;[ i",1 I::tCC()RDFII",ICE I.'.1 I::II:::'F'I... ]Z C:I:::II",I' f' I;: I'.)NI~:IL.I[;: 0 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 Applica'tion Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, secti.on, township, range) /I Location (address or directio~s'~ (b) Property Owner ~"/2~/' ~':/~/' 'Telephone: Home ¢2Z"'/~¢,¢~"~o Business (c) L-e~nstltut-ion .~L,I,¢'.~ /~.~,:~,ze~,.~T'" Telephone Mailing Address (d) Real Estate Co.~pany and Agent Telephone __~ ~ ~ ~ (e) Mail the HAA to the followina address: or: Check here [~, if hold for pick up. List contact person and day phone number below. 17034 Fagle River Loop Roa~] No. 204 Eagle River, Alaska 9957~, TYPE OF RESIDENCE Single-Family J~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] 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 attestin9 to the legality and status. Page 1 of 2 72-025 trey 8'86! Front '~Jo~ s. Jeeuibue leUO!SSajoJd eq~ u! suo!ssFuo JO sJOJJ8 JO~ elqisuodseJ leu s! a6eJoqouv jo XHledio!un~ aql 'penss! s! eleo!j!lJe3 e aJojeq eiep ezXleUe Jo suoi~oedsu! ~onpuoo leu op SHHQ ~o seeXoldLuq 'slueLueJ!nbeJ ale,s pue leJepej u!elJe3 XJs!les el JepJo u! suolin~ilsu! 6u!puel J!eql pue seuJoq jo sJeseqoJnd el Xse~Jnoe e se s!ql seep SHHQ eql 'e~selV jo ale,S eql u! peJe~s!beJ Jeeu!bue leUO!SSe¢oJd ~uapu@depu! ue ~q e^oqe ~ qdeJl~e~ed u! UaA!8 suo!~elueseJdaJ aCll uodn ,~luo peseq seleofj!tJeo leAoJddV R~iJoq~RV qlleeH senss! (SHHC]) seo!^JeS ueu~nH pue qlleaH jo lUeLUpedec] ebeJoqouv ~o /,Hled!o!unv~ eqJ. NOI/n~¢o Ie^oJddV leUO?,!puoO ~o sudJeJ. 'leUO!Hpuoo pe^oJddes!G )~ pe^oJdd¥ euoqdelal ONi~=!,=JNiON:~ $ ~, $ uJJM jo agueN 'uo!~oadsu! s!q~ jo alep aH1 uo loa~ja u! suo!~elnbeJ pue 'seoueu!pJo 'sepoo a~elS pue led!3!unv~ lie LII!M a3ue!lduJoo u! s! uue~sXs lesods!p Jeie~a~,seM Jo/pue Xlddns Jele~ eHs-uo aql 'uoi~oedsu! pue uo!leb!~se^u! XLU UJOJJ pue Sel!b e6eJoqauv jo Xl!led!o!un~ aLI1 peu!elqo UO!~eLUJOJU! 8L[:I UO peseq leLll/~,HJ8^ JSLilJn,I 'u!aJatl peleo!pu! eJn]onJls jo edX1 pue sguooJpaq JO JaquJnu eq1 a~en bape pue leUO!loun~ 'ejes s! LUa~SXS lesods!p Je~e~alse~ Jo/pue Xlddns Ja~e~ eHs-uo eql leql S~OLIS le^oJdd¥ qlleaH s!Lll bo uo!le6!~saAu!/~LU ]eLfi/~,HJ8^ I 'rnoleq u~oqs elep uo!lep!le^ aLI1 bo se pue o~eJaq pex!jje lees Xua Xq pe!H1Je3 s¥ WELL DATA ~1'( o~-/''' !~I{~LITY OF ANCHORAGE (MOA) F,~\C\?~A~ Sg~\C-~LE~,LTH AUTHORITY APPROVAL (HAA) C~>~O~ CHECKLIST- FEBRUARY 1984 ~,- ~, ~ .~, ~'~ 264-4744 ~ C~ ~,~). Legal Descrip, tion: ~ ~~~ ~ Well Classification Well Log Present ~'4) Date Completed Total Depth /,/~¢C;'~ Cased to ~'~ Static Water Level I'~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/~Tank on Lot To Nearest Edge of Absorption Field on ~_ot To Nearest Public Sewer Line If A, B, C, D.E.C. Approved (Y/N) ~ '- /"~ ~ '"'J "J Yield Depth of Grouting ~-~ Pump Set At Sanitary Seal on Casing(~N) Depression Around Wellhead (Y/~¢~) / ~ ¢;~,iEb ; On Adjoining Lots /, d::)~::~ /'Jr'~ I ; On Adjoining Lots ~. ~t~I~.. To Nearest Public Sewer Cleanout/Manhole ~//~. To Nearest Sewer Service Line on Lot Water Sample Collected by /~-~¢~--2 ~::~(p.~-CLAi....