HomeMy WebLinkAboutHIDEAWAY ACRES LT 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Lot I''r~' 1 Block ~
~
l ownshlp, Range, Section
M~!enal No ol Compam~lems
TYPE OF SYSTEM
ENCH ~.] BED
/
[] W. DRAIN
OTHER
SO FT
Date Installed
FT
DISTANCES
~'--~'0 SEPTIC ADSORPTION
__FR0 ~ ~ TANK FIELD WELL
WELL
LOT LINE
FOUNDATION
7o ' Z C?:
AS-BUILT DIAGRAM tShow Iocahot~ Of wed. sephc syslem property hnes. Iourldahon,
drp, oway, walol bodlos, elc )
WELLS
[] OTHER (Identify)
'"-ry~'--p R I VATE
FTJ FT
REMARKS:
7 ~ '7-1.4/~
Scale:
Inspections Pedormed by:
IZjc
filunicipal and Slate guidelines i,i ellec, ell lifts dale: 1 ¢2'"'"/~/~_ '
.i ?.t'.::~ :..:,I ..I.. F:'I:ii:R IENCi i lqEl:ii:l::i'.S DIES I GI".I ,, VARR :1: I::'Y '1ANKS I I',lTliii:Gl::;: t '1'",'~
[]l:,:U'..::ii i ~:~i.'~l') I'::' :1: I...I .... I. N CII...t.) CR I .f3 ,, IqO '1 1 FY Df'IHS I:::'R
!:,'.i'.:il::"[:i%:!lON BY II-Ilii E]',.IG.I;l',lEi. iiii:F;:,, THIS
~ ii..:;i F'IEI::;~M .1: !' ;i. ~iil :1 ',!iiSl..IED I:- t:)F~ I HEi: !E X :I: ,"i!i I :I: I",IG :5 Ed~!!:DI':;~CICIM !iil I IqGl.l:i F:'AM I I..Y
I.'~ ;: ',>Ii}]',lC;Ii:: ONLY ,,
.. , ,,_,-,-3 r-~ ~ ~ pi<
'o~ 4"[;2: ~4~ J -:.
/
~ Jz' z'-.o" ~O,jo I, lo,',,-i,:,, tSre .... -'Ali,
SEWER SYSTEM 'LOCATION PLAN
LOT I BLOCK I , SUBDIVISION
,,, ~:?' ""
r:.'T~ ~5):}' :? / '8~$v ~ ~ SECTION/TOWNSHIP/RANGE
,~:>'?, ' : ',,~' ,~5 ,:,~ SCALE, NOTE,
' PROPERTY CORNERS, WELLS, AND SEPTIC
~ c. ,~;~z " . ,,,,o~ot,,;,,,- ., / . SYSTEMS INDICATED IS NOT EXACT.
¢~ - .. n* NORTH / P c,¢ ~/p/%'~' DIMENSIONS INDICATED HAVE BEEN
.......... '~ ~r:!'~'f P" -~77~'. DETE¢IMINED BY USE OF CLOTH TAPE AND
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchora§e, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR :~ ~..
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
DATE PERFOR
/~rC ~,'Township, Range, Section:
SLOPE SiTE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
",pth l0 Waler ^,,~r
Monitoring? ~ Date:
13
14¸
15
16--
17
18
19
20
COMMENTS . .~/(.d/'-)
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN FT AND
;~ ./~d ~ -f- /':~:' :z 7', ,/~d
.FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: _
72-008 (Rev. 4/85)
oGRE,
ER ANCHORAGE AREA BOP'"JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99§03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE // /-
FROM WELL/(, :(?
INSIDE LENGTH
- "J ' , OF
- COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH_ LIQUID CAPACITYI ¥ ')L/~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS / DIAMETER __
LINING MATERIALC~ ?Z"(', /"')~RIB SIZE:
---, LENGTH¢ '?", DEPTH /: .~]
DIAMETER DEPTH ~i:)/ DISTANCE FROM: WELL
BUILDING FOUNDATION -/-'~->. NEAREST LOT LINE
ADDITIONAL ABSORPTION
WELl_:
TYPE :'),//' ,' /)
BUILDING
FOUNDATION
__CONSTRUCTION_ (""/(2~1~/~/(' ~/ , .[
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
CESSPOOL
APPROVED
NEAREST
LOT LINE
OTHER SOURCES_
DISAPPROVED
NEAREST
SEWER LINE_
REMARKS
_SQ. FT.
