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Home My WebLink AboutWOODHAVEN #1 TR B LT 1Woodhaven T act B Lot I #01§-281-56 Municipality of Anchorage Development Services Department Building Safety DMslon On-Site Water & Wastewater Program, 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ak.us (907) 343-7904 Page 1 of 5 On-Site Wastewater Disposal System and/or Well Inspection Report Permlt Number:. SW010247 PID Number:. O15--281--56 Nam*:JUDY & DAVE HOFFENKAMP WastewaterSystem: I-I New · Upgrade Addre~: .3800 CLEO AVE. *ANCHORAGE AK, 99516 ABSORPTION FIELD Phone: No. of Bedr~oma: (907) 345-0985 5 DDeep Trench r'lShollow Trench r'lBed mMound lief LEGAL DESCRIPTION ~" ~ 2.0 ~o/s~ r~ SEE DWG n 1 - WOODHAVEN TRACT B SEE DWG r~ .29 n - - - SEE DWG r~ 30 n WELL: [3 New [3 Upgrade 12 r~ 5 n ~. ~ ~. 560 sa. rL D ,3054/ F-810/ $CH 40 PVC ~. A+ 8/2.3/01 ~. ~ ~ TANK SEPARATION DISTANCES =s.p.c =.o,~n. 'S.T.~.. =o~.r 1o SepUc AbsF~e~dfl°~ StaUonUft Hold~ngTank ~.~/~"~ ANCHORAGE TANK 1250 we, 100'+ 100'+ 100'+ - 25'+ STEEL 2 5u,ace Wore/ ~00'*100'+ 100'* - - LIFT STATION L~t Une 5'+ 2'+ 5'+ - - 1250I ANCHORAGE TANK FoundoUon 5'+ 10'+ 5'+ -- -- TIMER ! TIMER] 45 Cur[oln Drain N(iNE KNOW 20 OSI 05 HHF MOA ~e.~or~s: ~>~ ~.,~. ,-,~ ~ BENCH MARK ,~,.~-_,O=,,z~,P ~ vi~0- LIFT STATION TOP MANHOLE LIND 103.27 n [nspe~ons performs:! by: AWWC, [NO. Date~: ~.:....1 .... .}'~, ........... 1 st 8/16/01 3rd 8/23/01 5th 8/24/01 :.~,.....~~ ~ ,~ ~ .,l~,i~l~ ............. 2nd 8/23/01 4th 8/24/01 ~ '. ~""""E f, 'r, ~,'/¥ I ~ ss.,' ~ Department of Healtl~d ,Ht~n Services approval r/~.~il~o.%;., .....!;...~!, E-t~! 53;....~,,.." .'~ R~viewed and approved by:.~ Dote://--~-~J '~'~,~,{[~-*~ ofe,e,o'"' ":'"~"-:'~'~' ~;~' ~ ~'~: AS-BUILT DRAWING SW010247 015-281-56 CLEO AVENUE . F I ~??::.~!+i III -- ~':'.. .,'""~-.:.~"6 m / ~/~.~:';~.-V.'- :/ ~ ~ Br ~.o , ..~ -.~ ~'. ~~~:-~.':. :, ".~ / ~ "~ ........ / ·-.".~*- L'*' ' [',~ ~.,; ~"~'~ ~ I ~~.~'~.::/ / ~ ,,~, ,~ u,~ ~%~' ~1 / I ~SI~TER& WASTEWATER ~ '~;v ~-~ ~ - ~ ~-.,~, ~ONSU~TANTS, lNG. JUDY · DAVE HOFFENKAMP (907) 545-0985 2 or WOODHAVEN LOT 1, TRACT B AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ~ ~'~ AS- BUILT D I~AWIN G SW010247 015-281-56 / /./x/ ~n~mnu ~r~;~'~e~-~-:*~ ~x:>~r:~=~-:~¢:~' ~P OF ~D - 112.74 UN~ - 113.03 / ~R UN[- 111.14~ B.s.o. ~S~ ~TER & WASTEWATER PR~ FOR: ~ONE NUMBS: P~E NUMBS: I ~"'~ ;'~'"~ JUDY · DAVE HOFFENKAUP (907) 345-0985 2 OF AS-BUILT DRAWING OF SEPTIC SYSTE~ UPGRADE SEP-19-OI WED 8:57 AM DAVID HOFFENKAM? FAX XO. 348 0985 P. ]A~I~IiCflON lib;POInT ./,0NICIPALITY OF ANCItOIbiGE -- B~LDING SAFETY DIVISION 4700 SOWI~ [ Dt~GAW ~REE~ ANCHOI~GF. ~.~S.[~A ( I~CTIONS. Voice: (900 343~300 ~: (900 249-7777 INI"OI~IA~ZON: (gOO 34~.8211 ~.:.k(.~ ~. ~,.~ --, TJT'~ ~F E~ ~z I~PECTION: ' ~ ?/1' ) ~o oo 84 O0 8 .~ .......... &oo_~& ............. ~o I1 ,111 II IIl~) III IIh~ III II II II II II III III III III III I11 Ill 30000 Fw F ....... 1 2 4 ~0¥-19-01TUE ll:19 Att GCI CABLE ~AX RO. gU't~b~U r. ~ November 19, 2001 Dave and Judy Hoffenkamp 3800 Clco Avenue Anchorage, Alaska 99516 Dear Mr. &/or Mrs. Hoffenkamp, Subject to your agreement to indemnify the company as set forth below, GCI Cable Inc. of Alaska has no objection to the septic system encroaching into the 10' utility easement on the east property line of Lot 1, Tract B, Woodhaven Subdivision Add. #1. Known as 3800 Cleo Avenue in city grid 2735. This letter of non-objection in no way precludes GCI Cable from full use and enjoyment ofany rights it may have within any portion of the utility easement and or the fight-of- way, including unlimited access for servicing its facilities. Also any additional and extraordinary costs incurred during any future required construction, repair or reconstruction of GCI's facilities to accommodate any or all of the encroachments shall be paid by the property owner. By signing below, you agree to indemnify and bold GCI Cable harmless, now and tbrever, for any damage, costs, expense (including reasonable attorney's fees), liabilities and injury to ,'my person or property occurring as a result office encroachment. Please indicate your acceptance by signing and returning this letter to myself at address below. Sincerely, A-(c~ance ~,e~ecca c:o~ton OSP Design Engineer 5151 Fairbanks Street · Anchorage, Alaska 99503 * 9071786-9200 Cable services i)rovided by GCI Cable, Inc. ANCHORAGE WATER & WASTEWATER UTILITY George P. I, Vuerch, Mayor Engineering Division 3000 Arctic Boulevard Anchorage, Alaska 