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Home My WebLink AboutLAKE O THE HILLS BLK 3 LT 5 oGRE,~ .......iR ANCHORAGE AREA BOr,_~,JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL ! / -:7 INSIDE LENGTH MANUFACTURER f'~ ~'~ ~/~ MATERIAL COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY / 7~O GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER __ 4 ~ .:/~1 LINING MATERIAL CRIB SIZE: DIAMETER BUILDING FOUNDATION__ NEAREST LOT LINE Z~)f"~ ADDITIONAL ABSORPTION .~('/ /[~-/~/~}14 OR WIDTH LENGTH DEPTH I/ q, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. WELL: TYPE //; ~ fC CONSTRUCTION. BUILDING NEAREST FOUNDATION- LOT LINE DEPTH /g,.'v DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM . CESSPOOL APPROVED OTHER SOURCES DISAPPROVED DISTANCES: , NSTALLED By: F~' ~------~ ~L)/V~/v/ LOT 5LOPE: REMARKS: Form No, FO-031 DIAGRAM OF SYSTEM NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION GreaTEr ANChOrAgE Area Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL sYSTEM -- APPLICATION AND PERMIT PERMIT NO.. PHONE TO BE INSTA ED B F'NANCEDTHROUGH/Z SOil TEST RESULTS . ;~ NOTEs THIS PERMIT IS NOT V~LID OTHER WITHOUT 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. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ., SEEPAGE PIT TO NEAREST LOT LINE. DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD DRAIN FIELD ., DRAIN FIELD SEEPAGE P'T J~L~ ALSO CONSIDER AREA WELLS. SEEPAGE PiT 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 SACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREAT~ ANCHO ARE ROUGH ORDIN E NO. 28-68 AND THAT THE ABOVE DAT~ ~ {/--7~ APPLICANT'SSIGNATURE ~. ~/~v ' ' ' :~ De< ~nent of Environmental Quality~ '~ ...... ' ~ 3320 "C" Street Anchorage, Alaska 99503 Performed for ~rr..>_~ Legal Description: ~ ~Jd- ~r ~>~'~7 Z~ 'This form reports: Soils log Depth Feet 4- 5- 6- 7- 8- 9- lO- ll- 12- 13- Date peKformed 771{ Percolatio~ test I 14 - Was ground water encountered? ~ If yes, at what depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation r(~te m~nute, . Proposed installation: Seepage Pit .... ]' Drain Field' Depth of Inlet Depth to bottom of pit or trench COMMENTS: Performed By: ,/~ ~.,~,~..~ ~.~/-~ Certified By: Date: Redi~rm® 4S 472 DETA(~H'AND FILE FOR FOLLOW-UP M-W DRILLING INC. P.O. BOX 110378 UNIT ANCHORAGE, ALASKA 99511 QTY. MATERIALS PRICE AMOUNT PHONE 349-8535 NAME CITY LEGAL DESCRIPTION LEGAL OWNERS BANK HOME PHONE WORK PHONE TOTAL MATERIALS WELL ~UMBER DIAMETER DEPTH STATIC LEVEL GPM DRAWDOWN PUMP MAKE HP SETTING VOLTS PHASE AMP RATE SERIAL NUMBER MODEL SCREEN LENGTH SLOT SIZE LI~eR/SCREE~ DESCRIPTION Of WORK WORKMAN DATE IN OUT I HOURS· I RATE LABOR Ail charges shall be paid in £u// within ten days un/ess other arrangements are made pdor to drilling. The customer shall pay in- /~ MATERIALS {FROM ABOVE) terest at the rate of 1 ~ % per month on any OTHER CHARGES amount not paid within ten days. Failure to pay may result in a lien against the properS. PAY THIS AMOUNT ~ ( ~ ~ · '.' ~ - MUNiC PALITY_=OF ANCHORAGE:, ' ': (~/' 'DEPARTMENT OF HEALTH &-HUMAN sEF~I'CE$ :.; . ..~ , :. r, ?DivisiOn,of,Envir(~.nmental s~'rvic~S ." ' ~)~ ,.v .; - - ~" ~',: ~, ;" on;Site Sd~iceS Section. :.-.: P.O. Box196650 Anchorage~ Alaska '~g9519-6650 '~E~'~i:~'l CX+~ 0 F' H ~LTH AUTHORi ~;" --~,,. ' APPROVAL FOR A'SINGLE FAMILY DWELLING · :Parce I.O.~-~ ~"~('n'' ; ' HA'A~ 1, GENERAL INFORMATION ~ :~ ~ ,.~°'mplete lega description.: ~ ~/~r ~' O~ . Locati, address or directions) //~O ~.