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HomeMy WebLinkAboutBOREALIS LT 9 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 Inspection Report Permit Number: ~At'~?~-Q52.-I- PID Number: c~/5'2.~ 5 o5- Name: ~4~ 5.~ Wastewater System: Q New ~pgrade Phone: J N°' of Bedrooms:  ~ Deep Trench Ilow Trench ~ Bed ~ Mound ~ Other LEGAL D ESCRI PTIO N Soil Rating: - ~ GPD/Sq. Ft. Total Depth from original grade:~ , Lot: ~ ~;,~~/.~Subdivisi°n: Depth to pipe bottom from origmal gra~e:~Ft. Gravel depth beneath pipe ~ Ft. Township: ~ Range: ~ Section: Fill added above original grade: Gravel length: ~ Ft. 7~ Ft. WELL: ~¢~t~ ~ ~ Gravel width: Number of lines: I Distancebe~.nlin~ Classllication (Pr~ate, A.B,C,: Total Depth: Ft. Cased To: Ft. Totalabsorption area: ~ 0 SQ. Ft. P~a~rial: Driller: Date Drille~: Static Water Level:Ft. ~r~,, ~. ~'' Date installed;D/~ Yield: GPM IPump Set ``: Ft. ICasing Height AbOveGrOund:Ft. TANK' SEPARATION DISTANCES o Septic ~ Holding To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Stahon Tank Sawer Lines Material: Number of Compa~ments: Surface Line ~ ~ .~/ ~ Size in gallons: Manufacturer: ~ "Pump on" level at: ~ "Pump off" level at: ~ High water alarm at: Foundation /O I /5 / ~ ~ ..... ~ BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL Insnections pedormed by'/~/~ Dates: 1st/~/~ ~. ~'~~ Department of Health~ Hurry.ices approval Reviewed and approved by: ~~~ Date: /~/~ 72-013 (Rev. 9/91) MOA 25 permit Ho. ~ L~ c~ 5'~.~ Z.~- Pege Z. , of L~ Municipality of Anchorage 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 .Legal Description: /.o-r' d~, i~or/..~-AUS 5u{~lVlSlO~,l PID No.: O/~'- ZI).~- 05' Permit No. Page .~ . of ~ Municipality of Anchorage 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 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 Inspection Report Permit Number: ~uU~/5"~$Z"SL PID Number: ..................... ~ateri..a. 1 .~:as..Bu.r~ed..Ons~,to,. G~.gater~al Excavated ~rom Bur~al Site ~'~s ~sed as Backf~ii ~n ~roa of ~ew Trenches. ..... ~'ato'rial ~s'Od fO'~ BaC~fii1 ~a's the Samo as the In ~lace ~ateri~l--~th the 8amo hBsorption Characteristics. 204.1 IS~le.$hee~) ~.1 IPid~e~i) ~' Jnc, Groron Mas~ 01471 To Order PHONE ?OLL PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 6 7 8 9 10 11 12 13 14 16 17 18 19 2o (ENGINEER'S SEAl:.) DATE 0 '" Township, Range, Section: SLOPE II II II WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Alter SITE PLAN Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop ~z... I0.'~o i~' z.. ~pl$" I. PERCOLATION RATE /~"' (m~nutes/,ncl~) PERC HOLE DIAMETER TEST RUN BETWEEN zlJ FT AND ~" .. FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ' ///~' ~"/q-'~ December 5, 1995 Municipality of Anchorage Department of Health and Human Services Onsite Services Section P.O. Box 196650 Anchorage, AK 99519-6650 Attention: Robbie Robinson Subject: Lot 9, Borealis Subdivision Lot Line Waiver Fee Dear Robbie: We applied for a lot line waiver with the septic system application fee for Lot 9, Borealis Subdivision. We were unable, however, to place the system 'in the location originally identified making the waiver unnecessary. We are therefore requesting the $115.00 fee for the lot line waiver be refunded and the waiver be rescinded. Thank you for your assistance with this matter. Sincerely, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950324 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:SHEA MARK OWNER ADDRESS:4921 ALPHA CIR ANCHORAGE, AK 99516-2253 DATE ISSUED:10/06/95 EXPIRATION DATE:10/06/96 PARCEL ID:01520305 LEGAL DESCRIPTION: BOREALIS LT 9 LOT SIZE: 16855 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WAIVER WR950049 APPROVED FOR 2 FOOT LOT LINE SETBACK. ISSUED BY: / - ~ ~~ ~ DATE: October 26, 1995 Municipality of Anchorage Department of Health and Human Services