SEPTIC//--,/.
TANK /~' :D<''
DISTANCE FROM:
SEEPAGE ///'~ '
SYSTEM
DISTANCES:/
.4 ('
LOT SLOPE:
REMARKS:
Form No, EQ-031
DIAGRAM OF SYSTEM
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4§6!
PERMIT NO.
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
MA,L,N~ ADD~ESS
INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT._/~2
, DRA~N FIELD . OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED /~/.~- ~/~L/~J
SOIL TEST RESULTS /~1, //~ ~(/~/Y ///' . NOTE: THIS PERMIT IS NOT VALID ~lTHOUT SOIL TEST
COMPLETION DATE ANTICIPATED ~ /~/
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,
SEPTIC TANK SIZE_
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEEPAGE PIT ~ /
SEPTIC TANK TO SEEPAGE PIt WALL /4 /
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD _ --
DIAGRAM OF SYSTEM
· DRAIN FIELD.
SEEPAGE Pit ~2 ~ '/
', - , DRAIN FIELD
SEEPAGE PIT ~/~'~') /]
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT /~ /
/~_~ t /~,/
, DRAIN FIELD
WATER MAIN TO SEPTIC TANK DRAIN FIELD //~ /'
SEPTIC TANK,
SEEPAGE PIT_
TO RIVER, LAKE, STREAM.
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
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
?
TO BOROUGH REGULATIONS REGARDING INSTALL/ON.
CONFORM
LICENSED DESIGNER
CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
~SCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
ANCIIOR/iGE
FAIRkIANKS
CONSULTANTS, INC. JUNI~AU
R & M NO. 462096
Mr. Harry Foosness
1436 Matterhorn
Anchorage, Alaska
Re: Test Hole and Soil Log Report for Sanitary System
Lot 2 Hideaway Acres
Dear Mr. Foosness:
We are submitting herewith the test results and our comments regarding
soil conditions encountered at the subject site. Thais investigation
was performed in accordance with your request of November 11, 1974, and
those .procedures outlined in a letter dated September-i[3, 1971 by Mr. Rolf
Strickland of the Greater Anchorage Area Borough Department of Environmental
Quality.
A single test hole was put down within the Lot 2 ares for the purpose of
defining general subsurface soil conditions for the proposed sanitary
system. Excavation was accomplished with a tractor mounted backhoe and
the test hole was extended to a total depth of 13.0 feet below ground
surfade, The final log prepared for the test hole has been included in
Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be ~f service to you.
Should you have any questions with regard to the above~ please do mot
hesitate to contact us.
Very truly yours,
R & M ENGINEERING CONSULTANTS
James W. Rooney ~~
JWR:pjm
xc: GAAB
Test Hole-1
11~11a74 ]~
ORGANICS
ORGANIC SILT
0.0'
0.5'
1.57
SILTY SAND W/SOME GRAVEL (SM)
6,5'
SAND
MEDIUM TO COARSE GRAIN (SP)
NO WATER TABLE
13.0' T.D.
NOTE: TEST HOLE EXCAVATED WITH TRACTOR MOUNTED BACKHOE.
Engineering 8~ Geological Consultants Inc.
_~_.C-HOR A~ FAm~.KS ALASKA Ju~u
Harry Foosness Property
Log of Test Hole
Anchorage, Alaska
SCALE 1"=2' IcH~o W.E.D. [~mo~. No. 462096 l~w~ ~o.
][1/13/74
R&M ENgiNEERING & GEOLOGIL AL CONSULTANTS
22g EAST 51st AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99603
TELEPHONE 907-279-0483 TELEX 090--35419
Civil Engineers
' .;,:, ~ ....... ,, .Gee/eEists
JAMES W. ROONE¥, P. E.
MALCOLM A, MENZIES, P,E,, L,S,
JAMES FI. WELLMAN, P.E,
July 24, 1973
Land Surve?ors
RALPH R. MIGLIACCIO
Engineering Geologist.