~1~ '~ r, Day phone Day phone :': ' Address oth~e requested, ~rW!l/.be held for pickup,. :;-f;'3.. TYPE OF WATER suPP~Y: . ' '- ; : -:- . .. · ... , , ·., .' : - : ~ . . -, .. Ind~wdual well . -~-' -.' ' "-77::~ ;':' ":~ ~ NOTE: If community well system, provide walden confirmation from State'AD~Cattest- . TYPE OF WASTEWATER DISPOSAL: 'Individual on-site ~ '"- Holding tank ' '~:-; ' ':'" Community_'0n~site ' ' ~,~::~ Public seWer '" ~' -~- NOTE: If cammunity Wastewater system, provide wfi~en confirmation from atte~tlbg fo the legality and status ofbyStem, 72-025 (Rev. 1/§1) Front MOA#21 '6; 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 verifythat 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 dis ;~osal system is in compliance with all Munici pal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~o~rcc~S ~/7~ Phone DHHS SIGNATURE · "~'---- Approved for Disapproved. Conditional approval for -.:Additional ,Comments, / bedrooms. Date ' bedrooms, with the fOllowing stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not Conduct inspections or analYZe, data before a'certifiCate ,is issued. The MUnicipality of Anchorageis not : responsible for errors or omissions in the p.rofessional engineer's work. 72-025 iRev1/91) Back MOA~I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /--~';~ ~)~:. ~, /--m~. 0) '7-/-/Z"///zZ-~' Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal If A, B, or C. attach ADEC letter. ADEC water system number Date completed /,~ ~°~' Driller Cased to Uh~,~o~,', Casing height /. Wires properly protected (Y/N) "/" FROM WELL LOG AT INSPECTION Well flow. ~' ~ ~' ~ 5 p.m. SEPARATION DISTANCES FROM WELL TO: / ; On adjacent lots /~ Septic/holding tank on lot //~ ~ Absorption field on lot / ~ ~ .... ; On adjacent lots Public sewer main Sewer service line Public sewer manhole/cleanout - Petroleum tank WATER SAMPLE RESULTS: Coliform (~ ~ Nitrate ~)'/(~ ~,P//'~ ~ Other bacteria Date of sample: z.///~//~] ~/ __ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed . ~//'Z////~ Cleanouts (Y/N) Y Highwater alarm (Y/N) -- Date of pUmping ~z/7/el ~ ~ Tank size /~5~ ~'~q/' Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) Alarm tested (Y/N) Pumper ~O"T'O - ~00 T-~,~ SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: Well(s) on lot //~ / On adjacent lots ,/~ + / To property line ~0-~ / Foundation /-/? ' Water main/service line - Sudace water/drainage Absorption field 72-026 (3/93)' Front CONTINUE D ON BACK PAGE C. LIFT STATION Date installed ,/'~/~ Size in gallons -- Vent (Y/N) f "Pump on" level at Highwater alarm level -- Meets MOA electrical codes (Y/N) -- Manufacturer --' Manhole/Access (Y/N) "Pump off" Level at ,Cycles tested -- SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~' On adjacent lots -- Surface water D. ABSORPTION FIELD DATA Date installed / Length Total absorption area Date of adequacy test Soil rating (GPD/FF) /~-¢ Width [ ~z / Gravel thickness Cleanout present (Y/N) Water level in absorption field before test System type c ¢--I [~ Total depth Depression over field (Y/N) Peroxide treatment (past 12 months) (Y/N) Results (pass/fail) ~r $_S for /-7/ Bedrooms /V If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ¢ ~' ¢ On adjacent lots /OO ,k/ Property line To building foundation --¢z~"¢- / To existing or abandoned system on lot On adjacent lots ,~O'¢- / Cutbank ~ Water main/service line Sudace water ,/L-~'¢' / ~0 / Driveway, parking/vehicle storage area Curtain drain -- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name ~-~-'~'/~. Date /-,/ CE - 1~93 HAA Fee $ Date of Payment Receipt Number 72-026 (3~93)' Back Waiver Fee $ Date of Payment Receipt Number CT&E Ref.# Clieilt .