Onsite Services Section P.O. Box 196650 Anchorage, AK 99519-6650 RECEIVED O0T 2 6 1995 Municipalhy ol Anchorage Dept. Health & Human Services Attention: Robbie Robinson Subject: Lot 9, Borealis Subdivision Septic System Construction Permit No. SW950324 Dear Robbie: We have revised the Site Plan for the new septic system for Lot 9, Borealis Subdivision to avoid conflicts with existing trees and the existing waterline. The new location will require removal of the existing shallow bed in its entirety. Contaminated materials will be buried onsite. The attached Site Plan shows the revised location of the system. Please review the new site plan and advise if you have any questions or comments. ~ yD~jZ ~',2'"~ Sincerely, ~/J~ l,~ ~ Michael E. Anderson, P.E. LOT 9, BOREALIS SITE PLAN SCALE 1" = 20', LOT 9, BOREALIS SUBDIVISION SCOPE OF WORK Remove existing shallow bed system and bury contaminated drainfield rock and soil onsite. All piping to be removed from site. Construct 2 - 5' wide by 38' long absorption trenches with 4' of drainfield rock beneath distribution pipe at the location shown on the Site Plan. Distribution piping to be placed at 5' below ground surface. Place geotextile fabric over distribution piping. Mound over trenches after construction. drain away from trench area. Grade to Rick Mystrom, Mayor Mtmicipa ty of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 6, 1995 Michael E. Anderson, P.E. Anderson Engineering PO Box 240773 Anchorage, Alaska 99524 Subject: Waiver Request for Lot 9 Borealis Subdivision Waiver Request #WR950049, PID #015-203-05, SW950324 Dear Mr. Anderson: Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 2 feet from the south property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sinc~ly, ,,,,~. Robert W. Robinson On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section W~%ver Review Worksheet WR$ WR950049 PID$ 015-203-05 HAS Permit Date Received: Oct ~, 1995 Legal Description: Engineer: Lot 9 Borealis Subdivision Applicant: Waiver Requested: Michael E. Anderson, P.E., Anderson Engineering PO Box 240773, Anchorage, Alaska 99524 Mark Shea Lot line waiver of 2-feet of south property line Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Points:  Granted: Waiver is Granted: Waiver is NO? List Conditions ~r for above: ~ ~ ~ ' //-~ ~.~~ Rec $: $01356/3395 Amount: $ 115.00 Date Paid: 10-3-95 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 October 3, 1995 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 9, Boreatis Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The absorption bed on the subject lot has apparently failed and must be replaced before a Health Authority Certification can be obtained. We are therefore proposing to leave the bed in place and construct a new shallow trench absorption system to treat the effluent from the four bedroom home. Hopefully the bed will dry out and regenerate itself for future use if it becomes necessary. The lot is only 16,800 square feet so the area for the new trench is limited. In addition the home is served by a community water system and the trench must be a minimum of 10' from the line. The only area available for the trench is that shown on the attached Site Plan. A lot line waiver will be required to place the new trench within 2' of the south lot line. The existing tank and lift station will be used to transfer effluent to the new trench. The topography of the lot slopes from south to north from 3% to nearly 10%. It also slopes slowly from east to west at 0% to 3%. No groundwater was found in the testhole at depths over 11'. The bottom of the trench has been designed for a maximum elevation of 6' below the ground surface. If the absorption trench is placed in the location shown the following statements can be made: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The subdivision