99503-3898 http://www, awwu.ci.anchorage.ak.us Chm~ed b t the Municipality o. f Anchorage October 23, 2001 Dave & Judy Hoffenkamp P O Box 110028 Anchorage, AK 99511 Re: Woodhaven, Tract B, Lot 1 (Grid 2735) Tax ID 015-281-56 Encroachment into Easement Dear Property Owner: The Anchorage Water & Wastewater Utility received a request from Jeffrey Garness of Alaska Water & Wastewater Consultants, Inc. on October 23, 2001, for a letter addressing AWWU's position regarding the existing septic system that encroaches into the utility easement located on the east 10' of the referenced lot. An asbuilt drawing of septic system upgrade dated September 22, 2001, was submitted with the request. AWWU water mains are not available to the referenced lot. Wastewater facilities are to be in accordance with the Hillside Wastewater Management Plan (HWMP). AWWU is not using the utility easement and has no objection to the encroachment. If you have any questions, please call me at 343-8009 or the AWWU Planning Section at 564-2739. Sincerely, Hallie Stewart [ngineering Technician Cc: Alaska Water & Wastewater Consultants, Inc. O:~ ngineefing\Planning~Pla nning~HM$~encroachment s~easement-no w-s - no obi.doc October 10, 2001 Jeffrey A. Garness, P.E., M.S. Alaska Water and Wastewater Consultants, Inc. 6901 Debarr Rd., Suite 2B Anchorage, Alaska 99504 ACS Alaska Communications Systems ACS has no objection to the encroachment of the septic drain field into a platted easement located on Lot 1, Tract B, Woodhaven Subdivision, as depicted on the as-built drawing submitted. Acceptance and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: 1. ACS will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. Any ACS facility damaged or destroyed as a result of this encroachment will be repaired at no cost to ACS. 3. Any costs incurred by ACS for special construction necessitated by this encroachment will be borne by the property owner. e Ail applicable safety code regulations will be observed and maintained. This letter of non-objection will in no way preclude ACS from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, Grog Schmid, Foreman Outside Plant Engineering EP.TANCE: DATE: G$\ r $: mswd/cor/nonob/Revised Woodhaven. doc 600 Tr- r.r,I O e Av,,n.~'~ A,~r.h<~,aq.'., AI,~';~ 995r)3-6091 ~,-I 907.564.1000 ~';v:';; acs,',l.¥~,, ...... ENS'i'AR ENSTAR Natural Gas Company A Divb. lon o~ ~'~ SEMCOEflEr~Y I~O. Box 190288 Anchorage, AK 99~19&~288 (907) 277-5551 11/12/01 Alaska Water & Wastewater Consultants Inc. 6901 Debarr Road, Suite 2-B Anchorage, Alaska 99503 Re: Letter of Non-objection Grid A2735G To whom it may concern: ENSTAR Natural Gas Company has no objection to a septic field encroachment into 10 feet utility easement situated on the east boundary of the subject property for Lot 1, Woodhaven Subdivision. · Acceptance and use 0f this letter of ncn-objection by your.-,elf, your heirs, your assigns or your successors, will constitu!e agreem~:nt to the following stipu?ation~: · .-, : ..:: : ENSTAR will be:l~eld harmless, now and forever for any damages or injur.¢ to any person or property as a result of this e~croachment. ~ .. ,i 'Any ENSTAR facility damaged or destroyed, as a result of this encroachment . will be repgired at nO cost lo ENSTAR Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the property owner. Ail applicable safety code regulation.-., will be observed and maintained. This letter of non-objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincerely, 'o~~ M. Manuel L cc: File 7 November 2001 Jeffery Garness 6901 Debarr Road, Suite 2-B Anchorage, AK 99504 Engineering Eo~ First Avenue Alaska 9950 ~ - ~ 685 RE: Lot 1, Tract B, Woodhaven # 1, 3800 Cleo Avenue Non Objection for Judy and Dave Hoffenkamp Dear Mr. Garness, The above referenced property in not in the Municipal Light and Power Service area; therefore, a letter of non-objection is not required from this utility. Contact Chugach Electric Association regarding this matter. Pho~ ~07-Z63-,5408 Fax 907-Z63.53Z! www.mlandp.com Sincerely November 16, 2001 David and Judy Hoffenkamp P.O. Box 110025 Anchorage, Alaska 99511 Subject: Conformed Copy for Encroachment Permit EN01061 Dear Mr. and Mrs. lloffenkamp: Enclosed is your conformed copy of the Encroachment Permit on Lot 1, Tract "B', Woodhaven Subdivision. Ifyou have any questions, please call me at 762-4738. Sincerely, Chuck Couts, SR/WA Right-of-Way Agent II Enclosures A L A $ K A 2OO1-O787:57-O Recording Dist: 301 - Anchorage 11/21/2001 2:46 PM Pages: 1 of 4 ENCROACHMENT PERMIT 1203-21D G-2735 EN01061 This permit is between Chugach Electric Association, Inc., an Alaska non-profit electric ' cooperative, (herein"Chugach"), whose address is P. O. Box 196300, Anchorage, Alaska 99519 and the David E. and Judy K. Hoffenkamp Trust, (herein "permittee"),'whose address is P.O. Box 110028, Anchorage, Alaska 995 i 1. 