~ample ID Matrix Cl|eatlqam~ Ordered By Proj~t Name Commercial Tesiing & Engineering Co. Environmental Laboratory Serviee~ LABORATORY ANALYSIS REPORT WATP-R H)I.AP, CONSULT DAVID AUSMAN UA wORK Ordc~ 77247 pli...lted Date 0A/I 1/94 (~ 14:11 hrs. Cotlea~il~tv 04106194 ('.at hrs. lleceivedDatc 04/05/94 [~ 15:30 'l'echlHca! Dtrcvtor 8'J'~i'I-IL~ C, EDI~ Sample Nilr~t~-N RoIYrINE ~MpLt~ COLleCT]ED BY: UA. .QC Allowabl~ EXt, Anal Rc~alt~ /.t~1 Unii~ Method Limits Date Date Init 0.]0 IT m//L FiPA 353,2/300.0 10 04/01Y94 CMI~ '=-=~ "~" -- -~=~--- "'-=:-~ UA= Uaavailabl= * i, ee ~p ecial Insttl=ti on s Abov ¢ }IA =14ot Analyzed ** 8~ 8~plc ~sAbovc ~ D= ~°n~~i°n' ~= ~ 5633 B Street, An;horage, AK 99618-1600 --Yet: {~7) 662-2343 Fax: {g071 56a-5301 ENVIRONMENTAL FACIUTIE~ IN A~S~, cOLOmBO, F[ORIDA. ILLINOIS. MAR~ND. NEW JERS~, OHIO, UTAH, WEST VIRGINIA INVOICE SEWER AN D DRAIN ",,,'~'~u_f ~, ~ * CLEANING SERVICE Oob~dm~ . R~-~ER ~ERVtCE OA~[ HRO. . 8T~M ~AWING HRS. TRIPCHA~E HRS. OVE~IMECHARGE H~. ADDITIONAL ~R CHARGE HRS. (b) (c) (d) MUNICIPALITY ' ~F ANCHORAGE c~': .... DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION A~PLICATION FOR N~.ALTH AUTHORITY APPROVAL CERTIFICATE Information Application Date z Legal Description (include lot, block, subdivision, section, ~township, range) Location (addreps or ,directions) Applicants Name ~zd~r~'-~ Telephone - Home Business Applicants Address Z?:~/~''' -~"~'","~'-,'PZ~''-~' ~:~z~ :~ Appliqant is (check one) Lending Institution ~; ~er/builder~ Buyer ~ ; Other ~ (~plain); f Lending Institution ~ ~ Telephone Address (e) Real Estate Co. & Agent Address Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family [~ Multi-Family Number of Bedrooms ~ f 3o Other (describe) 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 Tank Note: ~f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ,JPage 1 of 2] '5. e , Information Engineerin~ Firm Providin~ Inspections Tests~ File Search~ Data and ".. As certified by my seal affixed hereto and as of the validation date shown below, I the on-site verify that my investigation of this Health Authority Approval shows that ~~ 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 regula- ttons in effect on the date of this inspection. Name of Firm Address '~)~D (ENGINEER SEAL) Disapproved __ DHEP Approval Approved for~>LL~ bedrooms Approved ~ Terms of Conditional Approval CAUTION THE ~f0NICIFALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEI~- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ae Be Well Classification MUNICIPALITY OF kNCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (PLAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ~NVIRONMSNTAL PROTECTION Well Log P=esent (Y~N~))~ Total Depth Static Water Level Casing Height Above Ground Electzical Wiring in Conduit ~N) Separation Distances f~om Well: ·RECEIVED Legal Description: ~)T~ I:JL0C~f If A, B, C~ C, D.E.C. Approved(Y/N) Date C/~,pleted ~ Yield Sanit~ ~al on ~sing ~ ~ession ~nd ~l~ead To Septic/Holding Tank on Lot //~ / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ,,ft~/~/55/.~ On Adjoining Lots. To Nearest Public Sewe~ Line /U//~: ~o Nearest Public Sewer Cleanout/Mar~hole /L/I~' TO Nea~e. st Sewer Service Line on Lot Water Sample Collected By ~~ ' Date water sample Test Results V ~/?~/_g/~/~/-~/~ y SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~/N) Ai~-tight ~ap~ ~N) 4~-Depression over Tank (Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N)./b/W; for Holding Tank High-Wate~ Alarm (Y/N) ~mpora~y Separation Distances f=om Septic/Holding Tank: Foundation Cleanout ~N) Holding Tank Permit (Y/N) ~ To Water-Supply Well To P~operty Line To Wate~ Main/Service Line To Building Foundation'~cj/' Field ~ i ~ !