No preview available
HomeMy WebLinkAboutHERITAGE HILLS BLK 2 LT 3* 0 tqslw oa k Ml- 09 p 2 Municipality of Anchorage Page of 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 Number: O 1 �_ 2-7-1 Sw C1900-1_ Permit Number: Name: �L Wastewater System: ❑ New Upgrade Address: A-jGP' 41 r s� 131 sem-At" qgsib ABSORPTION FIELD Phone: ( No. of edrooms: �(�eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: (D Total Depth from origir/al grade: //- 5 L 7" . GPD/Sq. Ft. Lot: Block: �, Subdivision, .�FfL tn t_ � A w s Depth to pipe bottom from original grade: - - - 1. 5 I Ft. Gravel depth beneath pipe Ft. Township: Range: Section: Fill added above original grade: amPED Gravel lengm:: / 2. Ft. 7our( Ft. WELL: ❑ New 13 Upgrade Gravel width: �+ Number of lines: l Distance tween lines: IJ Ft. Ft. ' 'cation (Private, A,13 Total Depth: ase Total absorption .ar_e�a: P030 3n4- 4 O 1 Ft. C G.. SC Ft V Driller: Date d: atic Water Level: Installer: Date instal d: S ! Z Ft. Yield: P t at: ,ng Height Above Ground: - TANK Ft. Ft. EPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding ublic/Private Manu cturer: Capacity In gallons: P tY From Tank Field Station Tank Sewer Lines r+ Material:_ S��L. Number of Compartments: 'Z. Welh lot (,DZ!� Z�1+ I I loo * tbof+ LIFT STATION Watee Lot Z�l t �! �!+ Size in gallons: Manu a Line �' /1 7.3 56 "Pump on" level at: "P ' level at: High water alarm at: Foundation � _ Curtain Irk JA Pump Make el Electrical Inspections performed by: Drain N BENCH MARK Remarks: Location and Description: of Nast= C i B & A90 F — Fou o Assumed Elevation: ODv O ENl�I�N_FiF F Inspections performed by: ;41 -UVJ C" hl �► Dates 1st jgr Z A. Department of Health and Human Services approval° y r .NCE -793 #iC4r1""�•.»..-�, jd+ Dater Reviewed and approved by: 72.013 (Rev. 8/91) MOA 25 PERMIT NUMBER: AS -BUILT DRAWING PARCEL 1221 -09 1 SW990072 1 A B C D1 32.7 23.2 — D2 33.9 25.2 — S7 34.0 26.8 — S2 32.3 31.5 — D3 32.9 33.3 — D4 33.0 34.1 — FD 34.6 36.4 — 001 78.1 78.0 — MTt 78.6 78.1 — 0O2 25.0 41.2 MT2 28.4 46.8 --------- 1D' unury EASEMENT------ — — cot SHED I— C ------:I / / I ALTERNATE SITE fpTH/2 L 7—, — iINN. CXP17E -96.381 Stl 512 f07 of f" –1,01,01 f" AfIW-9336 / ATAMif-"m �' (I NSW 1250 GALLON I I INJiRf GE DING Af 19kf-92.89 5 f IC 1 AfOUIILf-920 9.6E -83.76 ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 TYPE OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: CRAIG AND MARYRITTA ELY 786-3526 DATE: DRAWN BY: SCALE: PAGE: 7/1/99 A.C.G. 1 = 40' 2 OF 2 _H 0 ..... . . .. ....... .........oO J Tb A. ness Q Opo E-7953 �4�sy prof e s siooO �O00000�6 II D1 GALLON IXISTSE ITANK SEPTIC MI2 I \ W 002 (/LHOMEOWNERS J OOM ESIGN OOMS EQUEST. fI EXISTING GRAVEL DRNEWAY V 1 EAST 131st AVENUE iINN. CXP17E -96.381 Stl 512 f07 of f" –1,01,01 f" AfIW-9336 / ATAMif-"m �' (I NSW 1250 GALLON I I INJiRf GE DING Af 19kf-92.89 5 f IC 1 AfOUIILf-920 9.6E -83.76 ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 TYPE OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: CRAIG AND MARYRITTA ELY 786-3526 DATE: DRAWN BY: SCALE: PAGE: 7/1/99 A.C.G. 1 = 40' 2 OF 2 _H 0 ..... . . .. ....... .........oO J Tb A. ness Q Opo E-7953 �4�sy prof e s siooO �O00000�6 / — PERMIT NUMBER: SW990072 AS -BUILT DRAWING PARCEL ID NUMBER: 015-221-09 ------ — ----,o ururrrw A B C -- — CQL— SHED I C ----- D1 32.7 23.2 Aunewre s,E D2 33.9 25.2 S7 34.0 26.8 S2 32.3 31.5 FD 11 D3 32.9 33.3 D4 33.0 34.1 II II Dz FD 34.6 36.4 I I 01 F7041SE 7150 0M10N / j �� 'TAW8 001 78.1 78.0 Yi21 MT1 78.6 78.1 c / A ot CO2 -- 25.0 41.2 / B EpSOUSL 3 BEDROOM M -- 28.4 46.8 OEM DDNE FOR 4 Off r' PER HDMEO'RNM REa= ' � C I I a � EKSTMDRNEwr Mf fA f WI. (YJI,i -95,11+ L I I EAST 131st AVENUE am-9'� sn 7 5V TOP aIr" - M ELHf - "M f I I NeW I M GALLON gra 5f Pflc f" ATM" -9289 . .0.16 -_ 7--c-'-S I • S / o� ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 28. ANCHORAGE, AK. 99504 PHONE: (907) 337-8179/FAX: (907) 338-3246 LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 TYPE OF WORK: AS -BUILT OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: CRAIG AND MARYRITTA ELY 786-3526 DATE DRAWN BY: SCALE: 7PAGE: 5/18/99 A.C.G. 1 = 40' 2 OF 2 I I .