HomeMy WebLinkAboutPARKS LT 1AOnsite File
Parks
Lot 1A
PID# 051-104-83
Formerly Parks Substation Lot 1.
Formerly T15N R1W SEC 9 Lot 94B.
AMEA
MATANUSKA ELECTRIC ASSOCIATION
MEMORANDUM
DATE: March 18, 2013
TO: MOA
FROM: Yukon D. Tanner, Proje Manager
SUBJECT: Septic Tank Removal
The septic tank at the Park's Substation on Lot 94A has been removed per Municipal Code
Requirements.
Recognizing the current address as 20418 Steffes Street, that shall be the same address for the
combined properties as lot 94B will no longer exist. The house is being removed and the
substation will be expanded onto that lot.
Project: Parks Substation - MEA -Lot 94B BLM Small Tract 94 Plat No 73-139
Date: 12/4/12 Logged By: Norman K Gutcher
TEST HOLE NO.1
Depth
(feet)
Description
Top Soil - ± 4" - Frozen
1
Sand, Gravel SP - Tan in color - Frozen
2
Sand, Gravel (SP) -Tan in color -Thawed
3
Sand, Gravel (SP) - Gray heavily compacted^ _
4
5
6
7
8
9
10
I 1
Bottom of Test Hole
12
13
14
15
16
17
18
19
20
21
22
23
24
AK Rim File No. 12-00326
TEST HOLE LOCATION:
Within 25' of proposed SAS.
COMMENTS:
No water or bedrock layer were encountered.
This soil log was prepared for the sole purpose
of determining the feasibility of constructing
an onsite wastewater disposal system at the
location of the test hole. Soil type ratings are
based on visual observation and have not been
verified with laboratory analyses. These soils
have not been ' analyzed for structural
properties, structural stability, and seismic
stability or for any purpose other than
wastewater absorption field construction.
Anyone relying on the information in this log
for any use other than wastewater absorption
field development shall do so at his or her
own risk.
Alaska Rim Engineering, Inc.
PO Box 2749, Palmer, AK 99645
C11At,p- 1FFR 0.4`01.i
oGRE'
:R ANCHORAGE AREA BOr'"' GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELl
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
~E/ MATERIAL
LIQUID DEPTH
NUMBER Of
~''r~'~' ~'- COMPARTMENTS ~
.LIQUID CAPACITY /~7 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS I DIAMETER ~'
LINING MATERIAL LO6 CRIB SIZE:
._ OR WIDTH I~¢' LENGTH Ioi DEPTH
DIAMETERJ~_DEPTH ~! DISTANCE FROM:
TOTAL EFFECTIVE
WELL
BUILDING FOUNDATION ~.~l , NEAREST LOT LINE l~1 ABSORPTION AREA (WALL AREA)
.SQ. FT.
ADDITIONAL ABSORPTION
TYPE CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION __ LOT LINE SEWER LINE
CESSPOOl OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH
SEPTIC
TANK
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form NO, EQ~031
DATE
GREATEr ANCHORAGE ArEA BOROUGh
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
, DRAIN FIELD
OTHER
TYPE AND SIZE Of FACILITY TO BE SERVED
FINANCED THROUGH
TO BE INSTALLED BY I~--///w~
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,
SEEPAGE AREA SIZE
MINIMUM DISTANCE$,REQUIR_..EMENTE
FOUNDATION TO SEPTIC TANK ~ I
FOUNDATION TO SEEPAGE Pit ~ ~ DRA~N Field
SEPTIC TANK TO SEEPAGe PIT WALL /~ [
SEPTIC TANK SEEPAGE Pit 20! , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /~ SEEPAGE PIT //~ ~
DRAIN FIELD ALSO CONSIDEr Area WELLS.
DIAGRAM OF SYSTEM
WATER MAIN TO SEPTIC TANK , SEEPAGE PIT
DRAIN FIELD
' /r_)O t
SEPTIC TANK, , SEEPAGE PIT , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
eXCAVATION 5 FEET INTO UNDISTURBED
~4 INCh DIAMETER CAST IRON ~IPHON PIPES ON SEPTIC TANK AND seePAGE PIT
FiTTeD WITH AIRTIGHT REMOVABLe CAPS,
GRAVEL BACKFILL
CONFORM TO BOROUGH R GULAT]ONS REGARDING INSTALLATION,
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-6~ AND THAT THE ABOVE
IS IN ACCORDANCE With SAID CODE.
