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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 6 LT 17ASkyway Park Estates Block 6 Lot 17A #019-151-20 S~,,,D,V,S,ON: ~.,fi'/-'/ ~"~ ~.' /~'"4 -~-U'.Z'. I"'oC~: I '~1 C?- ~0 C~ """r ~ o06. ~ ~' 7/' I ~ · YJ'* CO I : I s,z~,.: · I~.,.: I~***..,.: / 7~ . I~*~"o~-~'"~: 7' . CONNECT LOCATION: ~' ~ ,~ ~, ~PO ~C COMMENTS: ~~'~ " ~ ' '~ , INSPECTED BY:: I ~A~E',_ '.: ' · !. : ,., Owner 1221 Shore Drlve Anchorage, Alaska 99502 June 20, 1979 Subject: Soils investigation for sanitary sewer system on Lot 17A, Block 6, Skyway Park Estates Subdivision, Anchorage, Alaska. Dear Owner: At the present owners request, I conducted a soils investigation at the proposed location of a new drain field on the subject lot. This investigation, which was accomplished on June 19, 1979, consisted of the inspection of soils removed during the drilling of a 15.5' deep test hole, using 6" diameter solid flight augers, powered by a Nodwell mounted CME 45 drill rig. After completion of drilling, Test Hole No. 1 was filled with water and a percolation test performed. The results of 'this test are tabulated on an accompanying sheet. The soils encountered are graphically shown on the accompanying test hole boring log. The soils consisted of a surficial layer of organics 0.5' thick, overlying an orqanic silt with some gravel 2.0' thlck, overlying a sandy gravel with some silt 2.5' thick, underlain by a gravel with some sand and a low trace silt to a total depth of 15.5'. A water table was encountered while drilling at 13.5'. The topography of the subject [Lot is flat with no discernible drainage. Vegetation present on the lot consists of dense tall spruce and birch, with some iow bushes, and a low ground cover of mosses and some short grasses. An accompanying sketch shows the subject lot with the approximate locations of the test hole, the sanitary sewer system cleanouts, and the buildings in relation to the property lines. I appreciate tile opportunity to be of service. Please contact me if there are any questions regarding this soils investigation. Very trulI yours, ~ichael B .., g~8~mann Consulting Geologist / Attachments: Drawing of test hole boring log with location sketch, and tabulation of percolabion test results. xc: Department of Health and Environmental Protection June 20, 1979 Lot 17A, Block 6, Skyway Park Estates Subdivision, Anchorage, Alaska. Percolatio test performed on June 19, 1979, using Test Hole No. 1. The 6" diameter, 15.5' deep test hole was filled with water and the water level drop measured periodically for one hour. TABULATION OF PERCOLATION TEST ~SULTS TIME LEVEL(inches) DROP(inches) ET(min) 1649 23.0" start start start 1659 54.0" 31.0" 10 0.3 1709 61.0" 7.0" 10 1.4 1719 66.0" 5.0" 10 2.0 1'729 70.0" 4.0" 10 2.5 1739 72.5" 2.5" 10 4.0 1749 74.5" 2.0" 10 5.0 RATE(min per inch) Average percolation rate for last one half hour of test = 3.5 minutes per inch. ~Michael B./~se~g~ann Consulting Geologist S69°40' 00"E 80.06' Seepage pit y cle nout 5 ' Utility Easemen~ NOT TO SCALE Distances are approximate and have not been measured by surveying methods as to location of test hole, well or cleanouhs. Topography is essentially flat, wi~h no discernible drainage. Michael. B. Bergmann Consulting Geologist Box 191, Star Route A, Anchorage, Alaska 99502 (907)344-9150 Test ltolo No. 1 6-19-79 anJcs: moist, loose, ~greon and brown. %- ~ -- 0.5' Drganic Silt: w/some Gravel, .