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Home My WebLink AboutSOUTH LAKEWOOD HILLS #1 BLK 6 LT 2 ANCHORAGE AREA BOm tGH Department of Environmental Quality" 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS -~/~/~ '~ 7'~' LEGAL DESCRIPTION L. SEPTIC TANK: D,STAN E ' INSIDE LENGTH INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY /~,~? GALLONS. SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL ~ BUILDING FOUNDATION__ ADDITIONAL ABSORPTION DIAMETER OR WIDTH CRIB SIZE: DIAMETER NEAREST LOT LINE _~ . LENGTH-I)', DEPTH / / DEPTH DISTANCE FROM: TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. WELL: CONSTRUCTION NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED REMARKS TYPE BUILDING FOUNDATION CESSPOOL APPROVED DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: Pipe MATERIAL: ~// LOT SLOPE: Form No. EQ-031 DIAGRAM OF SYSTEM // DATE GRE:ATEr ANCHORAGE Area BOROUGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE PIT , DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT BOIL. TEST COMPLETION DATE ANTICIPATED DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF FOUNDATION TO SEPTIC TANK fOUNDATiON tO seEPAge PiT ~ ro [ , DRAIN fieLD SEPTIC TANK TO SEEPAGE PIT WALL //,~ ' WATER MAIN TO SEPTIC TANK I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCR[BED~SYSTEMs/~//7~//IS IN ACCORDANCE WITH SAID CODE. ~ '~~/~ /~ DATE APPLICANT'S SIGNATURE The sediments were fairly loose with a low Water content. The were some erratic Sw and M1 bodies but thes accounted for les~ 5% of the total sed- iments. eOMNENT$: 2 e..*~~p~n ~o ~ott'o~ Of Pit Or '~renc~ T~s~ Po~o~ By: Perooo ~ ..... ~t~- ~tf'led.: " '" ' ' : ' ............ ~'~ ~::~ ........... MUNICIPALITY OF ANCHORAGE ,~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. Cf 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) Location (address or directions) (b) Property owner/~o~,¥ Mailing Address (c) Lending Institution Telephone: (home) ~¥~-95// Business Telephone Mailing Address (d) Real Estate Company and Agent f~ Address "~ ~-00 Cor'o(o~. Telephone ~ 7~'- ~-7~'/ (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the Stat~ 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 ')pOM s,JeeU!§Ue leUO!SSeloJd eqt u! suo!ss! LUO JO S JO J J9 JOJ elq!suodseJ lou s! eb~Joqouv to/il!l~d !o! u n rAJ eq/'penss! s! el~o!l!~Jeo ~ eJ o~t@q elep eZ,ileU~ Jo suol~oadsu! ~onpuoo lou op 9NFIQ ~o sg@~olduJ~ 'slu@Lu@JJnb@J all~s pug [~Jgp@J u!glJgo Bu!puel J!~ql pue seuJoq Jo sJ~seqoJnd ol ,tselJnoo ~ se s!ql seop SHHO eq[ 'mlSel¥ ,to etelS @ql uj peJe~s!6eJ JeaU!SUe leUO!SS@loJd luepuedepu! ue iq 9Aoqe ~ tldeJBe~ed u! ue^!B suo!leluas@JdaJ aq~, uodn ,~lUO pgseq le^oJddv/il!Joqln¥ qllSeH sgnss! (SHH(3) SgO!AJgS u~LunH pue q~l~eH ,to tueLu~Jed@Q elSeJoqouV ~o,fl!led!o!un~ eq.L leAo~ddv leuo!l!puoo ~o suJje± pe^oJddesic] ,,~ peAoJddv ,~q SLUOO]peq ~ lOlL peAo~dd¥ 'l~/AOl~clcl~¢ 8FIFIE] '9 ~f'~'£1-_.,c'~ euoqdele/ 2'~n~ /'~/.u~.~_Z ¢-/';~/-/~'/._.,--/ WJl41oeweN 'uo!io@dsu! slql Io el~p aql uo loalJe u! suo!JelnB@J pue 'seoueulpJo 'sepoo elelS pue led!o!un~ lIB ql!M aoU~!ld~O0 UI S! ~1SXS leeode!p JaleMelSeM Jo/pue ~lddns Jal[~M el!S-UO eql 'uo!ioedsu! pue UO!I~SRS9AU! X~ ~oJl pue Sal!J eB~Joqouv Jo ~iIled!o!un~ aql moji paul~lqo uo!lemJoju! aql uo p~seq 1Bql ~llJeA JeqlJn~ I 'u!eJeq peleolpu! eJnlonJls lo ed~l pue s~ooJpeq jo Jaq~nu aql Joj el~nbep~ pue ]euo!lounI 'ejes s! ~els~s lesodslp JeI~MeIS~M Jo/puc ~lddns J~J~M 9~S-UO eql leq~ SMOqS leAoJddV Xl!Joqlnv qll~aH s! ql lo uolleBllseAu! X~ leql ~!Jea I 'MOleq UMOqS elep UOllep!lea eql lo se pue oleJeq PaX!tt~ lees ~ ~q Pe!l!lJeo sV MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification P r~[/~-e Well Log Present (Y/N) ~ Date Completed I¢ '7 'i~ Total Depth /?