~"7 ;Date Results ~-~(~-;~¢ ~ --- '~~~l~,- - Water Sample Test ~ Comments ~ ,,~ .~d~..--., ~q.~¢~3 ""~'~--"7~ ~ ~.~-~V--~ ~"~( [3. SEPTIC/NOED[~G TANK DATA Date Installed [,-¢ ~1~ Standpipes~)/N) Air-tight Caps ¢~N) Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Huldin'g Tank: To Water-Supply Well \ To Property Line ~ To Water Main/Service Line Course \ ~-----------------~'~ I..~. Comments "~¢-~'~ ~-.¢:::¢---~'¢O~t.~ II Size __~, ~:2¢;'4:~ No. of Compartments Foundation Cleanout (Y~) Date Last Pumped \'~-~ \ c:~,¢ ~i~'l r~/~ ; for "~ Temporary Holding Tank Permit (Y/N) 1"~/~ I To Building Foundation (.z2d2 To Disposal Field ,.-~.5 I To Stream, Pond, Lake, or Major Drainage Page 1 of 2 · 72-026 fRev 8'861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field "~ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field~: To Water-Supply Well / To Building Foundation Lot r") {/"~ To Water Main/Service Line \ t~5/ I'''I~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design'~'~'~~ Length of Field ~ I Depth of Field Lc Gravel Bed Thickness f','c/~d~ ~¢'~ p.z-~ ¢¢;¢_ Cd_;:ym.~l- Standpipes Present Date of Last Adequacy Test \'7..---~ I/-~--'~i~"~ To Property Line .¢- ,5-/ To Existing or Abandoned System on ;On Adjoining Lots '~ ~I"~F- To Cutbank (if present) ~¢~/~-- :/ V~/~--~, High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) '~ycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and tIAA guidelines in effect on the date of this inspection. 17034 Eagle River L~op Road No, 2~te Comp~le ~Ivnr: Alaska 995~ MOA No. ~ ~ Receipt No. ~' ¢ ~/ - O~/ ~_ Date of Payment ,/.~ ~ t ~ ~ ~ Amount: $ / ~O Page 2 of 2 72 026 trey 8'861 8ack un cipafity ot Anchorage P.O. BO,., 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 6, 1988 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 16 Block 2 Highland Hills #3 waiver Request Number WR88-001 Dear Mr. Shafer: Your request for waiver of the required 10 foot setback of a septic system absorption trench to a lot line has been approved. This distance has been waived to 5 feet for the subject lot. This department also has no objection to the location of the absorption trench standpipe in the utility easement. Because the absorption trench encroaches upon a lot line that fronts a public right-of-way, there should be no chance of interference with another septic system. In addition, letters of non-objection from the utilities .regarding the absorption trench standpipe located in the easement appear to be in order. This waiver applies to the existing absorption trench only. Any upgrade in the future will require all setback distances be observed or another approval from this department. Sincerely Daniel J. Roth civil Engineer On-Site Services cc: Gus Andress, P.E. Manager, On-Site Services/Water Quality Programs / AS-BUILT [ hc!,'Lly Vr'l'(ifv [)~at I J]~','e stu'veyed the following' ,, v,~ ,,,.:.,,, o,,,.¥,.~..../._ e~.. ./~..,_ ~1~ ..~ ..'~. . · " ~-/,.:.4/~j 1,4 7/~ _._~.~.,,~,, .~.~..--,& '~ '' '?~' H~'~,wdin(. Urecin¢I, z\lasI,.~i, and lhat the R,?~is~m'ed Land Surveyor No, 880-~ fha:.: 45J;, FlnRle River, Alask:~ ]'bon~ 69.1.'