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HomeMy WebLinkAboutAMAZING GRACE LT 7Onsite File
Amazing Grace
Block
Lot 7
PID# 015-235-03
Formerly Straley Lots 6 & 7
/-/OLMA/V AVE.
al S 69a 58'15"E of
C0' 50�
al
R
W
8
N
`�C
a
2
Lot4y 5,6 7, .lock
Strayy Sub di ISIOn
Anchorage Re—carding District, Alaska
7/-175
LOT SURVEY CERTIFICATION
I hereby cerllfy teal I have eu"oled the propafy Shown end deeorlbee
hereon, and that the bnprwemenle situated maroon are within Ins prop-
erly lino and do not "or too or incroaah "ad Iaowl property and In al
na Improve name on adjacent property overlap a wer"Oh on IM promisee
M ,s"slloa and that there are no roadways, utility lines, Of of Mr visible
enumenle an Sold property Swept os Indicated berson.
car
1/6.100
1. Q I WELL
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LOT6
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it /O° UT/L.
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LOTS
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al
R
W
8
N
`�C
a
2
Lot4y 5,6 7, .lock
Strayy Sub di ISIOn
Anchorage Re—carding District, Alaska
7/-175
LOT SURVEY CERTIFICATION
I hereby cerllfy teal I have eu"oled the propafy Shown end deeorlbee
hereon, and that the bnprwemenle situated maroon are within Ins prop-
erly lino and do not "or too or incroaah "ad Iaowl property and In al
na Improve name on adjacent property overlap a wer"Oh on IM promisee
M ,s"slloa and that there are no roadways, utility lines, Of of Mr visible
enumenle an Sold property Swept os Indicated berson.
car
Q
At
p•O
R. L.Duna
rte•.• 15.119 •,.iii
laromenle of heard other than those Sha
the plat of record are got shown herean ant Is
,`AaFES$IONP� �r
otherwise noted.
LEGEND
IZ Brass or Aluminum capped monument recovered
O Iron pips and/or rebar recovered.
O 2 x 2 flub 6 tack recovered
• 5/8.1li z n rebar set this survey
Scale a_ r Date �y Prepared by: R. L. BUTTON
lXJ -09 -93 Registered Land Surveyor
(907)279-6200 519 W. Eighth Ave. Anchorage AtWer9A50/
Ref. 97 PO I F B. No. 4/ // I Pro% %ty�'*
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~,ddress
LEGAL DESCRIPTION
Township. Range, Section
[~EPTIC
Capacity in gallons
RO. ol GompadmCnls
TYP~E OF SYSTEM
[] TRENCH ~BED [] W. DRAIN [] OTHER
originaIDepth tOgradepipe bottom from 7/ /~ FT Total depth from original grade ~,~/~
Gravel depth beneath pipe
FT ~ ('~.
Gravel width
Distance between lines
Pipe material
puc_.
WELLS
Fin added above original grade
Gravel length
/~..~ FT
Total absorption area
Classilication (A,B,C)
[] OTHER (Identify)
DISTANCES
SEPTIC ABSORPTION
TANK FIELO
WELL
LOT LINE
WELL
,FOUNDATION
AS-BUILT DIAGRAM (Show Iocatio~ of wen, septic system, properly lines, foundation,
driveway, water bodies, etc.)
Installer Date Installed:
REMARKS:
72-013 (3/85)
I I'
(].n,,~r~er. lqamI.?=' '!'OH
[h/,ff'le:H'" {'i(::[(:Jl"i:2!iTi!iB:', ?~Sz:J,C) I'iUFI:::H('dq
:[)ay
'~:.:!~lil.:: mt,i!~!.t l'lav~-5! at. ]lea!!~'t. 2
T)t::?i::,'It.h 't,o t.I::)p of ?,ei::i'L :i c: '[',.,~trfl,::(~-;) 'C 4.~0
E':X :l;li}'l':il',[(::i ['l[il.r[):[l~i[5 '[ABII::: HUE;T' BE: PtlI¥1F:'[:!iD ~':'ihlD F:l[..i...li~:i:;' WITH S('qq.C) OR
CFIU!!:;Hiii:D. DE:V :[ (~i' :!: ii:IN I:::Fi'.[:IH IEtxtE} :i: t'a.'E:li[R ~ S D',!:S ]: BN F!Ei:i:~!U ]: IRi!i!:{:i DI-I!'IS (::fl::'P!::I[]VP,!
