HomeMy WebLinkAboutWOODHAVEN #1 TR B LT 2
:~ GREA,ER ANCHORAGE AREA BOR,.JGH
~,,,, ,./~ ~ ,, Department of Environmental Quality
'%~? 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
°,STANCE /¢.~¢¢~%.. NUMBER OF
~ Z '-qA'
INSIDE LENGTH,~__ INSIDE WIDTH ' LIQUID DEPTH LIQUID CAPACITY /~$ LLONS.
'~F ~ ~ / TOTAL LENGTH
DISTANCE FROM WELL ~7 [ OUNDATION ~ NEAREST LOT LINE ~. OF LINES
NUMBER OF LINES / DISTANCE BETWEEN LINES IRENCH WIDTH~ IN. TOTAL EFFECTIVE
ABSORPTION AREA~¢,/ SQ. FT. LENGTH OF EACli LINE
D~.T,~ o~ F,LT~.
WELL:
TYPE
BLJILDING
FOUNDATION __
CESSPOOL _
APPROVED ..
NEAREST
LO'F LINF
OTIqE R SOURCES
_ DISAPPROVED---
NEAREST
SEWER LINE
REMARKS
[)EPTH
SEPTIC SEEPAGE
TAN~<. ..... SYSTEM
____ DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
LOT SLOPE:
Form EQ 032
DIAGRAM OF SYSTEM
G.A.A.B. '-,,,)
DEPARTMENT HEFILTH AND ENVIRONMENTAL 'OTECTION
n .2.510 E. I'U[:,OR RD., ~RNC:HORROE, RK. 9~.c~7
PERMIT NO. ( 76~44 )
RPPLtCRNT .L,:g~L~.I...T.~R~?_E~ '?100 LAKE ,]TIS
LOCATION CLEO & JEROME
LEGRL L2 TR B NOODHFIVEN SUBD LOT SIZE
;344--566.5
47250 SQUARE FEEl'
TYPE OF' SOIL RBSORATION SYSTEM IS: TRENCH
f"IA~IMUM NUMBER OF BEDROOMS = 4
SOIL RATING <SC!. FT/BR)= 2L25
THE RE6IUIRE:D --.;IZE OF THP SOIL ABSORPTION SYSTEM IS:
[;:, E F' q"H:= 7 LE N~3'IFHI= 5t G R IAI'.,,-" EEL E:'EP'f'H=
THE LENGTH DIMENSION IS THE LENGTH (IN FEEl'> OF THE 'FRENCH OR DRAINF'IEL. D.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETI4EEN THE SURFACE OF THE
GROUND fiND THE BOTTOM OF THE E~CRVRTION <IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GREIVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETI.4EEN THE OUTFALL PIPE
AND THE BOTTOM OF ]'HIE E~4CFIVATION (IN FEET>.
BACKFILLING OF"' ANY SYSTEM WITWOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPRRTME:NT WILL BE SUBJECT TO PROSECUTION,
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWRGE DISF'OSFtL SYSTEH IS
i00 FEET FOR A PRIVATE NELL OR 288 FEET FOR R PUBLIC HELL.
NELL LOGS ARE REG!UIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS
OF THE NELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
I NSTf~LLRI'I ON.
F'ERf'I I T ',,,,,"FILL I E) FOR OI'-,.IE "~;'E; f"'] I-?-. FF~Oi~I Z SSSL~EE
I CERTIFY THRT
J.: I AM FRHILIAR WITH THE REQLJIREMENTS FOR ON-~SITE SEWERS RND WELL':!; AS SET
FORTH BY THE MUNICIPRLITY OF ANCHORAGE,
2'.: I NILL INSTALL. THE SYSTEM IN ACCORDANCE NITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF 'T'HE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
APPLICANT LOREN TRAVERS
GREATER ANCttORAGE AREA BOROUG"
Department of Environlnen[al
3330 "C" Street
Anchorage, Alaska 99503
ty
SOILS LOG - PEROI,ATION TEST
Performed for //~:~,~' ,~72~ ~:'-~'~ Date Performed
Legal D e s c r i [)~n~-~- ~ ~ ~_~~_~ '~ ............ ~
lhis form reports: Soils log_~ Percolation test
Depth
Feet
3-
4-
5-
6-
7-
8-
lO.-
ll ....
12-
13-
ld ,-
Reading Date Gross Time Net Time
_?~_p_th to_~_t_e]'_ Net Drop
iT~c~o 1 a t ~-o~'~ W~ t--~ ........... ],~inute. ' .................................
