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Home My WebLink AboutVALLEY VIEW TERRACE BLK 3 LT 2 Z-~, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION / /~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~UPGRADE L[~ capeskin ~allons ..~. Inside ength Width Liquid depth ~ / '~--O F HOME'DE: DISTANCE TO: Well /.,/~ Dwelling -- PERMIT NO. Manufacturer Material Liquid capacity in gallons Well Foundation Nearest lot llne PERMIT NO. DISTANCE TO: No, of lines Leng/~e Total length of lines Trench width Distance between lines Top of til~ to finish ~rade Material Beneath tho Total effective absorption area ¢ inches PERMI~/~ ~ Length2` Width Z,2 Depth~ , ~ effective ab[ R ~on ar Type of crib Grlb diameter GHb dept~ Total DISTANCE': TO: Wel7/~ / Buildi~d~ Nearest i~e~$ ~,ass--.~ J --~--~-- Driller Distance ,o lot llne PERMIT NO. Building foundation Sewer llne Septic tank Absorption area{s) DISTANCE TO: OTHER PIPE MATERIALS , ~ A~--~/~_~~~~~ DATE LEGAL ~_...MUNICIPALITY OF ANCHORAGE~--~ Department, ~ Health and Environmenta~ .?rotection ,' .... , 825 ,, Street, Anchorage, AK. 99501 ~ 1 / ~ ~ ~ WELL AND/OR ON-SITE SEWER PERMIT ~~; . _ ~Location: ~~ ~~~ ,~ Phone Numar:/ ~'~~ / Legal Description: ~ r~3 ~/~i/~ ~ ~ Lot Size: . Type of Soil ~sorption System Is: / ~ Trench: Drainfield: Seepage Bed ~~ Holding Tank: of Bedrooms: ~ Soil Rating(sq.ft/br) /~/~ Maxim~ N~ber The Required Size of the Soil ~sorption Syptem Is: ' DEPTH LENGTH GRAVEL DEPTH &t~d~ ~IDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minim~ depth of gravel between the outfall pip~. a~d the bottom of the excavation(in feet). ~/30~ ~ / ~ ~ ~ -~ . ** REQUIRED SEPTiC(HOLDiNG) TANK S ZE Pe~it applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the n~ber of residences that the well will serve. ~ ~ * TW0(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Min~ distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co--unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days Of the well completion. Other requirements may apply. ~Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * * I certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of ~chorage. (2) I will ~nstall the system in accordance with codes. ' (3) I under~ that ~n-site sewer system may require enlargement if the /~'~si~is~odeled to include more that 3 bedrooms. Date: :~ ~ ' , PERFORMED FOR: SOILS LOG MUNICIPALITY OF ANCHORAGE E] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: · (/ SLOPE SITE PLAN / 10 11 12 13--- 14- 15- 16- 17-~ 18- 20- WASGROUNDWATER //~/.~ S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop COMMENTS 72-008 (6/79) PERCOLATION RATE TEST RUN BETWEEN FT AND -- FT XXXX (minutes/inch) Pe<-formed For Fr~nk Knifht -Legal Descrip~'ion: Lot B'l"ock J This Form Reports Soils~g 1 4 6 Depth Fee Lo% 1 and 2 Soil Characteristics Brow~ Sil~y Smndy Gravel'(GM) with sandy gravel seams (~w) Was Ground Water Encountered? Nn If Yes, At What Depth? Date Performed 9/14/72 SubdiviSion ¥~1]?~ V~]ew P-6-~i on 'rest Reading Date tPercolationl Rate Gross Time Net Tim'e Depth to, H20 Net Dro 'M'~nute Proposed Installation: Seepage Pit X.. Drain Field Depth Of Inlet .Depth To Bot'tom Of Pit Or Trench COMMENTS: 1~ nC. ft. nf ~r~in~,{"e ~re;~ ~n rnqu~re~ pnr be~room ~'e'rformed'"'By e.,~! ~nln D~ta certif'i"e"d "By: GR~_~Y=~R ANCHORAGE AREA BOROUGH~-~ DEPA[ )NT OF ENVIRONMENTAL QUAIL 3500 TUDOR ROAD ANCHORAGE; ALASKA 99502 CASE # Performed For Frank Knight Legal De~ription: ~ot Block This Fork Reports Solls~g Depth Feet 5 7 8--- lO Lot I and 2 Soil Characteristics Brown Silty Sandy Gravel(GM) with sandy gravel seams (GW) Date Performed 9/14/72 Subdivision Valley View Percolation Test Was Ground Water Encountered? If Yes, At What Depth? r T Reading Date Gross Time Net Time Depth to H20 Net Dror ate Minute Proposed Installation: Seepage Pit × Drain Field Depth Of Inlet ,Depth To Bottom Of Pit Or Trench COMMENTS: 185 ~q. rt. of ~r~in~ ar~ is require~ per be~room Test Performed By O~linle Data Certified By: · ' g Svs. Inc Date: MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES~; ?