FORM NO, E~-016
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
Parcel I.D. Cf
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) -~',,',6' ~'~'~,'¢,~/- j. ,E',-,',/~,,¢'~.~ ,,~,~.
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well /'
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
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
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, th, e 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 ~'~ ~"¢'/- ~,~' '~/'~-"'~,~ "~ ¢- ~"' ~/ Phone
Address ¢'¢'~ -~", "~/~',~-,"-r', z2,¢_.,, ,,~=',~¢~,,,,~,~-,~_, ,,52/.~'.
Engineer's signatUre '~ 1~' Date
DHHS SIGNATURE
c"/ Approved for '7"~/~ ~F..'~'
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 DH HS does this as a courtesy to purchasers of homes
and their lending institutions in orderto 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~O25 (Rev. 1/91} Back MOA ~21
ECEIVED
Municipality of Anchorage JUL 2 8 1998/
DEPARTMENT OF HEALTH & HUMAN SERVIC~F~NtC~ALt~ OF ANCHOI~
Environmental Services Division NViRONMENTALsEI{ViCE$ ~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
LegalDescription: ~r qff~.tff~=. ~ ~'~)~ ~/zz.J ParcelI.D.: ~.4--/,/o,y'-,.~'.~5,
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
Cased to .~/'~ ~,-..~'~z Casing height (above ground)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
WELL DATA
Well type ,'~,~',
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Collected by:
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ~'~' ~ Nitrate
Date of sample: ~. ~' .~u,~y · ~, /.e ~
B. SEPTIC/HOLDING TANK DATA
· ~'. ~ g.p.m.
Other bacteria ~ ~'~' '~
Date installed ,,u~,,, ,,~ ?qT~/l'ank size ~',~ ~'e ~,~'- Number of Compartments __
Foundation cleanout (Y/N) A./
Date of Pumping /z~/j,~.
C. ABSORPTION FIELD DATA
,~ Cleanouts (Y/N)_ Y
Depression (Y/N) '"J High water alarm (Y/N)
Pumper ~ ~,~,~,~-Y
Date installed ,x../~ / ,.~/ ~ ~' ~- .,./' Soil rating (g.p.d./ff
Length / ~ ~','~ Width ~'~ A"~ Gravel thickness below pipe
Effective absorption area ,~'/Z.~ ~/~'Monitoring Tube present (Y/N)
Dateof adequacy test ~/~'~Y' ~ /~'~ffResults (Pass/Fail)
System type
,~ ~.,,z Total depth /~'-,~'
__ Depression over field (Y/N)
For .-~ bedrooms
Fluid depth in absorption field before test (in.); ~'-/~g, Immediately after ~&'.~'gal. water added (in.):
Fluid depth -~',~ '~ (ins) Minutes later: / .~' ~ o Absorption rate = 5"--4",o .g.p.d.
Peroxide treatment (past 12 months) (Y/N) /t~ i If yes, give date ~
72-026 (Rev. 3/96)*
LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Septic/holding tank on lot
AbsorPtion field on lot
"Pump on" level at*
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Public sewer main
Sewer/septic service line
Size in gallons
~at*
Public sewer manhole/cleanout
Lift station ~.~'
On adjacent lots
On adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation
Water main/service line ~ ~ ",~",'~ Surface water/drainage /~'<~ '~-/Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /~.,,~--,,z, Building foundation .,~/ ,z",~ Water main/service line
Driveway. parking/vehicle storage area
Wells on adjacent lots
Surface water '
Curtain drain x.J,~,~'
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections
in conformance with MOA HAA guidelines in effect on this date.