~, loose, bm. \ (OL) %- ..... 2.5 ~andy Gravel: w/some Silt, dry, dense, brn. ~ (G~) ~ ~5.0 ;ravel: w/some Sand, low trc Si].t, vy dense, dry to wet, scat Cobbles & Boulders, gray. (GW-GM) · 5 ' WD 15.5 'TD Water table encountered at 13.5' Test hole boring log represents soils encountered on Lot 17A, Block 6, Skyway Park Estates Subdivision, Anchorage, Alaska. GAAB-HD I GPr'~,TER ANCHORAGE AREA BOROn' ~H HEALTH DEPARTMENT 327 EAGLE s'r. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /~ jL/~ d MAILING NAME__ /~, /v',Cy ADDRESS LOCATION LEGAL DESCRIPTION SEP'rlC TANK: DISTANCE FROM WELt J'~ [~>~ MATERIAL LIQUID CAPACITY__ /~)_O,~ GALLONS. INSIDE LENGTH ~O/g ~4~1...,OC lC: NUMBER OF , COMPARTMENTS LIQUID ..~ I(~ t~ INSIDE WIDTH ~' t DEPTH "~ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE SEEPAGE PIT: - I OUTSIDE DIAMETER_ OR WIDIH . D,STANCE FROM WELl /$8 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ,LENGTH__ ~ ,DEPTH. ~'~'~' , / BUILDING FOUNDATION J ~ , 2~('~ O SQ. FT. TiLE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA__ FOUNDATION DISTANCE BETWEEN LINED SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE , NEAREST LOT LINE TRENCH WIDTH TOTAL LENGTH _, OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILl: IN. ABOVE TILE WELL: LOT LINE T Y P E ~,~/')'~ '///.~ ,~ DEPTH NEAREST ., SEWER LINE 1/(~I DISTANCE FROM ,BUILDINO FOUNDATION._ SEPTIC ~ C)~'~ I SEEPAGE TANK__ , SYSTEM WATER _SAMPLE .... NEAREST OTHER ~'j.. / , CESSPOOL , SOURCES_'Li'~ DIAGRAM OF SYSTEM DISTANCES: ,,g- C= JOG' DATE APPROVED 9 -2 WATER WL@DRILLERS LOG 05�� . ". Drilling CoR fl M T q v Mu��Oz D " le Well OwnerA T&2?�t;; rPanje No Area of Wel qEDL �04?q OT FILL IN (if known); distance from.road: Lee N - f I tr T�IOCA__ V_ - .g - , -1 - = I - - - - i . j Size of Casin, epth of'Hol _d 1 r3 () f e e t. C.I. Static water level__� —5feet (above) LbSIzo land,surface. Finish of well (check one) open end Screen Perforated Describe screen or perforations: Kv%x� ygVOq'aED Well Pumping test at, _L_Q_gallons per (hr) (min) for__L�_ftours w1Zn T:j Vp- ' feet -of drawdown from Static level. RemarkS`NqK\11 \NVAS'�ZZK05�4'M /yM%juq 'Rglbn al W'03(5 V, rxyc,-V\ WELr bo'd ..___�epth in ground feet from surface to J5 to 30 to to t o 12 to to to to 'to to to to Give details of formations penetrated, size of material, color, and hardness. t� ILI to GREATEx, 327 Eagle St. ANCHORAGE AREA ~,OROUGd~i° c.seNo. IIEALTH DEPARTMENT Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT RESIDENCE ADDRESS NO~77-- ;M-F;~ LOCATION OF INSTALLATION.__5)g4-,C ~Z/, APPLICATION TO INSTALL: SEPTIC TANK_ / , SEEPAGE PIT_ / ,[)RAIN FIELD__ ,OTHER. FINANCEO THROUGH ,ELO;TO,E F,L'EO OOT,¥ HEA'T. DEP, .TMENT /AW THIS IS TO SERVE AS · SEPTIC TANK SIZE 61~TANCE~: ~)~ ~,~.A_~) , PERMIT TO INSTAkL A ~g~-~ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED 'E d~ SEEPAGE AREA. ~ 8~ L~_TYPE DIAGR OF SYSTEM I certify that I am familiar xvith the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. ? \/ ALASKA GEOLOGICAL CONSULTANTS 2227 SPENARD ROAD ANCHORAGE. ALASKA 99503 May 23, 1969 Hmrcy and Marie Jones Lot 17-A Skyway Park Estates Anchorage, Alaska Dear Mr. and Mrs o Jones: Pnrsuant to your request, we have performed a percolation test on your property described as Lot 17-A, Skyway Park Estates o The test was conducted at the eight-foot depth in the excavation which you provided. The sol~~the foltowing: 0 - 1' Organic topsoil and forest litter 1'- 3' Gravelly silt of low porosity 3'-8' Gray, dense silty gravel with considerable porosity The test was conducted in a six-inch diameter hole one foot deep., After saturation, tbe percolation rate was constant at o~2~2ne i~ .