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HomeMy WebLinkAboutLATTA LT 6 Municipality of Anchorage Page 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 ~nspection Report Permit Number: -~'bJ ct~ Oo '2.°~ PID Number: _ OJ'~ '" /~ - ~ N~e: ~],~ ~,~ ~ ~c ~¢~,e~ Wastewater System: D New Address: ~ ~ ~e~. ~, ~o ~..~ ~4~ ABSORPTION FIELD Phone: / ; I No, of B~drooms: ~--18~ ~ .~ ~ ep O Shallow Trench aBed DMound ~Other Total Depth ~r~m original gmd~: LEGAL DESCRIPTION ~o~,,,~,~: O. ~ ~D~sq.,,. ~.~3- [~. ~ot: ~ Block: Subdiv~iom Deplh to pipe bo om fro~ original grade: Gravel depth beneath pipe Township: ~ Range: _ Section: ~ Fill added above~l original~ ~,~lgrade:~. Ft. Gravel length: ~ I Ft. WELL: e~s~ New ~ Upgrade Gravelwidlh: ~l Number of lines: Distance~nlin~: Ft. ~ - ~ Ft. Classification (Private, A,B,C): ~ 'Cased To: Total absorotion area: Pipe material: Driller: ~ Date Drilled: SlalicWatorLevel:Ft. [nstaller:~o0~ ~ ~0~ ~C. Datel~t~d~ ~ Pump ~t at: I Cas,ng Height Above Ground: ~.~ ~,. ~,. TANK SEPARATION DISTANCES ~ ~ ~o~ ~ To Saptic Absorption Lift Holding ~ublic/Privat( Manufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~ ~O~A~ ~ 10 0 Material: Number of Compa~ments: Surface Water ~ {~+ ~ ~ ~ LIFT STATIO Lot Z~ si~ i~ g~,o~: ~u~tu~r:~~ Foundation /0 1 ~ ~ 0 ~ ~ ~ ~ "Pump on" le~"Pump off" level at: High water alarm at: Cu~ainDrain " '~Od;~ ~No, J~ ~ P~ake & ~e,~ . II~ctrioa' 'nspecti°ns peal°treed by: Remarks: ~&~ ~?~ ~ BENCH MARK Loc~tion and Description:  Assumed Elevation: ENGINe'S SEAL/ Inspectionspedormed by: ~.~,U.C. ~ I~c. Dates:lst ~/~fl, , _ F~"'"P~''''' '' ~', ~="'~ Depadment of Health and Human Se~ices approval Review. approve by: ' D.te: 72-~13 (Rev. 9191) MOA 25 PER,., N.,,.E.: AS BUILT DRAWING ,^RCE' SW990029 = O15-142-51 · , / \ / \ I \/ E. 112TH AVENUE  A B C ZDeL1 ,, ~0.1__~8.2 - ~z~'~ '~II ~ ~ DBL2 10.9 ~7.9 - DSk3 2~.0 16.4 - ~/ ,, ~ FD I 24.2 13.3 ~o5 /~ ' ~ ~ ~ ~0~_ - '11.5 42.8 d~~ /X ',, ~ ~~ Mil - 25.3 ~0.1 ! ' ~ / ,/ ~ .......... - ~ISTING ~ENCH TO BE / / SEPT[O TANK USED AS A RESERVE S~Er~ / t 6901 DEBARR RO~ SUi~ 28. ANCHO~GE, AK 99504 PHONE: (flOT)337-6179/F~: (fl07) 338-3246 ~TTA SUBDIVISION, LOT 6, ....... 'I:1 ~FV ~'"WT"'~ 1YPE OF WOR~: ' ' AS-BUILT OF SEPTIC SYSTE. UPGRADE TI~ OO~ER 346-1860/261-7669 , J.L.M. 1 = 40' 2 OF 2 A B C BL1 10.1__ 18.2 - BL2 10.9 I7.9 - TI~ 12,1 17.3 - y2~ 18.3 16.3 - BL3 21.0 16.4- - BL4 23~7 13.B - D 24.2 13.3 - 0 24.8 14,1 - ~1~_ - '11.5 4.2.8 IT1 - 25.3 30.1 02 - 51.5 28,0 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box ¢96650, Anchorage, AK 995¢9-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 09, 1999 Expiration Date: Mar 08, 2000 Permit Number: SW990029 Legal Description: LATTA LT 6 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Tim Comer for Murtie Schrecengost Owner Address: Dynamic Prop, 3111 C St. Suite 100 Anchorage, AK 99516- Parcel ID: 015-142-51 Site Address: 011200 LATTA CIR