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HomeMy WebLinkAboutT15N R1W SEC 5 LT 95Onsite File T15N R1W Section 5 Lot 95 #051-082-03 Municipality of Anchorage On-Site Water and Wastewater Section * (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP1 91500 PID Number: 05108203 Dwelling: RM Single Family (SF) F1 with ADU F-1 Duplex (D) El Two Single Family Project, F1 New ❑ Upgrade Name Sarvela ABSORPTION FIELD ❑ Deep Trench X Wide Trench E3 Bed C3 Mound Site Address 21020 Alluvial Dr El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 841-2047 14 1.2 GPOW1 7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5 Fd JGravel depth beneath pipe 2 Ft. Subdivision Block Lot 95 Fill added above original grade 0.5 Ft.1 lGravel length 71 Ft. Township Range Section 15N 1W 5 Gravel width 5 Ft.1 Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic 1 Absorption Holding i Sewer Total absorption area lNumber of trenches Dist. between trenches Lift Station From Tank Field Tank 3 Line 507 Ft2l 1 Well 100,+ 100'+ na na 1TANK 25+ It Septic 0 S.T.E.P. El Holding 0 Other Manufacturer Capacity Greer 1250 Gal. Surface Water 1001+ 00'+ n a na Material Number of cornpartm-ents; Lot Line 10'+ 10'+ na na NA Plastic Foundation 10'+ 10'+ na na LIFT STATION Manufacturer capacity Reeirtarks, Septic System Replacement Gal, Existing Sewice From House To dcol Alarm location Electrical installed by Installet PIPE House T rainfield D3034 d of to Dean Drainfield D3034 Co/MT D3034 BENCH MARK (Assumed elevation) 100 it Inspector Inspection 1,,11/12/19 11/13/19 Location and description dates- 2"' S" 41�1 Front Entry Deck ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF �h�4yy4 P� '`Q�� .49r.c* A sh" eng A cc—am i 2 /5/1 Septic Systemoa Approved Date Note: this approval does not include well permit requirements. �O F- °x Z � CD s jr, m �l „ �l o o� n D D o Z� N F F� C C F- --C) Cil D D z 70 70 n D D (OO 3 70 d d F F� r' 1 F-1 D o n -o r :33� z o A D F7 `.0 fTl z -0 ul n ave CD U p n Q H �M H o � z F9 Cil n ° F SCJ ry A D F9 Cil �° d3 C� o a < � d N 09 0 II t) A roQ- o W ON O � TI O P _0 c+ N P O h N M 50' ROW Reserve / 50' R eserve �a 0 h 0 m Ac m 30QV)V)Q Non ru-n n ri O mututaa 0s V ? 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On-Site Wastewater Disposal System Permit Permit Number: OSP191500 Effective Date: 11/7/2019 Work Type: Septic Upgrade Expiration Date: 11/6/2020 Tax Code Number: 05108203000 Site Legal Address: T15N R1W SEC 5 LT 95 G:1457 Site Mailing Address: 21020 ALLUVIAL ST, Chugiak Owner: SARVELA JOHN W & MARILYN Lot Size in Sq Ft: 108900 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: E Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The entire drainfield is not within the 30 ft radius of the percolation test. An additional percolation test is required prior to construction of the drainfield. If results require a design change, construction shall stop pending Onsite review and approval of a change order. Please submit results with the inspection report. Received By: 7-: i Date: // /7 Issued By: t`.CkV/I fi\ et, a / Date: iii MUNICIPALITY OF ANCHORAGE I• �` Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section '/ Fax:_907-343-7997 v�6i89� N� rami fi ON-SITE SEPTIC/WELL PERMIT APPLICATION a NOV 0 4 2019 Parcel I.D. 051-082-03 � Property owner(s) SARVELA JOHN Day phone 841-2 4 ' of . . 