1. Easement...Chugach is the grantee or user of an easement ~or the construction and maintenance of electrical facilities, as follows: Dedicated by lhe plat of the subdivision known as Woodhaven Subdivision Addition No. 1, according to Plat Number 70-343, recorded on the 18th day of November 1970, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, Described in that certain written instrument recorded on the 25m day of July, 1952, in Volume 76, Page 86, on file in the office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Easement") which pertains to the following described real property: The Easi Ten Feet (E 10') of Lot One (1), Tract B, Woodhaven Subdivision Addition No. 1, according to Plat Number 70-343, recorded on the 18th day of November 1970, on file in the Office of the District Recorder, Anchorage Recording District, Seward Meridian, Alaska. Permittee acknowledges the validity of the Easement. Permittee warrants and represents that PermiUee is the owner of the fee simple interest in the land subject to the Easement and the following described real property to which the Easement is adjacent: Lot One (i), Tract B, Woodhaven Subdivision Addition No. I, according to Plat Number 70-343, recorded on the 1 lth day of November 1970, on file in the office ofthe District Recorder, Anchorage Recording District, Seward Meridian, Alaska, (herein "Parcel"). Page l of 4 2. Encroachment. Permittee has purchased or constructed the following improvement on or within the real property subject to said Easement: A septic system drain field with standpipes that encroaches approximately Eight Feet (8') into the easement for a distance of approximately Thirty Feet (30'), (herein "Encroachment"). 3. Permit. Chugach hereby authorizes Permittee to continue the existence of the Encroachment in its proposed location subject to the covenants set forth in this permit. 4. Indemnification. Permittee shall indemnify and hold Chugach harmless from any claims for personal injury, property damage or other loss arising in any way from the continuation of the Encroachment. - 5. No Expansion or Increase. Permittee shall not in any way expand or increase the extent to which the Encroachment occupies any of the real property encumbered by the Easement without the prior written consent of Chugach. Chugach has no obligation to provide such consent. 6. No Interest in Real Estate Acquired. Permittee hereby acknowledges that the Encroachment and any additions thereto, even if in violation of this permit, has not and shall not in the future give rise to any interest or estate in the real property subject to the Easement or any other real property. Without in any way limiting the foregoing, Permittee acknowledges that the Encroachment is not adverse to any interest of Chugach and its continuation is entirely with the permission of Chugach for purposes ofthe common law doctrine of adverse possession. This permit creates no interest in the real property subject to the easement. 7. Modification of Utility Facilities. If the electric utility facilities located within the Easement are upgraded, added to, replaced or reconstructed, Permittee shall pay that portion of Chugach's total costs for such modification which is reasonably attributable to accommodating or preserving the Encroachment. If such payment is not made within thirty (30) days ofwritten demand for same, Chugach may terminate this permit in accordance with paragraph 9, below. 8. Covenants Running with the Land. The obligations ofthe Permittee arising from this permit shall be covenants running with the land which shall burden the Parcel and the Permittee's interest in the.land subject to the Easement and shall benefit the Easement. 9. Termination. Chugach may terminate this permit after the giving of thirty (30) days written notice of such termination if: a. The Encroachment is enlarged, increased or extended within the real property affected by the Easement. Encroachment Permit - Page 2 of 4 2of 4 b. The Encroachment is damaged by any means to an extent o fmore than thirty percent (30%) of its replacement cost at the time of destruction. e. Permittee fails to make the payment described in paragraph 7, above. I0. Term. This permit shall, if not sooner terminated by Chugach, expire forty (40) years from the date hereof. 