~dro. g12_per one and one-half minutes. We anticipate no problems in sewage dis¢'~s-~T'~t--~.'~ gravels from a depth of three feet to nine feet. HJM:js Very truly yours, ALASKA GEOLOGICAL CONSULTANTS By: Consulting Engineering Geologist Mr.. ~licha.~l Star Route A Box 191 A~chorag~, Alaska 99507 to Lot 17A Block 6 Skyway ParCh available within seventy (70) f~t o~ th~ nearest lot line o~. $:'he ~4unicipali~y o~ Al~u~rag~D~pa~:tul,~nt of Pm~lx(- ?~o~k~ to V=:uifv that th~ ~-~-~ctur~(s) is o~ J,s 1~o%~ ¢~on~ect~l ~u~d notify any ancl all st~u(:tur~ located On the subjot~t prol~ertY to pub].ic YOU must apply for a conn~c~ion p~r~ait from th~ p~rmit officer for th~a f~u~icip;~lity of ~chora~e, 3500 East ?%~dor ROad. If you have any questions r~gar~[%in~7 th~ above, ploas~ do not ltesitat~ to contact tile p(~r;nit office al: 279-8686, ~x~e~sion 259 or MUNICIPALITY OF AN Allec ."Ok 111111111d ArRUSI" Development Services Department : a 1\\.1 ' .ne: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 h cu Certificate of On-Site Systems A No pygl L g� Parcel I.D. 019-151-20 Expiration Date: (-3O -( 1. GENERAL INFORMATION Complete legal description Skyway Park Estates Block 6 Lot 17A Location (site address) 1221 Shore Drive Current property owner(s) Kenneth Zogas & Katherine Coone Day phone Mailing address 1221 Shore Drive, Anchorage, AK 99515 Real estate agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer El Waiver request for: Distance: Received by: aD/2-f7/4/ Date: g/1d�� COSA to be released to the engineer,unless othe 'se requested by the engineer. COSA Fee $ t E-1/11.32 Waiver Fee $ Date of Payment C Qa 6 I O Date of Payment Receipt Number_ Receipt Number COSA# 06C17 LW? Waiver# 5. STATEMENT O'= INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigatio ase• on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows t t 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 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 203, Anchorage AK 99503 Engineer's Printed Name Benjamin Schiller, PE Date 8/28/18 9Fslii 6. DSD SIGNATURE ?C' S stem #1 A roved for 3 bedrooms • y pp / Benja Schiller .92 System#2 Approved for bedrooms r`lilfiF9 P� �aaKS"��?,�� Disapproved i>>xxxNES Conditional approval for bedrooms, with the following stipulations: S • ON-S1 f E WATER AND 9 WASTEWATER c`" pROGKANI By: . , tn. - Original Certificate Date: T3I �I 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 Checklist blue sheet If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Skyway Park Estates Block 6 Lot 17A Parcel ID: 019-151-20 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/25/69 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 120 ft. Cased to 120 ft. Casing height (above ground) 36 in. FROM WELL LOG AT INSPECTION Date of test 1969 8/14/18 Static water level 45 ft. 100.9 ft Well production 10 gpm 6.75 g p m WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic 6.01 ug/L Date of sample: 8/8/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material N/A Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank(Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed N/A Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested 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 >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: 10' >5' >5' Building foundation Property line Absorption field >10' >10' >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >1 Water main >10 Water Service line >1Surface water > �� Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION _+``��xx\ I certify that I have determined through field inspections and --=-.79t ,?t4 review of Municipal records that the above systems are in Ole... • ` TH , *+�� conformance with MOA COSA guidelines in effect on this date. ::;.,. 01•. ,":•r', Engineer's Printed Name Benjamin Schiller, PE gennSchiller 8/28/18 1.7f.,•••• C 12592 •`5./� Date °I```\\`fes o ``' COSA brown sheet 10-10-12.doc Note: Alaska Water and Wastewater Consultants, lnc. shall bo paid ,~"~ at, or pdor to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As cerb'fied by my seal affixed hereto and as of the validation date shown below, I verify that my , ; investigation, baseri on procedures outlined in the Health Authodty Approval Guirielines forthis application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and ariequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information oblained from the Municipality of Anchorage files and from my invesEgation and inspe~'on, 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 357-6179 Address 690;I DEBARR ROAD, SUITE 2B * ANCHORA(~E, AK 99504- Engineer'~ Printed Name JEFFREY A. CARNf~SS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineerfng 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 sen/ed 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. A WWC, 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 fight whatsoever. Date 5. DSD SIGNATURE Approved for / bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X bedrooms, with the f]lowing stipulati.~.~.~ .r'.. ..... '-. ~. , Manitenance Agreements Supplemental Engineers Reo~ Other Original Certificate Date: (Rev. 12,~0) Municipality of Anchorage Development Services Department Bufldlno Sa;~ty On-~te Wster & Wastewster Pn~mm 4700 ~xlth Bragaw St. p.o. Box 196650 Anchorage. AK 99519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Des~ption: WELL DATA Weft bl~ PmVA~ Date completed *1969 Tofaldapth *118 fl. SKY~AY PARK {:.~h S/D; LOT 17A~ BLOCK 6~ *PER M.O.A. (DA.A.B,) RECORDS If ~ B. or C pro,da PWSID~ N/A San~ry seal fi/N) YES Cased to 40+ fl. Parcel ID: 019-151-20 We;~ Log fi/N) NO Wlres pmpe~ protected (Y/N) YES Casing height (above ground) 12+ FROM WELL LOG Date of test G / Star, water lever ~ ~.,.~'~"~ fl. Well i~:~uctlon .~ 9.p.m. WATER SAMPLE RESULTS: ATINSPEC~ON 10/31/2001 49 ,fl. 6.0+ g.p.m. Coliform 0 colonies/100 mi. Nitrate 0.5 mg./L. Other bacteria 0 Date of sample: 10/31/2001 Collected by: AWWC~ INC. B. SEPTIC/HOLDING TANK DATA PUBLIC SEWER Date installed colonle~100ml. Tank Type/Matedal. Tank size . gal. Number of Com~ · ~r tank(Y/N) High water alarm (Y/N) C. ABSORPTION FIELD DATA PUBLIC SEWER Date installed Soil rating (g.p.dJff=or ft~odrm) System type Lengt~ '" fl. Width ,ft. Orav~ fi. Date of adequacy test ~Fall, . y. or . ..bedrooms uvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. UFT STATION Oate installed Size in gallons ~ "Pu~p on" level at in. "Purop off" n. High water alarm level at