9 Mailing address 21020 Alluvial St Site address same Legal description (Sub'd., Block & Lot) T15N R1VV SEC 5 LT 95 Legal description (Township, Range & Section) Lot Size 108,900 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. � - e VE (Signature of propewner or authorized agent) Permit/Rush Fees: S13 Waiver Fees: Date of Payment: /440 7T� Date of Payment: Receipt Number: 0Q(�/�95U Receipt Number: Permit No. 3$Piq /5cb Waiver No. G\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc NICRTI- I M ENGINEERING SteveEng.com Steve Eng, PE, PH PO Box 770724, Eagle River AK 99577 907-694-7028 SteveEngPE@gmail.com Date: 11/2/19 Number of Pages: To: MOA On-Site Services Subject: T15N R1W Section 5 Lot 95 Septic System Upgrade The subject property has been served by a septic system for many years. The septic tank is to be decommissioned and a new tank/trench installed. The design calls for a new 70' long trench with new 1250 gallon septic tank. The entire subdivision is on private wells and septic systems. The terrain is flat with very slight slope toward Peters Creek in northeast. A new soil test is used for design. Groundwater was monitored at 11'below ground level. The soil below an upper level silty layer demonstrates a favorable perk rate. An additional perk test can be performed at construction if required. Please review the wastewater system design for the existing home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Ste \bTHI IV ENGINEERING SteveEng.com T15N R1W Section 5 Lot 95 SPECIFICATIONS& DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, single family home. This is a developed subdivision. This is a large lot in a neighborhood of large lots.No adverse impacts are expected from tank/trench upgrade.No conflicts to the other lots will take place by this septic system construction upgrade. A new soil test reveals sand(SP) w/gravel. An application rate of 1.2 GPD/FT2. Length=500 FT2/5'x 0.7= 70'trench(2' effective). Previous septic system undersized, so will not be utilized. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1250 gallon septic tank. Install Double Cleanouts. • Install new foundation cleanout/sewer service if required. • 10' minimum between the tank trench,tank to house. 10' to property lines, • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for 1' cover. • Tank& solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. Install Manway Riser in 1st Compartment. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be 'A inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric)to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron,PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2%slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) 04) * 9S 444/1. • Steven `•v En, d�eai-ROFEsc0- "' Septic I Area Alluvial Street Flat 4,, Slope 50' ROW Reserve 2 Flat c;34, Decommission Old Q,i See age Pit per UPC Slope \_ r 70.0-- New Trench \ 0 CO-. .. f.0 0TH M hatAlternate ite Slope MIIIIIIIIMI New 1250 Gallon N—septic Tank w/DCO's ----Decommission Old I Septic Tank Per UPC Septic I \ 4 Bdrm Area DESIGN NOTES: Fri I 1. New Trench Depth At 7'. R1oo.o 2. New 1250 Gallon Septic Tonk. 0 3. 