is currently served by a community water system. Lot 9, Borealis Subdivision October 3, 1995 Page Two The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 October 3, 1995 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 9, Borealis Subdivision Septic System Design Lot Line Waiver Request MUNICIPALITY OF ANCHORAGE ENVIEONMENTAL SERVICES DIVISION OCT 03 1995 RECEIVED Dear On Site Services Engineer: The attached Site Plan shows the area available for a new shallow trench absorption system to serve the four bedroom home on the subject lot. Limited space is available and a portion of the trench will encroach within 2' of the south property line. This line abuts the 50' Right-of-Way for Alpha Circle and should have no adverse impact. The subdivision is served by a community water system and septic systems for adjacent lots are well over 100' from this area. It is not possible to locate the trench in any other area without significant impact to aboveground features of the lot or substantial additional costs. Since placing the trench within 2' of the lot line will have no impact on other lots or easements in the area I recommend the waiver be granted, Please let me know if you have additional questions. Sincerely, Michael E. Anderson, P.E. LOT 9, BOREALIS SITE PLAN c~,o,~,..~ 0,,,-,',= SCALE 1" = 20' CHECKEDBY DATE SCALE ..... ~ou~ ., .... LOT 9, BOREALIS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Perc. Rate: 12 Min./In. Application Rate: .8 GPD/SF Reduction Factor: .5 Shallow Trench System 1,500 Gallon Tank (Existing) 4' Gravel Beneath Dist. Pipe 4 Bdrms. X 150 GPD / .8 GPD/SF = 750 SF of Absorption Area 750 SF / 5 LF X .5 (Red. Factor) -- 75 LF Total Absorption Trench Therefore: Construct a Shallow Wide Absorption Trench System With a Total Length of 75 L.F. Distribution Pipe Placed at 2' Below Ground Surface. Mound over System to Provide a Minimum of 3' of Cover. ¼ 4381 ~ NOTE: TYPICAL WIDE TRENCH SYSTEM (NO SCALE) Bottom of Trench to be 4' Above Groundwater. Grade Area Over Trench to Drain Maintain 10' Separation from Water Service Line. PERFORMED FOR: LEGAL DESCRIPTION: 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DEPARTMENT OF HEALTH & HUMAN SERVICES ~P P Municipality of Anchorage ,. NTOFHEAI.TI'I&HUMAI 825' L Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ ~[~'~'~° ........ .' ,.~,.,>,, :' · I ~0/7--~ (-J 5 ~ U I~, Township, Range, Section: SLOPE SITE PLAN / ~WAS GROUND WATER N O / NCOUNTERED? S IF YES, AT WHAT 0 DEPTH? P E Oepth to Wm~~Al~r' ip Mlmitoring? Gross Net Depth to Net Reading Date Time Time Water Drop · ,, - /,/,... - ~= z. ~,: z.;' /5' S" I Y~" ~ $ /. :¥O /5' q l./ " I '/¥" PERCOLATION F~E / ~/~mmutea/mch) PERC HOLE DIAMETER TE~T RUN BETW~r.H'~'''' FT AND ~ ~ COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72-008 (Rev. 4/85) JOB SHEET NO. CALCULATED BY CHECKED BY SCALE OF DATE DATE ! /0-~ I 8,5' I. z,~ 7t.. /. ~' / 73 ,-/.7. ?$ ........................................... :=?.%:TEad ~.:'.;t ~.",~3!2'~I !Pld~edit~--~'~!,~: Grot~n f~ss 01411 ,ToOtdirPHONETO~FREE1.800-22~'6380 MUNICIPALITY OF ANCHORAGE D ,RTMENT OF HEALTH AND HUMAN SEt .',ES ,_~" ~ ~ Environmental Health Division ~ j 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address 5"'~'Z Block Township, Range, Section I Perm,t NO. [No. of Bedrooms I~7°a?v' 1 LEGAL DESCRIPTION Subdiwsion gore~ h~ TANKS [] SEPTIC Manulacturer DISTANCES WELL SEPTIC TANK ABSORPTION FIELD WELL LOT LINE ,.~' ~0 ~ /V, ,4. FOUNDATION I 8 ~ ~' N, 4. AS-BUILT DIAGRAM (Show tocatlon of well, septic system, property hnes, foundation, driveway, water bodies, etc,) Ancher~.j,e [] HOLDING Capacity m gallons t5'o~ No. o Compa~,~ents Material .Stee I TYPE OF SYSTEM [] TRENCH [] BED [] W. DRAIN [] OTHER Depth to p~pe bottom lrom Total depth from original grade original grade ~.,,~ '" 6" ET q ' ~. ,.5"' ET Fill added above original grade Gravel depth beneath p~pe ~ - ( FT ~.,J" FT Gravel length Gravel width .,3~ FI 8 ~ F1 Total absorption area Distance between lines Number el lines Installer ~.