11. Entire Agreement. This written permit constitutes the entire agreement be~wee.n the parties with respect to the subject matter hereof and supersedes all other prior or contemporaneous agreements, oral or written, between the parties. No modifications, amendments, deletions, additions or alterations of the permit shall be effective unless in writing and signed by all of the parties hereto. CHUOACH ELE~q~IC ASSOCIATION, INC. By: L(('Thibert, Executive Manager T&D Network Services PERMITTEE_ David E. and Judy K. Hoffenkamp Trust D,~vid E. H~fr~arnp, TruStee ~/ Juffy g Hoffenka~n~, Trustee Date: //- /6-,p o I Encroachment Permit - Page 3 of 4 3of 4 STATE OF ALASKA ) ) SS: THIRD JUDICIAL DISTRICT ) ' · The foregoing instrument was acknowledged b~fore m.e this_ //~' day of / ,,,,n,,,,,,,, ~ ~ ... ...0/:~. Not.~,-v Public In nnd for the State ofAlas~ka.. _ // ...-' ~.%' '.Y~_ ~. -- ~ . . · . - ... ~'Ca ~-'eO:-.~.' ~'[/I 0~..'"° ~.. -.._ My commtss,on expires. ~': '? 0~" e. BL '.~_ o- ~,~..'.-' ~ -,'" STATE OF ALASKA ) ) SS: TI~IRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged ~fore me.Lh/i~ /?~' dayof ~d-~ts~'terl,,~-,~ ,2001, by ~'~' I ;~'Z~'' · Executive Manager, Transmission and Distribution Network Services of Chugach Electric Association, Inc., an Alaska corporation, on behalf of the corporation. Notary--l~uubli¢ m and for the State fAI s_ka My commission expires: ~I:l~ ,~ ~.~0~ AFTER RECORDING RETURN TO: Chugaeh Electric Association, Inc. P.O. Box 196300 Anchorage, Alaska 99519-6300 Encroachment Permit - Page 4 of 4 4of 4. i.BUILT l~, . CORNERS SETTHIS DATE hereby certify that I have pedormed a Mortgagee's inspection ~f the following described property: Lo'r' 1) 1"'~4r a~ Wood,Avia su~olvl~/od ADD. /'/0. I · Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and .............. ;~o h6t '0~dap ~)r-en~i;0~ch on the-pr6pert~/ lying-adjacen[- thereto, that no improvements on propen'y lying adjacent thereto encroach on the premises in question and that there are no roadways, transmis~ion lines or other visible easements on said ..... :: :-: --: ~--:-: '- ~rope'r~y-exc-Ept ~ m-di~t~d he'eons:-':-:: ....... ~':': ........ ' this /'~ ' *a~ofw//~ ~' 2001 - _ ....................... FRED WALATKA & ASSOCIATES -. ...... (907) 248-1666 .......... Engineers and Surveyors ....... November 26, 2001 Municipality of Anchorage Public Works On-Site Water & Wastewater P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Lot Line Waiver for Lot 1, Tract B, Woodhaven #1, To whom it may concern: We request that your department issue a 2 foot lot line waiver from the east property line to the new drainfield. I am unaware of any adverse impacts this ~vaiver would have on adjacent ~vells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your ~assistance' ~ 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: ak~v~vc.com Municipality of Anchorage Development Services Department Building S~cty Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK. 99519-6~50 www.ci.anchotage.ak.us (907) 343-7904 Waiver Review Worksheet PID~: 016-281-66 HA#: Date Received: 11/26101 Legal Description: Woodhaven #1 Tract B Lot 1 Engineer. ~leffrev A. Oarnes$. PE Alaska Water & Wastswatsr Consultants Inc. 1~901 Debarr Rd.. Suite 2B Anchorac~e. AK 995204 Applicant: ,,lydy ~, Dave Hoffenkamo Permit~: ~W~t~)247 Waiver Requested: 2 feet from Lot line to dralnfleld Criteria: Geology A. Water Table B, Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: Waiver is Granted: v~ Waiver is not Granted: LlstConditionsorReasonsforabove: ~E~- E,~[_.rliL/EE~ I$ /~7[-~p[l=j~ /.. ~/~/~ Date: 11-2[ '~/ By: P~'/~/ Name of Reviewer Reo#: 12872 Amount: $115.00 Date Paid: 11/2612001 ipali Mtmic of Anchorage George I: Wuerch. .llagor Building Salary Division P.O. Box l~;C~0 · ~7i~ $. Bragaw Street Anchorage, Alaska ~519-6~0 h it p://~a~av.cl.anc homgc.ak.us 11126/2001 Jeffrey A. Garness, PE Alaska Water & Waste~vater Consultants Inc. 6901 Debarr Rd., Suite 2B Anchorage, AK 99504 Subject: Waiver Request for Woodhaven #I Tract B Lot 1 Waiver Request #WR010096 Parcel ID #015-281-56 Permit # SW010247 lhfl~llc Works Dear Mr. Gamess: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 2.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. I f there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Civil Engineer On-Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 wvw.d.