-fora f" as ntf-"m KOnff-920 ........... ! .... ....:...` O r A. Ga ss.: Q 9,-7953 Op fe^•�' ..... '•c�Ao4 C.11 Y \ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade 2insl o� 3-j2 q7 Date Issued: Apr 27, 1999 Expiration Date: Apr 26, 2000 Permit Number: SW990072 Legal Description: HERITAGE HILLS BILK 2 LT 3 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: CraT Maryritta Ely Owner Address: 5441C1E 131 STAVE ANCHORAGE , AK 99516-2353 Parcel ID: 015-221-09 (J-)/-\C;LsV,\/AL� Site Address: 005441 131 STAVE E Lot Size: 21700 SQ. FT. Cn Lem Ls.k . nL-r-, Total Bedrooms: 3 Permit Bedrooms: 3 Th'permit is for the construction of: Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. it k am�naec� S'E .99 f0 VV%Cl0c)2-r CIA Received By: Issued By: G �(� Date: Date: �27'99 Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B. Anchorage, AK. 99504 Phone (907) 337-6179 — Fax (907) 338-3246 May 5, 1999 Municipality of Anchorage Department of Health & Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref Septic System Upgrade for Lot 3, Block 2, Heritage Hills Subdivision To whom it may concern: 1. GENERAL: The existing 3 bedroom home is served by a private septic system and well. The existing 1000 gallon septic tank was found to be collapsed and in need of a replacement. It was later concluded that the existing crib was in a state of failure. Per the homeowners' request, we are proposing to install a septic system that will meet the requirements for a 4 bedroom home. A new 1250 gallon septic tank was installed on 4/28/99 (permit no. SW990072). Two test holes were excavated on April 22, 1999. The soils are summarized as follows. 2. SOIL CONDITIONS: Test hole #1 was excavated to a depth of 17.5 feet. There was approximately 0.5 foot of organics with 1.5 feet of fill beneath it. From 2 feet to 7 feet was a SM/ML material. From 7 feet to the bottom of the hole was a ML material that became more dense as the depth increased. Two perc. tests were performed in test hole 41 at depths of 3.5 feet and 7.5 feet. The upper bench was found to perc. at a rate of 7.5 minutes/inch and the lower bench perked at 20 minutes/inch. Test hole #2 was found to have 1' of organics at the top followed by a SM/ML to a depth of 6 feet. From 6 feet to the bottom of the test hole was a ML material, similar to what was found in test hole #1. One perc. test was performed at a depth of 4.5 feet and the soils perked at a rate of 17.1 minutes/inch. 3. DRAINFIELD: We are proposing to install one trench that is 72 feet long by 2.5 feet wide. It will be 11.5 feet deep with an effective depth of 9 feet. This corresponds to an absorption area of 1296 ft2, or an application rate of 0.46 gpdM2 (assuming 600 gpd total flow). 4. SURFACE WATER: There are no surface waters within 100 feet of the proposed upgrade. 5. TOPOGRAPHY: The ground where the proposed bed is to go has a 5% or less slope to the north. There are no concerns regarding the slope of the terrain. 6. CLOSING: If you ve any questions, please call me a 337-6179 or 244-9612. Sincerely, Jere ess, P.E., M.S. TRACT D, HERITAGE HILLS PROPOSED SEPTIC DRAINFIELD (SEE DESIGN, PAGE 2 OF 2) /LOT 1, BL96K 2 LOT 2 BLOCK / HERITA7 HILLS HERITATCE HILLS i I I I 100 o-100 1 ` EAST 131st f -- LOT 5, BLOCK 1 0 HERITAGE HILLS Q 0 0 0 W LOT 6, BLOCK 1 D_ HERITAGE HILLS IJ - LOT 4, BLOCK 1 HERITAGE HILLS GGAN�D o 0I LOT 3, BLOCK 1 Ld HERITAGE HILLS m J ALTERNATE SITE EXISTING SEPTIC SYSTEM _�—EXISTING 3 1 w+olusn, BERM HOUSi ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 28. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 TYPE OF WORK: SITE PLAN PREPARED FOR: PHONE NUMBER: CRAIG AND MARYRITTA ELY 786-3526 DATE: DRAWN BY: SCALE: PAGE: 5/4/99 A.C.G. 1 = 100' 1 OF 2 OF A .. .. of re A. GOr"ess: ..D 14g� '. 7953O�D NOTE THE CONTRACTOR SHALL HAVE THE NORTH AND WEST PROPERTY LINES AND THE 100' WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. TRACT D APPROXIMATE LOCATION OF EXISTING CRIB TO REMAIN IN PLACE FOR FUTURE USE AS A RESERVE SITE. 10' UTILITY EASEMENT -------- — 0 SHED C---- T I PROPOSED DEEP TRENCH--,,, 72' LONG BY 2.5' WIDE I BY 11.5' DEEP MAXIMUM. ADD 9' OF CLEAN, WASHED I SEWER DRAINROCK. / TH#1 7—/ —/ / ' TH#2 \ + INSTALL FLOW � DNERTER INSTALL DOUBLE CLEAN-OUT EXISTING 1250 GALLON SEPTIC TANK - INSTALLED 4/28/99 \ + (PERMIT NO. SW990072) LOT 2, BLOCK 2 c/ HERITAGE HILLS / \ \ / EXISTING 3 BEDROOM 00 HOUSE. SEPTIC DESIGN \00 DONE FOR 4 BEDROOMS 00 PER HOMEOWNERS REQUEST. 11 00' 1 EXISTING GRAVEL DRIVEWAY lr 1 �1 EAST 131st AVENUE ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 #PE OF WORK: DESIGN OF NEW SEPTIC SYSTEM PREPARED FOR: PHONE NUMBER: CRAIG AND MARYRITTA ELY 786-3526 DATE: DRAWN BY: SCALE: PAGE: 5/4/99 A.C.G. 1 = 30' 2 OF 2 SITE \I f A. Garness.: Q I m C —7953 oQ� ���'�' ''••.........••' ...goo 4�1�rPro fes sionao ALASKA WATER & WASTEW. cant nCDADD DnAn cirm 9P SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 PERFORMED FOR: CRAIG AND MARYRITTA ELY DATE PERFORMED: 4/22/99 DEPTH TEST HOLE #1 (feet) — ORGANICS 1 FILL 2 SOIL CLASSIFICATIONS 3 11 12 13 14 15 16 17 18 IL COMING DENSER ITH DEPTH DEPTH TO DATE GROUNDWATER DRY 4/22/99 DRY 4/29/99 SITE PLAN GP GM GC SW SP SM Sc CLOCK TIME ML CL OL MH CH OH - - NET DROP (INCHES) TH1 / ING 3 BDR H9USE LOT 2. BLOCK \ 00 ��000 pie®s °®wo A 2 100' W LL RADIU o° EAS 131stVAVENUE DEPTH TO DATE GROUNDWATER DRY 4/22/99 DRY 4/29/99 SITE PLAN READING CLOCK TIME NET TIME (MINUTES) - - NET DROP (INCHES) TH1 / ING 3 BDR H9USE LOT 2. BLOCK \ HERITAGEHILLS — A 2 100' W LL RADIU o° EAS 131stVAVENUE 4" i? 3 3:56 6" I DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/23/99 1 3:26 — 6" — = 2 3:56 30 2" 4" i? 3 3:56 6" — 4 4:26 30 2" 4" w a 5 4:26 — 6" — 6 4:56 30 2" 4" 4/28/99 1 10:55 — 6" — = 2 11:25 30 4 5/8" 1 3/8" i? 3 11:25 — 6" — 4 11:55 30 4 1/2" 1 1/2- /2"1:55- 3 1 -55 Cy 6 12:25 30 4 1 /2" 1 1/2' 19 � PERCOLATION RATE 7.5/21.8 (M 20 TEST RUN BETWEEN 3.5-4.0 F COMMENTS: PERC. HOLES WERE PRESOAKED 4+ HOURS RI 0 USE 0.45± GPD SF SOIL RATING. PERFOMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFORM (J ACCORDANCE WITH ALL STA E A DATE. DATE: S S PERC. HOLE DIA. 6 (INCHES) .5-8.0 FT. BASED UPON VISUAL SOIL RATING, CERTIFY THAT I GUIDELINES IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901PHONERR (907)337 -6179 UIlt 26 FAX (907 338 9504 3246 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: HERITAGE HILLS SUBDIVISION, LOT 3, BLOCK 2 PERFORMED FOR: CRAIG AND MARYRITTA ELY DATE PERFORMED: 4/22/99 DEPT" —_ TEST HOLE #2 (fee ORGANICS 1 as 2- 3— 3 SM/ML 4- 5— 6 7- 8- 9- 10-11 8 910 I1 1 11 12 13 14 15 16 17 18 ML BECOMING DENSER WITH DEPTH SOIL CLASSIFICATIONS a o GW GP GM GCOL SW SP SM NET TIME (MINUTES) 0 R G ML CL MH CH ®, 4/23/99 1 3:28 — 6" — 2 3:58 ESC .'�/OH 1 7/8- 3 3:58 DEPTH TO DATE GROUNDWATER DRY 4/22/99 DRY 4/29/99 SITE PLAN THTH 2 -� L j ING3 / BDR ROUSE LOT 2. BLOCK \ HERITAGE HILLS A EAS 131 stVAVENUE / --- P — — J DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 4/23/99 1 3:28 — 6" — 2 3:58 30 4 1/a., 1 7/8- 3 3:58 — 6" — 4 4:28 30 4 1 /4" 1 3/4- 5 4:28 — 6" — 6 4:58 30 4 1/4" 1 3/4" 19 � PERCOLATION RATE 17.1 (MIN./INCH) 20 TEST RUN BETWEEN 4�5 .'AND COMMENTS: PERC. HOLE WAS PRESOAKED 4+ HOURS P OR T/jb , ST PERFOMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFOR E IN ACCORDANCE WITH ALL STATE DATE. DATE: S HOLE DIA. 6 (INCHES) I FT. CERTIFY THAT I IDELINES IN EFFECT ON THIS GAAB-HV, Gl R ANCHORAGE AREA BORA' '; GtPAA4TMENT OF ENVIRONMENTAL O.UALL_•,7 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 • INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME /tk�caO G�G/[��J��'�i'l'�i/ -ADDRESS'/1.f��� '-(�C✓ PHONES �d LOCATION� LEGAL DESCRIPTION SEPTIC TANK: ` NUMBER OF DISTANCE FROM WELLJ7f��61 MATERIAL���' COMPARTMENTS LIQUID CAPACITY /!