.{542 /~' P.O. BOX 1388 ~ ALMER, ALASI(& ~9645 P~IONE (9071 745-321I Thomas R. Minnich General Managor Myrna Johnston Target Realty, Inc. Post Office Box 774627 Eagle River, Alaska 99577 Dear' Ms. Johnston PZ/dig ENSTAR Natural Gas Company A DIVISION OF SEAGULL ENERGY CORPORATION 3000 Spenard Road P.O. Bo× 190288 Anchorage, Alaska 99519-0288 (907) 277-5551 December 17, 1987 Target Realty Attn: Myrna JohnsoR P.O. Box 774627 Eagle River, AK 99577 Dear Mrs. Johnson: ENSTAR Natural Gas Conlpany has no objection oF the encroachment of the sewer riser in the utility easement on lot 2, Block ]6 Highland liil'ls ¢t3 Subdivision. Very truly yours, Daniel V. Westervelt Right-oF-Way Engineer DVW/j kk State of Alaska l'his is to certify that on this 17th clay of December, 1987 before me, personally appeared Daniel V. Westervelt to me kRown and I<nown by me to be the person named in and who executed said letter. In testimony whereof I have hereunto set my hand and seal tile day and year in this letter first above written. Notary Publ'iCr, i~.n and For tile/ State of Alas~:a /, res S'FATEMENT OF NON-OBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Matanuska Electric Association, Inc. (MEA) has no objection with the location of an septic system within the utility easement along the easte~y boundary of the following property; Lot 16, Block 2, Highland Hills Subdivision,Unii; No. 3 Section 28, T 14 N, R 1W. S.M. Anchorage Recording District This non-objection is conditioned by the stipulation that MEA will be held harmless from any and all damages to the encroachment that may result from .the existing and future use o~ said easement. Matanuska Electric Association, Inc. General Manager or hi~'Representative Dec. 14, 1987 Date MEA ACKNOWLEDGEMENT STATE OF ALASKA ) ) ss, THIRD .~UDIC[AL DISTRICT ) .. The foregoing agreement was acknowledged belore me this /~/ Notary P,~bli~or t~e State of Alaska My commission expires. 333.1/121#.1 FEDERAL TAX ID # 92'0040440 ~,'O:l,i f,l¢~OL[,; :;:~vP;i! l,¢3t' i,}l,, 1.204 TIME TIME _. I~.~/~((~ -~ TIME ~SPECTOR INSPECTOR~ MUNICIPALITY OF ANCHORAGE DEPT. OF IF/',L];I &  DEPARTMENT OF H~ALTH & ENVIRONMENTAL PROTEC~RONMEN]AL [; ,/FECTION 825 L Street - Anchorage, Alaska 99501 I980 ENVIRONMENTAL SANITATIO~ DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTION~: Complete all parts on page 1. Incomplete requests will not 12~ processed, Please allow ten (10) days for processing, 1. PROPERTY OWNER ~ PHONE I MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3, LENDING I~TITUTIO~ 4. ~LTOR/A~NT ~ PHON~ MAILING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION G, TYPE OF RESIDENCE NUMBER OF~BEDROOMS [~"'~1NG L E FAMILY [] One [] Four [] Other _ --I Two E~] Five [] MULTIPLE-' FAMILY [~],-'"'T~r ee ~] Six ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A wel Icg is reauired for all wells dril since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.} 8, SEWAGE DISPOSAL SYSTEM [~F~I ~ ~IVI DUAL/ON-SITE~* [] PUBLIC UTILITY YEAR ON-S TE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 {Rev. 6/79)j-l.)~.) ~- A.,f.~v?