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GREENLAND BLK 3 LT 4
Greenland Block 3 Lot 4 #010-115-24 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5uj loci to PID Number: c3J!�7 - 17Z — 10 Name: ! Jec.k U441T-0 R.e ��lM G Wastewater System: ❑ New X Upgrade �v1.16r q,G o ATrrl: JortlJ Q+u4,riE Address: n At. -rowr ocA. galSo3 Zo1 G . 5A ABSORPTION FIELD Phone: 2`I e SDS No. of Bedrooms: 3 jK Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: �+ Total Depth from or ip inal grade: CT • GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: 1 Gravel depth beneath pipe 1 14 E OID 2 ..5 Ft. Co • ✓� Ft. Township: _. Range: Section: —, Fill added above original grade: 1 Gravel length: r 2 Or _' I Ft. fp Ft. WELL: r New ❑ Upgrade Gravel width: Z S Number of lines: ( Distance between lines: 6 GIST r�] • Ft. Ft. Classi i n (Private, A,B,C): Total Depth: Cased T Total absorption area: Pipe material: Ft. Sob Sp. Ft. ASTM 0-3631f F_610 Driller: rilled: Static Water Level: Installer: Date installed: Ft. CARES GRGgdf(TI�� 5�17/`i$ Yield: _ Pump Set at:si Height Above Ground: TAN K TANK GPM FL Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Litt Holding Public/Private Manufacturer: _2.4 Capacity in gallons: From Tank Field Station Tank Sewer Lines IY'. .4Y, � , oa Aca6 1000 wellSTgeL- Material: Number of Compartments: SurfaceLIFT STATION Water too I- 1o01i- Lot21 1 Size allons: Manufacturer: Line I Q Foundation 120 r-. 135 _ '.Pump on" level at: I "mp oPu High water alarm at: Curtain 11 Pump M el Electrical Inspections performed by: Drain Ne BENCH MARK Remarks: d� Location and Description: T M T of STI loo . o Ta P of 4r.Ao — 10�5•�� Assumed Elevation: /00, O Ft ENGINEER'S SEAL •y.. G�1' ••• �. •� 1s 5 f b 9B • •f • �•* Inspections performed byeTV% Dates: rd„t 7320 East Chester Hts. Circle 2nd .511-712S , .., . ..-. »• Anchorage, Alaska 99504 3r, s 09 � Department of Health and Human Services approval`nF� 67953 ��� Reviewed and approved by: Y'Z Date: 1512 'Q& • ,... s 72-013 (Rev. 9191) MOA 25 PERMIT w9 NUl.,1' - : AS -BUILT DRAWING PARCEL I SW9€10110 015-172-- 10 NG nim 1-4 IWWCH 1000 OAI�c& !Tr'nc fMK EXISTING; 3 BEIRM EXIST, IiUUSE 4/I_LL _ _ 1— Jr2 j 1tw1000 q �nc'rew'� -94.1 z FINAL GmAnr. 2 FOOT W OF COVER ALASKA WATER & WASTEWATER .AL DESCRIP'HON: GREENLAND SUBDIVISION; LOT 4, BLOCK 3, c of WORK: AS -BUILT OF SEPTIC SYSTEM UPGRADE =PARED FOR: PHONE NUMBER: KIM SUNBERG 346-2619/346-4779 'E:DRAWN BY: SCALE: PAGE: 5/18/96 1 1. L. M. = X10' 2 OF 2 v�."A s�p0 * T y*� ...... ....... ........... J f e A. Garness; 40 fir'. —7953 ` e� .......... Fc°vv ��l��Pr 0 f e6e0�d�� `) (.�" per" 988 leo ✓ 1 PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE-.xCc�VC' �C'1 c aC DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980110 DATE ISSUED: 5/12/98 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE: 5/12/99 OWNER NAME:SUNDBERG KIMBAL A & OWNER ADDRESS:4841 115TH AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01517210 LEGAL DESCRIPTION: GREENLAND BLK 3 LT 4 LOT SIZE: 27000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST 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 ENGINEER MUST NOTIFY DHIiS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: EXISTING SEEPAGE PIT SHALL BE ABANDONED PURSUANT TO THE 1996 UNIFORM PLUMBING CODE DURING THE TIME OF CONSTRUCTION OF THE NEW WASTEWATER SYSTEM. IN LIEU OF THE ABANDONEMEN`, A ATER MONITOR LOCATED CLOSER TO THE EXIST IJNC Ski PAG- T Y PROVE NO GROUNDWATER ENCROACHES THE SY EM J /1 DATE: 3 /s RECEIVED BY: Alaska Water & Wastewater 7320 East Chester heights Circle — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers May 5, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref Septic Upgrade Design for Lot 4, Block 3, Greenland Subdivision. To whom it may concern: The existing 3 bedroom house is served by a private septic system and well. The existing seepage pit is surcharge and must be upgraded prior to the sale of the house. A test hole was excavated to the north of the existing septic system. Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached is the soil log which shows the soil profile, and the percolation test results. The soil below the organics, to a depth of 5 feet, is generally silt with some light gravel (GM/ML). At a depth of 5 feet, the soil transitions to silty sand, and silt, to a depth of 17 feet (bottom of test hole). Groundwater was encountered during the excavation at a depth of 15.5 feet. On 5/5/98, groundwater was encountered 13 feet. Two percolation tests were performed, one at 4.0 feet to 4.5 feet which perked out at a rate of 12 minutes/inch and one at 7.5 feet to 8.0 feet which perked out at a rate of 15 minute/inch. 2. TRENCH DESIGN: a. Percolation Rate: 15 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 750 ft2 f Effective Depth: 6 feet g. Reduction Factor = N/A h. Width: 2.5 feet i. Minimum Length: 63 feet long j. Effective absorption area = 750 ft2 k. Maximum depth = 8.5 feet 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: Beginning at the south property line, the lot slopes downward from south to north at a average grade of approximately five percent. There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, P.E., M.S. v �ln v� �NJ W t N `j I—•: e—W sw C)! 0- MCI - y T cV'N iV u� c� rl rr cv c! o C4R -e.7 Cil G c0 Tia CA u5� Yp 14 `�•2 yrao t'iG N Irl •� -"W Ore I L1 F -W ted. h"W b� ~LJ ~'�� rj re ,�� lO \ mo L i �C�U C v rC Iv J E P� *G��a� /®�� ) t �i `! 1)G I'W 1 Jru UW iv ~W a� Ln Z FAST 1 1 4fh AVENUI - W - Pt1� fUNDEVELIIPED) w'y ALASKA PROPOSE,D FX 571146 WASTEWATE • LEGAL DESCRIPTION: SEPTIC SYS I CFI F 711 , Ex15'fSFIGe GLA55 C VFLL p c V) `i _ .--- - 7.11 1 T+I'#2 WELL PREPARED FOR: f--EXISTING PI-IONF NUMBER: KIM SUNBERG i WITHIN 150 ITE:7 EXCEPT AS NOTED.I rI vN MZ I - L9 �OF A .-Y USO A ' r y Gern ss 7953 odd U Profession o F-SYSTEMul M1(n In �1 ------ -- Y n '� ,�� lO \ mo L i 1)G I'W 1 Jru UW iv ~W a� Ln Z ~� - W _q Pt1� PREPARED BY: w'y ALASKA 1 FX 571146 WASTEWATE • LEGAL DESCRIPTION: i- 9lr , Ex15'fSFIGe GLA55 C VFLL p r7 WELL PREPARED FOR: PI-IONF NUMBER: KIM SUNBERG J\—i Lh 15th A\F N U E — -- / 5/5/98 NO"CE TH OF THE PRCi. J.L.M. = 100' -- i WITHIN 150 ITE:7 EXCEPT AS NOTED.I rI vN MZ I - L9 �OF A .-Y USO A ' r y Gern ss 7953 odd U Profession o �1 d FtW d� W U W _q PREPARED BY: ALASKA WATER & WASTEWATE • LEGAL DESCRIPTION: GREENLAND SUBDIVISION; LOT 4, BLOCK 3, TYPE OF WORK: SITE PLAN PREPARED FOR: PI-IONF NUMBER: KIM SUNBERG 346-2619/346-4779 DATE: DRAWN BY.,717 PAGE: 5/5/98 J.L.M. = 100' 1 OF 2 i WITHIN 150 ITE:7 EXCEPT AS NOTED.I rI vN MZ I - L9 �OF A .-Y USO A ' r y Gern ss 7953 odd U Profession o --------- PROPOSED_ DRAEIPNFIEL.D Irl 63 FEGF LONG BY2..5 FEET WIDE WITH 6 FEET OF SEWER DRAINROCK. INSTALL DRAINFIELO PARRALEL TO CONTOURS. COQ— CO INSTALL. DBI. CO 1I1411 TH f2 PROPOSED 1000 GALLONINSTALL BULI. RUN SEPTIC TANK—,� DIVI_RTER VALVE d --EXISTING :SEEPAGE PIT — _ TO DE ABANDONED SUCH COr- THAT rr MAY BE USED IN THE FUTURE CD�LAT J C �`' ----EXISTING SEPTIC TANK TO BE ABANDONED COMPLETELY ams ...-INSTALL DUL CO ✓x� _L CO Z (V C) M t E' _j L7 LT] a 1 3LdLd LTJ t Ci v N7 z J0 ,5 �U w cj "v J Y If) Y Ci r-] EXISTIN15 BDRM LXTS"I. I-IC1l.