Mr. Carl Luchsinger
Box 94, Star Rt. A
Anchorage, AK
Re: Test Hole and Soil Log Report for Sanitary System
Lot 1 & 2 Hideaway Acres
Dear Mr. Luchsinger:
We are submitting herewith the test boring results and our
comments regarding soil conditions encountered at the subject
site. This investigation was performed in accordance with
your request of July 23, 1973, and those procedures outlined
in a letter dated September 13, 1971 by Mr. Rolf Strickland of
the Greater Anchorage Area Borough Department of Environmental
Qua ii ty.
A single test hole was put down within the Lot 1 and Lot 2 area
for the purpose of defining general subsurface soil conditions
for 'the proposed sanitary system. Excavation wa~ accomplished
with an auger type drilling rig and the test hol,e was extended
to a total depth of 25 feet below ground surface'. The final
log prepared for the test hole has been included in Drawing
A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of seA-vice to
you. Should you have any questions with regard to the above,
please do not hesitate to contact us.
Very truly yours,
F, & M ENGINEERING & GEOLOGICAL CONSULTANTS
James W. Rooney
JW?,: p h
>:c: G~AB ~/
THI
7-24-7~
SILT~ TRACE TO SOME
SAND AND GRAVEL (ML)
SILTY sAND, TRACE
GRAVEL TAN (ME,)
SAND, Med. To Coarse
Grain Gray (SP)
No Water Table
25.0' T.D.
TH2
7-24-73
ORGANIC SILT
0.0j
SILT, TRACE SAND AND ,~/
GRAVEL TAN (ML) ')
7.0~
SANDY SIL:F TRACE /
GRAVEL (M L)
12.0'
GRAVELLY SAND Gray (SP) ,/,~,,)_
14.0'
SAND Gray Med. To
Coarse Grain (SP
SAND~ Coarse Grain
Gray ( SW )
20.0'
25.0' T.D.
No Water Table
No~e : Tee'} Holes Extended With Auger Type Drilling Rig.
J~ Engineering ~ Geological Consultants
Carl Luchsinger Property
LOG OF TEST BORINGS
Anchorage Alaska
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~)Z',~'-¢~'/' -~::~ NAA # ,.~_.~, ~ ¢¢)_ .,~-)x-~.¢--
1. 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
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone /'L"~////~
(e) Mail the HAA to the following address: (or check here I~if hold for pick up.)
List contact person and day phone number below:
TYPE OF RESIDENCE
Single-Family~ 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 th legality and status.
SEWAGE DISPOSAL
On-site ~;~ Public [] Community [] Holding Tank E]
/
Note: If community well system, must have written confirmation from the State E)epartment of Environmental
Conservation attesting to the legality and status.
72*025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
Ascertified by my seal affixed heretoand as of the validation date shown below, Iverifythat myinvestigat[onofthis
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 flies 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.
Name of Fir~' ~,",'¢/-¢" ~' ,¢ :/-','-~-~ Telephone -~ ' '-~
Address
'
Date
6. DHHS APPROVAL
Approved for .~ bedrooms by
Approved ~. Disapproved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 DHHSdo 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.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Hea, lth Auth,.0rity Approval (HAA)
~!i~.',~'/ki i I, ~Hl~'C~i§3% F~EBRUARY 1984
:','i:~.~4744
Legal Description:
A. WELL DATA
Well Classification
Well Log Present (Y/N) /~/ . Date Completed (/4 ~o,~,,~. Yield
Total Depth¢(~' Cased to _~;.l' ' & Depth of Grouting
If A, B, C, D.E.C. Approved (Y/N) ____
Static Water Level ,-~ '¢
Casing Height Above Ground ~ *
Electrical Wiring in Conduit (Y/N) .~/
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ](~O r
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line _
To Nearest Sewer Service Line on Lot
Water Sample Collected by (."~-~'li/fl~/
/
Water Sample Test Results ~i~,/~ ~/.~( /--/Cd- Z-¢~t ~,/
/
Comments
Pump Set At /__,.),1 /~o '~,¢,-,
Sanitary Seal on Casing (Y/N) F
Depression Around Wellhead (Y/N)
; On Adjoining Lots ~'/~"
; On Adjoining Lots
j~/ //~- To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed /42/7.~ Size_/d..,d-£-'
Standpipes (Y/N) y
. Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N) l~,( ~/"-I
Holding Tank High-Water Alarm (Y/N) /~./ /.~
No. of Compartments
~'/ Foundation Cleanout (Y/N)
Date Last Pumped /
;for J(../
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well [ L~C.?