~[~ D v sion of Environmental Services' On-S~te Se~ces Section '5- P.O. Box 196650 Anchorage, Alaska 99519_6650 ~ 343--4744 '" :~;.,.,:., ..~; ~- CERTIFICATE OF HEALTH AUTHORITY.., , APPROVAL FOR A SINGLE FAMILY DWELLING .... p!~cel LD. # ~'~-'~C') 7.-~,;-~ ' ~ . _ .-;:7 .... GENERAL INFORMATION ..... ~ .... ~Lcomplete.leg~ldescription ~ ~ ~'~ '- Lending agehcy Ma ing address ,.~' ~._~,. ? Agent ' :,:: ';:. ';~:.L Addre~ Day phone Day.phone -::";;~:~5 Unless Otherwise requested, HAA will be held for ';~' ~,.'~ 2;~"~'NUMBER OF BEDROOMS: o~:~ ~-~ 3. :~;¢~PE'OF WATER SU .--~ ..... -.-. ....... ~ ........ Individu : ': ':?i~. -.'; ':." ~'- :'::. v:: ,.,:: -; :'L~. . . .. -, r,.-~,~. · ~ Publlcwate , . , NOTE: ~f communi~ well system, provide wri~en confi~ation from S~ ADEC aRes~- . lng to the legali~ and status of syste~. 4. ~PE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Cc mmunity on-site Pub lic sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) =rent MOA~I 5. STATEMENT OF INSPECTION BY ENGINEER ,, As certified by my sea afl xed hereto and as 'of the'validation date shown below, verify that my investigatio.n'df 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, gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulat ons in effect on the date of this inspection. ... 6. "- DHH~ SIGNATURE ................... :~ ~ ' · Condit ona approva form~,, '~ ~"~ ~:b~rooms,'}wth 'the fo owna 'st ~uatons :, ,, The ~nh~ipe ty of,Anchorage Departn'ient of Hoe th and Human Services (DHH$i' issues Health Authority '-. Approval 'Certificat(~ based only upon the representations given in paragraph 5 above by an independent professional en~,~eer registered m the State of Alaska. The D HHS does this as a courtesy to purchasers of homes ahd' their lending i~stitutions in order to satis~ certain f~:te ral and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchor.age is not responsible for errors or omissions in the professional engineer's work. 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 Descriptioo: ~,-7-~ ~'~ N/&t.~ k]l~O3'~'l;~[74g~ ~%~l~.Parcel I.D.: A. WELL DATA Well type ~124'dPCl~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Date completed ~ Cased te--~ Casing height (above ground) Sanitary seal (Y/N) q~ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform O Wires properly Protected (Y/N) ~:~ FROM WELL LOG AT INSPECTION NI/1~ g.p.m. ~' ~ g.p.m. Nitrate O.I ~/~, Other bacteria 0 Dateofsample: ~/~A¥ ~1 [~, Collected by: l~Z~_.lxl"F B. SE~IC~OLD~G TANK DATA Date installed ~ ,-a~T~ size~l ~Number ofCompamnents ~ Cleanouts (Y~) Foundation cleanout (Y~ ~O Depression ~m) ~ High water alam (Y~ ~ Date of Pumpiug ~ Pumper ~/~ C. ABSOR~ION FmLD DATA ~~ ~ ~ ~ ~ ~ ~q¢~) Date installed ~ ~ Soil rating ~ or fl2~drm) [~ System ~e Leu~h ~ Width [~ Gravel thc~ess below pipe ~, ~ Total depth Effective abso~tion area ~ O. g, Molfitoring Tube present(Y~ ~ Depression over field ~ Date of adequacy test ~y ~ ~& Results Cass~ail) ~ For ~ bedrooms Fluid depth in absoCtion field before test (in.); ~ In~ediately ~e~g~. water added (in.): Fluid depth ~ (ins.) Miuutes later: ~ ~. Abso~tion rate = ~ ~ .g.p.d. Peroxide treatment (past 12 ulonths) ~ d~ If yes, give dat9 ~/~ D. LIFT STATION Dato installed Size in gallons Manhole/Access (Y/N) ~,~'"~ "Pump off' Icvel at* ltigh water alarm level at* .