~ 91 2_ sO FT[ ~' FT Sod ra~-m~- -- -- [Pipe material ~__~-~ WELLS E~ ~ PRIVATE ~ OTHER IIdentifv) Gtassd~c~bo~ (A,B,C) ~ oral Depth ] Gased to F~I FT I~t~llol Date n~tal Municipal and State guidelines in effect on this date: Health Department App ro vah.'v~ "/~'~/~ Scale: It~ _-- .,~Ot Inspections Performed by: Date: cedify that Ihis inspection was performed according to ali Date: 72-013 (3/85) ENGINEER'S SEAL Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICI 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~-~ ~ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: iLOPE 11 il, WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water Alter Monitoring? , Date: SITE PLAN ~I"~I II I~1 I I 1 /~I I1~¢1 .I I'%?'1~ I I I,I I ,I ,I~ I, ,1 I Gross Net Depth to Net Reading Date Time Time Water Drop (minutes/inch) PERC HOLE DIAMETER FT AND ?' ~'' FT /! PERCOLATION RATE JpT RUN BETWEEN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ¢- ~--~? 72-008 {Rev. 4/85) 8 ....... ~&z'..' A .~'~ ,.... .... LO; SURVEY CERTIFICAYION' HEREBY CERTIFY THAT I tIAVE SUttVEYEDTHE P~OPE~TY SHOWN AND DESCRIBED H~REON AND TIIAT THE t~P~OVE~ENTS SITUATED TllE~EON AH~ WITHIN THEPROPE~TY LIN~SANDNO ENCttOACttMENTS ~XIST, ' Prepared by: GERALDV. RANDALL, JR. Reg. Land Surveyor Z8ZO "C" STREET ,. SUITE ~ Phone: 279,74t4 ANCHORAGE. ALASKA 99503 A5 --.~U ~/..'T' /o - e-. ~o 'T-~ Z C E rZ 'T'/ /~ / d h "r / o /,,,/ oF' IT IS 1 tie CONTRACI'OIt'S RE,SPC)NSIIIILI'TY 10 CttECK TOP OF FOUNDATION IN fWLA. TION TO FINISH GRADE AND BUILDING SET BACKS IN RELATION TO LOT LINES AND EASEMENTS. 'LEGAL DESCRIPTION: LEGEND: · 5/8 REBAR RECOVERED o 518 REBAR SET THiS SURVEY f] 2%(2" HUB & TACK SET ~ EXISTING ELEVATIONS DATUM ASSUMED SCALE: / ~1 · =..,-30 Municip tYof Anchorage P.O. BC 196650 ANCHOHAGE, ALASKA 99519-6650 (907) 343-4200 TON Y KNO WL ES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES October 8, 1987 Dwayne Rathbun 4921 Alpha Circle Anchorage, Alaska 99516 Subject: Lot 9 Borealis Subdivision (4921 Alpha Circle) Correction of Overflowing Sewage Problem Dear Mr. Rathbun: Thank you for your expedient response to the overflowing sewage problem on your property. The department appreciates your continuing effort to keep the septic tank pumped and the area of overflow sanitized. This complaint was transferred from Eva Aulston of the Environmental Sanitation Section to On-site Services Section of the Health Department. Please consider this letter a follow-up to our previous conversations regarding this matter. I realize that you have had some disagreements with the first engineer hired to investigate the septic system problems on your lot and have indicated that you were going to terminate this engineer's involvement in this matter. Our concern is to help resolve the problems'on your lot'as quickly as possible. I have enclosed a copy of our list of approved engineers and a copy of our permit requirements for on-site wastewater disposal systems. Please contact one of the engineers on the list provided. It is important to proceed quickly with an upgrade of your septic system.before winter freeze-up occurs. The soils investigation and ground water monitoring required for an upgrade permit can be reasonably accomplished within the next two weeks. Design, permit issuance, and installation of the system can be accomplished within an additional ten days time barring major complications. In the interim, the tank should be pumped on an as needed basis. We would appreciate your prompt attention to this matter. If you are unable to proceed promptly with the process of remedying this situation please contact me at 343-4744. Thanks again for your cooperation. Sincerely, orris Civil Engineer On-site Services cc Gus Andress, P.E.,Manager, On-site and Water Quality Eva Aulston, Environmental Sanitation GRE, 'R ANCHORAGE AREA BOi Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 "GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ ~1/~T'~ ~A/~T~ MAILING ADDRESS -~/~ BO)K ~.97-/J~ LOCATION~)Fr~ I~I~I~L f T'~L//J..T ~.L~. LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE FROM WELLi~' ~ ~L INSIDE LENGTH '"'" MANUFACTURER ~a)~ INSIDE WIDTH MATERIAL~.