~'-- TO Dispc~l TO S~e~, Po~, ~ke, ~ ~jor ~aina~ -/ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorpt. ion, Strata Date Installed ~//~ ~/ Width of Field ..... /~ ~ ~ f~' Type of System Eesign Depth of Field //--/~/ Gravel Bed Thickness ~ / Square Feet of Absorption Al~ea _~/~;~ Standpipes lh~esent~N) Depression over Field (.Y~)) Date of Last Adequacy Test Results of Last Adequacy~Test ~.d.~/-- ~ ~)(~/~z3 ~L ~_~ -- 't' - Separation Distanc~ from Absorption Field: To Water-Supply Well /~ ~ To P~operty Line To Building Foundation ~-~/~" To Existing or Abandoned System Lot ~J / ~ ; On Adjoining Lots ., ~'z~-- To Water Main/Service Line ~ '7~ / a~ To Cutbank( if present) To Stream/Pond/Lake/or Majo~ D~inage Course .7~/0%) / To D~iveway, Parkin~ A~ea, or Vehicle Storage A~ea ~ 5/-~/~ H , , ' Date Installed / ~ns~~__ ' Size in Gallons : / :~:A~,c, Tss ~- "P~t%~ On" Lavel at~ / ~..J-"~ "Pump Off" Level at__ ___ High Water Alarm ~v~Q//$~"'"r__-- Vent (Y/N) __- Tested for ~" Pumping Cycles du~ing Adequacy Test. Meets MOA Electrical ~'~(Y/N) ** Check Permitted Bedroom Rating Against HAA Request I c~rtify that I have checked, vo~?ified, ~ c~nfcmTa~d to all MOA H3~ Guidelines in effect on tke date qf this inspection. Signed Company KB1/dB/s [Page 2 of 2] Date ~ MOA No. ~c~7~'~-0 ~/ · 2-15-84 ALASKA ei UIROIIITII F1TAL COFITROL $ R'dlCe$, InC. ROBERT GIERINGER 2727 SECLUSION DRIVE ANCHORAGE ALASKA 99504 SELLER-WEDGWORTH MAY 31 1985 ROBERT GIERINGER 2727 SECLUSION DRIVE ANCHORAGE ALASKA 99504 50160 LEGAL:LAKE OF THE HILLS BLOCK 3 LOT 5 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-APRIL 24 1985 THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 589 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1750 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON MAY 29 1985 . FLOW TEST ON WELL WELL FLOW DATE-APRIL 24 1985 THE WELL FLOW RATE WAS 4.6 GPM FOR 2 HOURS. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. 1200 UJesl 33r(] ]~oenue. Suite [~, ~nchoroqe, Alosko 99503,(907) 561-5040 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received November 5, 1976 Mrs. Wed~orth will be home Time of Inspection ~ Date of Inspection \~~t~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. ll:I~/a'm' 11-8~76 Monday Bu/~holz l. Approval requested by: Alaska Mutual Savinqs Bank % Greg Walker Mailing Address: Post Office Box 8-9093 Phone: 274-5722 2. Property Owner: Robert C. & Mary Mc Clure Phone: Mailing Address: % Jack White Company, Elliot Lawson 277-1553 3. Legal Description: Lot 5 Block 3 Lake of the Hills Subdivision 4. Location: Mountain Lake Drive 5. Type of facility to be inspected Single Family 6. Well Data: 'No. of bedrooms 4 e A. Type Individual C. Construction ~~ Sewage Disposal System: On-sit6 system A. Installed B. Depth D. Bacterial Analysis B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Material 8. Distances: A. Well to: Septic tank , 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 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 6 Type of Inspection: CM RO VA. FHA CONV × Property Owner: Robt. C. and Mary H. McClure f~' ~ Mailing Address: % Jack White Co.~l C. St. Day Phone.'-~'~''~''~' [~'~"~ ~%~-~e~,~J Anchorage, ~ 99503 Name of Buyer: William H. and Marian R. Wed~orth 99501 ·~4~ ~ .~ Mailing Address:~ ~ P.O. Box 1319, Anchorage DayPhone: ~%,%~%,%'3~'~ ~ame of kendin~ Institution: ~.