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HomeMy WebLinkAboutBIRCH HILLS TERRACE #1 BLK 2 LT 5Birch Hills Terrace #1 Block 2 Lot 5 #050-141-17 Municipality of Anchorage Development Services Department Building Safety Division - On -Site Water and Wastewater Program. 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 Pagel of 2 www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW SW050312 PID Number: 050!t -17 Narnp:Wastewater System: ❑ New ® Upgrade M&M. ABSORPTION FIELD pnahe: Nurrbe. M aetoms: 56q.21111nn Fyt 1n2 It 0 Deep Trmm O stream Trench 0 Bed ❑ Mond o Dula: SW Wang: Tow Depth baro onanr grade: LEGAL DESCRIPTION 810ok: Lot; su664rm: 9 Pirch Hills Terrace Nn- I Depth to pipe boom from adgkul grade: F1_ Gravel depth berth pipe: F1 -0; T~aNp: Rage: seam: Fe added shove mgrnal grade: Gravel Length: Well: ❑ New ❑ Upgrade Gravel eldlh: F1_ Number of fines: asbngbehoenhom: Ft Cbsseaum (Phare. A. a. Ck Exists Tota Depth: Cased to: Total abso"m area: Pipe Material: Doer. Drs Dcbd: slate Walt Last: Mbaer. Dab Misted: F1 JR's Pumnina 912712005 Yhad: wrro sa r: uvno Ilaphl Aboaa tach°: Gk D 5- 4 5DU TANK GPM FL Fl. SEPARATION DISTANCES ® septic 0 Holding ❑ S.T.E.P. O Other. To Septic Absorption LIR Holding ublituPrlvate Ma ufacltan Anehora eTank ppcatr. 1250Ga1. From Tank Field Station Tank Sewer Line Melena: Nuntrer of eanpartmenls: was 228 200+ 100+ Steel 2 100+ 100+ LIFT STATION sw"acewslt &xa: Menuladhaa: La Line 144.7 99.7 Gr. 'Perp m•bM 0: Pore elr WM r: wp a.lara mac Fdadauan 23.2 70 in th M 50+ 50+ Purrp Make s Mad" Ele csl Inspecdms penorned br. Chran Drrm Re.wM: BENCH MARK Deeo Burial tank Laaam and DesmPem: Garage Slab Assurmd Ebvaum: 721.0 FL Engineer's Stamp \P\�................... ' # Inspections performed by: PES, LLC Dates: 1"9/2712005 d9T" •..............:s.....0 2"°09127/2005 • Development Services epartment approval �� C.Steven K. Pannone.* .ii Reviewed and approved b JIM LL Date: ♦ :, r1o. CE 8149 `5�� #•., �. `ee.ee�SSt� . �� PERMIT NO:SWO50312 RECORD DRAWING P.I.D.NO: 050-141.17 WASTEWATER DISPOSAL SYSTEM LOT 5, BLOCK 2 BIRCH HILLS TERRACE NO. 1 etlo- 1+5� NOTES: 1) All work shall be performed In accordance with AMC15.65. 2) Materials used shall be In accordance with those specified In AMC15.65, Wastewater Disposal. 3) Maintain 10' separation to all lot lines and water lines, unless noted otherwise. 4) Lots served by community water systems. No wells within 100' of proposed system. U R.Pannone 0 12 1 IN J�' 09 Stanley & Alice Sears P.O. Box 770283 Eagle River, AK 99577 569-2000, ext 102 i M Em W q uw nvm axrwa Lb M/31'J YW HV3Y� NOIIVOIf101 I Na tie N0 m N 0 W w o O)WM O)l 0 Q 1nNN�1�Om 80OPPL55 Ir w w Z = z w C O ��....Cr F W$ yZ �ZF �UCL N gV1 �W W ZK Nm Y Wp N W N o m20 ga PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fax PLAN MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO50312 Legal Description: BIRCH HILLS TERRACE #1 BLK 2 LT 5 Design Engineer: 0062 Pannone Engineering Services Owner Name: STANLEY & ALICE SEARS Owner Address: PO BOX 770283 EAGLE RIVER. AK 99577-0283 Date Issued: Aug 23, 2005 Expiration Date: Aug 23, 2006 Parcel ID: 050-141-17 Site Address: 011530 SKYLINE DR W Lot Size: 140518 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ 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 specked 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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. 