Signature '~
Engineer's Name
Date "7-
HAAFee $ ,~
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
:~ DEPARTMENT OF HEALTH & HUMAN SERVICES
· ,. ,D v s on of Environmenta Serv ces ::~ :~.,,
On-Site Services Section '
P.O, Box'196550 Anchorage~Alaska
- - · CERTIFIOATE OF H~LTH AUTHORI~
APPROVAL FOR A S NGLE FAMILY DWELLING
Parcel t.D.-~-~- ~'-~ ""' ,, . ;. ~.~. '----~H~ '~ :~~
.... 1 .... GENERAL INFORMATION * ,,.~' J.~; -:' ..... ~,~*
.~Compl~'' ~dle_alg description ' ~~ ~ ~ ~.. ~,.
Location (site ad~ tess or directions)
~-- ,~. -..~ .. ~ DAY__ phone'
~' g tO th Ilty yste ........
4.: TYPE OF W. ASTEWATER DISPOSAL: ;
' NOTE· ~: if Communi~ wasmWater system, provide Wri~en confirmation from State ADEC
: ::"~eSting to the legali~'and status of
As certified by my seal affixed hereto and as of the validation date shown,below, I verify that my
investigat on of th s Hea th Author ty Approva app cat on shows that the on-s te water supp y
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 tn compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firr~-';''''~';/~'~' r ~~ ~
Address
Engi
The Municipality Of Ap~horage Department of Health and Human Serv cea (DHHS) Issues Health Authority
ApP~6Va Cert f cate~"~;~ on Y' UPon the..rePresentat °nS g Yen n paragraph5 above by e~ independent
profeSSional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending instlt~tions in 0rd~ ~0 satisfy ~ertain federal and state requirements:EmploYees °f DHHS do not
conduCt nSpect 0ns or ana yze data befo, rea certificate ia issued. The Municipality of Anchor?ge is not
resPonsible for err0m or omissions In the professional, engineer's.
WO~.~ ~'~:~ · ~ ':' : ~r ~ ~'~; :1 ' i '~'".: ' ~' ~., ;:, ~ :
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~"" ¢¢/¢'"~ ¢' ;~"¢-'/t~'~/c~'J"~4'/~arcel I.D.
A. Well Data
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANOE$ FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~_//.~
Sewer service line //z) ",z~Z~
g.p.m.
AT INSPECTION
,,
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ,...,"d~- y /~ /¢~..¢~'
,'7/
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed "~'-~'Y /.z. ,,¢2'~/ Tanksize
Cleanouts (Y/N) /u/ Foundation cleanout (Y/N) ,4,'/
High water alarm (Y/N) x/~,~/ Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Abso.rption field .~'~ ~'
Compartments
Depression (Y/N)
Foundation
Water main/service line
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION DISTA~ON TO:
n ~t~/ett~~' On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump
Sudace water
D. ABSORPTION FIELD DATA
Date inStalled ~ ~, /.;C
Length /'~ '/-/
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Width
_.~ ,,.~..,¢-.,.z Cleanout present (Y/N) .
~y /~-.~ /¢¢,r Results(pass/fail)
Soil rating (GPD/F¢) /~ Sy~em ty~
Gravel thinness ~ [Y Total depth / ~
~ Depress~n over field (Y/N)
~ for ~ Bedr~ms
~ ~ertest ~ ~
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot / z¢,~)/7. On adjacent lots /'~ ~ ~ ,z-',z Property line / ¢'~'~,
To building foundation --¢ ?'~'/, /7//'t-~' To existing or abandoned system on lot
On adjacent lots / ~',¢ 'cz"/ Cutbank /c)/',.¢ Water main/service line ~'~
Surface water
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~,[~e~a~e' of this inspection.
,
Engineers Name
Date 7- 15.~5
HAA Fee $ '~ (~¢2 ,
Date of Payment ,-7/~D/~ ~-'
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
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 Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~~ Telephone: Home
(c)
Business ~"-~t"~ 0'~ ~/-/
Applicant Address ~,~),~'<~'o>~ ~E:)c~ct-2_~ /~.t'~,,A.~l~-~.... ~c~/~,'~
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other.~ (explain);
(d) Lending Instit,tion_ ~(~_ '"~¢¢¢---L'{~"'
Address ./¢/.~ ¢ ~ ~s~-& ?