Lot Size: 16414 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: E~ Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 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. Received By: Issued By: Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B ~ Auchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consultiug Engineers February 12, 1999 Municipality of Anchorage Department of Health & Hmnan Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Lot 6, Latta Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and a private septic system. The septic system is in a state of failure and must be upgrade prior to the sale of the house. Comments regarding the proposed design are summarized as follows: 1. SOILS: A test hole was excavated and two percolation tests were performed. The soils below the organics is a GM/SM material to a depth of 5 feet and than transitions to SM to SM/ML material to a depth of 18 feet (bottom of test hole). One percolation test was performed between the depth of 2.5 feet to 3.0 feet and the other percolation test was performed between the depth of 5.5 feet to 6.0 feet. The percolation rates were found to be 1.67 and 1.33 minutes/inch. Due to the high percentage of sand/silt, the insitu soils should act as a sand filter. A grab sample can be provided if deemed necessary. No groundwater was encountered at the time of excavation and after seven day the monitoring tube was found to be dry. It is our opinion by a visual rating that a 0.8 gpd/sq.ft, should be used. 2. TRENCH (PRESSURIZED)- DESIGN: a. Percolation Rates: 1.67 & 1.33 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons pet' day e. Minimum Absorption Area: 563 ft2 f. Maximum Total Depth: 11 feet (maximum) g. Effective Depth: 7 feet (clean, washed sewer draim'ock) h. Width: 2.5 feet i. Reduction Factor = N/A j. Minimum Length: 45 feet k. Effective absorption area = 630 ft2 (563 ft2 OK) 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seenonthe attached onthe design, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely, arness, P.E.,M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log and a 4page construction specification letter which are all part of the design package for the upgrade of this septic system. i ! SW 1/4, SE 1/4, NW 1/4, NE 1/% LOT 28, NE 1/4, SECTION 22, T12N, i I SECTION 22, T12N, R3W ] '~ PRIV/~rE WELL & S~C ~ ~ FIELD V~I~ED OF ~ ~ ~ NO ENCROACHMENTS ............. J L. _ ,. ~i~ ..~:~:~::~2~-~l~.;:~; :~ ..z:7~x- ............. i~' X~ iI E. 1 12[h DRIVE ~] / · ~ ~ Lum ,, ~t .... /u ~ / ~ - ~ 0 / flELB VERFED OF X ~ ' '" ~ ~ ~ ~ / NO ENCROACHMENTS P ~ S S D ~ PROPOSED SEPT C .... ......... o~ ~ ;' ~ ' i / EXISTNG : ......... ~ - ~ 5 ..... ~~~--- ~~~ _ ~ ¢ . / - _ ~.~ ................... ~ / K / N / ~.~~ ..... ~ EOT 1, DAVID RIN~ LOT 2, DA~ ~INO SUI~ 2B, ANCHO~GE, ~. 9950~ PHONE: (907) 337-817g/FAX: (907) 33B-3240 ~PE OP WORK: ~ SITE P~N d~ PREPARED FOR: PHONE NUMBER: VOt~/". ~[--7953 ." 