~-' Cased to /7~E' Depth of Grouting Static Water Level /3o ' If A, B, C, D.E.C. Approved (Y/N) N, ~, Yield _~ C, ~',/¢~ ~¢~u' tf~120 Pump Set At 178 r 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 N, To Nearest Sewer Service Line on Lot Water Sample Collected by r~/,cf'~,, Water Sample Test Results Sanitary Seal on Casing (Y/N) '¢ Depression Around Wellhead (Y/N) h/ PC ¢.c., ; On Adjoining Lots Io¢" ¢-¢ c,o. ; On Adjoining Lots To Nearest Public Sewer ~ ~c~ ; Date Comments SEPTIC/HOLDING TANK DATA Date Installed 5-/$1 / 7 '/' Size I ~ ~',~( No. of Compartments Standpipes (Y/N) Y' Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped I / l¢' /90 Pumping/Maintenance Contact on File (Y/N). N, · ; for /~f'~' Holding Tank High-Water Alarm (Y/N) N./I-. Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well lC"?" ,c~,, ~. ¢,. To Building Foundation /7 / To Property Line 8Y~ To Disposal Field To Water Main/Service Line ~> ~,F ~ To Stream, Pond, Lake or Major Drainage Course ~ f 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata [)ate Installed 'T/ ~l / ? y Width of Field 16 ' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test '/t5',¢'~,~ ,~ Type of System Design Length of Field / ? t Depth of Field h~ Gravel Bed Thickness 5' ~ Sta)~hdpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well Icg' 'Fo Building Foundation Lot 'FO Water Main/Service Line 'Fo Stream, Pond, Lake, or Major Drainage Course 'Fo Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ~ ~o ' To Existing or Abandoned System on ; On Adjoining Lots ~ 3'0 ' To Cutback (if present) _ D, LIFT STATION N, A, Date Installed 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) Pumping 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, c,~Cl~.~?~Z~rl~ffect on the date of this inspection. ~?;:.... 0,~... ?t ¢,¢_~ ~/ ~ ~' ~Englneer's Seal Date ~ (~ ~¢ ¢¢ ~D~.,~,.~t~...,.,,,,. MOA No. ~_~ % ". ~H~o~o~E ~. ¢,~oo~: N ~.. · ,~ ....... Receipt NO, ~/¢~/ Receipt NO. *~¢ of . ment /-/¢-¢b ¢ W iver Amount: $ /~ a~ , Date of Payment 72-026 (Rev. 7/88)Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. / ~~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~,,~~,~ FEDERAL TAX ID # 92-0040440 ANALY$IZ REPORT BY 3A~PLE for Work Order $ 19170 Date Report ?xlnted: JAN 10 90 @ 11:18 Clisnt Sample )iD:L2 B6 S LAKEWOOD }{ILLS O/S SPIGOT PWSID :UA Colleen. ed JAN $ 90 ~ hrs. Boceive~ J~}] 5 90 ~ 16:30 Preserved with :A~ ~EQUIB~D Client }lam P.O,$ NONE RECEIVED Ordered By Analysis Completed :JAI{ 6 90 Send Reports to: Laboratory Supez\,l~o~ '.~EPHgN C. ZDE lJEE~TOP TECHt~ICAL SRV / Chomlab Ref ~; 9123 Lab S3~pl ID: 3 l~atrix: ~ATER Aliowabl* Parameter T~tc-d ~*~ult U~it ~ 14e ~hod Li~it s NITP, ATE- ~I 0.!0 r~/1 EPA 353.2 10 gmaark~: SAgFLE COLLBCTED BY ~.F. le~t~ Periorm*d * Sea Special instructions Above UA=Unavai!able Non~ Detected "See Sample Remarks Above Not ~nalyzed L~:Le~s Than, GT:Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC~ TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PRIVATE WATER SYSTEM Name Phone No, Mailing Address City State Mo. Day Year Zip Code SAMPLE TYPE: [] Routine E] Check Sample (for routine with lab ret. no. [] Special Purpose sample ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 21 I 31 I "1 I 51 I Time Collected Collected -, By TO BE COMPLETED BY LABORATORY Date Received Time Received Analytical Method: Analysis shows this Water SAMPLE to be: ~. Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. ~ /7~'~ Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* 9125 ~ I ,~lyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB Final Membrane F~~ Report e ~BY'~___.