To Property Line ~._. _d_2 ¢
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
7'0 Disposal Field ¢o
Comments
72-026 IRev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /,-? / /6
/
Width of Field ~ L ~ ,,
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
~¢ l~'~f/;.~ Type of System Design
/
Length of Field ~E.) ~
Depth of Field /,Z '
Gravel Bed Thickness ~ '
Statndpipes Present (Y/N) V'
Date of Last Adequacy Test
/
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation '7~.
Lot /
TO Water Main/Service Line//(~
To Property Line -~"~" /
To Existing or Abandoned System on
; On Adjoining Lots
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parkir~g Area, or ,Vehicle Storage Area
Comments .,/'~,-'"~.~;~ ~.~/[-'-/'~'"*,n /~ //~/~',~"
Date Installed ~ -
Size in Gallons ~
"Pump On" Level at ~
High Water Alarm Level
Tested for X
Meets MOA Electrical Codes (Y/~
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permi~t~
I certify that}/h/~
inspection. ///
Signed
Company ' ~-~
Date
MOA No.
td Bedroom/Rating Against HAA Request**
~e~checke/d,/~e~fied, or conformed to all MOA and HAA
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7t88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
ct on the date of this
Engineer's Seal
NORTHERN TESTING L. ABORATOR E$,
600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASi~A 99709 907-479-3115
2505 FAIF[BANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY CLIENT
.~PRIVATE WATER SYSTEM
Mo. Day Year
Purchase Order No,
SAMPLE TYPE:
[] Routine
Zip Code
[] Special Purpose
[] Check Sample (for original contaminated
sample with lab reference no.
Sample Time
No. Location Collected
2
3
4
5
6
7
8
9
10
[] Treated Water
/~Untreated Water
Collected by Laboratory Ref, No.
Signature of Representative
FOR LABORATORY USE ONLY
CASH CHAflGE
TO BE COMPLETED BY LABORATORY
Received at: ~Anch. [] Fbks.
Date Received
Time Received
Next Sample Due
COMMENTS:
SATISFACTORY
UNSATISFACTORY
RESAMPLE
OTHER BACTERIA
TOO NUMEROUS
TO COUNT
U
R
OB
TNTC
Direct Verification
Count LSB BGB
Result' Comments
*No, of To:o:m Colonies per 100 mis.
i
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
TELEPHONE (907) 562-2343 5633 B Street
Anchorage, Alaska 99518
Drinking Water Analysis Report for Total Colifo?~ Bacteria
TO BE COMPLETED BY WATER SUPPLIER
[] PRIVATE WATER SYSTEM
Name f ~..~_~%,., "% .f~'~Ph°ne No.
/g Address
City State Zip Code
Mo, Day Year
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
.) [] Treated Water
[] Untreated Water
SAMPLE Time
NO. / LOCATION Collected
3[ I
4[ I
Collected
B
TO BEC COMPLETED BY LABORATORY
s shows this Water SAMPLE to be:
/~SJ Sl:isfactory
[] U 3atisfactory
Sa nple too long in transit; sample
should
not be over 30 hours old at examination
to(indicate reliable results. Please send
new sample via special delivery mail.
Date Received ll-tO-
Time Received
Analytical Method: Membrane Filter
* No. of colonies/100 mi.
Lab Ref, No. Result*
J
J
J
Analyst
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
TNTC
OB =
BACTERIOLOGICAL WATER ANALYSIS RECORD
Membrane Filter:. Direct Count
Verification: LTB BGB
Final Membrane Fj~t~'~ults _.~,..~
Reported By ~ --
Time:
= Too Numberous To Count
Other Bacteria
PAF:~T I OF' 2
RE:MAINDE:R TO FOLLOW
Collform/lOOml
Coilform/100ml
& GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order $ 10415
Date Report Printed: NOV 15 88 @ Ii:S9
Client Sample ID:HIDEAWAY ACREAS LOT 2
PWSID :UA
Collected NOV lO 88 @ 13:00 hrs.
Received NOV 10 88 @ 14:20 hrs.