I:::'F:'~ :i; [)F:;', iD CCiN{i~ii:kLIC:T:[[iN,, IEXC(~V&'I':ICiIxiS HUB'I ['~[~: [)F:'ENI:3:)/E;I..(]SE:D 'IHIE
:1: [:lNi~ ,, ']'[I :[ ~ F'i~:RH :i: 'I :i: l~i FOR f~ 4 Fq~:DF?.C) OM ~:'~ ,, F, RIZ~ ]: DE]XlCE~ ONLY ~, ~ql'~lD
]: C.t3;kl :[ F:Y FH,"a'[ :
.3,, :[ t~:i.:!.], ar:!lti~l"~:) i'.o a:l,i. I~!Ci(I al-icl
cJ J, 55'~,o,t'lcz~'e~B { pl:)f/i any e:<
?:i i. g rmx:l
[ !!im;uc.x.:l l'~y
./
. ~unicipality of Anchocage
DE~ARTfd~NT OF iqEAETH A HUMAN SER'd
825 "L" StroeL Anchorage. AlasRa
SOILS LOG -- PERCOLATION
Township. Range, Section:
6-
8
9
10
14-
15-
17-
18
19
20-
- ~ ~-~, .,~
~,'u .~ ~/'
~*:'~. ~'t''~ ' ~. ~ ~ , I
I
:.SEWER. SYSTEM"LOCATION PLAN.
· IIF I1~ / <'F~/ I T~ ACCURA~ OF LOCATION OF EXISTING
~= ~' ~ ~ ' NORTH ~dC.- I DIMENSIONS ["DICATEO HAVE BEEN
BK020 t.-/~ 9'/0
M~JNICIPALITY OF
DEPT. OF HEALTH
t NVI:~ONMENTAL PRO[EC~C~
APR 6 19~
RECEIVED
ANCHORAGE
DISTRICT
REQUESTED BY
'90 FIE'P, '6 PFI 1 5?
Whereas, Lots
Jointly owned by
District.
EASEMENT DEDICATION
and 7, Block 1, Straley Subdivision are
~r. Tom Leyden ~n the Anchorage Recording
Lot 7, Blo~k l, Stralsy Subdivision is hereby set aside for
the purpose of a wa~tewater disposal area for Lot 6, Block 1,
Straley s~bdivision until such time as there is no longer any
need for such use by the owner of Lot 6 referenced above.
The owner of Lot 6, Block 1, Straley ubdivmszon shall have
the right to utilize Lot 7, Block 1, Straley Subdivision for
wastewater disposal and Lot 6, Block 1, Straley Subdivision
cannot be sold without Lot 7, Block 1, Straley Subdivision
until such time as alternate Wastewater systems are installed
to provide Other service to Lot 6, Block 1, Straley Subdivision.
Tbis,dQcument has been e.xecuted and agreed to this ~ day
of _/~ ~ /9 q0 , 1990 in the Anchorage Recording ulstrict,
Anch6rage, 'A'la~ka.
m L~ydon
Anchorage, Alaska
Subscribed and sworn to before me, in my presence, this ~~
day of _ ~ , 1990, a Notal~f Public in and for the
State of Alaska.
un ¢ipmhtYo
Anchorage
P.o. 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
March 13, 1987
Edgar J. Muhlhauser
% Active Realty
2217 East Tudor Road
Anchorage, Alaska 99507
Subject: Lot 6 Straley Subdivision
On-site Sewer Permit #860059
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of February 26, 1987.
Your permit expired on the date of issue basis by authority of Municipal
Ordinance existing at that time. A new permit must be obtained from this
Department for any well and/or on-site sewer system not installed by the
expiration date. The new permit will come under the calendar expiration
date as per the new Wastewater Ordinance (effective May 20, 1986).
If you have drilled the well, a well log needs to be sent to this Department
for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as-built.inspection repprt (three part form) must be sent to this
office for review and approval, and for documentation.
If there are any further questions, please call this office at 343-4744.
Program Manager
On-site Services
RWR/ljw
enc: copy of permit
i:::!i~ t:;;J1 ]ilI
C/O P:C:ll :I]¥'E FIiEi?~II/IIy
TED JOHNSON, P.E., L.S.
3121 Sleeping Lady Lane
Anchorage, Alaska 99515
(907) 349-5304
February 10, 1986
Municipality o£ Anchorage
Health and Environmental Protection
Environmental Health Division
825 L Street
Anchorage, AK
Sub~:
Straley Subdivision, Lot 6
Gentlemen:
Mr. Edgar J. Muhlhauser, the owner of sub3ect lot, requested
that I perform a Health Authority Approval (HAA) on the septic
system located on that lot. My investigation revealed that the
system would not meet current requirements and that, futhermore,
the soils were inadequate to support a septic system that would
meet current criteria.
