The URL can be used to link to this page

Home My WebLink AboutSPENDLOVE VIEW HEIGHTS #2 BLK 4 LT 6 Municipality of Anchorage Page I of 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: ~,/q¢50.5~(~ PIDNumber: 01'7~o1~ Name: ~'T'~v~ ~. ~'~t,4 ~t~--V~ Wastewater System: D New ~ Upgrade Address: · ~s~ ABSORPTION FIELD Phone: ~ ~ ~ ~ of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: Total eepth from original grade: 0,~ GPD/Sq. Ft. Subdiv~ion: Depth to pips bottom Irom original grade: ' Gravel depth beneath pipe Lot:,. ~ Block:~ ~LO~ V,~ fffS¢~ S' ~' Ft. Township: Range: Section: Fill added above original grade: Gravel length: I~ WELL: ~l~Tl~ ~ New ~ Upgrade Gravelwidth: ~ I Number of lines: Oistance between lines: Ft. ~ I ~ Ft, Classification (Private, A,B,C): Total Depth: ~ Total absorption are~ Pipe material: Driller: ~e Drilled: Static Water Level: Installer: Date installed: Y~ Pump Set at: Casing ~eighl Above Ground: .~ .,. ~,. TANK SEPARATION DISTANCES ~eptic g Holding ~ S,T,E.P. To Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~~ ~ Well- ~ I$d' _ ~ ~ ~ Material: ~ Number°fC°mp~rtments: Surface ~_ Water ~0o I0o~ ~ --- LIFTSTATION Lot ~ ~ ~ .... Size in gallons: Manufacturer: Line ~ Foundation ~0~ ~ ~ ~ "Pump on" level at: "Pump o~water alarm at: Remarks: ~ ~,~' T'~¢ ~ 7~-~ ~ ~'~ BENCH MARK Location and Description: Assumed Elevation: Ioo.o Ft, ENGI~L Inspections performed~4~¢¢ m.¢~ L~ ~,a. No. 204Dates: 1st I I- ~ - ~ Eagle River, Alaske 99517 2nd ~ t- q ~ ~5' ~ m,~ ROBERT C. COWAN Department of Healt~d Hu~ Services approval '*i, 'aA''e~;,,., ' . ....,,.: Reviewed and approved by ~ -~ Date' /z ~[~, *¥~,.~,,,' 72-013 (Rev. 9/91) MOA 25 SW950336 2 2 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 LOT 6, BLOCK 4, SPENDLOVE VIEW HEIGHTS #2 01740129 Legal Description: PID No.: ST1 ST2 /-FINAL 93.8 99.7' /GRADE ~ NAL GRADE~ ! ~96 O' NEW ~ ~ 95.1'~ 1 500 GAL 9zL)' SEI 'TIC TANK 9 ).3 1 500 GALm 9-28- )5 3RAVEL DF:iV ~)/WELL 72-013 A (Rev. 9/91) MOA 25 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:SW950336 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:STEENMEYER STEVEN M OWNER ADDRESS:13101 STEMP CIR ANCHORAGE, AK 99516 DATE ISSUED:10/ll/95 EXPIRATION DATE:10/ll/96 PARCEL ID:01740129 LEGAL DESCRIPTION: SPENDLOVE VIEW HEIGHTS #2 BLK 4 LT 6 LOT SIZE: 49257 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 3~3-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL OHLY 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: DATE: HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN 801L TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, RE. ROBERTA. SHAFER, P.E. October 3, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 6, Block 4, Spendlove Heights S/D %2 Request you issue a permit to upgrade the septic system serving the five bedroom house on the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring 'tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER, ALASKA 99577 50' SITE PLAN i . ~ :7~...,,. ..... ~.~ ~-~'-.., ., STEMP CR.~ ~ o UPGRADE , / Fr] <: Fr'l ~m ._, ~> ~,N o= zo ~oo o~mO .' ../ 0 ; .~ i ~ '+.','.~, >W~I~* Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 82,5 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST LEGAL DESCRi TION: Township, Range, Section: 10 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER ENCOUNTERED? sI IF YES, AT WHAT ~ O[ DEPTH? p Depth t0 Water After DA ¥ Moniloring? - Date: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ 7 C %._ TEST RUN t3ETWEEN (minutes/~nch) PERC HOLE DIAMETER __ FT AND -/ ;/'~ FT 17034 Eigle River Loep RoadJ~e.204,., ACCORDANCE WITI~rJ~.~,,z~i~P~ GUIDELii~-b ,'~ EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/851 ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 6, Block 4, Spendlove Heights S/D ~2 October 3, 1995 GENERAL: 1. De The scope of this project includes the installation of a 1500 gallon septic tank and two five foot wide drainfields to serve the existing five bedroom residence on the referenced property. The existing septic tank is to be excavated, pumped, crushed, and abandoned completely. The existing leachfield is to be abandoned in place. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 6, Block 4, Spendlove Heights S/D I~2 October 3, 1995 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement· Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This J.s equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 6, Block 4, Spendlove Heights S/D $2 October 3, 1995 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling° MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T_y~pe of Pip_9 Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM FS10 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 6, Block 4, Spendlove Heights S/D #2 October 3, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with 'hhe installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect 'the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 6, Block 4, Spendlove Heights S/D It2 October 3, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196660 Anchorage, Alaska 99519-6660 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. ' GENERAL INFORMATION . Complete legal description Lot ~; Block 4; Sp~ndlov~H~ights #2 ; ,::, Location (s~te address or directions) I$ I 01 St~mp ~, _~, ,, ~- -~, ' ,~,~.-i,..~..,,' ~, . ..... . ,r Anchoraq~, AK · ~ .':;,~.-- · -~, ...'-~ Prope~y owne~, St~ven ~ Ti~ St~ ~ :~' ~;~ -.-,::, Mailing address: ?.0. ~o~ 11~55Z A~o~g~, AK Day phone 345-6296 99511 Day phone Day phone ' NOTE: L: If communi~ well system, provide wri~en confi~ation from State ADEC affest- 4. TYPE OF WASTEWATER DISPOSAL: . -. ':~ ,-:,~ .~,..'~ ~./ '~!- ~.- · :"-~ , L,~:,:-"-.'-.';:',-'~':'~:~:~?:'~.:lndividual on-site - ' ' -~' --~ Holding tank ':'' : . ' 't'.'* :'Community_ on-site ,.. ........ Public sewer ·NOTEi' If community wastewater system, provide written confirmation f/'°m State ADEC attesting to the legality and status of system. ' ~ ' ' ' · 72-4:)25 (Rev, 1/91) Front MOA I~21 STATEMENT OF INSPECTION BY ENGINEER _ As certified bymy 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 inves.ti=qation 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. Nameof Firm Address Engineer's signature S & S ENGINEERING J~O,~4 '"agra River Loap Road No, 204 Eagle River, Alaska 99577 "phor~e ~'~¥ -~-~ 7~/ Date h //c /~/J-' .... DHHS SIGNATURE ' '~ Appr6~'for * ~"' b~rooms.: ....................... ' ' ' ' ~., '- Disapproved. _-. ,,,;.,.:,~,. ...... :.Conditional approval for '"'- .... :;b~rooms, With-the' following stipulations: ........... . ......... ....... ', ~;;-..; ....... , The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.- "~' ' ', ~; ' ' ' *'., '. ' ' 72-025 (Rev, 1/91) ~ack MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Dcscriptioa: /_or/~, E,t,a,~, ~ ~F,~'No~.owr V~.~ro,~ t'~r~ ~ ,~ Parcel I.D.: A. WELL DATA Well type "~'P-.~ v~'r~ IfA, B, or C, attach ADEC letter. ADEC water systetn nmnber Log present (Y(~ _~O Total deptb 'o/t/--_ Date colnplcted Cased to '0/1z~ Casing height (above ground) Sanitary seal Wires properly protected (Y/~ t,,Jo Date of test FROM WELL LOG AT INSPECTION Static water level u [ g Well production WATER SAMPLE ~S~TS: g.p.m. g.p.m. Coliform 0 Date of sample: I1 /2.- l/ q,.q~ B~'IOLD1NG TANK DATA Nitrate Collected by: Other bacteria O 17034 Eagle River Loop Read No, 2~ Eagle River, Alaska 99577 Date installed It- q~qG-~ Tat~k size I~-?~°~t' Nnmber of Compartments gZ Cleanouts Foundation clcanout ~) ~ Depression (Y~ ~ High ,vater alarm Date of Pumping ~- Pumper - ~ C. ABSORPTION FIELD DATA Date installed l t-q- Lengtb ~ ~q -r'~r~ Width Effective absorption' area Date of adequacy test ky"*, Soil rating ~r ft2Podrm) O .G, .Systcm type ¢zt4t~-ouJ-rO--~'~4"*t Gravel thickness below pipe ~-~' ~ Total depth ~ t Monitoring Tube prcsent(~N) t/e~ Depression over field (Y/~ 1"4/o Results (Pass/Fail) For bedromns Fluid dcptb in absorption field before test (itl.); ~-- hnmediately afier---'--~gal, water added (ill.): Fhfid depth ~ (ins.) Minutes later: .... Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date D. LIFT STATION Date installed Maohole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" ~ "Pump ofF' level at* *Daturtl E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: e(g~holding tank on lot Io ~ Absorption field on lot Public sewer main '-7~ Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/clcanout Lift station SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: Building foundation (,, o ~ Property liue {~ ~ Absorption field ~O ' Water maitqservice line lo 4-- Surface water/drainage Ioo .e Wells on adjacent lots too %- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation q Q Water maipdservice line Surface water ~ ~o -v Curtain draiu Mo~ /<~4ouoto Driveway, parking/vehicle storage area I t Wells on adjacent lots Ioo ', Property. line F. ENGINEER'S CERTIFICATION I certi~P that I have determined thrufield inspections cma review of Municipal recol~aOI]~ ~ ~ystems are in co,~)brmance with ~()~ H. Ld~uidelines m effect on this &te. Signature ~ augineer'sName ~oS~ar C. G,~,~ ~'~'~ Date 1t //6 / q ~ HAAFee $ ~DD z ~ Waiver Fees Date of Payment //~/ 7 -- ~ 3~ Date of Payment Receipt Number /~ &//Zh Receipt Nulnber Rev. 8/95 OSS: haa.wk.doc CT&E Environmental Services Inc, L a b o r a ~ o p/ D i v i $ i o n r_~'.,~ll.~'~#'~'~.~.~.,,~r~~.~,.~.,~,~,~,~,~: Water Analysis ~epon for Total Coliform Bactsria Anchorage, AK 99518.1605 /.V~TRO'CTIO.Y2 O.V ~I/E~ SIDE BEFO~ COL LfCTI. YG SA3'/PLE T~I: (~O7} ~2-23;3 II Send Results' ~ .Send .£'4 3 ,¢,.4., ,- ~,i.,¢. Send R~$uh& Q Send ln~'Oieg S.~'~fP bE DATE: ;Montl} S..\MPLE TS?E: Routine Repeat Snmple (for routine ~mple with lab roe no. .~) Special Purpose SA~LE LOCATION Year Water Untreated Water Time Collect'ed Collected By ' TO B~."COM?LETED B'~' LA.~OP._A. TO~\' .,.knalysi,-'. iho'.','s :his \',.'a.-'~r S.A~N,[pLE to be: Sad/~etor;,' Saff, p(~ ov~: 30 ho~rs old, :~suI~s ma2 new ~nmple via Special ddiv~ mail. D~'~ te Reeeh'ed Time R4eeived Analysis B,~gn n Method: r', M.',[O- MUG * Number oFcolonies/lO0 mi, Lnb Rcr. :",'o. Result* Analyst s,,,,,,,,,.~.~.c. (:..:c,.'t~b ~ .,u~ ........ ~ O *-.:',:: ~/~. Client notified of unsatlsfac/oo' results: ~axcd Pflon,.ed ..qpok,~ . BACTERIOLOGICA_L WAT£R .4aNA_LYSIS RECO[U) MMO-~DL'G P,e;ult: Total Coliform Membrane Filter: Direct Count (~ Colo,ir~/100 mi BGB COblFIR.H PA i'OF TWO M~mb~t of tho SGS Group {$o¢i~t~ G~p.Jral~ d~ Surveillance.) } GPS'ON ~TE~P69&06 *' BNIISB± qUID~BWNOD £0:9T ?~?I'l~'~i::~ CTS, E Environmental Se~'vlces Inc, WORK Ordmr 194B1 9rinte~ Date ].1/09/95 ~ 15:23 hrs. Collec~md Data 11/0~/9~ ~ 16:5~ hrs. Reeeivad Dat~ 11/0~/95 ~ 1]:1~ hrs. T~hnical Dire~gor ST]~DH~N C. EDE :!1~ !~eu\arka~ $~PLE COLLECTRD BY: BOB C. Q¢! Allowable ~x~, Anal , ~ ::~il',e c~ ~. Resul ~s Oual UI~i~m M~hod 'L ~.thl tk~ Date ~ ~:: t~-I~ 2,50 ~i~/5 ~DA 35~.2 10, 11/06/95 CI~R :: U~e~ached, Reported val~e ia ~ha practical q~antificatl~n li~l%, LT ~ Lea~ Than GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: ~z:~<--/~]]~ Mailing Address: ~ /~_~_. /~z~/~/d~/~x- Phone: 2. Property Owner: ~/~/~ ~~~ Phone: ~'~ Mailing Address: . 3. Legal Description: 5. Type of facility to be inspected 6. Well Data: No. of bedrooms A. Type f'/~:'/~'~--*~-'.~ B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: 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 t Distances: A. Well to: Septic tank /~-~z., Absorption area Nearest lot line~ ~/~ , Other contamination Sewer Lines B. Foundation to septic tank /~, Absorption area C. Absorption area to nearest lot line ~-?~ ×~ EQ-034 (1/74) Page 1 of two pages Page 2 of two:Pa.ges - R .st ar ApproVal of~Individuai ~er Water Facilities Legal DescriPti~on ~J ~, ~'~/~/~"~>~'~--~,, ~. ~ Comments ~ ' :~ i 'i [i' ~ ',:-. · 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~,~,~ S IGN~n ~-/?S'__-~-~--~~_- ..... Date EQ-os4 (1/74)