3' Cover Or Insulate. Water Well 4. Lots Served by Private Water Wells. i C I 5. No Conflicts Within 200'. vin 6. Check Well Separation Prior To Construction. rr a! 7. Septic Tonk NOT Under Driveway. 0 I 3 I 8. Decommission Existing Tank/SP Per UPC. Water Welt c 9. Add DCO If No FCO. co Ln in Flat Slope I FlatFlat � Slope No Neighbor Conflicts / Slope I NORTHRIM _••'E` `k''�� 1• = 60' ENGINEERING �'�"` �. T15N R1W SECTION S SteveEng.com %" LOT 95 PLAN PO Box 770724 �i Eagle River Alaska 99577 7 19 % UPGRADE SEPTIC LAYOUT 1 907. 694. 7028 I IPF PA11r TANK /TPI Nf HI Dote'„, „,, 194Enj., • Foundation Cleanout / ri Tank Cleanouts Fin ^ate de Opposing Cleanouts Between Septic Tank & Trench 4'Cover or Equal Sewer Service 1250 Gallon MOA-Approved Septic Tank Solid Pipe Monitor Tube DESIGN NOTES: CO Slope 1. Depth of New Trench is 7'. Final Ground 2. Septic Tank & Solid Pipe to be Placed on Compacted, Original Ground Stable Soil, Free from Boulders. ;�; ':. :-.:,:'•,: 3. Sewer Service Line is Minimum 2/ Slope & 3' Cover. ;• ::,-,,,..�,; 4. Water-Tight Couplings. rl .. ,..,,,' ; 5. See Specification Sheet. t=3 '- '•c=• 7 0 6. All Work To Conform to Municipality of Anchorage (AMC) Filter ,; SOILS LOG - PERCOLATION TEST NhTI-RIM Date Performed: 10/23/19 FAN INEERING Performed For: Owner Legal Description: T15N R1W Section 5 L95 DEPTH (FEET) T.H. Location: See Attached Test 1 - ra Boring Location Map 2 - SM/ML perk Groundwater? Yes 5 - Depth 14' 6 - Water Depth 7 - 0 SP w/ Af ter Monitoring. 11' Date: 10/31/19 8 - Gravel # Date Gross Time Net Time Depth Net Drop 0 9 - Cobbles 1 10/31 0 -- 6" -- 10 - C 2 10/31 10 10 min. 3" 3" 11 - 3 10/31 10 -- 6" -- 12 - 0 ° 4 10/31 20 10 min. 2" 4" 13 - 5 10/31 20 -- 6" -- 14 - Seep 6 10/31 30 10 min. 2" 4" 15 - 7 10/31 30 -- 6" -- 16 - 8 10/31 40 10 min. 2" 4" 17 - 9 10/31 40 -- 6" -- 18 - 10 10/31 50 10 min. 2" 4" 19 - 11 10/31 50 -- 6" -- 20 - 12 10/31 60 10 min. 2" 4" 21 - Percolation Rate 2.5 min/in Perc Hole Diameter 6" Test Run Between 4' & 5' omments: Measured To The Nearest 1/16". erformed By NorthRin Fng, I CERTIFY THAT THIS TEST WAS erformed in Accordance with All State/Municipal' Guidelines in Effect N THIS DATE. DATE: NOR THRIM ••'474.4,`N •• \ ' '* T15N R1W SECTION 5 TH ENGINEERING C.-) •' �% SteveEn com * .49Ili . * LOT 95 9 PO Box 770724 4:'.‘‘ c„g. ogle River. Alaska 99577 a- r T E S T H O L E L O G 907.694.7028 h� 1/7/19 • Dote: EET: GEOTECHNICAL 11/2/19 1 i LOT 83 LOT 81: , LOT 05 0 4 t, jk 330.00 o' 'r ''' .�`'�4,s% .ttr , . \ 7 ' FJ6A PO'r.►ERLINE =4Sit �` 3 .4-" ,DR I VE4JA Y 40 •Yw4K C•fGv/�.y.w .....a•.a•.• .4? ^ N - • ..., . \ 0 ., . . C .. � iar"ii it. A1C( ..w L� '% NO.1 d23.s ,•,;, ,� SHED 32 �S��F p� •. �/c:1 c+� �aF pR ..... ',yr ear o �..�1 113 24 1 HOUSE cco +� CfES�fu�lt� ,�� 8 26 I.OT 96LOT 95 `.,rte, LOT 9h . 0 i SCALE 1 in. - 100 ft. • 1 W ,o I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: RLM LOT 95, SEC. 5, T. 15 N., R. 1 W., S.M. , ALASKA , —` - 2 ----- -_ ___ ____. ---- . ANCHORAGE RECORDING DISTRICT, ALASKA: AND THAT THE I' '.;OVEMEN:\ t.. I'1EST Vi , 333.00 ,r SITUATED THEREON ARE WITHIN T* PROPERTY LINES AND DO NOT OVER- WOOD 2x1," LAP OR ENCROACH ON THE PROPERTY LYING ADJACENT HE E O, THA? RERAR NO IMPROVEMENTS ON PROPERTY LYING ADJACENT TU.FRETO ENCHLAC,H ;;N THE PREMISES IN QUESTION AND THAT THERE ARE ?O RUAL;-?A?S, TRANS- . MISSION LINES OR OTHER VISIBLE EASEMENTS• UN SAID PROPE TY LOT 99 LOT 100 LOT 101 EXCEPT AS INDICATED HEJ?EON. BATED AT ANC}K RAGE, ALASKA �-y .