I)roposed installation: Seepage Pit Drain Field
;)upU~ of Inlet .............. · Depth-~--J]~m-~-~)it or Lrench
COilI1ENTS,:
040 (8/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &.HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Propedy Owner ~ P~- ( Telephone: Home
(c) Lending Institution H~/'¢,~ ¢) ¢'~b,~. Telephone
Mailing Address
7~ ,¢,~' ¢ 7 .~.~ Business
(d) Real Estate Company and Agent
Address /
Telephone
(e) Mail the HAA to the followine address: or: Check here,J~ if hold for pick up.
List contact person and day phone number below.
I.
TYPE OF RESIDENCE
Single-Family ~
Number of BeOrooms
WATER SUPPLY
Individual Well'S' Community I-'1 Public {"1
r
Note: If community well system, must have written confirmation from the State Department of Environmentel Conservation
attesting to the legality and status.
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 72-025 fRev 8/881 Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 w~stewater 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 'T"~
/
Address
Date
/ -
Engineer's Seal
DHHS APPROVAL
Approved for ..~--(~-~) bedrooms by
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
CAUTION
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 D H 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.
Page 2 of 2 72-025 CRev 8/86) 8ack
Well Classification
Well Log Present {Y/N)
Total Depth _ ~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descriouom /~07
If A, B. C. D,E.C. Approved (Y/N)
~/ .DateComp[eted _(-~1 "~ t ~"~'~ Yield
Cased to __ ~ ~ Deoth of Grouting ~ 0/~ ~,~'
Static Water Level ~.~
Casing Height Above Ground I ~ il
Electrical Wiring in Conduit (Y/N) ~
Separation Distances from Well:
To Septic/Holding Tank on Lot / Z~ ~--
To Nearest Edge of Absorption Field on Lot ! ~,O
To Nearest Public Sewer Line ~ O ~'L~,~.
Cleanout/Manhole _ N ¢) 1'4. I~~''
Water Sample Collected dy ~ ~'
Water Sample Test Results _ ~
Comments
Purr o Set At __z~ c~ 7' 7'0 ~
Sanitary Seal on Casing (Y/N) '~
Depression Around Wellhead (Y/N) ~
On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed ~U-/'~ 17,~ Size ! ~.-'~O NO. of Comoartments _ '~a
Standpipes (YIN) _~ ~E Air-tight Caps (YIN) ~ Foundation Cleanout (YIN)
Depression over Tank (Y/N) ~ Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~/~ ; for
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Wel j' ~-
To Property Line ,¢~
To Water Main/Service LLne _
Course
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disoosal Field
/O
To Stream. Pond. Lake. or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed '"~ ~ ~'"'/ / ~
Width of Field .~, ~
Square Feet of Absorption Area ~ ~'/¢
Depression over Field (Y/N) ~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I ~ O
To Building Foundation __ ,~-'~
Lot N
To Water Main/Service Line ~.~ ! I~
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 (Y/N)
Date of Last Adequacy Test
TO Property Line ~ '~ ~:3
To Existing or Abandoned System on
; On Adjoining Lots ~ /fJ..-~3
To Cutbank (if present) i~'/~9/~/~"--
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)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked verified, or,,eonformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~ Date t,~. /'~'"'. ~ (~
MOA No.
/
Company
Receipt No. ~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
,~ ~D [ 203W ISmAVE 'C' SUITE 203
RESIDENTIAL WELL INSPECTION
LEGAL: Lot 2, Tract B, Woodhaven Subdivision
LOCATION:
OWNER:
TYPE OF WELL:
12041 Jerome Street
Earl Falk
On Site Single Family
WELL LOG AVAILABLE: Yes
INSTALLATION REQUIREMENTS MET:Yes
WELL YIELD FROM WELL LOG: 20 gallons
per minute
PUMP YIELD FROM TEST:
5 gallons per minute~-
DATE OF INSPECTION:
April 6, 1988
TEST PROCEDURE: Well was pumped at a constant rate while the
drawdowu was monitored with an acoustic probe. A~ the beginning
of the test water level was found at 25 feet below top of casing.
At a pumping rate of 5 gallons per minute the water level dropped
to 34 feet after 1.5 hours and remained at that level for the
remainder of the test, two hours. A total of 1000 gallons were
pumped. '' '
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli
and total nitrates on April 8, ].988
E.Coli 0. Total Nitrates 0.37mg/1.
Max. allowable Total Nitrates 10mg/1.
TEST RESULTS: This well meets the requirements of the
Municipality of Anchorage.
THIS WELL WELL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE
THA~ FOUR HOURS
The Municipal requirement for well flow is 150 gallons of water
per bedroom per day. This well exceed this requirement. The
assessment' of the condition of the well applies only to the
conditions as of the day tested. The flow rate may change due to
subsurface conditions that may n6t be observed from the surface,
and changes in the land use and other factors that may impact the
aguifer feeding the well.