546-1860/261-7669 IJ~,~ L '. TIM COMER '~ [e~" ........... ' 'AT[:2/12/98 I A.C.G./J.L.M. 1 : 100' 1 OF 2 NOTES: 1: THE CONTRACTOR SHALL HAVE THE WELL RADII FOR THE iREFERENCED PROPERTY AND THE NE GHBORING PROPERTY TO 'I'HE WEST; AND ALSO, THE WEST PROPERTY LINE FLAGGED 3Y A REGISTERED lAND SURVEYOR PRIOR TO CONSTRUCTION. 2. THE EXISTING SEPTIC TANK IS UNDERNEATH A PORTION OF 3ECK CLOSE TO A HOT TUB. THE CONTRACTOR SHALL ARRANGE NITH THE HOMEOWNER OF ANY CONSTRUCTION WORK THAT WILl_ E~E NECESSARY ON THE DECK/ttOT TUb. ~Y 2 FEE~ WIDE BY 45 ~ LONG. , ~% ~ ADD 7 EXI~ING ~ENCH TO BE , AREA I DESIGN OF SEPTIC SYSTEM UPGRADE PREPARED FOR: HO " ~AT~ DRAWN BY: SCALE: ALASKA WATER. 8,: WASTEW.A. ~T~,~ CONSULTANTS, INC. 7320 E. CHESTER HTS. CIRC!~E ANCHORAGE, Al(, 99,504 - PHONE (997) 337-6179 * FAX (907) 338-3246 I SOIL LOG - PERCOLATION TEST I LEGAL DESCRIPTION: LA1-FA $___~UBDIVlSION; LOT §,_ ..... PERFORMED FOR: TIM COMER ...... DATE PERFORMED: 2/5/99 TEST HOLE ORGANICS GM/SM PRIMARILY SM SH TO SM/ML SOIL CLASSIFICATIONS ~GW ~ ORG GP ML GM CL GC OL SW MH SP CH SM OH SC DEPTH TO DATE 3ROUNDWATER DRY 2/5/99 DRY 2/t 2/99 DATE READING \V/ El, 112th DRIVE PROPOSED UPGRADE ~SEoEF PAGE 2) 2/5/99 UPPER BENCH CLOCK TIME NET TIME WATER LEVEL (MINUTES) READING BOTH PERC BENCHES WERE PRESOAKED FOR 4 HOURS. 6" 5 MIN. 6" NET DROP (INCHES) MIN. 3" 5" 6" MIN. 5" 3" COMMENTS: B.O.H. 2/5/99 1 LOWER 2 BENCH 3 PERCOLATION RATES 1.67/1.3,3 TEST RUN BETWEEN 2. THE HIGH PERCENTAGE OF SAND IN 5 MIN. 2-1/¢" 3-3/4" 5 MIN, 2-1/4" PERFOMED BY ALASKA WATER & WASTEWATER t, THIS WAS PERFORM)~D/4N ACCORDANCE WITH ALL DATE. DATE: Z.,// 5 MIN, 2-1/4" PERC. HOLE DIA, 6" TO 6.0 FT, &CT AS A SAND FILTER. 3-3/4" (INCHES) , CERTIFY THAT 4ES IN EFFECT ON THIS GREA ER ANCHORAGE AREA BOR ,,JGI"I Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTIO,,N REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM LOCATION /~[ ~ ~ LE GAL DESCRIPTION __~3~; ¢~1 ~¢ SEPTIC TANK: DISTANCE FROM WELL ? ,-,~./~/") MANUFACTURER INSIDE LENGTH_c?¢~' _ INSIDE WIDTH SEEPAGE ~ /¢I_A-d~L,4~ AZ NUMBER OF PFT-S / DIAMETER __ LINING MATERIAL '"~-~'~-'~'~ CRIB SIZE: BUILDING FOUNDATION__ NUMBER OF MATERIAL COMPARTMENTS LIQUID DEPTH __LIQUID CAPACITY / f~'~-(¢ GALLONS. OR WIDTH'~ LENGTH ¢6/ DEPTH ~ DIAMETER___DEPTH (~ DISTANCE FROM: NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~,~ SQ. FT. ADDITIONAL ABSORPTION WELL: BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE. OTHER SOURCES. DISAPPROVED NEAREST SEWER LINE__ REMARKS. DEP-rH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES; INSTALLED PIPE MATERIAl · LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM DATE. G? ,A,B. 1..O"1' :!i;]iZ. EZ :t..6;,'!:;i..,:! 5!;(:!L.IF::lt:;?.lii!; i""rT:'l!: OF '!!:;(:l ]i I... F::llii',5!;Oi';i:Erl' ]i O1",1 5"r'5'1'l~iXI :11 :!il;: i"IF::I;:.:',;!;I"'II..I!"I i",ILII'IE!:EI:;':'. 