5. The following special provisions. - (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. Received Issued By: COtL Date: Zq 4 7 d r Municipality of Anchorage Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-141.17 Permit Number SW Property owner(s) Stanley & Alice Sears Day phone 569.2000 Mailing address (1) P.O. Box 770283 Mailing address (2) Eagle River, AK Zip Code 99577 Legal description (Lot, Block & Sub'd.) Lot 5 Block 2 Birch Hills Terrace, No.1 Legal description (Section, Townses/Sqn.Ft ) Lot Size 140.518 Ac THIS APPLICATION IS FOR: Site Address: 11530 W. Skyline Drive Number of Bedrooms 3 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: p Waiver Fees: Date of Payment: 94& Date of Payment: / Receipt Number: / 2/i Receipt Number: (Rev. 12/00) Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax August 22, 2005 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lots 5, Block 2 Birch Hills Terrace No. 1 S/D Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new septic tank be issued for this property. The system currently serves an existing three-bedroom house. The lot is currently developed and is served by a private water system. 1. Tank Replacement. The original 1000 -gallon plastic/fiberglass sunset tank was installed in 1975. It has recently collapsed aril is causing slow drainage for the property owners.The existing tank is located approximately 30 feet from the house on a flat knoll. I amproposing to move the tank closer to the house. A deep burial tank will be installed. The tank will be located outside the 100 -foot protective well radius of the private well. See the attached site plan.The existing drain field was inspected and found b be dry and operating properly. 2. Surface Water: There is no surface water within 100 feet of the proposed system. 3. Topography: The average topography in the area of the proposedseptic system is approximately 5 percent. The surrounding ground is steeper. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, .••P��. OF.... �•' Steven R. Pannone, P.E. T 49— H Civil Engineer .,,,,,,��„ ,,,,,,,,• Attachments: i ""4;""...... "'"a7"""' #. C�Sleven R. Ponm 1.. n •. No. CE 8149 �E551CF i C:\Work\Letters\5-2 Birch Hills Terrace No 1.001.doc S PERMIT NO: DESIGN DRAWING P.I.D. NO: 050-141-17 WASTEWATER DISPOSAL SYSTEM LOT 5, BLOCK 2 BIRCH HILLS TERRACE NO. 1 NOTES: 1) All work shall be performed In accordance with AMC15.65. 2) Materials used shall be In accordance with those specified In AMC15.65, Wastewater Disposal. 3) Maintain 10' separation to all lot lines and water lines, unless noted otherwise. 4) Lots served by community water systems. No wells within 100• of proposed system. 