~ ~ TNTC = Too Numberous To Count OB = Other Bacteria BGB Time: PART ONE OF TWO REMAINDER TO FOLLOW Collform/100m! Collform/lOOml ~ FLATTOP TECHNICA~SERVICES -- ~'f_ff/ /~/~.//'..~....,. 14530 Echo St., Auchorage, AK 99516 ,J-'-.x~"--~' ' '*--'~'"~- Ph. (907) 345-1355 ADEQUACY TEST DATA SHEET Legal Description: LoF ~, r31octv~/ S~. Lct&e~,.-,o,:~' Street Address: It' 00~ ~c~4fi Client Name: ~mm~,/ Test Date: f/~ ~ TeSted By: Initial Conditions: Float #1 in c..oaz~d~ C,O, Float #3 .in set "b.t.o.. "pipe w. fluid Float #4 in set--" b.t.o. " pipe w.--"' fluid Water added through: set 13-~" b.t.o. ~-Z" pipe w. %¥ " fluid /& set 7~" b.t.o. 2~'" pipe w. ,~-Z" fluid ~-~ ACTION TIME H20 METER NET. GAL WELL FLUID LEVEL TAKEN LEVEL ~'~,~.~./¢ ~ __ o -tt q ' q7 ~ -- -- ez~ -- Adequate for ~ + Bdrms Measured Well Yield Unit Absorption Capacity =-'7'£'~P'~"f~,,-' - _- 3~,' Surge Capacity = Average Absorption Rate = ~';~ -Zq,----~.~ =~o~$~Adequate. for ~ Bdrms MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Data GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) I.~.t' ~ tg(oct'r 6"~ .Co. t. alreto,,oo( I¢,lt.r ~/.c, Location {aOOress or directions) (b) Applicant Name ~o~.r'~ ~m~ Telephone: Home 3 ~- (c) Business ApplicantAddress '1(,000 R,~er~ l~. /¢~1c6of'~¢,~ ~ 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 [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] 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; Page 1 of 2 72-025 (11184) 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, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wast~water 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 J~i'~ '~(~ Address / u/.5-.3 (7 t~-C40 .~¢ rw'C,~' Telephone ,.4-,,c4o,-,T~,e., xS~' Engineer's Seal Approved for bedrooms ;;; rrn~V;;c o n c ~l~o~al Approva~isappr°ved~ ' Conditional 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANC~KLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 I~NVIRONMENTAL PROTECTION Legal Description: ~o~ MAR 3 ,198 WELLDATA RECEIVED Well-Classification ~'r~ u~-'~'~' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~ Date Completed 1.9 ?~ Yield Total ~'-l"Z~'.a'e~ Cased to ~ 1~7' Depth of Grouting ~- Depm ~e~ Static Water Level I ~ 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 ~1, ,4. Water Sampie Collected by Water Sample Test Results .~,~'t~,,,'~C~y Pump Set At ~, Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~' i00 ' lO~"¢ec~ On Adjoining Lots '~' tOO' To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ;~/17 B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) ~ 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 IO.q ~ TO Property Line :2~ ~O~ TO Water Main/Service Line ~' ~, Course ~ t No. of Compartments t Foundation Cleanout (Y/N) Date Last Pumped '~/P-I /"~' ; for H,~, Temporary Holding Tank Permit (Y/N) To Building Foundation 1'7¢ To Disposal Field ~* (_31~ .~e~.~ C.o.~S'~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~'/~3~,"~ Type of System Design ~'i'~ Length of Field I ? ~ Depth of Field fl' Gravel Bed Thickness ~' ' Standpipes Present (Y/N) ~ Date of Last Adequacy Test -~ //~ ¢'~' Separation Distance from Absorption Field: To Water-Supply Well I0'i ~ .~¢'~,,'~ ~, o, To Property Line ~_ To Building Foundation ~¢ ¢ To Existing or Abandoned System on Lot N~, ; On Adjoining Lots ~ ;~ ~ To Water Main/Service Line /~1, A. To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~. ~'o¢ ' To Driveway, Parking Area, or Vehicle Storage Area ~ ~ Comments ~/'~0(- (~o,~! ~ $~ /¢',F ~ ~'+ ~toc~e¢- ¢.