�SE WLLL I Exl%TiNG CLASS "C° >_ WELL .5 i hi i i i [Y- r� \.. FA` STNM TE 1 1) Th A V F N U I VEST PROLPER TY L NETFL AGGEDEr13Y A IS RUIRELREGISTERED TO HAVE l"HE LAND SURVEYOR PRIOR TO CONSTRUCTION PREPARED BY: ALASKA WATER & AST'EWATE LEGAL DESCRIPTION: GREENLAND SUBDIVISION; LOT 4, BLOCK 3, 0 TYPE. OF WORK: ... ...�.� DESIGN OF SEPTIC SYSTEM UPGRADE ••• d f re A. rness. Q PREPARED FOR: PHONE NUMBER: oo m CE-7953 o DO KIM SUN®ERG 346-2619/346-4779 DATE: DRAWN DY: SCALE: PAGE: �%r' G •...... • • •' F.c(aG� 5/5/98 J.L.M. 1 = 40' 2 OF 2 ®'oZZ u +.t Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN 825 "L" Street, Anchorage, Alaska 9951 SOILS LOG -- PERCOLATION PERFORMED FOR: Gross Date Time SUrJI&ca-6 _I<.n 90 LEGAL DESCRIPTION: L-1/ S�/ Gr EEajLA>JY2 TON A . JAMES P. •' WAS f-FEj�L -1 SIB 2 3 M1 � � I O' I 61'&IML SILTY 1411)')i ;UI 3UMIN / 11 c 4 � S- vLf s: oy - 6" 3'{ OMrw Hr ar, — I S^^/ML S�Ky S&No 6 — 7 li 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS nship, Range, Se, SLOPE I: I WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT — • DEPTH? Depth to Water After ` ' Monitoring? 13 Dale; 13,o,N. 11 h P 0 wt°ROFES94�: aDA`Ii y s ;tion: SITE PLAN y� S E QC 0 � µ Gross Date Time • ' 90 ilia aH A . JAMES P. •' WAS NO.9 08C. nship, Range, Se, SLOPE I: I WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT — • DEPTH? Depth to Water After ` ' Monitoring? 13 Dale; 13,o,N. 11 h P 0 wt°ROFES94�: aDA`Ii y s ;tion: SITE PLAN y� S E QC 0 � µ Gross Date Time Net Time Depth tDY Water Net Drop aH -1 SIB y:3i — Err — ;UI 3UMIN / 11 c — S- vLf s: oy - 6" 3'{ OMrw Hr ar, — : it — 6 " — PERCOLATION RATE lot I /S (minutes/inch) PERC HOLE DIAMETER G"P" ' or4' TEST RUN BETWEEN y0 k,$ FT AND �'S-8 U FT PERFORMED BY: � _i'—""_ `'" I %f 1L � 4 ✓ �--A CERTIFY THA T/I-YSpTEST WAS PERFORMED IN ACCORDANCE WIrl4 ALL STATE AND MUNICIPAL GUIDELINES l� EFFECT ON THIS DATE. DATE: y 2YI �V 72-008 (Rev. 4/85) Mi -� GRE- -eR ANCHORAGE AREA BOf 'IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME , � C1�J MAILING ADDRESS_ -I Y1 Lir PHONE LOCATION !� /;�� -• I C_L' it LEGAL DESCRIPTION A% -% 1 �•Li� �/ - ij�r i _�., �_ SEPTIC TANK: DISTANCE I NUMBER OF FROM WELL '1'2 MANUFACTURERS%<<-< -MATE RIAdL,/ /'/ ,I/" / _COMPARTMENTS__ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /!. ( GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH/LENGTH=t , DEPTH r LINING MATERIAL _ CRIB SIZE: DIAMETER I DEPTH -L— DISTANCE FROM: WELL. TOTAL EFFECTIVE BUILDING FOUNDATION / NEAREST LOT LINE 21, ABSORPTION AREA (WALL AREA) ') ('"I _SQ. FT. ADDITIONAL ABSORPTION WELL TYPE l)I i IL CONSTRUCTION ! I 1_ - DEPTH ' DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE TANK SYSTEM _ CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: 0 '! `,/ �Gu 1 1 INSTALLED BY: I > r % ` (:'J'' —- PIPE MATERIAL: L L, (r, ' ( 4L(II _ LOT SLOPE: REMARKS: ��I(t. i` IJ�i t Yuri((✓ Q( Form No. EQ -031 DIAGRAM OF SYSTEM v 1 � '-°`-- � - <<,. 1���-:-._--mow I !( •.i.'�.. - j 0 G.A.A.B. /c, (- ' I otc) GREATER ANCHORAGE AREA BOROUGH PERMIT NO UEPARTMENT OF ENVIRONMENTAL QUALITY3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT ` 4 MAILING ADDRESS --/" 7l 'S" / PHONE INSTALLATION LOCATION _ LEGAL. DESCRIPTION v% / �7//'• I � J/� INSTALLATION OF: SEPTIC TANK - SEEPAGE PIT DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED-(�/'r%'LT'� Y� FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS _ .//LIiiSCliYitQ� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 12,24( _, 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. SEPTIC TANK SIZE TYPE _ SEEPAGE AREA SIZE w TYPE � MINIMUM DISTANCES, REQUIREMENTS DIAGRA OF SYSTEM FOUNDATION TO SEPTIC TANK '+'�A FOUNDATION TO SEEPAGE PIT �`� DRAIN FIELD I I�--- SEPTIC TANK TO SEEPAGE PIT WALL 1 j f 11 I 1 I _�- SEPTIC TANK SEEPAGE PIT DRAIN FIELD - } �'- I - 1 ' - TO NEAREST LOT LINE. WELL TO SEPTIC TANK d� SEEPAGE PIT DRAIN FIELD 90/ �- r� ALSO CONSIDER AREA WELLS. I � WATER MAIN TO SEPTIC TAMC SEEPAGE PIT DRAIN FIELD SEPTIC TANK, 0o SEEPAGE PIT DRAIN FIELD -�, I I TO RIVER, LAKE, STREAM. , ( 1 I 1 I �- CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. t - i GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. , I i i I t f -- ._L_ 1 OR I_ -1 LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. 4 DAT/F�. L7L L ��/G '2� /,APPLICANT'S SIGNATURE�-AFZ Il - GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL. QUALT7Y Case 11 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For�DL! _Dated Performed V Legal Description: Lot_y Block .'�_Subdivision_l�e�y,/��r� This Form Reports Soils Log_ly _Percolation Test_ Soil Test Must Be Logged To 4' Below Proposed Seepage System Depth Feet Soil Characteristics I- 2-- 3-- 4-- — 2-- 3-- 4--- y S4 �A S 5- 6-- 7-- 8- 9__ - 6-- 7—"8-9__ � /0 10- 11 m- 12 -- 13- 14-- t6 2-- 13--"-- 14-- l6 r -Was Ground Water Encountered? )?y_ If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H2O Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet — _____ Depth to Bottom of Pit or Trench"— COMMENTS: Test Performed BY_���?i�P-r�__�_ fiicr�n�,Q Date Certified BY: Date: Parcel I.D. 015-172-10 -7 Municipality Municipality of Anchorage NMI On -Site Water and Wastewater Program (907) 343-7904 r. Certificate of On -Site Systems Approval 1. GENERAL INFORMATION r Expiration Date: oC - 2w—/ Z Complete legal description Greenland, Block 3, Lot 4 Location (site address) 4841 E 115th Ave. Current Property owner(s) William Yelvington & William Yelvington Jr. Day phone Mailing address Real Estate Agent 2920 Brandywine Ave. Anchorage, AK 99502 2. TYPE OF DWELLING: F-_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well IX Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Sz Waiver Fee $ Date of Payment / G/�/� �� Date of Payment Receipt Number ©lO / /�fO Receipt Number COSA # QSi�� ��� Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal fixed-hereT[i and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. BOX 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for J bedrooms bedrooms Date 11/9/2016 OF Steven f2.•Paamone- i�,. CE -8149 bedrooms, with the following stipulations: By: �-^'�^ ( Original Certificate Date: 12l� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet C ., If more than 1 septic system is on the lot: COSA Checklist # + of + Structure served by this system 1 Certificate of On -Site Systems Approval Checklist - Greenland, Block 3, Lot 4. 015-172-10 Legal Description: Parcel ID: A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Unknown Y Y Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth unknown ft. Cased to Unknown ft. Casing height (above ground) 12+_in. FROM WELL LOG AT INSPECTION Unknown 11/8/2016 Date of test Static water level Unknown ft. 60 ft: Unknown 5.9 Well production 9 -P.M. g p m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic' N ug/L Date of sample: 11/8/2016 Collected by: PES B. SEPTIC/HOLDING TANK DATA. SOPtic/Steel 5/17/1998 Tank Type/Material Date installed Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation. cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N r Date of pumping / Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 5/17/1998 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench Length 62 ft. Width 2.5 ft. _ Gravel,below pipe 6'S ft. Total depth 9.5 ft. Eff. absorption area 806 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11/8/2016 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 58 in. Water added 477 gal. New depth 69 in. Elapsed Time: 80 min. Final fluid depth 58 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off" level at Cycles tested Manhole/Access (Y/N) in. . High water alarm level at in. Meets alarm ,& circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot. 