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-281-56 Permit Number Pmpen'yowner(s) Judy & Dave Hoffenkamo Day phone 345-0985 Mailing address (1) P,O, Box 110028 Mailing address (2) Anchoroqe. AK Zip Code Legal description (Lot. Block & Sub'd.) Woodhoven Subdiv;slon ~ 1: Lot 1. Tract B Legal description (Sec'don, Township & Range) H/^ Lot Size ~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Acres/Sq.FL Number of Bedrooms Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub ~ Jacuzzi Swimming Pool Water Soffenlng Unit Therapy Pool [] I certify that the above Information is correct. I further certify that this application Is being made for a Single Family Dwelling and Is In accordance with applicable Municipal codes. ALASKA WATER & WASTE'WATER CONSULTANTS~ INC. Waiver Fees; Date of Payment: Receipt Number.. 'ALASKA WATER & WASTEWATER JIJLILJ" I CONSULTANTS, INC. ' ....... June 27,2001 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 1, Tract B, Woodhaven Subdivision/fl (Bottomless Intermittent Sand Filter - ISF) To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system consists ora 1250 gallon septic tank and a trench type drainfield that were both installed in 1976. The existing trench is in a state of failure and must be upgraded. Much of the property is Iow lying, with shallow groundwater. During break-up there are some ponded areas that eventually dry with the arrival of summer. The most suitable location for a septic system is in the southeastern comer of the lot, which is the higher in elevation and, therefore, not plagued with seasonal surface ponding, or as shallow of groundwater. Given the limited space in which to put the system, we are proposing that a 1250 gallon S.T.E.P. tank and a Bottomless Intermittent Sand Filter (ISF) system be installed. Comments regarding the upgrade are summarized as follows: 1. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, a application rate of 4.0 gallons/day/fl2 should apply for the ISF effluent. 2. DRAINFIELD DESIGN: Bottomless Intermittent Sand Filter (ISF) a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate for ISF: 2.0 gallons/day/ft2 c. NumberofBedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 225 ft2 f. Effective Depth below pressure pipes: 3.0+ inches g. Width: 12 feet h. Length: 30 feet. i. Effective absorption area = 360 ft2 j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank". 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwe.com k. Air Supply Line: "Wasteflow' emittefline, I/2 inch I.D, "Anchorage Tank". I. Sand Material: In accordance with M.O.A. latest standards m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and less than 1% passing the #8 sieve. We are proposing to excavate down to a depth of 2.0 feet (maximum - remove all organics), place a minimum of 6 inches of sand, install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 6 inches of 3/8 inch pea gravel, with the pressure laterals midway in the layer. We will use a conventional lift station (Anchorage Tank), equipped with a programmable timer so that flow can be intermittently dosed to the ISF. 3. SURFACE WATERS: There is no surface water within a 100 foot of the proposed septic system upgrade. 4. TOPOGRAPIIY: As can be seen on the attached topography site plan, there are no slope concerns. 5. MATERIALS AND CONSTRUCTION PRACTICES: The materials used, and the construction practices will comply with the MOA "Intermittent Sand Filter Design, Installation & Maintenance Manual". The contractor should read this document prior to construction. Copies are available at the Municipal Onsite Services office (4700 South Bragaw Street.). 6. CLOSING: I am open to any suggestions from your department, which would be an improvement to the proposed design. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thankyou ~r your assistance. Jeffr~yl~(Gl~mes~. M.S. PresIde$tt ~,,j NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akxvwc.com J i I i I WOOD}~VI:N $/D 1~2 I ~ 4~; i I Sl~ER S/D ~3 I ~ I I ~ I I I I ' I CLEO AVENUE I~N~ miii ~ ~0 ( " ............. m.~ ~ ~ -~~i~ 7- ...... "" - ~ ~ ~ 2, ~ B; ~ I W~D~ S/O ~2 ~0~ $' I J~ mil / I k mil / I ~ ~ III / HU~ m )1~ ,/ i i L~ 2~'+ ~oM m iii ~ .... ~ I PRO~ S~c U~ ~ III I III I ' Ill I ~ 6; m iii i ~ S/D ~3I m Ill L~ ), ~ B; I m iii W~D~N S/D Jl I mil I ~ Ill I J III I ~w. ~: ~., Ft ' ?1.