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WELL:
SEPTIC SYSTEM ADEQUACY TEST
Lot 2, Tract B, Woodhaven
12041 Jerome Street
Earl Falk
Single Family 4 Bedrooms
On Site Single Family
#1
SEPTIC SYSTEM:
FROM MUNICIPAL RECORDS:
TANK: Greer Steel, 1250 Gal.
ABSORPTION SYSTEM: Trench
ABSORPTION AREA: 540 sq. ft.
SOIL RATING: 125
INSTALLATION DATE: July 1976
DATE OF LAST PUMPING: March 29, 1988 A Plus Pumping
2 Comp.
DATE OF TEST: April 6, 1988
TEST PROCEDURE: System was inspected and measured. Tank was
found with 2.5 feet of cover and 46 inches of liquid. 6" Trench
sump was nine feet deep and ~J. tb_43 inches of liquid. 1000 ~,~
gallons of clean water were added.to the sump while the water
22;"
levels in the sump and tank were monitored. Neither water leve~s
hangDd. The sump was not ~erfor~t d. The horizontal
a~s~r~Du~on pmpe could be seen entering the sump at water
level.
TEST RESULT:
-the Health and
Anchorage.
This system meets the code requirements of
Social Services Department of the Municipality of
NOTE The operational life of all septic systems depends on the
local soil conditions, groundwater levels that may fluctuate
during the year, and the water usage'of the family being served
by the system. These conditions are outside the control of the
evaluator of this septic system. We can therefore not giw~ any
estimate of how long this system will function satisfactory for
current or future occupants.
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HFJkLTH
DEPAR%MENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1o _~e3~era__~1%n~fo~.'mation Application Date
(a) Lea;al Description (include lot, block, subdivision,
Zo~2. ~'z~ ~ Am~,~/bq~l ~5~ 41
section, township, range)
Location (address or directions)
· NumSer of Bedrooms
3. Water Sup?l_3_-
Individual Well ~
~uyer [Z ; Other ~-'d <ex~lai~);
(d) L~nding Institnt{on_ Tsle]~hone ~ _~
(f) Mail the ~ to ~he following address:
..... -- .... ~~-7-
2. ~f Residence ' ~
Single-Familyj~ Multi-Family ~ Other (describe)
Community~_~ Public~_~
Note: If community well system~ must have ~itten confirmation from the State
Department of Environmental Conservation attesting to the legality and status°'
Sewage Disposa_~l
0nsite~ Fublic~-! 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]
En.8.i_neerin$ Firm .?~r~ovidin8 Inspections~ Tests~ File Search~ Data and Information
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 ~.~astewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based om the information obtained from the M~nicipality of Anchorage files and from my
investigation and inspection, [:he on-cite wa~er supply and/or %rastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
t ioms in effect om the date of this inspection.
Name of Firm~. ~/~ll&~/~z//~t~ ~/~/- 5'z:~'/IC~':, I~, Telephone ~
Address /~ ~ 3~~3~ ~-/t3~ ~'Mz~~ ~ ~z~'~'~ ~- ~~~__
Approved for'~__3Z_bedrooms By
Approved _~ Disapproved
Terms of Conditional Approval
(ENGINEER SE~)
Conditional
CAUTION
THE MUNICIPALITY OF ANCHORA~g DEPARTMEbrf OF HEALTH Ai~D ENVIRONMENTAL PROTECTION
(DHEP) ISSI~S HEALTH AUTHORITY A~PROVALCERTIFICATES BASED SOleLY UPON TIlE P, EPRESENT-I
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDE]?ENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR I~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEIL~C AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS 0R ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. T}~ lfUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
:RR4 / e j/D 18
[Page 2 of 2]
(DHEP SEAL)
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264..4720
Legal Description: ~¢]~'.Z~
WELL DATA
Well Classification
Well Log Present(~N)
Total Denth ~ - ¢ Cased to
Static Water Level ~"1 /
Casing h~e~ght Above Ground /,
Electrical Wiring n Conduil
SeDarauon Distances from Well:
To S6 atic/Holding Tank on Lot -]'~'~"
To Nearest Edge of Absoruuon Field on Lot
To Nearest Public Sewer Line "~//~'
Cleanout/Manhole .