~-~ *Datull! E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Soptie/holdiag tank on lot 70~M ~ = 90; On adjacent lots Absorption field on lot ~ ] ~ ; On adjacent lots Pablic sewer nmin ~[~ Public sewer nlanhole/cleanout ~t Lift station Sewer/septic service line SEPARATION DISTANCES FROM ~EPTIC/HOLDING TANK ON LOT TO: Bailding foundation ~9OO~'~--~-)~.t-¥o l~line .'~10 Absorption field I'~ Water mai[ffsemce line "~O .Surface ;vater/drailmge "~'1~.O f Wells on adjacent lets SEPARATION DISTANC~E FROM ABSORPTION FIELD ON LOT TO: . · . ..~ I . ~,~ - I..~lJ . . . ,z~__-.~! .,....~0t Braiding fotlndatloll ;-~,-~. .-;, ~'~; ._,Water mauffsemce hlle ~ Surface water ~ ~ I~O Driveway, parkin~vehicle storage area ~'~0t- I Ca~ain draia ~/~ Wells on adjacent lots ~l ~o ~ tiao F. ENGINEER'S CERTIFICATION , in co,;)b,'malw~lh M~b~i;~ines in effect on ,biz date. ~n ,., ~ ._~-- Vh X'. CE-9126 ..'~ ........................................................................................................ ........ HAAFce * Y~ VO WaiverFee$ ~,~ Date of Payment ..2~-/~,/~' Receipt Nmnber ·/~ff~ Date of Payment ~ - ~ V ~L,~ Receipt Number Rev. 8/95 OSS: haa.wk.doc ~. ~.~ ~r $ " · N: ~..-~ · ~.~..1!~ , j ~.~ · ' . . . I l~' ' ' ' ~ ~ ': ' " I ''" ' '~' .. ~?~,~ .~-~ ,_,~ , · ',,,~: .. ......... ...~ :. .: ~s x .[4 .b~}¢~Y ...... ~ - · ' -' '-' ' ~ . ' ~7~i.~ ,. . .: " AS-BUILT /~I~Y ~.~ ~. ~, ~. ' ' Lnch~age Reco~ P~c~, ~as~, and that ~e ;m~ov~ .., ' . ' ~ , . i~enb ~tuated the~ a~ wi hin the propel .... : x' ' :- s ~lap or enoch on the pro~e~y ~;m8 aa~acent - · . · . : ,'~ no imp~o~ments on ~m~v l~n~ adlacem th~e~ ~'.. '-~ -'~ on thc p~m~es ~ ques~na that {h~ ~e ~ ~ad~-ays, y t~ ~ (7~ ~ ~ . Dated at ~le Riv~, .. ., ' "~ ~ '::~ ?~:7~' ROBERT C. JO~LNS~N :~ :~.~", ........ ~ ""-~ $CA~: R~isteffd Land 5u~'evor MAR 22 '96 il:43AM TRAN~ ALASKA TITLE AMCH P.273 PAIE 0102 MAR 22. '96 Ii:43AM TRAN~ A~ASKA TITLE ANCH Rick Mystrom, Mayor Munic pali of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 July 11} 1996 Brent P. Eaton, P.E. 3801-A Wilson Anchorage, Alaska 99503 Subject: Waiver Request for Lot 2 Block 3 Valley View Terrace Subdivision Waiver Request #WR960020, PID #050-352-09, HA960170 Dear Mr. Eaton: Your request for waivers of the required 100 foot horizontal separation of an on-site wastewater disposal system to a private well has been approved. The approved separation distances are a private well to the septic tank of 75 feet and to the second septic tank of 90 feet. This waiver approval applies to the existing on-site wastewater disposal system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are questions or concerns regarding this waiver request, please call this office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services D~,Jljm:Robuck ,,.~, MUNICIPALITY OF ANCHORAGE'~'' Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~i0~ql~ PID# 050-352-09 HA# NA960170 Permit Date Received: May 31, 1996 Legal Description: Lot 2 Block 3 Valley View Terrace Engineer: Brent P. Eaton, P.E. 3801-A Wilson, Anchorage, Alaska 99503 Applicant: M~chael Robuck ., Waiver Requested: Private well to septic tank of 75feet and second septic tank of 90 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: ,~ List Conditions or Reasons for abo~ Date: ~--~-~ Rec #: #01896 Amount: $ 62 _ Fa/x/t-.r, Z /7 EA~LE RIVER EARTH MILE 5. I MILE SUNNY GLEN DR. DR, SW160 BRENT P. EATON, P.E. CIVIL ENGINEER .