Excavations were made on the subject lot as well ss ad3oining
'lots in an'effort to find a suitable site for a septic system.
The soils unifornally fell in the GM and SM classifications. A
falling head percolation teat was attempted to confirm the visual
anelyeis end the percolation rate was negligible, Further
permembility tests on moil samples confirmed this reeult.
My professional opinion is that the only system suitable for this
mite is a holding tank system. A design of e suitable system is
enclomed for your approval,
Should you have any questions,
~ · :" '_' ................
please do not hemitete to contact
t4 0 L M ~ t4
SEPTIC SY'~TEIq FOR LOT Um ~ STRt~L6Y ,gUBOIVI$10t, I
( ROTO- FLOAT )
AIOT~= :
$~PTI¢ SYST~:M FOP~ tOT
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 FOR A SINGLE FAMILY DWELLING
Parcel I.D.# C~/~c'' ~-~[~ ~//~?_- HAA#
1. GENERAL INFORMATION
Oomplete
legal
description
Location (site address or directions)
Prol~e'rty Owner '~t
M~ilin~ ~ddres~
Lending agency
Mailing'address
Agent
Address
Day phone
Day phone
Day phone
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 (R~. 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.
Name of Firm'-"-~&cu,uor¢~ /_a.~'.
Address
Engineer's signature~<~~
Phone
Date
DHH8 SIGNATURE
L/~ Approved for /2-~ (/'/2.. bedrooms. " . ~
Disapproved.
Conditional approval for
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 DH HS 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.
Municipality of AnchorageF C E IV E D
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUL 1 6 1999
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
viud~c~pahty ut Ancl~orage
Oept, Health & Human Serv ce$
Health Authority Approval Checklist
Legal Description: ~-~
A. WELL DATA
Well
Log present (Y/N) ~ Date completed
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected (Y/N)
Date of test
Static water level
FROM WELL LOG
AT INSPECTION
-2.0/
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform '-" ~
Date of sample: ~-/(~['~'
Nitrate
t/, ~ -~ Other bacteria
Collected by~'~ -------
B. SEPTIC/HOLDING TANK DATA
Date installed z-//'2,3 / ~'O Tank size
Foundation cleanout (Y/N) ~
l'Z.5" C) Number of Compartments ~_ Cleanouts (Y/N) "~
Depression (Y/N) ~ High water alarm (Y/N)
Date of Pumping ' ~/'~'/~W Pumper
C. ABSORPTION FIELDDATA
Date installed ~/~-~,/~ ~)
Length -~"}~) Width
Soil rating (g.p.d,/fF or~ ~-~ c~ System type
~- ~ Gravel thickness below pipe ~ ,,-~- Total depth
Effective absorption area /N~) Monitoring Tube present (Y/N) ~' Depression over field (Y/N) ~
Date of adequacy test 7~//o [~ '~ Results (Pass/Fail)~-~,~'3-~ For z/ bedrooms
Fluid depth in absorption field before test (in.); "b r~,,c' Immediately after ~ gal. water added (in.): ~
Fluid depth'~¥ (ins) Minutes later: /z./~ Absorption rate = ~'~c~4~ g.p.d.
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
72-026 (Re~/. 3/96)* : '
D. LIFT STATION
Date installed ~
Manhole/Access (Y/N) ~ ~evel at*
High water alarm level ~ *Datum
E. SEPARATION DISTANCES
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot ? Z-¢' c
Public sewer main /v//A
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer/septic service line
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~ q ¢
Water main/service line
Property line / o' Absorption field
Surface water/drainage l¢o"~- .Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line /~' Building foundation c~'z¢ Water main/service line
Surface water /c'(-2''~ Driveway, parking/vehicle storage area
Curtain drain / ~'0-f- Wells on adjacent lots '/~'c~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
ENGINEER'S CERTIFICATION
I certify that l have determined thru field inspections and review of Municipal reco~~yste~; are
in conformance with MOA HAA guidelines in effect on this date. ~~.~,,~.,,~..'
Engineer's' Name
:- ..
Waiver Fee $
Date of Payment
Receipt Number
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
ParcelI.D.~)/,'~''-
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Day phone
Day phone
Mailing address
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: -/
TYPE OF WATER SUPPLY:
Individual well J
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;
79-025 (Rev. 1/91) Front MOA f~91
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.
Name of Firm '~''O b b''~'~
Address ~0
Engineer's signatu:e ~I ~~ Date ~//~ 3
· ..-~,:?:~, · .
'
.. /?,..:, .; ..