~,~//' ') ~' 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 NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~,~ ~ Connection Verified INSTALLER ~ _~ []Septic Tank or []Holding Tank ~ Size: /©O(~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER ~ TOTAL ABSORPTION AREA MATERIAL ~ ~..~.~ .~_~:r'-,-' ~ ~ 4, DISTANCESwELL TO: Septic/H°lding Tank IAbs°rpti°n Area ISewer Line INearest L°t Line Absorption Area to nearest Lot Line 5, COMMENTS / PPROVEDFOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompam/certificate) [] DISAPPROVED DATE BY ~~~ Time DEPARTMEIX 825 I~'IS mn~ _ #2: MUNICIPALITY OF ANCHORAGE OF HEALTH AND ENVIRONMENT L Street, Anchorage, Alaska 264-4720 EAGLE RIVER AREA PROTEC¥ION 99501 Date Received: March 7, 1978 ~3: Time Date ~-;~U~ ~3_. Date Date Insp /-J~,~%6~/. Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Coast Mortgage % Debbie Mailing Address: Post Office Box 1200 99510 Phone: 279-0665 2. Property Owner: Donald M. Leach Mailing Address: Post Office Box 988 99510 Phone: 272-8525 3. Legal Description: Lot 16 Block 2 Highland Hills #3 Subdivision 4: Single Family Residence: (x~ Multiple Family Residenc~':--'( ) Number of Bedrooms: Three Number of Bedrooms: Well System: Permit Construction Individual Well (x~ Community/Public System ( ) Depth of Well. -1--5~ i~1,©' Well Log on File~) Bacterial Analysis '7. Sewage Disposal System: On-site System ~ Public Utility ( ) Permit tt ~q~. Installed 1977 Installer .... Septic Tank Size _L,~\~% Manufacturer _~L%~ Absorption Area Li~i_~L___ Soils Rate Distances: Well to Septic Tank to Sewer Line __ Material ~ __ -~o Absorption Area Nearest Lot line Absorption Area to Nearest Lot Line REALTORS REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: _ Mailing Address: 4. Name of Mailing 5. Name of Mailing CMRO VA FHA _JD_O~uil~. T.~ach P. O. Box 988' Anchorage~ AK. 99510 Day Phone Day Phone CONV XX Lending Institution: _~oa~t MolLtgage . Attn: Debbie P. Oo Box 1200 Address: Anchorage, Ak. - 99510 Phone 279-0665 Realtor or Agent: _~¥rna Johnston or Hank-W-az~e~ AREA, Inc. Rea]_tors Address: P. O. Box 249 Phone 694-9555 Eagle River, AK 99577 (Fj~c(,-q]~ Legal Description: _Highland Hills Unit #3, Lot 16, Blk 2 Location: Hiland Road Mile 4.7,_ turn left at Wild Mountain Drive, 2n__d Log House on right. 7. Type of Facility to be inspected: ~ingle Family 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 150' 9. Sewage Disposal System ': Type of System: Public Utility If Individual, date of installation: Individual Individual 1977 No. Bdrms. 3 on-site) X [B REALTOR ' AREA, INC. REALTORS [] Anchorage "C" St. Office 3300 C Street [] East Anchorage [] Eagle River Eastgate Office -- Parkgate Office 5437 E. Northern Lights P.O. Box 249 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities ]Legal Description: Lot 16 Block 2 Highland Hills ~3 Subdivision Comments: Af fadavit Attached:~. ) ]Disapproved: Letter Attached: Date: 3 Date: Department Worksheet: SEf~! TO POSTMARK OR DATE R~r', ~i ~-,, With deliveryto addressee only ........... 65¢ 5~LPI~R rO ADD~ES~ OHL'/ .::.._:::,.7:..........,~ ..,..'~-~0~ (See other sido)