~80/ A Wilson S[reet · Anchorage, Alasko 99505 · Phone 229-5777 May 30, 1996 Dan Roth On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 RECEIVED MAY ,~ 1 1996 Municipality of A.nohorege Dept, Health A Human 8arvioas Subject: Lot 2, Block 3, Valley View Terrace Subdivision Dear Mr. Roth: This letter is to request a that a separation distance waiver be issued for the subject property. The distance from the well to either of the property's two septic tanks is less than the required 100 feet (see attached drawing). A copy of the easement granting the right of this system to occupy property on Lot 1, Block 3, Valley View Terrace Subdivision is attached to the Health Authority Approval package submitted to your office by me on May 9, 1996. A Health Authority Approval was previously issued for this property in October, 1984; no waiver of separation distance issued at that time can be found. The well and septic system was tested on May 2, 1996, and found adequate for three bedrooms. At this time a sample of water from the subject well was analyzed for coliform and nitrates by CT&E Environmental Services Inc. The result of this analysis was 0 colonies/100ml, and 0.100 mg/I Nitrate. The above results indicate no apparent health hazard associated with the current physical location of the well and septic tanks; the newest of which has been installed for nearly 13 years. Also attached please find a copy of local topography information, and well logs from several neighboring properties. If you have any questions please call me by phone at the number given above. C:~BPE~OOCUMENT~ROBUC~WAIVER.DOC / 004 / · MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE (a) Legal J)escription (include lot,, block, subdivisipn, section, township, range) Location (address or directions) (b) Applicants Name'/~/~~i~:/-2p/~_~_~ Telephone - Homo Business: Applicants Address (c) Applicant is (check one) Lending Institution ~ ; Owner/builder~ ; Buyer ~ ; Other ~ (explain); (d) Lending Institution Telephone Address Telephone ___~?~~_~/' (f) Mail the }LA~i to the following address: 2. ~y_pe of Residence Single-Family,S[ ~umber of Bedrooms 3. Water Supply Individual Well~'~ ., Multi-Family~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal ~ Onsite ~ Public ~ Community ~--~ Holding Tank ~ Note: If community ~ell system, must have written confirmation from the State Department of Environmental Conservation attesting to ~he legality and status. [Page 1 of 2] 5. E_ngineering Firm Providing Inspections, Tests~ File Search, Data and Informatio~ 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 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-~ite water supply and/or ~stewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone Address ~ Date ~ ~~~.'~i~ "?~/~/-~ //_-?.~ ~- ~'~.~ (ENGINEER SE~) ~ Approved for , ~ bedrooms ~~~/~ Approved ~ D~sapproued ~ CondSt~on~ Terms of Conditional Approval CAUTION THE I~GNICIPALITY OF ANCHORAGE DEPARTMEh~ OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF H~ES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES Of' DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~CHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TRE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 APPLI¢- NT FILLS OUT UPPER ONLY ~' '~-~/~/~ . Phone Address Zip Code Lending Institution ., Phone Realty Co. & Agent Phone Street Locati~ ~ / ~/ ~/~ ,~ Type of Resi~nce ~ ~ Water Supply dividual A~ACH WELL LOG. A well log is required for all wells drilled since June 1975. I~ldividual Year Individual Installed: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: (5 ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED CONDITIO AL A PROVAL* DATE By: ~ Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received Well to Tank Septic Tank Size Be MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~/~/~ Well Log P~esent Total Depth ~--~--~t Cased to Static Water Level MUNICIPALITY OF ANCHORAQ~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT ! Legal D es~rip, tion: If A, B, or C, D.E.C. ~pro~d(Y~) Date ~leted ~e /~TZ Yield~~ ~ t~ /mpth of Groutin~ Pump Set At ~ Casing Height Above Ground ~7Z 2'- 7~ Sanitary Seal on Casin Electrical Wiring in Condui~/~ Depression Atzound Wellhead Separation Distances f~om Well:/ ~ ~/~ To Septic/Holding Tank on Lot ~f/~/ /~f~ On Adjoining Lots TO Nearest Edge of Absorption Field/on Lot//~fl ~z ; On Adjoining Lots To Nearest Public Sewe~ Lin~ ~ ~ To Nearest Public Hewer Cleancut/Manhole /ff ///~ To Nearest Sewer Servic~ Line on Lot Wate~ Sample Collected By ~-~.)