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HomeMy WebLinkAboutLAKE O THE HILLS BLK 2 LT 1 GRF,'?":ER ANCHORAGE AREA BOF" ?GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS -~X/~ ~(2~ ,~Z ,)7 PHONE LEGAL DESCRiPTiON /--/ ~Z /~q'~'£ ~.,0/7~,~ //~/,//~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL Sf-43~'/ NUMBER OF COMPARTMENTS I LIQUID DEPTH LIQUID CAPACITY ~¢~)~ GALLONS. SEEPAGE PIT: NUMBER OF PITS I DIAMETER __OR WIDTH__ LINING MATERIALcO)lC ¢iff_¢' CRIB SIZE: DIAMETER.__ BUILDING FOUNDATIONI NEAREST LOT LINE ~¢2 ~7~. LENGTH DEPT, / ~ .DEPTH / 2~ DISTANCE FROM: WELL I ~ z¢) TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / / ~ ~/- SQ. FT. ADDITIONAL ABSORPTION WELL: tYPE Pf;F~¢ CONSTRUCTION BUILDING NEAREST FOUNDATION __ LOT LINE DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK__ SYSTEM CESSPOOL APPROVED OTHER SOURCES DISAPPROVED DISTANCES: t,~ -- /0~-2' 4C-/~'O' REMARKS DIAGRAM OF SYSTEM iNSTALLED By: ,//-5,.6 PiPe MATERIAL: LOT SLOPE: DATE. (~'/G~.A.B. ~ ~ -- ~ GreATER ANCHORAge Area BorOugh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99303 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. INSTALLATION LOCATION LEGAL DEBCRIPtION ~/ ~ ~ INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ND SIZE OF FACILITY TO BE S FINANCE-D~HR~rGH TO BE INSTALLED BY PHONE · OTHER NOTE: THIS PERMIT iS NOT VALID 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. MINIMUM DISTANCE~, REQUIREMENT~ 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 SEPTIC TANK, ///~ ~ SEEPAGE PIT TO RIVER, LAKE. STREAM. TYPE . ~ . ~'"// SIZE TYPE , DRAIN FIELD · , DRAIN FIELD / SEEPAGE PIT ALSO CONSIDER AREA WELLS. , SEEPAGE PIT 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. LICENSED DESIGNER DIAGRAM OF SYSTEM DESCRIBEDI CERTIFYL~__TTHATsysTEM~I AM~ ~L~IsFAMILIARIN ACCORDANcEWITH THEwiTHREQUIREMENTSsAiD CODE. OF G r EAT~A~c~ 07U/~4./~7 ~ ~/ AREA~~BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE G' TER ANCHORAGE AREA BOROUGH Depar,tment of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 Per f, ormed _ ~_'~¢>-N~ ~ Date performed Legal D e s c r i n t.~/¢~', ~/¢~ ~~ ~n~s form repor~ bOllS log ~ , Percolation test Depth Feet 9- 10- Ii - 12- 13- 14 = , Was gr~'und water encountered? If yes, at what depth? -Reading Date a .l(h .. Gross Time Pro?sed installation: llli FI, Ute Se~, ae, e F'i~- ' Net Time I Depth to H20i Net Drop 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 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) Telephone: (home) Business (c) Lending. lnstitutibn: Mailing Address .... Telephone (d) Real Estate Company and Agent Address Telephone ~74,-Z~-7~ / Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: .. (e) 2. TYPE OF RESIDENCE Single-Family'j~. 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 th legality and status. 4. SEWAGE DISPOSAL On-site ~. 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. 7/88) Page 1 of 2 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, Iverifythatmyinvestigationofthis 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 ,~,C ~' Telephone Address / ~//~" ~J '~'¢ /~v/~/ ~ 6. DHHS APPROVAL Approved for Approved bedrooms by '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 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 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 ,.,,~7~'?xx~¢HCI~ICIPALITY OF ANCHORAGE (MOA) MUN CIPA~"~'~' ~J'~-,~"~nRONMEf;~J~/CES DIVISl~aJth Authority' Approval (HAA) '~k~j// CHECKLIST-FEBRUARY 1984 JUN 2 3 1989 RECEIVED 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Yield -~" Pump Set At /d/~- Sanitary Seal on Casingt~N) Depression Around Wellhead (Y~). A. WELL DATA Well Classification Well Log Present (Y~__ Date completed Total Depth >/5"3 *Cased to ~5/¢) ,Depth of Grouting Static Water Level Casing Height Above Ground / Electrical Wiring in Conduit (Y~) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To NeareSt Sewer Service Line on Lot Water Sample Collected by /4-~'~' /z~. /,,J/~-,2 Water Sample Test Results ~'/'rz~ ~;) ; On Adjoining Lots ; On Adjoining Lots ,/o~ To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~'~~'~'-?/Size Standpipes (~N) DePression over Tank (Y~ 2-~-~ No. of Compartments / Air-tight Capsi~)'N) Foundation Cleanout (~) Date Last Pumped ¢0-/?- o~? /~<~ Pumping/Maintenan,ce Contact on File (Y/N) ~,/~/ ;for '~'/'~' :,H?J'~ing Tia~.,~k .H, igh-Water Alarm (Y/N) ,~)/~ Temporary Holding Tank Permit (Y/N) ¢ , ,,. :~.,.~,~,,,~.?j. ..... ,4,';SI~PA,.R..~TIOND[S,T'ANCES FROM SEPTIC/HOLDING TANK: -To Wa'Ca"~,~U'p~ly ~ell /¢ To Building Foundation /o ¢- To Disposal Field /~' To Property Lip,.e, .~ T,,~.'~¥'¢~, K4 ~ i/iTS ervi ce Line ~%.~.,ee,~,, ,Po'b.d,,Eake.;,,. ' or Major Drainage Course C o Fr~rl~.e .~S.¢. ,¢ -.. ,. 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test ~"~u~7'~"~ SEPARATION DISTANCE FROM ABSORPTION FIELD: / To Water-Supply Well /cz) -/- To Building Foundation Lot To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design ~,~/¢~ ,// Length of Field .~1 / z-7 Depth of Field /5/ / Gravel Bed Thickness /Z~ Statndpipes Present(~N) Date of Last Adequacy Test / To Property Line /,o y- To Existing or Abandoned System on / ; On Adjoining Lots ~ ¢' / To Cutback (if present) ,,J,//4 -B.._LI FT STATION Date 1 ~'~t'a-Hed._ Size in Gallons''-'---'''-'~-- "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) -"'"'-"'-"~--. _......P. umping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ //'~. 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ect o~,t~ of this CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order Date Report Printed: JUN 19 89 @ 13:42 Client Sample ID:L1 E2 LAKE O' THE HILLS PWSID :UA Collected JUN 14 89 @ 15:30 hrs. Received JUN 14 89 @ 16:00 hrs. Preserved with :AS REQUIRED Client Name : Client Acct: AKECSRP P.O.# NONE REC'D geq $ Ordered By Analysis Completed :JUN 16 89 Send Reports to: Laboratory Super¥i%or ~STE~PHEN C, EDE lJA E C S Released By : ~(J~. ~F/~ 2) Special Instruct: Chemlab Ref $: 5732 Lab Smpl ID: 1 ~atrix: WATER Allowable Parameter Tested Hesult/Units Method Limits ........................................................................... 2 ................................... NITRATE-N ND(O.IO) mg/1 EPA 353.2 10 Sample ROUTINE SABLE Remarks: SAMPLE COLLECTED BY A. WIEN. Tests Performed * See Special Instructions Above UA=Unavailable None Detected "See Sample Remarks Above Not Analyzed LT=Lese Than, GT=Greatez Than ' ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~,..~ ?'"~ ~ 9 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date / /"~'~/~ 7 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ~ / ~O/& ~ ~-/,~ ;JT~'~ ~4']Lb~ LAKE O'THE HILLS S/D / Corrected Legal Description Location (address or directions) / Applicant Name (b) Applicant Address O3oP-T- (c) Applicant is (check one): Lending Institution ,[~Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution ~'~"~-'~" -~--~ -';~/~ Telephone ,-~ Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~]. Multi-Family [] Other Number of Bedrooms/ ' '-~ (1~¢¢') WATER SUPPLY Individual Well~ CommUnity [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL onsite~ Public [] Community [] Holding Tank [] Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN'~NSPECTIONS, TESTS, FILE SEARCH, D/'--'~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 Address ~",'~'~'~ Date DHEP APPROVAL Approved for ,/"~'~/ f,5~) bedrooms by Approved ~/"~ _ Disapproved Terms of Conditional Approval Conditional Date CAUTION 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 H 1/84) MUNICIPALITY OF ANCHORA~I= DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION 9 6 987 RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: /..~/ Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ~ J00 ~0C-'bJf~Tl~ If A, B, C, D.E.C. Approved (Y/N) '"' Date Completed Yield Cased to g~R~ Depth of Grouting ( ~ / Pump Set At ~ '~ Sanita~ Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) I ; On Adjoining Lots 4" [00 ! ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Se~ice Line on Water Sample Collected by ~J~ ~J~g~ :Date /~(/~ ~ Water SamPle TeSt~R~sqlt~: :~ ~'~~ ~ Comments ~ ~A~/~ ~ ~ ~ ~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed ~'/'~ Size StandpiPes (Y/N) \'/~'~ (I) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '~(001 To Property Line To Water Main/Service Line 4---~.~/ Course /~JO/J~ ~j'L~'~/'J'~ "/"[ ~' No. of Compartments O/g~OOO/~ \j~"~ Foundation Cleanout (Y/N) ~5 D~te Las' Pumped ~ ; for ~ Temporary Holding Tank Permit (Y/N) / To Building Foundation '~'O To Disposal Field /~/ To Stream, Pond, Lake, or Major Drainage Comments A77-A CZ . A- ,O Pun Pp. zcne. pr- Page I of 2 72-026 (Rev 8/861 Fronl ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Length of Field ~'7 C.~ ~j 0 · Depth of Field /'~/ · - Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation"~ Lot [4014~' To Water Main/Service Line Gravel Bed Thickness //~'4- ,~5.'/~" ~. - Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) To Existing or Abandoned System on ; On Adjoining Lots 4"/~0 To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Comments Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that .¢~ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~(~Z¢4/~}/~ Date Company ~-'~~tO¢'~' MOA No. / / / Receipt No. /Od)/ O 0 / ;::2F- Date of Payment //-~'/ Amount: $ ~ ¢~ Page 2 of 2 72-026 fRev 8/861 Back Location: BESSE, ~PPS & PO~S 2220 FA~T 88 AVenUE ANCHORAGE, AK 99507 (9o7) 349-6451 Subdivisio~: Lot: Block: ~A/Z_.g/Nn"Hg' HIL~ Client's Name: Address: Initial Reading o~ Meter: GAr.fz;:ANS GAr.rONS H :45 '3,'7(a q4- 3 :~ 9 2,¢o ~ 7 5o INVOICE # 1 488 A+ HOME SERVICES 15900 Francesca Drive' Anchorage, Alaska 99516 345-1890 or 345*2444 CUSTOMER · Besse. Epps and Pott~ 2220 E. 88th Anchorage, Alaska '9950? ! Block 2 Lot 1 Lake ~ the Hills DATE DESCRIPTION AMOUNT 1-20-$7 l:~mp Sepl:ic 2, 000 gallons , 65 00 11201 ]~s (Briggs?~ Court · TOTAL / REMARKS /~L/~ /~ ~.,,. ~,~,~'. ,..~.~. ~,~.~ ~,~}~ <~Ga ons L/Septic _.Cesspool _ ~ Standpipes .Time 0BLEM AREA--CALL FOR MORE INFORMATION EDS TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape ~udge buildup on bottom ~ r on top ~ Jim cap missing or ~ Cut standpipe to 1' above ground ~eeds Septictrine neeos replacing --~)1 FA.Al:: PAY I:~nM THI& INVOICE-- /~ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received March 9, 1977 Time of InspectionS. Date of Inspection'~Sd/L/-~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Pouch 7-010 99510 2. Property Owner: Gary/Sally O. Betzner Mailing Address: NHN ll3th Avenue Alaska National Bank of the North Phone: 278-4581 Phone: Legal Description: Lot 1 Block 2 Lake of the Hills Subdivision Location: NHN ll3th Avenue 5. Type of facility to be inspected 6. Well Data: A. Type e C. Construction Single Family ~ B. Depth No. of bedrooms 4 ~ D. Bacterial Analysis Sewage Disposal System: A. Installed ~--~?j,/ ~y B. Installer C. Septic Tank: 1. Size ~E)~O 2. Manufacturer D. Seepage Pit: 1. Absorptio, n Area //~c/ 2. Material / E. Disposal Field: Total length of lines On-site system Distances: A. Well to: Nearest lot line .