4t 49 TM �V 0 Fw.I n rS� W rc 19 n VS wm 18 N �N K W o 0 tbESIGN CALCULATIONS: gTANK REPLACEMENT ONLY uS VEDROOMS:3 WIN SIZE TANK:10009 cr••••••••••••••• •• $ PREPARED FOR: PANNONE ENG. SVC, LLC R. Pannone .. Stanley d Allce Seam P. O. BOX 102954 "E 0149P.O. Box 770283 ANCHORAGE, ALASKA 99510 ex Eagle River, AK 99577 227-3522 P. 272-8218 Fax _,�, ♦ 569.2000• ext 102 1_ �♦♦ DATE:8.19-05 PLAN GRU -:r ANCHORAGE AREA BOR V Department of Environmental Quality °- 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME TA SJ �� MAILING ADDRESS CVY - PHONE LOCATION r t`t LEGAL DESCRIPTION /�O I ,�� 31 A :2 9-letH /0— s Zu&; �1 SEPTIC TANK: DISTANCE��-^ NUMBER OF FROM WELL °` ��� MANUFACTURER Sir/u SE% MATERIAL W �le- COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: I�/ TOTAL LENGTH` / DISTANCE FROM WELL/071 K FOUNDATION 471ty _NEAREST LOT LINE_0o` OF LINES NUMBER OF LINES DISTANCE DISTANCE BETWEEN LINES TRENCH WIDTHJw: IN. TOTAL EFFECTIVE ABSORPTION AREA l S SQ. FT. LENGTH OF EACH LINE f / DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ----IN. ABOVE TILE IN. WELL: *7,/g TYPE ----CONSTRUCTION — DEPTH — DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE , SEWER LINE , TANK_ CESSPOOL APPROVED DISTANCES: , OTHER SOURCES DISAPPROVED-- REMARKS INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: i%s/ �M LOT SLOPE: REMARKS: Form EQ -032 SEEPAGE SYSTEM_ DIAGRAM OF SYSTEM 1 /V -r DATE -2-Ir- 7`5 APPROVE CeWAI T t E ANCHORAGE AREA BO IL s a f PERMIT N011�Gf _ . DEPARTMENT OF ENVIRONMENTAL QUALITY ;r :t3�}C1 "C" STREET' ANCHORAGE, ALASKA 99503 ' S F 711 \ TELEPHONE 2,74-4561 C` 3f' `� �O4rrfo r�a`�' • S G ` DEPARTMENT SYSTEM -- APPLICATION AND PERMIT �. NAME OF APPLICANT�""------_-- INSTALLATION LOCATION MAILING ADDRESS -Y [-F 6 PHONE LEGAL DESCRIPTION f O'�C/" INSTALLATION OF: SEPTIC TANK-�X-------- SEEPAGE PIT--_----_-- DRAIN FIELD _- OTHER / TYPE AND SIZEOF FACILITY TO BE SERVED -- ��7�!�"� - ---------- O ALLED BY FINANCED THROUGH TBE INST ____-..— NOTE.- THIS PERMIT IS NOT VALID WITHOUT SOIL TEST SOIL TEST RESULTS ___- C^ `-,-----/�-�1------/-p�!� COMPLETION DATE ANTICIPATED - `� u l-1 -ela - - ��--------- FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMEN'T'AL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. , IAI SEPTIC TANK SIZE TYPE --- s -1--� EPAGE AREA SIZE _____ TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK __.-------------------- -- ---- FOUNDATION TO SEEPAGE Pty - �" DRAIN FIELD _-_ ----- SEPTIC TANK TO SEEPAGE Fri' WALL- .��-------------------- �^ La.fn..•L j SEPTIC TANK __`_'?.` SEEPAGE P44`-�_- DRAIN FIELD TO NEAREST LO'T LINE. WELL TO SEPTIC TANK --- -_!.___--.-- 6.6 SEEPAGE PIT--I�------- DRAIN FIELD _--L�+.•�.---.- ALSO CONSIDER AREA WELLS. zz"/ J WATER MAIN TO SEPTIC TANK--.�1%-----. SEEPAGE P4T.--i�-.--- 1 DRAIN FIELD__l¢__-__--. SEPTIC TANK, SEEPAGE PIT ..C� -- 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. W 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPT -IC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER U i I i t-. i i �c S CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-66 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. I also certify that this here will contain a maxinm of 3 bedr6Nw. I unde�+rJsttand an upgrade would cess h )q,131 more b ooms be added. DATE L..