~S~ ~THAL SAVINGS B~K .... TE~STER ~LL B~CH (attn: Creg ~alker) 9950~ Mailin~Address: P.O. BOX 8-9093, Anchorage Phone: 27~-5722 5. Name of Realtor or Agent: Jack White Company Mailing Address: 3201 C. Street, Anchorage 99503 Phone: 277-1553 (attn: Elliot Lawson) -6. Legal Description: Lot 5, Block 3, Lake of the Hills Sub. Location: South of O'Malley Road, last road on'right before getting to Hillside Dr. (turn South off O'Malley on Stony brook Drive) 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Single-Family Res. No. Bdrms. 4 Public Utility Individual_ x If Individual, number of dwellings presently served If Individual, depth of well unknown Sewage Disposal System Type of System: Public Utility. If Individual, date of installation unknown one Individual (on-site) X PLEASE NOTE ..... WHEN TEST %S COMPLETED AND RESULTS KNOWN PLEASE CALL ~ - F~LLIOT LAWSON AT JACK WHITE CO. AN~ T WTI,I, PICK UP CLEARANCE AND TAKE TO BANK .... MANY THANKS .... elliot lawson 277-1553 72-003(3/76) Pa~e 2 of two pages - Re st for Approval of Individual Y er & Water Facilities ')'egal DeScription Lot 5 Block 3 Lake of the Hills Subdivision Comments Approved ~~r~ Disapproved Date //~'/~ ,~7~ Apprg-~ ~Valid for one year from date signed Greater Anchorag~JArea 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) l. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: Department of Environmental Q,~ality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date. Received Time of Inspection Date of Inspection_~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER ~ WATER FACILITIES FOR Phone: ': v ' ''s ':' Phone: 3. Legal Description: ~,../-~, X::~ :,~ ~_/:2~: -~c 4. Location: ~'~-,~,':' ,~':~/~--~-/ s. earooms 6. Well Data: A. Type ~~./~, B. Depth C. Construction ;}. BaCterial Analysis 7. Sewage Disposal' System: ~~~~~ ~~~. A. installed ~-~ B. Installer ~ C. Septic Tank~ l: S~z~//~/. 2-?Manufact~ ~urer D. Seepage Pit: 1. Absorption Area ~/ 2. Material E. Disposal Field: Total length of'lines Distances: ~ Absorption area A. Well to: Septic tank //.% , / Nearest lot line ,~m'~ , ortner contamination B. Foundation to septic tank e~ / C. Absorption area to nearest lo.~ line Sewer Lines , Absorption area EQ-034 (1/74) Page 1 of two pages 3330 GREATER AHCHORAGE ARk,', BOE~UGH Department of Environm~n'tal ,,'~ality "C" St., Anchorage, Alaska ?;g503 - 274-4561 REQUEST FOR AP?ROVA[ OF INDIVIDUAL SEWER & WATER FACILITIES l. Type of insgection: 2. Property Ownei: Mailing'A~drOss-$ Ro~Yt C. McClure 3. Name nf Buyer: _ _~--~ B0~_4-!415 Mailing Address: .. 4. Name of Lending Institution: Mailing Address: Box 1200 VA FHA CiqRO _ / Edgar Deinsberg % Jack White Co.--Elliot LawsonDay Pho2n7?1553 Anchorage Dali Phone Coast Mortg~ga Cx~. · - ~ Phone 77q-n66~ Anchorage; :~:,~-- -- ' CONV x~ Name of Realtor or Agent: Jack White Co, .~Lliot Mailing Address: 909 W. 9th Ave. Anchorsge Phone~ 277-1553 o j Lo~ 5, Blk. 3, Lake~ 0 the Hills Sub. Legal Description: .... Mountain Lake Dr. Location: - Type of Facility to be inspected: Sing%e family dweR~ingBdrmS. 4 l~.~er Supply Individual Type of Supply: Public Utili·tY - If Individual, number of dwellings presently served - 0- ~ne~i_coo_str_gction If Individual, depth of well _ . Sewage Disposal System Type o-7 S~stem: Public utility If Individual, date of imstallation Individual (on-si te)x~ septic tank Page 2 of .two pages - R Lega.1 Description st for Approval of Individual ~er & Water Facilities [~ommegts Approved ~ ~~')C~'c~D i sapproved Date Approval Valid for one year from date signed Greater A~chorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information c6n~ined 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. ~ ~ " Date SIGNED ' ~ EQ-034 (1/74) '~ :'/ ~