~/~ , Other contamination B. Foundation to septic tank ~¢x× , Absorption area C. Absorption area to nearest lot line Septic tank /~/ , Absorption area ~, Sewer Lines / EQ-034 (1/74) Paae 1 of two oaees 'GREATER ANCHORAGE ARE/, BOROUC~NlCiPALFFFOFANC?RAC~ Department of Environmental Qu~'Ti ~PT. OF H::/',t';~ ~ 3330 "C" St., Anchorage, Alaska 99503~NVlRmZNA~N'~N§Bkl~T~C~ION MAR 9 -1977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIE~F~IV~ 1. Type of Inspection: ' CMRO VA FHA CONV xx Property Owner: Mailing Address: Betzner, Gary & Sally O. NHN ll3th Avenue Das Phone ? Name of Buyer: WINTER, Vernon C. & Linda M. Mailing Address: 1506 Cache Drive Day Phone ~272-244 Name of Lending Institution: Alaska National Bank Mailing Address: Pouch 7-010 Calais II Phone 278-4581 Name of' Realtor or Agent: Eddie Walker / Towne & Country Realty ~}~0ale ~lurphy / Jack White Company Mailing Address: 3201 c Street Phone 277-1553 Legal Description: Location: Lot 1, Block 2, Lake of the Hills S/D NHN ll3th Avenue Anch6rage, Alaska 99507 7. Type of Facility to be inspected: Single Family No. Bdrms. 4 8. Water Supply Type of Supply: Public Utility Individual xx If Individual, number of dwellings presently served 1 If Individual, depth of well 9. Sewage Disposal. System Type .of S~stem: Public Utility If Individual, date of installation Individua'l (on-site) Xh unknown (1974) Page 2 of two pages - R~ est for Approval of Individual wer & Water Facilities · ~L~gal Description Lot 1 Block 2 Lake of the Hills Subdivision Comments Approved~ .~~. ,~.~ ~ .~/~proved 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) e 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF Date Received ('"~L~, ~/,/c~¢~--~ INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested Mailing Address: Property Owner: Mailing Address: Legal Description: Location: ~0~ ~. Type of facility to Well Data: A. Type [~ :~ ~ 3( ~I~ C. Construction d~ Sewage Disposal System: Phone: Phone: ~Ltq- \~S B. Depth No. of bedr~~ D. Bacterial Analysis A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 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 FN_NqI1 (1/7Zi~ P::,r~m 1 nC f,,~n n:~c GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO __ VA FHA CONV/~ Property Owner: ~ M~l~_ · Mailing Address: ~_9~.)~ ~ '7 DaS Phone .~--~/~)~/'~-~ Name of Buyer: '~ek Mailing. Address: Name of Lending Institution: Day Phone Mailing Address: Phone Name of Realtor or Agent: Mailing Address: ~~ / ,' / v. . ~ater Supply Type of S~pp.ly: Public Utility Individual If Individual number of dwellings presently served If Individual, depth of well ~~~ Sewage Disposal System Type ~of S~stem: Public Utility individual (on-site) If Individual, date of installation Page 2 of two pages - Re _~st for Approval of Individual .~er & Water Facilities · Legal Description ~ / ~l ~¥' IT, ~ ~)~ ~\~ '(~' (~ ~f~ ~/~-~.. comments Approved ~ ~/, ~/~/~ Disapproved Date/.d..~ Appr~al ~,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) ll3th AVENU~ 4 -,% 2 ~?,~oo 103,500 ROC~RIDGE DRIVE I0~,000 I 5 6 4 / / ? ? 7 /.ISl Al. O"THE. ' HILLS SUBD.