�-�.L- APPLICANT'S SIGNATURE .Q„ FORM N EQ -0 GRE. E ANCHORAGE AREA BO' L i �MAhZ PERMIT NO. IDEPART'MCNT OF ENVIRONMENTAL C3UALITY so€ 3330 "G" STREET ANCHORAGE, ALASKA 89503 F TELEPHONE 274-4561 SEWAGE DISPOSALASYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT �1..____ �^�---- ---._ MAILING ADDRESS - '�_.�-L PHONE —.--�------ /✓J�a1�" - INSTALLATION LOCATION !C` �` . ------ —.-----5[-/-------- LEGAL DESCRIPTION --- - S - As rzlm INSTALLATION OF: SEPTIC TANK— _--.3_--___---- SEEPAGE. PIT ------.---. DRAIN FIELD TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH ---------- SOIL TEST RESULTS —_ ------- COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: THIS PERMIT IS FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING ANY SY TE ITF DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY LL BE S JECT TO R CUT SEPTIC TANK SIZE_ -- ------. TYPE MINIMUM MINIMUM DISTANCES. RE©UIREMENTS FOUNDATION TO SEPTIC TANK '^�_._�--. ---- - ---� FOUNDATION TO SEEPAGE P+' F --- -- DRAIN F SEPTIC TANK TO SEEPAGE P4* WALL r 4 C X4,1 ��• SEPTIC TANK ---, SEEPAGE P�'F .. ---- _--_, DRAIN IELD TO NEAREST LOT LINE. \ Ahbb1\WITHOUT SOIL TEST INAL INSPECTION BY THE GE AREA SIZ -- . TYPE IAARAM OF SYSTEM IIk } i I , '= I 111 } i o-. WELL TO SEPTIC TANK ---1 -------- SEEPAGE -----. ----- -- _ _ DRAIN FIELD ALSO CONS I R ARE WELLS. WATER MAIN TO SEPTIC: TANK ------------ SEEPAGE----- DRAIN FIELD...-------------' SEPTIC TANK, �.�. SEEPAGE PIT --� DRAIN FIELD Hous TO RIVER, LAKE, STREAM. s 1„� 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 INSTAL-LATION. i OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE N0�;28-68 AND THAT THE ABOVE DESCR�SYSTEMISRDANCE WITH SAID CODE. (��Y, Y// a *( 4.) DATE�APPLICANT'S SIGNATURE FORM O -HATER 8NC|Nk8CL XRLA kUK(>U(.. Department of [nviruno/cnLal Qua lity 3330 "C" Street Anchorage, Alaska 99 03 SUO,S l/)G |5<R01,&?100T[S'[ Un�V PcrfoM/�d -/�'- Performed f0 . -,/���!___' Legal Ucscriyti0n:-- t This form reports: �6/P2r�0|�t1OU L�5 |� log Depth Feet ' - / �- 3- / 5 v- 13 - 14 / Was ground water encountered? �- lf yu%, at whaL depth? Readi ny Da te Gross Time Net Time Depth to Water Net Drop I ation rate minute. Drain Field -Proposed iristalla�i76ri-:---S'-e-e--pa—ge Pit Deptil of Inlet Dept —ht-o'-b­6-CC6m--o'f---p it or trencit COMMENTS: ----- -----/ ��'^'''= �'---------�� ----- 8( -O4O (6/74) TT VELEVAT 10til DATUtA rKom c -IT' URIC > NW trz% TOP OF- kL-A&=l7tq.-4 o 1.01 3q k,oD, 4 t vro "fl Ir- Sr Q 's LE6 G N C: > -724 LiDCAT10" Pi�l) PO f, E 0 2 '510 V Y IT I;il IFWO$136161L-ITY TO CAM -TQP OF r-ovNOATIOK) C) 1�4AB Lo -V L -r- —T Z- 1 14EV-lP-f5Y Cv-ARTiPY TPAT i PPVL '30KVF-YED TPP FOLLDWIMC� PROPCRTY : i -01T �, 5LL)(-< 2, BIP -CH 1--IILL,6 TERRACE , u5p1v1lpioo, ADDITION NO, I AML(40k'-'A,C4E RSC-0WD4f\jcr PPE-c-imc-r-, ALA610,, AND THAT T1417 t?FL.tVVIIJ& t:V iA, I f4 t: I VUATiOiNt-. ARE Ae, Ali Aikl Li I. 4 "Y IYA Ol tSi ;:-lL0T- PLAJ-� 11-UVVEY L 0 T r -d, F3,L C) C K- Z- BJQ,C-I-! WL-L� 1-CVP.ACE `)(JP Mo, I ':CW\/VF-!T-ZEE d A�AC�IATE5 LAQL) :5LjPVF-VC)eej 2;5� F-At.,T- :2-c TP AVE A, N C 4-i ,0 v A o C-, 4 Lik"�K A CI r A 11.l Cl I DATE- - ClZiDE-P-A,mi ey: R. e L) M _W DRILLING, Inc. Box 4 1?74 1310(.: lnternationil An rEx rt IPALITY Ci A�!