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ F. COMMENTS *Field insulated per record drawing -� Survey on File G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review .of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date 11/9/.2016 COSA canary sheet_2-6-15.doc S eL fan'/ k-;5 % CE -8149 --:%A Municipality ofAnchora e p tY 9 • '� Development Services Department Building Safety Division On -Site Water& Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgionsite (907) 343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcel I.D. 010-115-24 Expiration Date: 12 -17-u- 1. 17-J -1. GENERAL INFORMATION Complete legal description GREENLAND: BLOCK 03, LOT 04 Location (site address) 4841 E. 115TH AVENUE *ANCHORAGE AK Current Property owner(s) JEFF BARBER & JULIANA SHIELDS Day phone 830-1360 Mailing address 4841 E. 115TH AVENUE *ANCHORAGE AK Real Estate Agent CLAIR RAMSEY W/DYNAMIC Community On-site Day phone 261-1360 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex . ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '- hn . o c1) ` Date of Payment Gi l I l @I7 L ►�G�Receipt Number COSA# ®`..r_\e 1y\1 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warrantyor future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date elb/2- 2- bedrooms, with the following stipulations: OF ON-SITE WATER AND WASTEWATER PROGRAM The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: i COSA Checklisty Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other By. (Rev. 11!05) Original Certificate Date: I ! —1 2— If more than I septic system is on the lot: COSA Checklist* _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: GREENLAND; BLOCK 3, LOT 4 A. WELL DATA *PER GEG TESTING **PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Date completedPRE-1 1 /1974 Sanitary seal (Y/N) YES Total depth *88+ ft. Cased to **40+ ft. FROM WELL LOG Date of test NO WELL LOG Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. ull Parcel ID: 010-115-24 Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/24/12 65 ft, 5.05 g.p.m. Nitrate ND mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 8/24/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/16-18/98 Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 8/30/12 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 5/16-16/98 Soil rating (g.p.d./ft or /bdrm 0.6 System type TRENCH Length 62 ft. Width 2.5 ft. Gravel below pipe 6.5 ft. Total depth *9.58 ft. Eff. abLorption area 806 W Monitoring tube YES Depression over field NO Date of adequacy test 8/24/12 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 48 in. Water added 455 gal. New depth 58 in. Elapsed Time: 140 min. Final fluid depth 55 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off level High water alarm level at in. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankn!ft station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surrace water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date (Rev. 11/05) EAST 114TH AI/ENUE Municipality of Anchorage Development Services Department Building Safety Division s q„ On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING �2 Parcel I.D. 015-172-10 HAA# ✓ J(J� 1. GENERAL INFORMATION Expiration Date: ,% Complete legal description GREENLAND SUBDIVISION LOT 4 BLOCK 3 Location (site address or directions) 4841 E. 115th AVE. *ANCHORAGE AK 99516 Current Property owner(s) DANA BRUDEN Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone 346-4216 4841 E. 115th AVE. *ANCHORAGE AK 99516 F.S.B.O Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, f verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. , Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 Date fZ 03 Conditional approval for bedrooms, with the filowing stipulations: ON-SITE •.'