Preserved with :4 DEG, C
Client Name : CORWIN & ASSOC
Client Aect : CORWINP
P.O,# NONE REC'D
Req $
Ordered By :
Analysis Completed :NOV Il 88 Send Reports to:
Laboratory Supe~vi~_:STEPHEN C. EDE 1)CORWIN & ASSOC
Special
Inet~uct:
Chemlab Rei ~: 3412 Lab Smpl ID: 2 Matrix: WATER
Allowable
Parameter Tested Result/Units ~lethod Limits
NITRATE-N 2.7 mN/1 EPA 353.2 10
Sample ROUTINE SAMPLE
Remarks: SAMPLE COLLECTED BY W. HERS&N.
i Tests Performed ' See Special Instructions Above UA=Unavailable
ND- None Detected "See Sample Renmrks Above
NA~ Not Analyzed LT-Less Than, GT-Oreater Than
!i)3330
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" Street, Anchorage, Alaska 99503 274-4561
Mailing Address:
Property Owner:
Mailing Address:
Legal Description:
Date Received Z-/~
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by: ~___~.~
4. Location: /V/¢~/ /~~~.
be inspected
5. Type of facility to No. of bedrooms
Phone:
Phone:
6. Well Data:
A. Type ~ ~~.~.__
C. Construction
7. Sewage Disposal System:
A. Installed ~L'779/
C. Septic Tank: 1.
D. Seepage Pit: 1.
E. Disposal Field:
~ B. Installer ~E~z)~) ~X.
Size lZ-~'~,~',,9'~ 2. Manufacturer ~~2/,~/,~
Absorption Area ¢¢/¢~/¢/~ 2. Material
Total length of lines
8. Distances:
/
A. Well to: Septic tank __/'~ , Absorption area _/~_6¢) ' ., Sewer Lines ___,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1174) Page 1 of two pages
GREATER ANCHORAGE AREA BOROUGH
Department of Environlnental Quality
3330 "C" St., Anchorage, Alaska
99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WAl'ER FACILITIES
1. Type of Inspection: CMRO VA FHA CONV x×xx
2. Property Owner: Harry Foosnes
Mai.ling Address: 3906 Locarno Dr._~ Anchorage [)ay~ Phone 277 3794
3. Name of Buyer: L. Jane Sutherland & Virginia M. Blanchard
Mailing Address: SRA Box 95L~ Anchor_age AK Da_y Phone 272 4401, Ext 249 (offi(
4. Name of Lending Institution: Coast Mortgage Co.
Mailing Address: 4450 Business Park Blvd,
Anchorag% AK 99503
5. Name of Realtor or Agent: n/a
Mailing Address:
Phone 274 9504
Phone
6. Legal Description: Lot 2, Hideaway ~MMKI[ Acres
Location: NHN Hideaway Trail.
7. Type of Facility to be inspected:
8. Water Supply
'Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual
If Individual, date of installation 1975
Sin£1e Family NO. Bdrms. 3
XXXX
(on-site)
XXX
EQ-037 (1/74)
Page 2 o'~ two pages - Re st for Approval of Individual er & Water Facilities
Legal Description
Comments
Approved · -, c~ ~'?' '
'~,~UD 1 sapproved
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)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279~.8686
Date Received
Time of Inspectlon_~//3; : ~ /'] il):)
Aoproval Requested
Address:
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & '¢qATER FACILITIES
FOR
Phone
,. ,, .. ,-
Prooertv Owner:
Leqal Description: ~</: .! ~. ? ,~ ( .": ,' '
.... ~,:,"
Location: '.'. ~
Type of Facility to be Insoected:
Number of Bedrooms: >. ~ ~ .~( /
Well Data:
C, Construction
7. Sewage Disoosal System:
C,
D,
Septic Tank: 1,
B.
Size_~~ 2.
Seepage Pit: 1o
Disposal Field:
Depth ............
Bacterial
,, .~.,
Instal ]er~_~
Total Length of Lines
Distances:
A, Well To:
Septic Tank¢/~i' _, Absorption Area
, ?~earest Lot I.ine ~2r/ , Other Contamination
Absorption Area to Nearest LotLine ....
, Sewer Lfnes
Request for Approval of Individual Sewer & Water Facilities
Page Two
9, Comments~
Aporova] Valid for One Year From Data Signed
Greater Anchorage Area Borough, De?artment of Environmental Quality
DIAGRA~J OF SYSTEM
/
,
!
t certify tibet the information contained in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located
Signed Date