~'z/~//~.~; Date Water Sample Test Results ~-~ 7~/~/~ co nts / SEPTIC/HOLDING TANK DATA Standpipe~Y)~ / ~ ~ Air-tight Cap6'~/~ J~oundation Cleanout Depression over Tank (¥~ .Date Last~umped ~&~c~.~-~ Pumping/Maintenance Con~aet on File (/Y~/~//~ ; f/or / · - ' Holding Tank High-Water Alarm (Y/N~//~- Temporary Holding Tank Permit (Y/~/- Separation Distances from Septic/Holding To Water-Supply Well To Pr_operty Line TO Water Main/Service Line course co nts Tank: To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Receipt # Date Paid: Amount: ~ff~6~ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorptipn Stmata Date Installed Width of Field Square Feet of Absorption A~ea /-% Depression over Field (.Y~ Results of Last Adequacy Test Type of System Design Length of Field ~--~ ~ Depth of Field Qravel Bed Thickness Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ///_~ ~ To Property Line To Building Foundation ~ ("~ TO Existing or Abandoned System c~ Lot /~OVJ~ ; On adjoining Lots ~ To Water Main/Servic~ Line ~ ~ To Cutbank(if present) To Stream/Pond/Lake/c~ Majo~ Drainage Course /C~ To D~iveway, Parking kuea, o~ Vehicle Storage A~ea ~-~ Counts ~?L343' (~ D. LIFT STATION Date Installed Size in Gallons "Pump O~" Level at High Water Ala~mLevel at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) /Pt~p O~f" [~ve]. at //~-~ Vent (Y/N) Pumping Cy~lgs during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroc~ Rating Against HAA Request ** . certify that I have checked, verified, or conformed to all MOA ~~,~n affect on the da~e ~f this ins~ction. ned ,,d: ~HB 1OB~ . Date ~ KB1/d5/s [Pa~ 2 of 2] 2-15-84 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 r'C" Street, Anchorage, Alaska 99503 274-4561 ~ ~ Date Received ,[.,/,.~ ,~ ~' ' ~.~ Time of Inspection /~/~' .~ ~ Date of Inspection ~/~ ~0 REQUEST FOR APPROVAL OF ~ ~ INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: ~~, ~ Phone: 2. ~roperty O~ner: Phone: Sa~lin~ ~ddress: 3. Legal Description: Location: Type of facility to be inspected No. of bedrooms Well Data: A. Type C. Construction B. Depth D. Bacterial Analysis 7. Sewage Disposal System: A. Installed B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area 2. Manufacturer 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , ~earest lot line , Other contamination B. Foundation to septic tank C. Absorption area to nearest lot line , Absorption area 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. FHA CONV~J.-/~'~ 2. Type of Inspection: CMRO VA Property Owner: ~1~/~ ! Mai-ling Address: 3. Name, of Buyer: ~'~/'O]~e. f _~-~:~V',.~ ...~ ~ ~/ Mailing Address': Des Phone (/q~-~7/~- 4. Name of Lending Institution: ~~$ ~ ~.~ ' Mailing Address: ~~. ~e6~ Phone 5. Name of Realtor or.A~ent: ~~'~- ~~t 6. Legal Description: ~ ~ ~/J~ ~__~/J~ ~~~.~_ 7. Type of Facility to be inspected: No. Bdrms. ~ 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 System: Public Utility Individual (on-site) If Individual, date of installation EQ-037 (7/74) ~ P~ge 2~of two pages - Re~,~est for Approval ~f Individual m~wer & Water Facilities ~egal Description Comments Approved ~~' Disapproved Date ~J~Z/~ Approval ~Va~lid for one year from date signed Greater Anchorage ~kr~ea Borough, Department of ~vironmental 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)