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I:;i:1 i I':'"r' T1'11:::t'i- I:::1i"1 I:::i:::11"'1];I....iiit:::11:;i: I,.I]i'1'1'1 THE i!!l'.r' -iI'"IE] I"llJi',l i[ l:: ]; l:'i::ll... ]i T"r' OF: F:II",!.(:;HI:II:;~F::II:'iEi. 1,.I i!i I..I 1!i t",I?i;TF:II_.I.... 'l"l"ll~i] :i;"r".ii'tTi]l"i Ut",II::'t{iI:;i'.5:TI:::II",II::' 'Ft"IF:IT '1"111:; (:II",l'-'!:;ill I'I': 5i;EI4fi{1";i L""i;"r'5:fT:'.l"l t"ll:::l"r' t;i'.I:(;!I.I]iI:;?.Ei Ii:NI....I::II:~'.(:iI~I"I!i:i",IT I1:::' 'Il'If] f)lii:l",l(:::l:!i :1:5 I:;i:l:!!;M(::ll)Ei:l..l:l) 'T(3:1: I'.,ICL..I...II::;,f!!: GREATER ANCIIO[d~GL AP, LA [;OROU(~,, i)epartment of I.:nvironl,enLa'l (/ualiLy 3330 "C" St. reet Anchorage, Alaska 99503 SOILS I,()G I~EI{OI,ATION TE~T Legal Description: Depth Feet 2 3 ,0 - 1'1 - 12 - 13 - 14 .- Was ground water encountered? I'f yes, at what depth? ................-T'- i7 ........... -|'-";/;~-:F'?-~?~'- ......... ] ...... ~/~- -J "'~ ~_ ].i~ / ~" .... :-:::::::~ .... ;~ ...... ~::;:?~.~ ........... ::.[:: ..... ,~::-::.::::.:~_.~:~_~,_-.:::-::_~:.:::.~:-_-::--:-~: ............. ['-- ;; ..... ~ -);- T~T~5 ............ [ ....... ~ J J/ " J. P~ol~ti6n rate ~' ~ minute. Proposed 'installa~16~-:'-~6~-ge Pit ~'~o~ Drain Field .............................. l)eI)~tl of Inle~ Depth to bottom oF pit or ~renci, COMMENTS: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTR AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01 5-1 42.-51 HAA# GENERAL INFORMATION Complete legal description Latta Subdivision; Lot 6 Location (site address or directions) 11200 Latta Circle Anchorage, AK Property owner Tim Comer Mailing address 11200 Latta. Circle Day phone 261-7669 Anchorage, AK Lending agency Mailin. g address Day phone Agent Tim Comer/ Dynamic Properties Address Dayphone 261-7669 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site · ' Holding tank .......... Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA~Y21 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 ALASKA WATER & WASTEWATER .~ ~ _~ / ~,~(, CON~i. iLTAN ~'-~ ~ ~ ,'v'r J, Phone Address 6901 DEBARR ROAD, $1,JlTE ANCHORAGE, AI.A~KA Engineer's signature Alaska Water & Wastewater Consultan~t§, Shall be PAID ~ ~or to, closing for the Engineering Se~ices Pr~ 6. DHHS SIGNATURE X Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority Approval Certificates.based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~ RECEIV u Municipality of Anchorage MAR 26 ]999 DEPARTMENT OF HEALTH & HUMAN SER'~[J~/¢iTY OF,~NCHo~e~ Environmental Services Division ENy~N~L$~i ES DIVI$j 825 L Street, Room 502 · Anchorage, Alaska 99501 · (uuo o~-~r~ Legal Description: A. WELL DATA Health Authority Approval Checklist --~u~p~,~.