~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~_'~.,"~'~'~-~ ~'. ~ Date Company ~(~-~¢'~ ~c~¢~¢~/' ~'¢~' MOA No. Date of Payment _~ °'~t~(- ~, Amount: $ Page 2 of 2 72 026 (1~/84) Seal NORTHERN TESTING LABURATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASKA 99701 907-479-3115 6957 OLD SEWARD HIGHWAY, SUITE 101 ANCHORAGE, ALASKA, 99518 g07-349-8623 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT I~, PRIVATE WATER SYSTEM Mailing Add ess State Zip Code SAMPLE DATE: ~, i? c~' Phone ~' '~'~' - t-~5-- MO, Day Year Purchase Order No. SAMPLE TYPE: {~ Routine [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. Sample Time NO. Location Collected [] Treated Water ~' Untreated Water 3 4 5 6 7 8 9 10 SignatureofRepresentative ~~ ~"~/~"~'~ FOR LABORATORY USE ONLY CASH CHARGE PREPAID TRANSMII~AL SPECIAL INSTRUCTIONS MAIL TO BE COMPLETED BY LABORATORY Received at: [~Anch. [] Fbks. Date Received ~/7I~¢ Time Received ~ ~/Z/~ Next Sample Due COMMENTS: SATISFACTORY ~ UNSATISFACTORY U RESAMPLE R OTHER BACTERIA OB TOO NUMEROUS TNTC TO COUNT Direct Verification Final Count LSB BGB Resutt* *No. of T~;,t~al Coliform Colonies per 100 mis. Time GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C' Street, Anchorage, Alaska 99503 274-4561 ~~ Date Received 2' REQUEST FOR APPROVAL OF 1. Approval requested by: Mailing Address: 2. Property Owner: INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Mailing Address: . . ..- 3. L e.ga~_l nD e~crip~o~l.:. _~ .~L.,~ ,2~ /~ ~ ~ ~ 5. Type of facilit3~ ~6 B~e inspected ~' /re. ~. No. of bedrooms Well Data: A. Type~ B. Depth C. Constructio~ ~ ~ ~ D. Bacterial Analysis Sewage Disposal System: A. Installed /~¢" C. Septic Tank: 1. Size Installer 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2~ Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer Lines B. Foundation to septic tank ~ , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page ] of two pages · Page~2~f two pages - Re~'st for Approval of Individual /~'~'er & Water Facilities Lega!' Description Comments Approved ~ ~, ~isapproved Da~e ~/~,4~ / 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/'~, Dater EQ-034 (l/74) 3330 GREATER ANCHORAGE AREA BOROUGH-.. Department of Environmental Quality "C'~ St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type 2. Property Owner: Mai-ling Address: 3. Name of Buyer: Mailing Address: of Inspection: CMRO VA FHA ~-~x~y'~z~- 4~ ~ ~] Day CONV v/ Phone.~m. ~ ~- Day Phone 4. Name of Lending Institution: Mailing Address: Phone 5. Name of Realtor or.Agent: Mailing Address: Phone o o Location: /~ Type of Facility to be inspected: ~/~:/~ No. Bdrms..~ Water Supply TYpe of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well / Sewage Disposal System Type of System: Public Utility Individual If Individual, date of installation_ (on-site) EQ-037 (l/74) DEPARTMENT OF ~EALTN AND SOCIAL SD. DIVISION-O~PUBLIC HEALTH INDIVIDUAL ~AND SEMI-PUBLIC BACTERIOLOG I CA [.-WATER ~DIVIDUAL ~ 'SEMI PUBLIC [] CHLORtNE RESIDUAL PPM ', CITY .r . ~'.- ZIPCODE ' ADDRESS COMPLETE THIS SECTION -~"~ ' ONLY IF WATER IS AN INDIVIDUAL SUPPLY . DATBCOLEECTED, ~ ' : Z j T S~ TIMECOLLECTR[~ . ' %] ~'~ Som~)leCo~lected From I~ K,lc~enTo~) [] BathroomJo~ ' ~ ........ tTo~ Asbe ~s,~- [] Yes Well- [] Dug [] DriVer 0 )dll~d ' [] Bored SOURCE []] Spnng [] Cistern 00lner · Walls-- [] Wood · [] Concrete E Meta O.Tile 0 BriSker LOCATION: [] In Basemem or Other Dra,nage Pi~,eC~' READ NSTRUCTIONS A-NA'LYSIS OFFICE []]] Un[btisfa~lorv SANITARIAN'S REMARKS ON. REVERSE SIDE BEFORE /\ COLLECTING SAMPLE [] Roar% '. : 06 1220 (bi BA6rERIOLOGICAL WATER ANALYSIS RECORD Dole Received ~/./ /'~'~./~'~ ~-- TlmeReceiveO Lactose Broth ~ % ~. 1 Otc 1 Oct 1 gcc 1 Oct .10cc I .Oct I .Oct 24 Hours "' x' EMB ~'~'~' ~'~' AGAR Loc[oSe BFolh 2~ hfs . 48 r~F5 Gram 1 ............. dl~a les Coliform ~ s~s to~¢ C Absent ~,