--... THIS f `` ii ,iN max' x. ,r GR/--~ER ANCHORAGE AREA BOROU''~'~, Dkr/-d:ITMENT OF ENVIRONMEI~TAL QUALI~ . 3500 TUDOR ROAD ANCHORAGE, ALASKA ggs07 27~-8585 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM - MAILING NAME_ ~'~,,~).,,,,~d;~--~/~,j~//_~....~'~f' ADDRESSf-~--d,J~.d.)J~ ~. ~/~/~ PHONE SEPTIC TANK: ~ (..~ "/'~//'~ ~(~)'~) NUMBER OF DISTANCE FROM WELL /,~CzP~/~.J'~ MATERIAl ./'.-'~'~--~':':':':':'~'~ ~~ COMPARTMENTS LIQUID CAPACITY ~ GALLONS. INSIDE LENGTH_ ~ INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS / OUTSIDE DIAMETER / OR WID. TH /.,~ , LENGTH //'~ , DEPTH NEAREST LOT LINE ¢=..~.¢2 /./'" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /~/.~2 sq. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELl F©HhJr~.TZON , NEAREST LOT LINE , OF LINES NUMBER OF LINES .//'""~ DISTANCE BETWEEN LINES TRENCH WIDIH IN. TOTAL EFFECTIVE ABS SQ. FI. LENGTH OF LAC DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE~ /~/~ / ~'/-/~- -~ ~,"~/~ WATER WELL: TYPF/~,,.,~,~//~.c'~ DEPTH ~ DISTANCE FROM / ~ , , BUILDING FOUNDATION SAMPLE NEAREST NEAREST / SEPTIC ........J SEEPAGE / OTHER LOT LINE / , SEWER LINE. ,TANK . SYSTEM , CESSPOOL. / , SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE ~.///,.~ ~//~--? - APPROVED ~,A',A,k, 2]92 WELL TO SEPTIC TANK ~-OF DR^,N FIELD /O/ . SEEPAge P'T /dO / ALSO CONSIDER AREA WELLS. · DRAIN FIELD _ EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. BOROU I LICENSED DESIGNER J CERTIFY TH^ M FA~llLIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND LEGAL DESCRIPTION / ' -: '"~' / ""~ DATE- Started i . / ~ , Ended PERMITNUMBER DEPTH OF WELL ~ s ~.' STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR KIND OF CASINO KIND OF FORMATION: From ,:~ Ft. to Ft. From ; Ft. to c Ft. From ; Et. to ;" Ft. From ' ' Ft. to '// Ft From Ft. to From / Et. to '~,: From Ft. to From Et. to Ft. From Et. to Ft. From__FL to__Et From Ft. to__.Ft From Ft. to__.Ft From Ft. to Ft From Ft. to--Ft. From Et. to Ft. From Et. to Ft. From Et. to Ft From__ From From From__ From__ From From From.__ From From From From From From From From.__ .Ft. to Ft. to .Ft. to Ft. to Ft. to Ft. to Ft. to .Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to Ft. to FL Ft. Ft. Ft, Ft Ft. Ft. Ft. Ft. Ft. Ft Ft Ft. Ft. . ~NcHO~GC lC pAL'~Y Or ~ .... MISCL. INFORMATION: DRILLER'S NAME /' ¢"~' PI~:Ri'd i T Ni3,, NOR'!' H D.. x ~H,! .. Lib LOOP · :t. 5N RIW SECTION S LOT t_OT SI E,8~-.91 A2 ASO00 S~JUARE I=EPZT Min:i.'mLm~ al:[stance bet~x~een a well amd any on-site sewage disposal system is 100 Eeet .~or- a ppivate well or' iS(] to ~00 -Feet {~com a public well depending up. on the tyge o{-~ pub!{c well. Min;Lmum ~.stamce .Fpom apr. iw~te well to a pr-~v~te sewep I~ne is E~S Eeet ~nd to a commun:[ty se~ep line :i.s '7S f:eet,, b~e!.l 'Logs mpa l~equ:[r~ed ~nd must be petu. pned te the depae'tment w~th:i.n BO d~ys o{~ the ~,~eil co'ropier;ion. i3thep r'equ~.r, eme~Tts m~y appiy~ Spec:i.