� WATER AND WASTEWATER PROGRAM - Attachments: p�cy ,•' Q� �: HAA Checklist L� Manitenance Agreements J'-� `c�• 0��,� Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By: Original Certificate Date: 7 /E— (Rev. E (Rev, 12101) ��re. 9 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. # _ 015 - I -7Z -I o HAA # Q92 (-'\j `1� 'I. GENERAL INFORMATION Complete legal description Lor 4� 13I_0C.K 3 Location (site address or directions) S 1 f=AsT J154h :: lwG- k SVpIB�K� Property owner _ �� Day phone 346^ Zblq /3YG Mailing address ye`I Asr IlEt, LIE. Lending agency_— Day. phone Mailing address_ /� A -r-r4 Agent JAcY CJI-I)-rE 9,C -AL ESrA?E 7404A JRLAI,�E: Day phone 2z`t - 9oso Address azo I 5-rgE-Fr b,,rjcAoQAGF 4 AK. _G Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: �'l�S iaCr 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site i< 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 (Rev. 1/91) Front MOA 021 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 320 East r � ats. Circle Phone _ 337 — 61-71 7;320 >✓ast Chester Hts. Circle Address ._ Anrhornon Alncl-n QQr%AA Engineer's signature V IS/} LV��FJL %111,--- Sum P(T 0 (--,D ZNJoiCL� 7—a 6. DHHS SIGNATURE Approved for = bedrooms. Disapproved. Date 5_/78/9� \ ..4:�{3L•vi'G Fara. �..°. ae• II -,� s� ffrr) � ;rc 1 •� � Sys C:J93J Conditional approval for bedrooms, with the following stipulations: Additional Comments By. Date 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. E=mployees 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. 72-025 (Rev. 1/91) BaOk MOA #21 RECEIVED • Municipality of Anchorage MAY 19 1998 DEPARTMENT OF HEALTH & HUMAN SERVICI=�nuNICIPAurYOFANC t Environmental Services Division ENVIRONMENTAL SERVICE 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lor '4' 61-y 69eer4r.Ar4n SAb) Parcel 1. D.:— 015 -17z - 1 0 A. WELL DATA Well type eyy )\)A -rt If A, B, or C, attach ADEC letter. ADEC water system number ni A _ Log present (Y/Q — !� Date completed *kloe' 'T•- tJO4. 7 I617N Total depth '- I `(2 1 Cased to q0' 4- Casing height (above ground) IS if 4 - Sanitary seal (ON) YCS Wires properly protected (0N) _ Yes T, eCe-. rA.o.A. PEC-oQD Ir.16Pee-Tio,d f{CroR.r FROM WELL LOG AT INSPECTION Date of test 6- 14/'4 r3 Static water level v Well production _ —g -p -m. -7.0+ WATER SAMPLE RESULTS: Nya (ZOSuL--iS Tb Foux,� -7'0 ePl 2�1�1 t hp��oaS PUMP Coliform Nitrate d Other bacteria Date of sample: 18/90 Collected by: �-'W_"TA_ t wa ex B. SEPTIC/HOLDING TANK DATA 79201,3031 Chester Hts. Circle Anchorage, Alaska 99504 Date installed -5 17 IS _ Tank size 1000 Number of Compartments Cleanouts ON) `itS_ Foundation cleanout aN) _1165 Depression (Ye t� o High water alarm (Y(9- t'� o � Date of Pumping ew Pumper C. ABSORPTION FIELD DATA Date installed 6 f I7zgs Soil rating g.p.d.'IV or ft2/bdrm) 0 System type _ `rRe�Grf Length �2 ' Width 2.51 Gravel thickness below pipe 6 �' _ Total depth 9 t-9.5 Effective absorption area SO,o _ Monitoring Tube present (9N) Yes Depression over field (Y)a 1J° Date of adequacy test _ tJeV3 Results (Pass/Fail) For -9 bedrooms Fluid depth in absorption field before test (in.); Immediately after_` gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g,p,d, Peroxide