~bJ~ NUMBER OF COMPARTMENTS LIQUID DEPTH '--' LIQUID CAPACITY I~'O GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER '--' OR WIDTH I I , LENGTH [& , DEPTH DEPTH ~ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) jfO/x~ SQ. FT. LINING MAT E R I AL'~~~ BUILDING FOUNDATION-~ , CRIB SIZE: DIAMETER ~., NEAREST LOT LINE ADDITIONAL ABSORPTION WELL: TYPE ~- BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST , LOT LINE , OTHER SOURCES DISAPPROVED NEAREST SEWER LINE DEPTH DISTANCE FROM: SEPTIC SEEPAGE , TANK __ , SYSTEM REMARKS DISTANCES: ~-~ "~ ~ I0 INSTALLED BY: '~ ',~ ~, ,.,I PIPE MATE RIAL:/~JLJ O LOT SLOPE: REMARKS: Form No. LQ-031 DIAGRAM OF SYSTEM DATE GoA.A.B. GreaTer ANCHORAGE AREA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAMe OF APPliCANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER NOTE: THIB PERMIT IS NOT YALID ~/ITI'IOUT SOIL TYPE AND SIZE Of faCilitY TO BE SERVED FINANCED THROUGH 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 DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT /.f- / SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT . TO NEAREST LOT LINE. /~WELL TO SEPTIC TANK DRAIN FIELD / / DRAIN FIELD- SEPTIC TANK, __, SEEPAGE PIT DRAIN EIELD /'/~) / DIAGRAM OF SYSTEM DRAIN FIELD / ALSO CONSIDER AREA WELLS. i 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 BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR LICENSED DESIGNER I CERTIFY THAT i AM FAMILiar WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE FORM NO, EG-O! $ TH-1 6-25-74 0.01 SILT, SOME SAND ' W/ORGANICS (ML) SILTY'SAND W/SOME GRAVEL (SM) -' · :".::S.ILT.'(SP) .. 2.0m ': .:SILTY SANDS W/SOME -. ' , ,. ~,:: ?;.. ~:', '< ' ...... ~,; ', -' - - · .... '~ A ' ' ''''~ .:~) ,.':~'-'~":' NOTE: Test hole excavated with tractor-mounted backhoe. Engineering 8~ Geological Consultants Inc. ANC.O RA(3E FAIRBANKS. ALASKA ~UN~AU BIG STATE CONSTRUCTION' ." LOG OF TEST HOLE ~:~:::~'~ ANCHORAGE, ALASKA 6-2( SCALE OWN ~YWED WED ""O~-NO, 462.046 owe NO. A-Ot PROPOSED DWE[.I.ING LOCATION 'NOTE: It i~ the ,con~ractor's /2~0 ToD o~ Foundation in re~atiomhip to Fkdsh Grade, Top of Fou~d~on as ~udicat~i ~s 'one c~,,r~e o~ block above Finish Grade. /0 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premises in Ruestion and that there are no roadways, transmission hnes or other, visible easements on said proper.ty except as indicated hereon. Dated at Anchorage, Alaska -thin /~/~ day of A'/:,,',/ ,19 F~ED WALATI~. & ASSOCIATES Engineers and Surveyors I hereby certify that I have surveyed the following described property:. R&M ENG,, EERING & GEOLOGIC,.-,,. CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Geologists Land SurveYOrs JAMES W. ROONEY, P. E. MALCOLM A, MENZIES, P.E., L.S. JAMES H. WELLMAN, P.E. RALPH R. MIGLIACCIO Engineering Geologist. June 26, 1974 R & M No. 462046 Mr. HOward Vines Big State Construction Box 224B Star Route A Anchorage, Alaska 99507 Re: GREATER ANCHoi~AGE AREA DE:PI. OF ENvn,ok~MENTAL Test EoZe ~d So~[ ~o~ [epo~C ~o~ Sa~Ca~7 STsCem Dear Mr. Vines: We are submitting~-erewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed, in accordance with your request of June 25, 1974, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 9 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 16.