�l'Ca GALLONS. INSIDE LENGTH `�` INSIDE WIDTH SEEPAGE SYSTEM: SEEPAGE PIT: LIQUID DEPTH= NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH / LENGTHS / DEPTH f LINING MATERIAL4'6"J/c�/�1� DISTANCE FROM WELL���� BUILDING FOUNDATION�� , NEAREST LOT LINE ��� .3D / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) TILE DRAIN FIELD:"/ DISTANCE FROM WELL NEAREST LOT LI FT. TOTAL LENGTH OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPT AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: DISTANCE FROM _ - WATER I DEPTH BUILDING FOUNDATION. SAMPLE , NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINEy SEWER LINE TANK ' SYSTEM_ CESSPOOL �, SOURCES `— DISTANCES: •S/iG t1l/�/ FkC,�r%fiTi�Y� DIAGRAM OF SYSTEM DATE L_,"dAPPROVED G.A.A.B. I ,i i GRi_,Avi, R ANCHORAGE AREA Bt-: Rc;UGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT l�•26 C�j� 7���Lj �� /U INSTALLATION LOCATI LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS L COMPLETION DATE ANTICIPATED MAILING ADDRESS SEEPAGE PIT DRAIN FIELD _ 2166 PERMIT NO. PHONE OTHER a_ . TO BE INSTALLED BY % L� C/ �✓�A' ft'C�Ll� (f c` NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.. SEPTIC TANK SIZE � / TYPE E AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK G, FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT `l' -y DRAIN FIELD TO NEAREST LOT LINE. i J WELL TO SEPTIC TANK /�) SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK l�"� SEEPAGE PIT DRAIN FIELD SEPTIC TANK, , SEEPAGE PIT ` `� (-J DRAIN FIELD , TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ! HEALTH AU`HORITY OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-66 AND THAT THE ABOVE DESCRIBE SYSTEM IS IN ACCORDANCE WITH SAID CODE. / Z C APPLICANT'S SIGNATURE �. r ,,+u i CASt"r 32-1 EAGLE STREET ANCHORAGE, ALASKA 99501 performied For i�; �ti Date crfcrf..ed' 1 Blo..n ,_;Lc4 pion- Lef,; po,cri?tion: Loe - - Percolat�cn esu This rcrm Reports a: So is Log ✓ _-- .----- Dcrth Location 'I;< r- z ch :'6et Soil Cnaracterastics vu S h { p DietSQo—�I 2 "'���,•/; silty 5�ti.y (',�rweF. 13�?u P Ily 11, G F•'ti 1 ;c -, O tij f CJS/ is LterCO.:.u�lOn 1<flTC i"/ InU _%G' - Drain Field ?r:%Yo:,ed Installation: Seepage Pit _ JC�it' If ;.let _ Depth To bottom. Of Pit Or Trencn L. Test perfor med bs;. ,l % :5_.f, :� <ic<c Data Certified by: r� Date: o 100 Was Ground Water Encountered? a .yes, %t. What Depth t Re4 Date Gross T ir.e j Net Time Deoth To H2O i \a = Drc? { LterCO.:.u�lOn 1<flTC i"/ InU _%G' - Drain Field ?r:%Yo:,ed Installation: Seepage Pit _ JC�it' If ;.let _ Depth To bottom. Of Pit Or Trencn L. Test perfor med bs;. ,l % :5_.f, :� <ic<c Data Certified by: r� Date: MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # n 14 - -A a 1 '9 HAA # a Q 2X01 IC LC La 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Mock 2• Hen.i.tage Hills Subdiyizion Location (address or directions) �Lntj Telephone: ds V�v t (b) Property ownerFneddie Mac (hme) -Business pp Mailing Address 0313792 1� 3b -S L7 4 u�Lc1a l] ,, Lfjf k 'A� (c) Lending Institution Mailing Address rvla & rr IL13 , C Telephone 141L, (d) Real Estate Company and Agent JACK WHITE COMPANY/Geonge McCoy Address 3201 C StAeet. Suite 100, Aneho&age Mask 99503 Telephone (e) Mail the HAA to the following address: (or check hereo if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE SS• Single-FamilyXX Number of bedrooms.3 3. WATER SUPPLY Individual Well IKK Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site BX 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. 