If A, B, C, D.E.C. Approved (Y/N) __
Date Comoleted ~,-'-/27" /97(0 Yield _('~,)
Death of Grouting
Pump Set At
Sanitary Seal on Casing Y~N)
Depression Around Wellhead (YN~
; Date
; On Adjolmng Lots
: On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lol
Water Sample Collected by
Water Samele Test Results
Comments ~_~) /A/t~.g-
B, SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~)N) Air-t ght CaesON)
Deeression over Tank
Purr 0lng/Maintenance Contract on File fY/N)
Holding Tank High-Water Alarm (Y/N) _
Separauon Distances from Septic/Holding Tank;
To Water-Sb aply Well /
To Property Line ~ / ¢'
To Water Main/Service Line
Course
Size ./,¢4,',',',',',',',','¢~ 6"4:~ No. of Cum oartments ~
Foundation Cleanout~N)
Date Last Pumped ~'~ ~ ~
~/~ :for ~/~-
Temporary Holding Tank Permit [Y/N) _ ~/~
To Building Foundation
To Disposal Field
To Stream, Pond. Lake. or Ma,or Drainage
Comments
Page ' of 2
72-026 11184'
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y,(~
Resulls of Last Adequacy Test
Type of System Design
Length of Field ~'"5/ /
Depth of Field '~ ~
Gravel Bed Thickness :~' /
Standpipes Presentl~N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well / 50 z
To Building Foundation ,~'¢°
Lot
To Water Main/Service Line /V~'/,q'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutbank (if present)
Comments
/
D. LIFT STATION .//,~
Dimensions
Size in
Gallons
Manhole/Access (Y/N)
"Pump On" Level at -""'""---~_ "Pump Off" Level at
High Water Alarm Level at ~_ Vent (Y/N)
~i~d. cfa~rc~ ~i~g Adequacy Test. Meets MOA
Comments
Check Permitted Bedroom Rating Against HAA Request **
I certify that l h.~,~hec~e/d., v.~rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~ &' '/~//'~"'~ Date ¢ ~---? ~ ~
Company ~ MOA No. ~><~ ~ ~ :
Receipt No. ~2 % ~ ~
Date of Payment ' ~} -~ ~
Amount: $ , ~ ~ o~,
Page 2 of 2
72-o26 (I 1/84)
ALASKA I dlROI F/leiqTAL COI1TROL B RUIC B, linC.
NANCY TRAVIS
12041 JEROME PLACE
ANCHORAGE ALASKA
99516
SELLER-SAME
SEPT 27 1985
WILL PICK UP iFROM OUR OFFICE
50629
LEGAL:WOODHAVEN ADD #1/TRACT B/LOT 2
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-SEPT 20 1985
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 540 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 680 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON SEPT 23 i985 .
FLOW TEST ON WELL
WELL FI,OW DATE-SEPT 20 1985
A FLOW TEST WAS PERFORMED ON THE WELL. 680 GALLONS OF WATER WAS
PUMPED AT A RATE OF 5.7 GPM OVER A DURATION OF 3.5 HOURS.
THE DRAWDOWN WAS 19 ' WITH A RECOVERY TIME OF 90 MINUTES
AND THE STATIC WATER LEVEL WAS 15.5 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
1200 [Ucsl 33r,J Auenu¢. Suil¢ B · Aachoroqe. Alosk. 99503,,(907] 561-50~0
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAl_ OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
Date Received
Time of Inspection
Date of Inspection.
December 10, ]976
l. Approval requested by: Alaska Mutual Savings Bank
Mailing Address: Post office Box 1120
Phonei 274-3561
2. Property Owner: Loren E. & Nancy E. Travers
Phone: 344-5665
Mailing Address: Star Route A Box 1560T
3. Legal Description: Lot 2 Tract B Woodhaven Subdivision
4. Location:
NHN ~Terome Road
Type of facility to be inspected
Well Data:
A. Type Individual
C. Construction
Single Family No. of bedrooms
B. Depth
D. Bacterial Analysis
E. Disposal
Distances:
3
Sewage Disposal System: On-si. re system ~7gml~/Z/
A. Installed __/~7~ . B. Installer
C. Septic Tank: 1. Size /,~l~]). 2. Manufacturer ~=¢. .
D. Seepage Pit: 1. Absorption Area ~593/0~,_~' 2. Material_ ~.
Field: Total length of lines
_, Absorption area
, Other contamination
, Absorption area
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
., Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages Re~..st for Approval of Individual L ~er & Water Facilities
Legal Description Lot 2 Tract B Woodhaven Subdivision
Comments
Approve Disapproved
~ / Approval Valid for one year from date signed
x-G4~eater Anchorage Area Borough, Department of Environmental
Quality
DIAGRAM OF SYSTEM
I 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)
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
2. Property Owner: __/-- _C).~ ~'/k) ]~: .
Mailing Address:
Name of Buyer:
Mailing Address:
VA
15'~,oT
4. Name of Lending Institution:. /~./~_~..~____/~L~/~_.~L~
Mailing Address: ¢)O. ~O~ //~O
5. Name of Realtor or Agent: [~) /iCl
Mailing Address:
FHA
Day Phone
Day Phone
Phone ,~-7~' ,~ ~(, ]
Phone
6. Legal Description:_ /--07~'¢)~_jTh¢3c~¢ ~. ('OO(2P /fie'qO£/~
7. Type of Facility to be inspected: __L~E-
~ ·
8. Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
No. Bdrms. *~
Individual
/
Individual (on-site)
EQ-037