DHHS SIGNATURE
~ Approved for ~z*-~) bedrooms.
Disapproved.
Conditional approval for 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 engineeCs work.
72~)25 (Rev, I/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal
Description:
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
Parcel I.D.
FROM WELL LOG
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to /(¢ J {- Casing height
'~ Wires properly protected (Y/N)
AT INSPECTION
.g.p.m. ~ ~
iCJNIC!?AI.ITY OF AI,~HOJU~.(~
ENVIRONMENTAL SERVI¢S DIVISION
g'J CEIVJ D
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot (
Public sewer main
Sewer service line ~
.On adjacentlots } 1,~.~ 4c, ~-t.~--~','~
; On adjacent lots ~ ]~ ~ ~' j '3 0
Public sewer manhole/cleanout ~//-~
Petroleum tank 'J~ O ~
WATER SAMPLE RESULTS:
Coliform ¢ Nitrate
Date of sample: /~"~i~'P~J" ~ ~
B. SEPTIC/HOLDING TANK DATA
Date installed Tank size
Cleanouts (Y/N) '~/" Foundation cleanout (Y/N)
High water alarm (Y/N)-~/ )~/J¢
Date of pumping ~.0/?~ /0 L~ '
( Other bacteria
Collected by:
Compartments
/ ~' Depression (Y/N)
Alarm tested (Y/N)
Pumper ~'~'tSZ{)~ ~'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot J ,~:LO
TO property line /ML-j.~
Surface water/drainage
'>/2. ~
On adjacent lots
Absorption field
Foundation 70 --
Water main/service line
72-026 (3/93)* Front CONTINUED ON SACK PAGE
C.. T STATION NO h-I
Date installed
Manufacturer
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed %~/¢/t~)
Length ¢','2 C~
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft~)
System type
Width ~ b¢~ Gravel thickness ~o ' [ Total depth
~ ~/ L~1~2 Cleanout present (Y/N) '~'(.~. Depression over field (Y/N)
§¢ ~ -% Results (pass/fail) '~ for
~ After test
H If yes, give date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /~.2~- 0 ~'
To building foundation
On adjacent lots
..~ ? ~-~:
On adjacent lots ,~,.¢..c.¢~ Property line
('~ (~-) '~ To existing or abandoned system on lot
Cutbank J'"~ ~/-~.~...~ Water main/service line
Surface water
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec¢ ~n the date of this inspection.
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~
Date Received
Time of Inspection
~ f~, Date of Inspection
1. Approval requested by:
2. Prop. erty.Owner: ~~ ~ Phone:
6. Well Data:
B. Depth / ~ /
D, Bacterial Analysis
A. Type ~
(
C. Construction (~// ~.~-?~:.~'~-
Sewage Disposal System:
A. Installed /y ?/
C. Septic Tank: I.
D. Seepage Pit: 1.
/
Size / ~-o ~ ~,,,~ 2. Manufacturer
Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines
Nearest lot line
, Other contamination
B. Foundation to septic tank
, Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Request for Approval
l~e~al Description
of Individual S~.~..r & Water Facilities
Comments ~ /-~ ~ ~
Approved
Disapproved~ ~. ~_~ate
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
'GREATER ANCHORAGE AREi~ BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of Inspection: .CMRO __ VA FHA CONV _~
Property Owner: ~.~ ~, ~'
Mailing Address: ~_.T2~y~y~ /~/~ ~/~/ Day Phone ~/ °?J~ i"
Name of Buyer: ~-~ ~ ~/~/~- ~]~ . !.
Mailing Address:
Name of Lending Institution:
Da~ Phone
Mailing Address: Phone
5. Name of Realtor or Agent: //C~__~/~_~-~-,~_] /~/Y~~,~.~
Location: ~ ~Z~- (/~-~ ~ ~-~/~ ~Y~
7. Type of Facility to be inspected: ~t~~' No. Bdrms. J--
8. 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 S~stem: Public Utility Individual
If Individual, date of installation
(on-site)
~Page 2 of two pages - Re t for Approval of Individual S~ .:er & Water Facilities
~egal Description ?' ~ ~- '
Comments
Approved
Disapproved Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are opera ti ng?s~ti sfactori 1 y.
S i G N E D ~. "~.~.2,,~;,..~..~_~//~, ~ ~? Date ~f/'x~
EQ-034 (1/74) ~//
0 0
'7
G
©
/IK~, oo
-2
p101,0-,-(~ ~[lI.d
IS ~ed grace
~lou plat.
L, EGEr';O :'
Bross Cop t,fonument
Iron Pipe
Survoy Hub a Tack
REVISIOn'IS