72-025 (Rev. pies) Page 1 of 2 Z 1 Z a6ed MOBS fess[ 'nektl ezo-ZL -Niom s,aaaui6ue !euoissa;ad ayl ui suoissiwojosjajaaolajq!suodsaj lou si 96eaoyouy;oAl!!ed!o!unW agl,panssi si aleoi;!laaoeaao;aq elepazAleuejo suo!loadsui lonpuoo lou op SH HO;o sa9Aoidw3 *sluawa.i!nbei elels pue 1eaap91 u!elaao Alsiles of iepio ui suo!lnl!lsui 6u!pua! Jiay; pue sawoq ;o sieseyoand of Asalinoo a se SM saop SHHO ayl 'ENse!y ;o ale1S ay1 u! paaals!6aa aaau!6ua !euoisseloid luepuedepui ue Aq anoge 9 ydej6ejed u! uaA16 suo!leluesaidaa aql uodn A1uo paseq pa;eo!lliao Jenaddy Aliaoylny gl!eaH sanssi (SHH(I) S90IA19S uewnH pue ylIeaH;o;u9wl,eda0 a6eaoyouy;oAl!!ed!3iunW eql Nounvo jeuo!l!Puoo ale(] Z &IM •aa a46W Y P" .4fl Ienoiddy !euoil!puo0;o sw.ial pano.iddes!O Ipanoaddy Aq swooapeq aol panoiddy 1VA05lddV SHHO '9 aleO i 11566 8Xse1v `JaAR1016e3 I'M 'ON P8011doo-I MAIN 01583 bEOLt ssa�pPb auoydalal �1NIMaaui�Na 5 5 wJ!d;o aweN -uo!loadsui s!yl;o alep ayl uo loege ui suoilelnbei pue 'sooueu!pio 'sepoo alels pue !ed!olunw pe ql!m eoue!!dwoo ui si walsAs !esodsip aalemelsem jo/pue Alddns jalem al!s-uo ayl 'uo!loadsui pue uoile61ls9nui Aw wa; pue sad!; 96eaoyouy;o Al!jed!oiunw ayl wo.i; peu!elgo uoilewjo;ui ayl uo paseq legl A;uaA aayunl ! -uiejaq paleo!pui am;onuls;o adAl pue swoapeq;o jagwnu ayl jol alenbape pue !euo!loun; 'ales s! welsAs !esodsip aalemalsem jo/pue A!ddns jalem 91IS-uo ayl leyl Smoys Ianoiddy Alijoglny 411eaH si yl;o tloile611SGAW Aw ley! A;uaA ! 'molaq umoys alep uo!lep!!eA ayl;o se pue olaJay pax!;;e !eas Aw Aq paipliao sy NOIIVWUO:N1 ONV V1VO'H0dV3S 311: `S1S31'SNO1103dSN1 DNI41AOHd WUI:f JNRl33NION3 '9 *UNIC1PALH*t9lltAUtboxdy MUNICIPALITY OF ANCHORAGE (MOA) Approval (HAA) ArmRONMEMMEEdKL-9M+jWRUARY 1984 343-4744 FED 21 1989, Legal Description: 92 RECEIVED A. WELL DATA ` Well Classification[00- � If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y N _ Date Completed f 9`� Z Yield g✓� b+ 'i Total DepthZO W4- Cased toDepth of Grouting .r Static Water Level 2,o '7 . Pump Set At tr Casing Height Above Ground Sanitary Seal on Casing (Y/ ) Electrical Wiring in Conduit (Y/ ) Depression Around Wellhead (Y SEPARATION DISTANCES FROM WELL:. . To-SepticfF*hltorTank on Lot , r%'� ; On Adjoining Lots' f To Nearest Edge df. Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ` N To Nearest Sewer Service Line on Lot' 2S Water Sample Collected by is -i si 2 K f lu Ped" ( - ; Date ' -6r Water Sample Test Results iel r rtee -r Comments ;)` //J q C0fEb/�IJCC:, GcJ/-!-{ &40 14 02,�,0 .}'T T�.A"e F B. SEPTIC/,4—ON-06 TANK DATA Date Installed 2> 7Z -Size 00 No. of Compartments 2 Standpipe()N)—Air-tight Cap (Y N) Foundation Cleanou (Y N) V_ Depression over Tank (Y&) A-) Date Last Pumped 2 Pumpin11 1.g/Maintenance Contact on File (Y/N) /� ✓� ; for HoldingTank High -Water Alarm (Y/N)Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC TANK To Water -Supply Well % 9 To Building Foundation To Property Line 30 To Disposal Field3 To Water Main/Service Line r To Stream Pond' Lake or Major Drainage Course Comment. MI1102 ✓1 S�,ec&cOf 72-026 (Rev. 71881 From - Pa9e 1 gf,2. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ly nn // u Type of System Design��a9e f'J o t Date Installed 6'/Z7'/72 r Length of Field .� Width of Field �`7 Depth of Field 6 Gravel Bed Thickness V_ L�E 6 Gerd oeA Square Feet of Absortion Area �' / Statndpipes Present(Y/ )T Depression over Field (YCN)) 01 Date of Last Adequacy Test Results of Last Adequacy Test Yo4 Zt rF.+c za -�e 3 r32 f SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Zoo To Property Laine To Building Foundation 6 r Z To Existing or Abandoned System on Lot /J � 1)- ; On Adjoining Lots 50 r 4 - .To Water Main/Service Line. To Cutback (if present) To Stream, Pond, Lake, or Major r Drainage Course /O o ' To Driveway, Parking Area, or Vehicle Storage Area l �f Comments D. LIFT STATION Date Installed ` Dimensions Size in Gallons anhole/Access (Y/N) "Pump On" Level at ump bff" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "'Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA;and HAA guidelines in effect on iy�;dafe of this inspection. + Signed S&S ENGINEERING .