~,~ ~SI~ ~TER & ~STEB~TER , CONSULTANTS, INC. ~ FOR C/O WENDY STEVENS PHONE NUMB~ DAVE AND JUDY HOFFEN~MP ~45-0985 1 OF WOODHAVEN SUBDIVISION jl= LOT 1, TRACT B ~,, SITE P~N FOR SEPTIC SYSTEM UPGRADE-~ ~- CLEO AVENUE ~' :.~-~./., .-',~' ."', , :1 PLUMB NG CODE "~1[~'~'.'"."?::.'.,.'.'. \ ~ /\\-- -_.._._._~_ _:: ._ _ ~ ~ / 1 ! / ALASIG~. WATER & WASTEWATER GONSULTANT$. lNG. JUDY & DAVE HOFFENKAMP 545-0985 2 OF WOODHAVEN LOT 1, TRACT B ~E OF WOR~: SITE P~N /~ .............. /l~~ ...... I I I [__ 11/4 ~ ~, ~ ~ ~N f~ (~X~ ~) ~P f~ ~ ~. (~L 1/4 ~ ~) P~N VIEW ,¢¢~ PROFILE VIEW ~w~ ~: ~S~ ~I'ER & WASTE~TER ~ DAVE AND JUDY HOFFENKAMP (907) 345-0985 3 OF ~ ~ _J.dlf~et A. ~rness~ ¢ I WOOD,AWN SUBmV~S~ON ~ LOT ~, ~LOCK ~ ~[ OF WORK: D~AIL OF BO~O~LESS INTER~I~ENT SANF FILTER (ISF) ,,, CONSULTANTS, INC. JSOIL LOG - PERCOLATION TESiJ ..... ~/~' LEGAL DESCRIPTION: WOODHAVEN SUBDMSION ~1; LOT 1. TRACT BVh?e~L.)~ '.,,=,,,.~, ,.-.. ess.-' PERFORMED FOR: DAVI~ HOFFENOA~P DATE: 5/14/2001 u~-o~][""C'w 7953~ · -.. ~~ORGAN,CS ITEST HOLE #~1 I I A s ~ GW ~ OEG ~GP ML ~CLEO AVENUE GC OL 4 SW SP CH SW NH ~' SH OH '-'- "~'-' "-~' DEPTH TO DATE ~ 5.o' 4'-6' 5/15/01 / / X JS~E P~ 4'-2' 5/21/01 / / 4'-~" 5/24/oi / x J l'-loo' 10 ~ 11 DATE RE'lNG CLOCK NET TIHE WATER LEVEL NET DROP TIHE (HINGES) RE'lNG (INCHES) 12 5/15J0001 1 2:51 - 6' - 2 2:55 4 MIN. O' 6" 13 3 2:55 - 6- - 4 ~:00 5 MIN. O" 6" 14 5 5:01 - 6- -- 6 ~:06 5.5 MIN. O" 6" 15 7 3:06 - 6- - 8 3:12 5.75 MIN. O" 6' 16 9 ~:12 - 6- - 17 10 3:18 6 MIN. O' 6" 11 ~:18 - 6- - 18 12 3:24 6 MIN. O" 6" 19 PERCO~TION ~TE <1 (HIN./INCH) PERC. H~E DIA. 6" (INCHES) TEST R~ BET~EN 2.25 FT. ~D 2.75 FT. 2 COHHENTS: PERFORMED BY A~ WATER · W~ATER I, JEFFR~ ~ G~N~S, CERTI~ T~T THIS W~ P[RFORMED IN ACCORD~CE W~ A~ ~A~ ~D MUNICIP~ GUIDEUNES IN E~CT ON ~IS DATE: .R~OR C/, ~.DY S~t~ ~: / DA~DA AND ~UD~D~HOFFE~ ~-uu~ ~ 0~ ~,~:, . ~ITE P~N FOR ~EPTICISY ~TEN UPGRADE · Sent By: Alaska Water and Vlastewatee Con; 907 338 3246; Jun-28-01 9:38; Page 1 PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated ~ '.,,~ c~ ,200_/, is made between the Municipality of Anchorage Department of Health and Human Services (DHHS) and the property owner(s) of /JO. / This agreement is made for the pu:pose of maintaining an on-site wastewater disposal system on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement tlmt the system is functioning as designed shall be filed annually with the DHtIS. ~opeh:/~Owner Nam'c* (Notazize Here) SudiciaI Dis~ict e~r~I SS. yez~o~._L, before me, the undersigned nqW'7~ ~ the person(s) whose nameis) is~h'e subscribed to the within instrument a~d a~knowlcdged that he/si.e/they executed the same for the purposes therein contained. In witness whereof. I hereunto set my hand and official~,~'71 .. ~-__ ,, ,_ . . *..~. ~-.2 .: ,¢.R ANCHORAGE AREA BOR~JGH Department of Environmental QuaJity 3330 C Street Anchorage, Alaska ggs03 ...... INSPECtiON REI~CJR~ C)N-~IT~ sEwAGE DISPOSAL SYSTEM LOCAT,ON_ .... LEGAL =SC,,,PT,ON SEPTIC TANK: FROM WEI L INSIDE LENGTH (/~t_~ NUMBER OF MANUFAC] URER -¢-'~ MATERIAL COMPARTMENTS ~"~ INSIDE WIDTII LIQUID DEPTH LIQUID CAPACITY /~- ~ _ GALLONS. TILE DRAIN FIELD: · / / FOTAL LENGTH ,,¢~ / / DISTANCE FROM WELL ~/¢'¢'2 FOLJNDATION NEAREST LO'F LINE ,~'l- _OF LINES ~(~¢ . TRENCH WIDTH ~ IN. TOTAL EFFECTIVE NUMBER OF LINES DISTAN,C~,~ETWEEN LINES ~_.~¢/ OEPTH OF FILTER ~ /. ~ .... / ,/ DEPTIh TOP OF FILE TO FINISH GRADE MAFERIAL BENEATllTILE ~2 /~'¢ IN. ABOVE qlLE . (/~ IN. WELL: TYPE CONSTRUCTION OEP FH DISTANCE FROM: BUILDING NEAREST FOUNDATION _. LOI LINE NEAREST SEPTIC ~.¢.}, SEEPAGE //¢c~ ? SEWER LINE TANK SYSTEM. CESSPOOL__. OTHER SOL) RCES APPROVED _ DISAPPROVED.. REMARKS SEWER LINE DEPTH: PIPE MATERIAL: - LOT SLOPE: _ REMARKS: PPROVEO Form LQ-032 DEPARTMENT HEALTH lAND ENVIRONMENTAL'..;:OTECTION ~I//~ ~(o - 2510 E. T,_,PO~ R~... ANCHOrAgE, AK. ~95~ .~ ,~,~. FIF'PLICRNT [~VID t40F'FENK~M~ '7~EiO LAKE O3'~5 4~2g ',~'[~79.'' '~" :g44-2;~t4 LEGAL L.I T~ B ~400DHRVEN SLIBD LOT SIZE k ¢.7258 SALIARE FEET TYPE OF SOIl. FIBSORBTION SYSTEM IS: :FRENCH MAXIMUM N.IMBE~ OF' BEDROOMS SOIL RRTING (SC! FT/BR>= t25 THE REQUIRED SIZE OF THE SOIL ABSORPTION S%.'STEM IS: THE I_EN(.