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. JWR:kd Xc: GAAB ANCHORAGE FAIRBANKS JUNEAU Parcel I.D. # 1. '.GENERALINF( .... C~mplete le, gal descri Location (site address or Property owner:!."' :....., Ar~/~. ' ~1!~.~ ~,~;',,,-,1,, ' . '. -,, Lending agency: Agen' ': ~ ..... ':'~;'i.. ..: "i'.'., Address Unless otherwise :; :~ "*' " .... 2.' ~ NUMBER OF BEDROOMS."~¢: I ~4'~ ';r 0 th {y,. a~¢ ' , ." ' ing t e legali status :,~ ,,;- , ~ ;:.:,,~ , ' ' 'i ! '");'," ~' ' : OF WASTEWAT~R DISPOSAL: : ,. ~ , ,r. ' , ~,,:' : , ~'. ;. '. Individual on-site Holding tank':" eJnleu§!s s,Jeeu!§u~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIClI~L C E IV E D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501, (907) $45~4,~ ! ~ 1995 Legal Description: A. WELL DATA Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist E>ort~at.t_~ ~'o~o,xJ ~$~0~ Parcel I.D.: Municipality oi Ancl~rag? Dept, Health & Human ~erwces 01~-- z-OS-O~' If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. Date completed Cased to Nitrate Other bacteria FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: Date installed I O]~.q / ~ '? Foundation cleanout (Y/N) Date of Pumping ~/~/e/~ C. ABSORPTION FIELD DATA Collected by: Tank size It"o-O,~ Number of Compartments T"uJO y Depression (Y/N) AJ High water alarm (Y/N) Pumper __ Cleanouts (Y/N). Y Date installed /O/Z$"-Z.7~ ..~5/?fi~Soil rating (g.p.d./ft2 or ftZ/bdrm) . b Length 7 ~e' Width ~" Gravel thickness below pipe Effective absorption area ?~,0 ~ c Monitoring Tube present(Y/N) ~ Date of adequacy test d~'tD ~J~. Results (Pass/Fail) '~:~$ S Fluid depth in absorption field before test (in.); O Immediately after t,{/~gal, water added (in.): Fluid depth ~/]/~ Minutes later: ~!~'~ ~ ~(itl?) ;'~Ab~i'Ption rate = ) ~ 019 g.p.d. Peroxide treatment (past 12 months) (Y/N) /M~ If yes, give date System type ~ t O~~ct4 ~ ~ Total depth ~ ~ __ Depression over field (Y/N) d For ~:~ ~ bedrooms LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* t/t'J-" Size in gallons "Pump on" level at* *Datmn /$"oo 6nc. ¢T;E. P "Pump off" level at* -~ t~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ! $ Property line ~.6, Absorption field Water main/service line '> gn9 Surface water/drainage )'lOt) Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /,~ t t Surface water ~' lO 0 Curtain drain /,dom ~ Water main/service line F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots > Z-O0 t I certify that I have determined thrufield inspections and review of Municipal records that the above s~3?~s are in conformance with MOA HAA guidelines in effect on this date. Engineer's Name Date HAA Fee $ ~t919, 0 P Waiver Fee $ Date of Payment ti ~,~/~-- Date of Payment Receipt Number , ~...~ '? ~.~0 0 ~_~) Receipt Number Rev. 8/95 OSS: haa.wk.doc 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FQR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION ~, Complete legal description /.--. ~ ~'~/¢~:~/~' ~ : ./2-~)//Y~_ ._-~ ~V/_~ ~-~ ~'~ '~ ~ Location (site address or directions) Property owner ~..~/~ ~.rl~2_ .- ~/~f./_~ .~. = = Mailing address Lending agency ~" Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing 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 #21 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. NameofFirm J..D_~~ 5~/"~'~ ~/'/~_4::~, Phone ~'~'~-~--/-~ Address ~'~/~"/~ ~U2 f~~l~~ DHHS SIGNATURE ,/~_ Approved for ~ Disapproved. Conditional approval for bedrooms. 