•• �•d� !70�ki� Rlver Loop Read W 20.4 — ~ Alaska 99577 Company EaabRiver, 9r Date Z ,,.. ........ .. MOA No. C E �' 9' O 3 y . +f.b..i A. thak, - .iP: •. Nei 1e57.6 : <,o Receipt No. ©����/1 Receipt No.w Date of Payment Waiver Fee: $ Amount: $ -76e_Date of payment 72-026 (Rev. 7188) Back Page 2 of 2 \� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date JPO 2Z., 0986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1.y f 31 G foe t• 20 Her,* #c%!r SID Location (address or directions) S"/A// a 03/ .fit Ave (b) Applicant Name Cher, I X10 bead Telephone: Home Business Applicant Address Sy it 4e A" G An alporgze" h& '991'r4d (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ;Buyer ❑ ;Other ❑ (explain); (d) Lending Institution A10-4 dv.A P646zt GC10 tr Telephone 3 `t.9 ® SYOO Address to yo ®r mQ114y ga< h-ie%L® e 99s-"56 - (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: held pcc(T 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3. 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. 4. 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 (11184) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 the date of this inspection. Name of Firm F166�0coh,4cof see-accer Telephone 3 vs,— Address d S>¢ Ahc_Aofc2 Date �� /y �< 196- o OF AtZV l �(� pOes oeoo Ca 4Q�° ®o o*4 o°aHeso aso o e �eeeoaoaeoeo some eee� 4 �: THEODORE F. MOORE ; EY °°° CE - 35£39 '47 LT 6. DHEP APPROVAL Approved for bedrooms byl" Approved Disappro� Condition Terms of Conditional Approval CAUTION Date Engineer's Seal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/84) DEPT. OF HEALTH BNYIgONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ?. 1986 CHECKLIST - FEBRUARY 1984 264-4720 RECEIVED ) Legal Description: i.af 3, (3/% 2, /�e'^�lole fTI11x S/. Po WELL DATA Well Classification Prtaaf-e If A, B, C, D.E.C. Approved (Y/N) N.A. Well Log Present (Y/N) N Date Completed 1972 Yield ? 948 ovM Total Depth ? 209' Cased to 5 W Depth of Grouting N.R. Static Water Level 208, Pump Set At -> n Y Casing Height Above Ground �`'1 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) N aj(•To Septic/Holding Tank on Lot 79 r� • ; On Adjoining Lots ? tOO ` To Nearest Edge of Absorption Field on Lot _114' 1w S•On Adjoining Lots (00 ` To Nearest Public Sewer Line N•A• To Nearest Public Sewer Cleanout/Manhole H. 1l. To Nearest Sewer Service Line on Lot N• A. Water Sample Collected by '7'go: n ; Date / l6 406 Water Sample Test Results SmAd:&c4*P no co/tArm or o14er bac hria Comments S -O' aralion nt f -1-t.»e 0,04 ;441 11QA;*A . jqurnPed sAftat'tly @ S:& It" B. SEPTIC/HOLDING TANK DATA Date Installed 6/27/72 Sizet 0No. of Compartments Z Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 711? /&C' Pumping/Maintenance Contract on File (Y/N) IC A. ; for Holding Tank High -Water Alarm (Y/N) N -A • Temporary Holding Tank Permit (Y/N) N. f! Separation Distances from Septic/Holding Tank: To Water -Supply Well 79' 4'rym S. A. To Building Foundation 19 To Property Line 7 3G' To Disposal Field 53' bCAvee4 e• a. r To Water Main/Service Line u A To Stream, Pond, Lake, or Major Drainage Course > t vo Comments So' serarotiion �r��ci�l�s+cnt Gef ta+e o i.�t�a!la�co•t Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Un k Type of System Design S oa epc of Prf Date Installed t'� / 7 /7P- Length of Field 30' Width of Field Square Feet of Absorption Area Depth of Field Gravel Bed Thickness Standpipes Present(Y/N) Depression over Field (Y/N) ri Date of last Adequacy Test 71 18 19c, Results of Last Adequacy Test Mefttat e zwp 3 Jr ecerto*, f Separation Distance from Absorption Field: To Water -Supply Well 119` From SJ* -10( if0, To Property Line __>, lU To Building Foundation Jr� _ To Existing or Abandoned System on Lot ALA. ; On Adjoining Lots '.31 30 1 To Water Main/Service tine CA.A. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION P( -A, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for _ Electrical Codes (Y/N) Comments To Cutbank (if present) N• A. u Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .!j7df,. 711�-"`G Date 7/2 e X86- Company1�v.�A „S'ar-S MOA No. 9,9 - Receipt No. Date of Payment " ��'�� ��'� °�F• "�� ��.•' A4=®N D Engineer's SealAmount: $ yr a 0. I••.e.•.1••••;!� e•Y ••• Page 2 of 2 4 WAR THEODORE F. MOORE ; c� 4 CE • 35E39 'v ®`r ®'� • • 6J`@SSj0i1 �8� 72-026 rniaar �-.relwot Lot li DAVID A. SLENKAMP MECHANICAL ENGINEER 694-9055 Dowvb�r �%R# lW9 !0 vw--�r 's -, Vl* ROBERT A. SHAFER CIVIL ENGINEER 694-2979 2 Wl� ae7tnei an tllr.l s"'md vrol ow-ty* il'V ttli-A vvv nfz,rtn' m t' '11), A20 o,'xiallwu Nd o, n P nof Tlx� mptic totilt mt,-u-arjful nam v v'lc--rm to 41,%'wP v tr-'�-lxtu IT") i '-'o to - NA lbo o'j'-14ar 3vivol, -1 ri vn w, 0 recon 'Q gr' , . I �--lt r 0 "ra fiddal tfy t1la fvn't-in, 71no vetcvr JA'Wol At V.,or ond" ol� P4 3-,�rna, ;w,l 0110 V'n f'. e. a �.Y'mrn V--�A It (4-d fzlimt ViLa fvatg'an 1, to 19' lLml mm, ClU 1, , '. 1 .6, I jile,-Iti,�1 4 ty nt' Aj.-�.' r o A ,*�-urtvpnt vi� "or, va ("q"y .-arl-riton rvxoty SRB 196X EAGLE RIVER, ALASKA 5. LEGAL DESCRIPTION DATE 'A ECEI V ED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR? a INSPECTOR INSPECTOR MUNICIPALITY OF ANCHURAC41: MUNICIPALITY OF ANCHORAGE DEPT. OF H=ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIORNVIRONMENTAL P:OTECTION 825 L Street - Anchorage, Alaska 99501 • DEC 7 1979 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER tC 'C_ I UuL PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCA ON 1'( 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS 2r SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY E�--Three ❑ Six 7. WATER SUPPLY �INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM E� INDIVIDUAL/ON-SITE** f q_7 1�a— YEAR ON-SITE SYSTEM WAS INSTALLED. E] PUBLIC UTILITY i NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)lk� U�jl LZLW� A / � per,-re&Atc-n 72-010 (Rev. 0/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE P-' SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY Lim INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL -- DATE DRILLED LOG RECEIVED 3�. SEWAGE DISPOSAL SYSTEM E;, fNDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER Eb�eptic Tank or ❑ Holding Tank Size: 7O If Tank is homemade give dimensions: SOILS RATING TYPE OF.A K MANUFACTURER TOTAL ABSORPTION AREA L MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ELJ% APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED i DATE BY i c 72-010 (Rev. 0/79) �; apCHO{AGf APfq s� ��etn JanuACY •. GREATER ANCHORAGE AREA BOROUGH (o - Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274 Cf`oj 1mIT). ab (9 456 Date Received June 10, 1976 Time of Inspection 3: 0/p.m. , DS Date of Inspection 6_1Y76 REQUEST FOR APPROVAL OF P Vza t INDIVIDUAL SEWER & WATER FACILITIES FOR lo•, 3C� 1. Approval requested by: Mailing Address: Phone: 2. Property Owner: Mich,&el Singsaas Phone: Mailing Address: 3. Legal Description 3300 C Street Lot 3 Block 2 Heri Hills Subdivision 278-2525 4. Location: See map 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: Individual A. Type (n C\ C. Construction B. Depth D. Bacterial Analysis 7. Sewage Disposal System: on-site system A. Installed B. Installer C. Septic Tank: 1. Size ® c9 c) 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank 6-6 , Absorption area Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages i _✓.� \.