treatment (past 12 months) (Y/N) — If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access High water alarm level ate _ Cycles testt� E. SEPARATION DISTANCES Size in gallons "Pump on" level SEPARATION DISTANCES FROM WELL ON LOT TO: 14- Septic/holding tank on lot _ 35 "Pump off" level at` On adjacent lots _ 1 =Z5 J+ ` Absorption field on lot 1 r::>5 +- On adjacent lots )25,+ Public sewer maim Public sewer manhole/cleanout /A Sewer /septic service line ZS + Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 120 ''- _ Property line -21, Absorption field 12 Water main/service line I" t _Surface water/drainage IOot+ Wells on adjacent lots %1�8, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Property line 10 Building foundation 1% It Water main/service line Surface water I0o, F Driveway, parking/vehicle storage area Curtain drain t I nac jCa00(,1 Wells on adjacent lots 11S 14 F. ENGINEER'S CERTIFICATION I certify that 1 in conforman inspections and review of Municipal re )s in effect on this date. Signature Engineer's Name Date 'A V PZy_40 'OFE� _ HAA Fee $ F'? 0;� r e)—o t ` Date of Payment Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORA(E DEPARTME )F lit"ALTH ANI-) ENVIRONMEN PROTECTIO -i--horaye, A' 9 01 825 1, Street, .71i k c� 279 - 51:1 1.1. f Y.. 224 or 22") LV ,'_late I Z C-- o j. v August 8, 1977 - Is #2. ----- Dal e Daj I n S p p REQUES,rP FOR APN',0VAf.,Q.F' 1-NfD1VXD1JATj SEWER ANID WATER FACILITIES pp-Ld-s zsY)Lb- Mc— oc, onding Institution Req Mall. -".ng Addre-Ss: 31 2"1 Property Owner - Robert M. Strauss hono --.2-79--3,293----.---. Mailinq Mdres-,,: Post Office Box 10-276 Klatt Station 99502 3,,Legal Des lr,ription.: Lot 4 Block 3 Greenland Subdivision ... . . ...... 4.-, Single Tilami1w 'Residence: (x) Number of Bedrooms% Three f Multiple ra-Mily Res,idencc,'.: Number of i3edrooms, 5., we"t .1 Tild"widuri), 'Noll (x) Syste-,m Permit �t 1)(2pth-pi- WC -1-1 J -ke. Wel . hog on "J.' SeWaqe Disposal IT,ristem: on-site 11-,�,,s.tem (x) PublAr Utility I . 0-V -2 Pea: mi t # Ins fa I led 1974 1 r1s, t a r o 8eptic Tan, Lj Absorption 11.> r.: Mater ia �s 7.; D i s t, a n c e s> Well to Sej-A-Ac, 'Tank t.o Abs-or-pti.cm Area NE r? .-,ot line Absorption Area to Se"Ver M'De to 'N(.-�arest Lot L.irie MUNICIPALITY OF ANCHORAGE ®� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONY_ X 2. Property Owner: Robert M. Strauss Mailing Address: p • 0. Fox 10.276 Klatt Statify Phone:Ab 4 z7g.t?.93 Anchorage, Alaska 99502 3. Name of Buyer:_ Not yet sold . . . Listed for sale with Jack White Co. c OJack White Cornnany Mailing Address:3201 "C" St., Ancha 99503 Day Phone: 277-1553 _ 4. Name of Lending Institution: Not yet determined 5. C:1 7 Mailing Address: Phone: Name of Realtor or Agent: Jon Dawson or Bill Swain, Jack White Company Mailing Address: 3201 "C" St. , Anch. 99503 Phone: 277--15 3 Legal Description: I,ot 4L Block 3, Greenland Subdivision Location: See attached street map. Type of Facility to be Inspected: Single Family Residence No. Bdrms. 3 8. Water Supply Type of Supply 4 Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72003(3/76) Individual_ X One Unknown —Individual (on-site) X of de31i h awl i +tV.r onmertr a 1 Protection ! c:(emqu.(sL for Ap )roval of Ind 7 vl(Iiia i_ Sower _.,g).d 1.' aci.1it1e.s i Lot_ 4:Block 3. Greenland,. Subdivision_. 1 -- At;')Proved: e Disapproved �� ��,J�n Date Department Warksbeet: 0i.9� �^^ l C) t`> l�L t to CA- .�Y S 16 r 6142 � I r � 1 l f -1I1 LJ. 2- itidsavi.t I,(.;tter Mt<ached: { j At;')Proved: e Disapproved �� ��,J�n Date Department Warksbeet: 0i.9� �^^ l C) t`> l�L t to CA- .�Y S 16 r 6142 � I r � 1 l f -1I1 LJ. 2-