~o~ ~ LoT ~ Parcel I.D.: Well type ~.tq&~'~'~ If A, B, or C, attach ADEC letter. ADEC water system number /,J/A- Log p resent (~)/,1~.) Total depth / O/~ '1 Sanitary seal ~) Date completed Cased to ~O~ + Date of test Static water level Well production ~ --' I 0 WATER s'AM~LE RESULTS: Casing height (above ground) Wires properly Protected ~) AT INSPECTION FROM WELL LOG glp.m. ~. ~ g.p.m. Coliform Date ~f'sa~nple: B. SEPTIC/H0'I. DING TANK DATA Date installed '/ Tank size Foundation cleanout (~)'N) Nitrate * ~ 7~ /~1~/~. Other bacteria ~ Collected by: A ,ual. ~, ~i ~ Id~' . Ioo o Number of CompaJ'tments ~- cleanouts~[~)'N) '/e,~ , Depression (Y~) f%/o High water alarm (Y~:) NJ o Date of Pumping, i~(,,,) Pumper - C. ABSORPTION FIELD DATA Date installed ~/'~/q I Soil rating ~ or ft2/bdrm) ~.~ Length ~,.G Width 'Z Effective absorption area ~.~o ¢ Date of adequacy test System type ""~/~.e,~c Gravel thickness below pipe '7 Total depth Monitoring Tube present(~/~ ¥~_..c Depression over field ¢lr~) Results (Pass/Fail) For .~ bedrooms Fluid depth in absorption field before test (in.); .._.--.-, Fluid depth (ins) Minutes later: Immediately after ~. gal. water added (in.): Absorption rate = -"-" g.p.d. Peroxide treatment (past 12 rnonths) (Y/N) If yes, give date ~ - 72-026 (Rev. 3/9§)* D. LIFT STATION Date installed Manhole/Access (Y/N) ~ High water alarm level~ *Datum CyctO'C~s tested Size in gallons "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot J ~ O m~ Absorption field on lot I o~ ' ~ On adjacent lots On adjacent lots Public sewer main / Sewer/septic service li~e ~:-~ I'P Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation I o 14'Property line '~- ~- 14-- Absorption field Water main/service line lo m+ Public sewer manhole/cleanout Ioo1¢ Surface water/drainage J Oo[~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I O I Building foundation ~Ot Water main/service line Surface water J oo I ~ Driveway, parking/vehicle storage area Curtain drain ~ o~ ~ ~ Wells on adjacent lots J /I ENGINEER'S CERTIFICATION ¢ I . --~ OF Ice~/fythatl h~d~rmi~;ru~i~dinspectionsandreviewofMunicipalreco~4~~ in conformance w/~h/~b~ gui~lines /~ effect on this date. /~ / Il~ILl Signature ~/v~ ~J ~ ~.~.;~.(.~...~ Engineerr''s Na~ ~v ~j~~ ~, ~~ HAA Fee $ ~/.7~ , ~-7_.~ Date of Payment ~ ./~-~ Receipt Number /_//-'~Z~ ~'~/'¢~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ~AR~g6-g~ 14~41 ~RO~/-CTE ENVIRONi/ENTAL zt~m~ OT&B E,,vh'~nmental Serv,ce$ Inc.. 661~301 T405 P.O1/02 F-187 Client J'Ot? Printed Date/Time 03/25/99 ~4:26 Colleetod Da'go/Timo 03/22/99 [6;00 R~eiv~ D~etTlme 03,'23/9~ 10:40 T~chni~i Dirtier: Stephen C, Ede / Prep AnalySiS Nirr~-~ 0.~?~ O,§O0 n~/L RPA ]00,0 10 ,~ 03/~3/99 031~3/99 SCL :~ DATE RECEIVED INSPECTION APPOINTMENTS ~ ~ ~,, " - DATE DATE DATE /L DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 SEP ~ 0 1980 ENVl RONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIBECTIONS: Complete ail parts on page 1, Incomplete requests will no~ be processed, Please allow ten (10) days for processing. 1, .