� -_ v1Ui`llCh'1!.i,!T'r �?;r.i iCl'�:�iAC-?i= 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 CONY 2. Property Owner: �/����'�% � c'`y'z �� Mailing Address:<�� /� S //Cx' Day Phone: 3. Name Buyer: of Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: Phone: 5. Name of Realtor or Agent: Mailing Address: '// Phone: 1d' -?C:S 6. Legal Description:j/IL� Location: 7. Type of Facility to be Inspected: �� �No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served%r If Individual, depth of well J 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) Paqe 2 of two ,pages - Reqs_,.. for Approval -of individual S,,_._,& Water Facilities e Legal Description Comments Approved Lot S Block 2 Heri 7Z, Disapproved Hills Subdivision Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM tj I certify that the information contained in anis requesL aur- aNNruvai uu ua a u— -- accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date D I I w ,E H-7 ALASKA 1 PAIMME,NT OF HEALTH AND WELF 3 �DIVISLON OF PUBLIC HEALTH"' APPLICATION FOR APPROVAL OF PLANS Alaska Department of Health and Welfare Branch of Environmental Health Pouch H Juneau, Alaska 99801 City Zip Code /5e X ------ -- --- -------------------- -- -- Mailing Address _✓.�'_�..... 5�-X72--- -Application Date 3¢ z . z.-� Business Telephone No. Il/s L(/�t f 2 / ��S fc " .. ...... ------------------------ . ---- --- ---- .... _... -•-- .--------------------------------- (Name .. _.:._ ----- (Name of project for which .approval of plans Is request d) In accordance with Alaska Statutes, Title 18, "Health and Safety', Chapter 05, Sec. 13_.05.040, (11), (12), and rules and reg- ulations prqpulgat,ed /thereunder, we, (Name of Applicant) - - herewith submit for your review and approval, with respect to SANITARY FEATURES, duplicate sets of complete plans for the proposed project described below. "Complete plans' shall be taken to mean General plans, Detailed plans and speci- fications, and a Project Report (Engineering or Architectural Report) including necessary data required for full understand- ing of SANITARY FEATURES of design. (Give complete but brief description of project) /��_�_/�_...--� ------ -/'fey-�--_%�- -- l i/--------------------------- ri�- >lv�s � �!----------------------- These plans were prepared b ��_T-�C_�`?__ _ _�_'?_ �E_rs _ tet« �_ _ / S'SdG(4�fG'S p y - C} - -- - -- - - (Ndnie of Design ng Engineer, Architect or Firm) �c %_ Q%?..-___[' ��e�.__'__[__r�L/1'.. __:--and by or under the direction of the following Engineer(s) or - -- _ (Address) - - Architect(s) duly licensed to practice in Alaska: % . GU /sow 73ZL (NAM/.,) / �'(TYPE OF LICENSE - (Civil, titechanical, etc.)- Certificate of P.e315irztiop No. ------------------------�J1 i- { ......----------- ------------------- ---------------- IE -------- This project is to be financed in the following manner: Sourees of funds_ ......------ vw� (List sources of funds and amounts). Alnountse .................. $----- a-------------------------- .................... ....... ............. .................................................... .--------------------------------------------------- ------. Total estimated cost of this project is - - - Th�{ess [fins are being submitted to you at Least one month prior to the contemplated date of advertising for bids ----- --- s r.1 '.'...._.-- - ---- - --- - - - - - - - -- - - - ( ate bids will be culled) We understand that construction shall not be started until your final approval of these plans has been received; that no revisions in the plans -affecting the SANITARY FEATURES of the project may be made subsequent to receipt of your final approval unless such revisions be- submitted and approved; that construction will be carried out is accordance with the approved plans; and that unless construction on this project is started within a two-year period subsequent to your approval, such approval will become void. Very truly yourrs, (Applicant)/ l !�� I& i/�� --s = - -------------------- - - - -,f__.-----cor- at on fl m, dlv!dual et /,�� . ` { U.CC2/....-'.yi -------------- (Signed) (Official Title)-y�C ✓.r.%'SrLQ7- --... .... -