~TH DIMENSION IS THE LENGTH ,::IN FEEl') OF THE TRENCH OR DRRINFIELD. THE I:;,EPTH OF' R TRENCH OR PIT IS THE DISTFINCE BETI4EEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF: ]'PIE EXCAVATION (IN FEET>, THERE IS NO SET I-,.IIDTM FOR TRENCHES. THE i3RRVEL DEPTH IS THE i',[~NIi',IUM DEPTH OF GRAVEL BETI4EEN THE OUTFRLL PIPE FIND THE BOTTOM OF THE EXCAVRTION (IN FEET). BRC:KFILI_INB OF RHY S~r'STEf'I WITHOUT FINRL IHSPECTION RND RPPROVRL BY THIS IDEPRRTi'dENT WILL BE SUBJ'ECT TO PROSECUTION. MINIMUM DI.STRNCE BETWEEN R WELL. AND RNa' ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR FI PRIVATE I,,.IELL OR 200 FEET FOR R PUBLIC 14ELL.. WELL LOGS FIRE REQUIRED RND f'IUST BE RETURNED T0 THE DEPARTMENT WITHIN ~0 DRYS OF THE P~ELL COMPLETION. 5PECIFICRT;[ONS AND CONSTRUCTION DIAGRAMS ARE FtVR~LRBL.E 'fO INSURE PROF'ER Z NSTRt..LRT I ON. F" E R I'"1 :[ T' %," R I_ ]E [2), IF': O R O N E "T' E: R F;~ F- F~ O Ih'l :[ .?E; .'S}; UI ~K I CERTIFY THAT t,: I AM FAI'IIL. IRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET F'ORTM BY THE MUNICIPALITY OF RNCHORRr3E. 2: I WILL :INSTALL, THE SYE:TEM IN RCCORDRNCE !4ITH THE CODES. 2i:: I UNDER!~,TFIMD 'f'HR'F THE ON-SITE SE!4ER SYSTEf'I MR"r' REQUIRE ENLRREiEi"IENT IF "FME RESIDENCE ;IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. ............... RPPLICRNI" DMV.Z'D HOFFENK-RMP , ~ty S_.~OI~LS I,OG PEROI,ATION TES'[' This form reports: Soils log_/% Percolation test GREATER ANCItORAGE AREA BOROUr'' Department of Environmental 3330 "C" Street Anchorage, Alaska 99503 Date Performed_~- ~i-2sJ Depth Feet 10 - 11 - 12 - 13- 14 .- Was ground water encountered? ..... ~y~_ .... If yes, at wt~at depth? Reading [)ate G.r_o_s_~ l?j?~_____~ Net Ti,.e _!~e_i!t_h_~?__W~_te_[~ Net Drop E%Fr-E]) 1--a-tTo :)epth of Inlet or trench COMI.IEI(TS: o4o ((, F R 0 M SIGNED SEND PARTS I AND 3 WITH CA~ON INTACT PART 3 WILL BE RETUI~NED WITH REPLY. Municipality of Anchorage Development Services Department Building Safety Dlvislon On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Sox 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-79O4 Parcel I.D. 1. O15'-281-56 GENERAL INFORMATION CERTIFICATE OF HEALTH 4`UTHORITY 4`PPROVAL FOR 4, SINGLE FAMILY DWELLING Expiration Date: "~- ~' -,._o I Completelegaldescription WOODHAVEN SUBDIVISION; LOT 1~ TRACT B, Location (site addressordirections} 3800 CLEO AVENUE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JUDY & DAVE HOFFNKAMP Day phone 345-0985 3800 CLEO AVENUE * ANCHORAGE, AK 99516 Day phone Day phone Un~s$otherw~e ~queste~ HAA w~beheldbyDSD ~rp~k~. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 5 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 sample results less than 30 days old. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,346.00 at, or pdor to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As cedified by my seal affixed hereto and as of the validation date shown below, I 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. I further verify that based on the information obtained from the Municipality of Anchorage t'des 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 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name. JEFFREY A. OARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, A WWC, /nc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with A DEC and MOA DSD Guidelines & Regulations. The reported results desctfbed the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identirzab/e features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate durfng the year, and the water usage of the family being served by the system. These conditions are outside the control of the eva/uator 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 encroachrnents. 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 #ght whatsoever. 5. DSD SIGNATURE Approved for --~ bedrooms. Disapproved. Conditional approval for .__ bedrooms, with the fllowing stipulations: .. 'o O -SI' E : ~: WA~ERAND :'" ~ · ----,.,A~ER : ... Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. Original Certificate Date: Municipality of Anchorage Development Services Department On-Sits Watsr& Wa~t~r Pmg~m 4700 Soulh Bragaw EL P,O. Box t96650/~ltotage, AK 99519-6650 Legal Description: A. ~NELL DATA Well type PmVA~ Date completed Total depth 72 HEALTH AUTHORITY APPROVAL CHECKLIST WOODHAVEN S/D; LOT 1, TRACT Ba Parcel ID: If A, B, or C provide PWSID~ N/A Sanitary seal (Y/N) YES Cased to 72 lt. FROM WELL LOG 8/1976 42 fl. 8/lg7 Nitrate 0.8 mg./L. Coflected by: Date of test Static water level Well production 15-20 WATER SAMPLE RESULTS: Colifon~ 0 colonies/100 mi. Date of sample: 11/'27/2001 B. SEPTIC/HOLDING TANK DATA Tank Type/Material $,T,E.P./STEEL Tank size 1250 gal, Number of Compartments 2 Foundation cleanout (Y/N) YES Date of pumping NEW C. ABSORPTION FIELD DATA Date installed 8/1 s-24/01 Length 30 