in. ~ Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absomtion field on lot N/A Public sewer main'k "~ ~9'+ Sewer/septic service line 25'+ On adjacent lots 100'+ On adjacent lets 100'+ Public sewer manhole/deanout~ .lDO / "~'+ Holding tank N,/A SEP~TIO. O,S~ANCES FROM SE~nC~HOU~.G TANK O. LOT TO: P U B LIC S EWER Building foundation Property llne~ AbsorptJonfleld Water main Water se~n~ water PUBLIC SEWER SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main ~ Water service line Surface water nveway, perking/vehicle storage Wells on F. COMMENTS · ~ ~ ~ A,~w~ ~ ~.~- G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above sy~tero8 ere in conformance wEh MOA HAA guidelines in effect on this date. Engineer's Printed NaPte ,~EFI-REY ~ GARNESS HAA Fee $ Date of Payment (~. 1~) Waiver Fee $, Date of Payment Receipt Number / / / I / (64-120) WE 105.12 103.87 Beor 16 / / / / 1 7 , 17A / HOV--$O--20~I 1~=22 ~ R£$ZD£HTZ~L NO~TG~G[o ~00~00~ P.02 APPLI(..NT FIILLS OUT UPPER HAL ONLY Address /.~'? // {.?//'~ ~' Zip Code ngle Family Water ~upply ~ Communlly ~-~ For wells drilled prior to that date, give well depth (attach log if available). ~ivldual Yoar Individual Instagod: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Date Date Date Inspector Inspector Inspector Field Notes: Time Inspector APPROVED BEDROOMS I I D~SAP~ROVBD ( ) CONDITIONAL APPROVAL' DATE_ E-- ! ~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENfAL PROTECTION JLII 2 6 "' "~ RECEIVED 'CONDITIONS OF APPROVAL Soils Rating Date~werlnstalled LWell To Absorption Area Well to Tank Well Log Received Septic Tank Size 72.023 ¢182) ALASKA I UIROIqm T1TAL CO[/TROL S RUIC $, linC. ~qineerinq ~, ~nuieonmenlol $1udies JULY 26 1983 MICHAEL BERGMANN SRA BOX 191 ANCHORAGE AK 99502 SELLER - BUYER- SUBDIVISION-SKYWAY PARK BLOCK-6 LOT-17A ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT/CRIB WITH AN UNKNOWN AREA, THE SYSTEM IS CAllABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 569 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 7/26/83 . MUNICIPALITY OF ANCHORAGE DEPT. OF HE/,,LFH ~'~ ENVIRONMENIAL PRO [ECFION RECEIVED SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 B~I~.HOUSE. ~, .,:~ ~....~.,..~..~ ~', No 2251.E ~ ,~ ~ ~?0 ESS~'~~ 1000 IS ADEQUATE FOR 1200 LUesl 33rd/~uenue, SuJle [/ · J~nchoroqe, /~lnskG 99503 · (907) 276-136~ GRI::AT~:R ANCHORAGE AR~A BOROUGH 0 Department of Environmental Quality 0 Tudor Road, Anchorage, Alaska 99507 ~79,-8686 ' Date Received REqUHST FOR APPROVAL OF / ~F ~.~ INDIVIDUAL S~WER & WATSR FACILItieS / lq . , . , (J Address: , ~ Phone: ~~7~t' ~q'/t/ . ~ ' ~. . ~ ~ ~ ' 5. Type of Facility to be . __~~ Number of Bedrooms: ,, Well Data: 'D, 'l/J A. Type '/ , B, Depth ..... C. Construction D. Bacterial Analysis Sewage Disoosal System: C. Septic Tank: 1. D. Seepage Piti 1. Disposal Fteld~ Be Distances: A. Well To: Septic Tank_J_~1 , Nearest, Lot Line t Absorption Area , Sewer Lines , Other Contamination B, Foundation to Septic Tenk "~ Absorption Area C. Absorption Area to Nearest Lot Line__ __ .... R~quest for Approval oi .ndividual l~ewer & Water Faotliti,~, Page Two Comments., Aporoved fsapproved Date ....... Approval Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Hmvironmenta] Quality DIAGRANI OF SYSTF~.. I certify that the information contained in this request for appreval to be a true and accurate representation of the subject sewer and water facilities located at: Signed Date