('-!(')RAGL (907) 274-4G] J DEPT. C: ANCHORAGE, ALASKA 953'W9 F `✓!ROis,v , 1;0N L' U g DRILLING LOG Well Owner—_�Vla45 RECEL VIEU Location (address of: 'Township, Ranke) Section, if known; or distance main r�Iol 1 1 1�- Ce.�ac -1--- I -- -- ---- Size of casin / I E Depth of Hole_._ _.___--_feet. Cased to--- i-. Static water level___-- -----ft. (above) (below) land surface. Finish of well (check one) open end ( ); Screen ( ) ; Perforated ( ) Describe screen or perforation_ -- ----------- --- - - ft. Well pumping test at— 0_` -gallons per (hour) (minute) for_—. hours with of drawdown from static level. Date of completion_ ��---�-; Igo -- Depth in feet from ground surface WELL LOG Give details of formations penetrated, size: of material, color and hardness 00 J� . 2 —STATE (00—TO- __k,Z-- WELL LOG Give details of formations penetrated, size: of material, color and hardness 00 J� . 2 —STATE 1. 2. 3. 4. 5. AA n SCA -,,LQ n(2,1 / "S GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 `L� Date Received September 10, 1976 V �� Approval requested by: Home Federal Savings & Loan Time of Inspection M. Date of Inspection - REQUEST FOR APPROVAL OF N IVIDUAL SEWER & WATER FACILITIES FOR Conv. Mailing Address: 535 D Street Phone: 272-1451 Property Owner: Stanley E. & Alice L. Sears Phone: 333-2017 Mailing Address: Star Route 2 Box 230D Eagle River 99577 Legal Description: Lot 5 Block 2 Birch Hills Terrace Addition #1 Location: Skyline Drive Type of facility to be inspected Single Family No. of bedrooms 3 6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal System: on—site system B. Depth 300' D. Bacterial Analysis A. Installed 1975 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 _i+4.1' �", 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 1. Type of Inspection: CMRO VA FHA CONV X 2 Property Owner: d TA I'% ce- 1. - e- ( 3�53' - -z o» Mailing Address:--3jDay Phone: 2LG 4-2, FAt `aye' 3. Name of Buyer:6 l ��� ��ce k • Sen."rs _ Mailing Address: Q_,q., o w-yL, Day Phone: 4. Name of Lending Institution: fi e ry �' �e��Qli s .0 L'Y G S Mailing Address: -Phone: -72-- / y�/ 5. Name of Realtor or Agent: Mailing Address: Phone: 6. Legal Description: 'I ,t S L-cl J- u ,> ln, xa r c: Location: Ski,, line- F09kA_%,lv 7. Type of Facility to be Inspected: Pvl vnky. L1 No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual D If Individual, number of dwellings presently served If Individual, depth of well 30O Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72-003(3/76) 72-003(3/76) Individual (on-site) X Page 2 of`two pages - Rec ;t for Approval of Individual S ;r & Water Facilities Legal Description Lot 5 Block 2 Birch Hills Terrace Addition #1 Comments Approved lll j:z�xO�Disapproved Date Approval;Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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)