~OPERTYOWNER MA) LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE 4. REALTOR/AGENT~~ ' J PHONE MAILING ADDRESS §, LEGAL DESCRIPTION £o~- & ~ /_ ~r~ STREET LOCATION c; 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ~,,~ Three [] Six [] Other 7. WAT RF~UPPLY ,~ 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 ~1~ IN DIVI DUAL/ON-SITE** [] PUBLIC UTILITY '~YEAR ON-SITE SYSTEM WAS INSTALLED. ~ q'g~). NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 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 []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank~or [] Holding Tank ~-¢~-w,~;~,~ ~ ..~_~.. Size: IC'~-~ ~:~ 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 E~]'~-APPR OV ED FOR ..."~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED / 72-010 (Rev, 6/79) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received March 7, 1977 Time of Inspection ~:0t p.m. \/ Date of Inspection 3-8y7 Tuesday /\ REQUEST FOR APPROVAL OF Bugh~lz INDIVIDUAL SEWER & WATER FACILITIES / ~ FOR Cony. 1. Approval requested by: Alaska Bank of the North Mailing Address: P~ouch 7-010 99510 2. Property Owner: H. Wilson/G. Mellott Mailing Address: Star Route A Box 60 99507 % Mike Crum Phone: 277-5511 Phone: 344-0817 344-7960 3. Legal Description: Lot 6 Latta Subdivision 4. Location: ll2th Avenue~ see map 5. Type of facility to be inspected Sinqle Family 6. Well Data: No. of bedrOoms 3 A. Type Individual B. Depth C. Construction ~,~//~ D. Bacterial Analysis £, Sewage Disposal System: On-site system, Permit ~76555 A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: Total length of lines /'/~ Distances: A. Well to: Septic tank /00; , Absorption area Nearest lot line /OJ-~ , Other contamination B. Foundation to septic tank ~C/L , Absorption area _ ~O/-~ C. Absorption area to nearest lot line __ 106' 1976 B. Installer. 1. Size /OOO 2. Manufacturer 1. Absorption Area vS-~ 2. Material Sewer Lines , EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re )st for Approval of Individual ler & Water Facilities Legal Description Lot 6 Latta Subdivision Comments Approved ~ Disapproved Date Apl ~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) '~MIJNI¢IP^LITY OF /',N~.q IORAOi! MUNICIPALITY OF ANCHORAGE DEP¥. ©F li:.xl.i';I & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTE(~]]II~I'~NMEN'rAI. ~op. iCTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 I'./IAR r.,,, ... 'l!')f7 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES .~[!C~EI \/~ ~: 1. Type of Inspection: CMRQ VA FHA 2. Property Owner:_ Mailing Address: ~/~/q Go A~-~/ /~/'~/ Day Phone: 3. Name of Buyer: CONV ~'~' Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: ~ ~ ~1 5.Name of Realtor or Agent: Mailing Address: Phone: 6. Legal Description: L- ~- ~ ~ /~-/~ -~'/~ , Location: /'/'Z-- /-~1 /'IT' ~'~ 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: No. Bdrms. Public Utility .Individual 72-003(3/76) If Individual, number of dwellings presently served If Individual, depth of well /~ ~; ~ Sewage Disposal System Type of System: Public Utility If Individual, date of installation ~'"~,,~ Individual (on-site) ~'~