(e) Real Estate Company and Agent
Address
Telephone
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms -~
Other
WATER SUPPLY
Individual Well/l~· Community [] Public
Note: If community well system, must have written confirmation from the State Department of Environmental 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
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto end as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-alta 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 disposa~ system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Telephone
$ & S E~glneeH~g
Address
Date Eagle ~,iver, Alaska 995;~r ~. ~ ~ ~ ~:~
Approved for ~ bedrooms by . !C~~,~te
//
~ Disapprove~' Conditional
Approved
Terms of Conditional Approval
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 purchasere 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 (MO~)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
MUNICIPAUTY OP ANCHORAOE
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
WELL DATA
Well Classification '--'?~.~, ~J/~"f'- '-----------------~- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present,~ Date Completed ~i~JOZ~ /~/~leld
Total Depth ~-,~- I Cased to ~/~) Depth of Grouting
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~/~
Separation Distances from Well:
To Septic/Holding Tank on Lot
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /~)O ~ ; On Adjoining Lots /~O / ~'
To Nearest Public Sewer Line ~' To Nearest Public Sewer
Cleanout/Manhole /'/~' To Nearest Sewer Service Line on Lot ~'O i ~
Water Sample Collected by ~ ~ ~ f.I/~4,~ ~'J~A ; Date /-.~'o- ~ ~.
Water Sample Test Results ~ ~'-/~r"?"/,5/¢~-d,_~'O/E¢ ~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~ Air-tight Caps ~/~N~
Depression over Tank,,(Y~)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /Co
To Property Line ~
No. of Compartments Z-
Foundation Cleanout -(-Y/(I¢)
Date Last Pumped ~/~,.~O-~,
/k/~.~ ; for '
Temporary Holding Tank Permit (Y/N)
To BUilding Foundation
To Disposal Field /~'"/
To Water-Me.k~/Service Line
Course
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 ,~' .. ~ L~ _ ~
Width of Field l~
Square Feet of Absorption Area
Depression over Field .~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water.Ma.~a/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (~/~)
Date of Last Adequacy Test
To Property Line /~ / V-
To Existing or Abandoned System on
; On Adjoining Lots "~¢' / ~
To Cutbank (if present) ""~.'~-
Comments
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)
/"//,h_.. 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.
S & S Engineering
Signed .......
Company Ea~le O. iver, Alaska 99577
Receipt No. '~3'-7 '~ I,~-)~'~-
Date of Payment ~--~-~ ~
Amount: $ ~
Date
MOA No.
Page 2 of 2
72-026 (11/84)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~-~
,fl·
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Approval requested by:
Mailing Address: ~/0(
Mailing Address: q~q~
Legal Description:
Type of facility to be inspected
Well Data:
A. Type
B. Depth
C. Construction
Sewage Disposal System:
D. Bacterial Analysis
A. Installed B. Installer
C. Septic Tank: 1. Size ~9~9~) 2. Manufacturer
D. Seepage Pit: 1. Absorption Area ~/2.~ 2. Material
E. Disposal Field: Total length of lines
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
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA .~, FHA CONV __
2. PropertyOwner://~')Y)~5' Q ~c~(hO~t~',~, v'~,~ ~0 ~,
Mailing Address'.~ ~ ~ ~
~y Phone
.
4. Name of Lending Institution~,~ ~.~ -_
Mailing Address: ~_~ ~.~-~ ~* ~~:~ Phone ~
5. Name of Realtor or Agent~ ~, ~A~,~ -~ '~ e~- ~*~.* ~'~
Mailing Address: q ~ ~ ~~& Phone-~"~'~'-~ )
Legal Description JO~4'- ¢/¢ ¢~ Location: ,~ L~ ¢/~/
Type of Facility to be inspected:
NO. 8drms.
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well '-I(~ ~l~- ¢
Sewage Disposal System
Individual
I
Type of System: Public Utility Individual (on-site)
If Individual, date of installation
EQ-037 (1/74)
Page 2 of two pages - Re
st for Approval of Individual
Comments
er & Water Facilities
Approved
-q.4d~/' lb~ Disapproved Date /~-/o~-96
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)