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 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 Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl.. CHECKLIST A. WELL DATA Well type Parcel I.D. ADEC water system number If A, B, or C, attach ADEC letter. Log present (Y/N) Date completed Driller Total depth Sanitary seal (Y/N) Date of test Static water level Cased to FROM WELL LOG Casing height Wires properly protected (Y/N) AT INSPECTION U -I I\ l :J J ::l a 'IAI(] g~DIA~I~ 'I¥1N~WNO~IIAN~i :.i©WOHDN¥ JO A/.l'~¥dOINrhW Well flow g.p.m. g.p.m. Pump level SEPARATION DISTANCES ELL TO: Septic/holding tank on lot ; On adjacent lots Absorption field on lot Public sewer main Sewer service line . __a_djacent lots Public sewer manh~/cJeanout Petroleum tank WATER SAM RESULTS: Nitrate Da sample: B. SEPTIC/HOLDING TANK DATA 6 Cleanouts (Y/N) '~' Foundation cleanout (Y/N) ~/ Depression (Y/N) F Alarm tested (Y/N) .~ (/~-) 4//~/"'~/'/_ .,) c~ '~... Pumper .--~' ,~ >7_L ~:~_~--~~ x° High water alarm (Y/N) Date of pumping Other bacteria Collected by: SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~ /~ //, I ~.~ / ' / Foundation Well(s) on lot ,/~./,/ /Z~.. _ On adjacent lots /. ~ ~./'EL~ /,,~:,1 / Topropertyline "-/~(? Absorption field U,' ~ Water main/service line ~' O/ ('~') Surface water/drainage C'// k ('~ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Vent (Y/N) ~/ "Pump on" level at High wateralarm level t~'!'/ f'-"~Y'~/;~/'/~? Meets MOA electrical codes (Y/N) Y Manufacturer 0/~ ~-'~ 0 Manhole/Access.(Y/N) . .~/ ~x~ ?lf~ "Pump off" level at Cycles tested ~ SEPARATION DI,S'~ANCE FROM LIFT STATION TO: Well on lot/k~'/l ~/~' On adjacent lots ,/ Surface water D. ABSORPTION FIELD DATA Date installed t (~)/-7~ C//~, Length ~'~)~ Width Total absorption area c~ Depression over field (Y/N) Results (pass/fail) Soil rating [Z~h,~ ~-~.~ Gravel thickness p/' Peroxide treatment (past 12 months) (Y/N) ¢ ~/~¢, System type .. ' Or O Totaldepth ~._z' Cleanouts present (Y_~N) Date of adequacy test . . for ~ ~ bedrooms ~~ yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ¢'-'_¢~/~t/4~q.~. ?_/L To building foundation On adjacent lots ~'"' Surface water /~I ~ Curtain drain Y (~ / 1 On adjacent lots Property line To existing o~band°ne.~ystem on lot Cutbank Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. # '15'17 ~. ¢¢' HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFICEe 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASAK 99503 (9o7) 349- 55 April 14, 1992 For: James Sizemore & Associates PWSlD Cf 211708 My review of the records on file in this office reveals that the Borealis Alpha Subdivision, Class 'A' Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Project Engineer '" DATE RECEIVED · ~, INSPECTION APPOINTMENTS . ~_ - __ , _' ._ _ . TIME TIME TIME ! DATE DATE DATE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONMENTAL PROTE~IO~ ENVIRONMENTAL SANITATION DIVISION Telephone 2~4-4720 RECEIME~ ~EQUE~T FO~ APPROVAL OF INDIVIDUAL WATE~ AND ~EWE~ FACILITIE~ DIREOTION~: Complete ~11 p~m on p~ge 1. Incomplete requem will no~ be proce~ed. Please ~ltow ~en H0) d~ys for processing. J PHONE MAI LING ADDRESS P~OP~TY ~51D~NT (IY ~ifferent from ~bove) PHON~ MAILING ADDRESS 3, "LENDING INSTITUTION MAI LING ADDRESS I PHONE' MAILING ADDRESS ,' 5. LE'~AL DES(~RIPTION ' ' /_..o7- -- iTREET LOCATION 6, T~'PE OF RESIDENCE NUMBER OF~BEDROOMS [] One ,1~ Four J~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other WATER SUPPLY [] 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 ~] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank_ or [] Holding Tank Size: f~)~-~-'~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE [] TWO [] THREE [] FIVE [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER ~ ,/ Septic/Holding Tank IAbsorption Area ISewer Line [] OTHER Nearest Lot Line 5. COMMENTS ~/APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 6/79) 2 unicipal ty A chorage 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DI:~PAR I'MEN'] OF HEAl_TH AND ENVIRONMENTAL PROTECTION October 13, 1980 Ernest E. Webb Star Route A Box 1681S Anchorage, Alaska 99507 Subject: Lot 9 Borealis Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The septic tank pumped with a receipt submitted to this department. (2) An adequacy test be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our review. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Amfac Mortgage Company Attention: Coleen 401 East Northern Lights Boulevard 99503 CIVIL - EITRUCTURAL · .ECTRICAL · MECHANI( L · LAND EIURVEYINI~ TECTONICS INCORPORATED ENGINEERS & SURVEYORS SEPTIC SYSTEM ADEQUACY TEST DATE October 31, 1980 S- 105 CLIENT: Name Address Ernest Webb c/o John Manning Real Estate 1577 "C" Street John Bashaw, Agent Telephone 276-1614 344-9019, Ernest Webb Anchorage, AK 99501 LEGAL DESCRIPTION: Lot 9, Borealis Subdivision 4921 Alpha Circle SEPTIC TANK: Material Type Probably concrete. Size 1500 ga Number Bedrooms LEACH PIT: DRAIN FIELD: 4 Surcharge Test 500 Rate of percolation 2,000 gal./day Sludge condition in tank: Pumped 8-21-80 by Northwest Pumping. X Required Tank Size 1500 gal. gal. water; 0.80 (150 x No. bedrooms) min. Remarks: 500 gal. dissipated in 2 hours, 45 minutes at nearly constant rate. System is functional and adequate. P.O. BOX 4-2265 ANCHORAGE, ALASKA 99509 [ 907) I NSPECTI ON APPOINTMENTS' 1,-TYPEOFRES1DENCE - [] SINGLEFAMIL¥ WATER SUPPLY_ ECTOR NU; r--i- ONE I- [] - I- PERM~TNUMBER , . _ -.. , n.~ '-:~1t F~-: INDIVIDUAL DEPTH OF WELL i--] COMMUNiTy - ~ pUBLICU~I LITY DATE DR I LLED LOG RECEIVED )ER )fled · INSTALLE oldingTank is homemade M.~NUFACTURER -- MATERIAL WELL TO: I -- [] CONDITIONAL APPROVAL (letter must accompany certificate) " ~ :' .... "' "~NICIPALITY OF ANCHORAGE ~ ~~ Department ~ 'H!eal th~and ~ ~Env ironment a~ ~oaection~ : ~ , ~'~ '~. ~.~i! ' //~ · ~ 825. L S~.'reet, Anchorage,. Alaska 995,01 ~ , , /~~-'~/~ 279-2511, ext. 224, 225 ~ ~~uest for Approval of Individual Sewer and Water Facilities~ Property Owner: Mailing Address: Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Phone: Phone: Mailing Address: Legal Description: Street Location: Multiple Family Residence: ( ) Number of Bedrooms: e Water Supply: *Individual Well ( ) Public/Community System If Individual Well, well depth If Community System, name of system Sewage Disposal System: On-site System (~ Public System If On-sits System, date of installation: ~/~ ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: e e GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 12/2/74 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. Ui(t State Contractors 224 - 99607 Phone: Phone: Legal Description: ho'~ '~ Boreaiis Subdivi~;ion Location: Al pi:a Circle Type of facility to be inspected Well Data: A. Type C. Construction A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: comiil. S,yS'~ approw_-,d Sewage Disposal System: 1. Size 1. Absorption Area Total length of lines No. of bedrooms B. Depth D. Bacterial Analysis B. Installer 2. Manufacturer 2. Material A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-034 (1/74) Page I of two pages Page 2 of two pages - Re t for Approval of Individual ' r & Water Facilities Legal Description Comments Approved i])4~ O.~4-~d' Disapproved Date Li~/'~//i , Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental quality DIAGRAH OF SYSTEH 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) 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 /~6 Property Owner: ~' ~c (]~o~t~o~ov'~ , Mai.ling Address: ~ ~ox ~ ~¢0l)~ Da..y Phone ~-© ~ Name of Buyer: Mailing Address: 4. Name of Lending Institution: /~/~m,~ A Day Phone Mailing Address: Phone 5. Name of Realtor or.Agent: Mailing Address: Phone Legal Description: Location: _.,~/~ ~.~ 7. Type of Facility to be inspected: ~.~J~Je¢~<'¢ No. Bdrms. ~ 8. Water Supply Type of Supply: Public Utility ~ Individual If Individual, number of dwellings presently served ~.~__ If Individual, depth of well ~,~. 9. Sewage Disposal System Type of System' Public Utility If Individual, date of installation Individual (on-site).,~'. EQ-037 (!/74)