~::Lcat~,ons and constpuct~.on d~.agr'ams ape available to :[nsu, pe pr'of>er. {nstaiiatJ. on, i c:er'tiFy that {:orth by the Mun~.c:ipa:l,:i. ty o.F Anchor'ag~ ~ I ~J~.].). ~nsta:l. 1. the system ~.n accof'd~nce ~,~:L'th the codes. aT~d ~et].s as set AF~F,L t(:;Abi,] ..... ~ .... :'RRM I T NO, · -'L I CRNT iRT I ON LOT SIZE ~¥;~C'C} SQURRE PEET :'E OF SOIL RBSORBTION SYSTEM IS: ~IMUM NUMBER OF BEDROOMS = SOIL RRTING <SD FT/BR>= REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: EPT~4= - LENGTH= GRRVEL DEPTH= ~THE LENGTH DIMENSION IS THE LENGTH <IN PEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION <IN PEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OLITFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). Et-~U I RED SEPT ! C TF:II'4K S I ~MIT RPPLICRNT Hi:tS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE :STRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE ~IBER OF RESIDENCES THRT THE NELL WILL SERVE. ~---- TWO ( 2 ) I hlSPEC'T I 0~4S PRE REQL; I RED OKFILLING OF RNY SYSTEM NITHOUT FINRL INSPECTION RND RPPROVRL BY THIS PRRTMENT WILL BE SUBJECT TO PROSECUTION. NIMUM DISTBNCE BETWEEN R HELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 0 FEET FOR R PRIVRTE WELL; OR 0 TO 280 FEET FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC WELL LL LOGS PRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS · THE WELL COMPLETION. ~ER REQUIREMENTS MR~ RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RILRBLE TO INSURE PROPER INSTRLLRTION. - PERP1Z T EX, P ~ RES DECEMBER _~.±.. ~.97~ 6ERTIPY THRT . I RM FRMILII~R WITH THE RE~UIREMENT~ FOR ON-SITE SEWERS RND WELL~ ~5 ~ET RTH 8~ THE MLINICIP~L~T~ OF RNCHORRGE. ,I MILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. :I UNDER~TRND THRT THE ON-SITE SEWER SYSTEM MR9 REQUIRE ENLRRGEMENT IF THE SIDENCE IS REMODELED TO INCLUDE~ORE THRN ~ BEDROOMS. ' RPPL~OnNT _~ .~ - UED BV '  3330 "C" Street, Anchorage, Alaska 99503 27.4-4561 Date Received ~~ -~ Ti e of Inspection ~ ' ~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval 'requested by: Mailing Address: ~--~ 2. Property Owner: ~~ ~'/~ Phone: 4. 5. 6. Mailing Address: Legal Description: Location: Type of facility to be inspected ~2~ No. of bedrooms Well Data: A, C. Construction D. Bacterial Analysis Sewage Disposal System: /~-~/ ¢. Septic Tank: 1. Size -7~o"-0 ~. 2. Manufacturer D. Seepage Pit: 1. 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 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 of Inspection: CMRO VA , . FHA 2. Property Owner: ~>~0~ Mai-ling Address: Day 3. Name of Buyer: ~, . ~.f~/~L~ ~-~L o Phone CONV ~.~ Mai Name Mai Name Mai ling Address: of Lending Institution: of Realtor or Agent: Day Phone Phone Phone ~V~/~ Type of Facility to be inspected: No. Bdrms. ~ Water Supply Type of Supply: If Individual, If Individual, Public Utility Individual number of dwellings presently served depth of well .~5~ ~ Sewage Disposal System Type of System: Public Utility Individual If Individual, date of installation ~ (on-site) EQ-037 (~/74) Page 2 of two pages - Re( ~$t for Appyovalldf Individual ~-~r & Water Facilities L~gal 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 operating satisfactorily. SIGNED Date EQ-034 (!/74)