fl. Depression over tank (Y/N) NO Pumper Well Log (Y/N) Wires pmpady protected (Y/N). Casing height (above ground) AT INSPECTION 10/22/01 30 ,lt. 7.2 .g.p.m. Other bacteria AWWCI INC. 015-281-56 YES YES 12+ in. 0 oolonies/100 mi. Date installed 8/16-24/01 Cleanouts (y/N) YES High water alarm (Y/N) N/A PEIELOW fiNAL GP, AD£ TO TOP OF SANDI Soil rating (~lor ltYedrm) 2,0 System M)e BOI'I*O~ILESS ISF Width 12 ft. Grovel below pipe 0,29 Total depth 2.,~ +/- lt. Eft. absorption ama 360 lt~ Monitoring tube YES Date of adequacy test NEW Results (Pass/Fail). PASS Fluid depth in absorption field before test - in. Water added - gal. Elapsed Time: - min. Final fluid depth - in. Absorption rate >= Any rejuvenation treatment (Past 12 mo.) (Y/N & type) NONE KNOWN Depression over field. NO For 3 bedrooms New depth - in. - g.p.d. If yes, give date - D. LIFT STATION Date installed 8/16-24/'01 "Pump on" level at TIMERin. Datum BOTTOM OF TANK E, SEPARATION DISTANCES Size in gallons 1250 "Pump off' level atTIMERin. Cycles tested NEW SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/fift station on lot100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Manhole/Access (Y/N) YES High water alarm level at 45 in. Meets alarm & circuit requirements?. YES On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholeldeanout Holding tank N/'A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field §'+ Water main N/A Water sen, ice line 10'+ Surface water. 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 2'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS Water main N/'A Driveway, parking~vehicie storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field it~pectlons and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Na~pe Date JEFFREY A. GARNESS HAA Fee $ Date of Payment Recei~ Number (R~v. 12J00) Waiver Fee $ Date of Payment Receipt Number NOV°Zg-OI 09:09AI4 FEO~-CT&E ENVIRONI~NTAL SRV 90Z5515~01 T-55~ P.OI/OZ F-400 ,~t~ CT&E Environmental Services Inc. Laboratory Division 200 W. Potter Ddve Anclqorageo AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref. #: Client Name: Project Name: Client Sample ID: Matrix: PWSID Sample Rem~s: 1018098001 AK Water & Wastewater Cons, n/a Woodhaven Lot I Tract B Drinking Water Client PO~. Wa Pdnled Date/T~me: 11/29/01 09:00 Collected Date/Time: 11/27/01 09:45 Received Date/T"~me: 11/27/01 13:35 Technical Director:. Stephen Ede Released Parameter Results POL units Total Coliform (MF) 0 col/100 mi Nitrate 0.80 0.5 rng~. Method SM9222B EPA 300 Allowable Prep Analysis Limits Date Date Init 11/27/01 KAP 10.0 11/27/01 SCL GREATER ANCHORAGE AREA BOROUGH DtYartqent of Environmental Quality ~330 "C" ~,~eet~,~Jlchorage, Alaska 99503 274-4561 , . N,,~x//~.~ /I~I~'~,,F~'/'~/) ' ~' Date Received January 3, 1977 ' ~L,~' ~qV ~N~WDUAL SE~ER & WATER FACiLiTiES 2n°t. 1. Approval requested by: Alaska Mutual Savlngs Bank Mailing Address: Property Owner: Mailing Address: Post Office Box 1120 2. David Hoffenkamp Star Route A Box 1560-P 3. Legal Description: Lot ]. Tract B Woodhaven 4. Location: NHN Jerome Road Phone: Phone: 344-3814 Type of facility to be inspected _Single Family Well Data: A. Type Individual C. Construction ~/~' Sewage Disposal System: On-site A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Distances: A. Well to: 1976 B. No. of bedrooms /O}~nlu'¢ 7~1~1~ B. Depth D. Bacterial Analysis system J~ q~-~'~r~ /~ ~'~ Installer 3 1. Size 2. Manufacturer 1. Absorption Area 2. Material Field: Total length of lines Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line , Sewer Lines .., EQ-034 (1/74) Page 1 of two pages page 2 of two pages - Re~ st for Approval of Individual t ~r & Water Facilities Legal Description Lot 1 Tract B Woodhaven Subdivision Comments Approval ~Valid for one year from date~signed Greater Anchorage Area Borough, Department of Environmental Quality Date 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) UEQUEST ' ~ : FOR APPROVAL OF INDIVIDUAL SF. WER and WATER FACILITIES 1. Type of Inspection: CMRO__ VA_ 2. Property Owner:_ ~ Mailing Address', 3. Name of Buyer:_ :~ ./'~/~ ~.~ Day Phone: ,'~ -~(~/~/ Mailing Address:_ 4. Name of Lending Institution:.~¢~' Day Phone: Mailing Address: 5. Name of Realtor or Agent: Phone: Mailing Address: Phone: 6. Legal Description: Location: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System ~-~-c-~¢f/~/,¢4~' /'¢¢7~ Type of System: Public Utility__ If Individual, date of installation No. Bdrms. ,Individual Individual (on-site) 72-003(3/76)