HomeMy WebLinkAboutEAGLE RIVER VALLEY RANCHETTES LT 5B
MUNICIPALITY OF ANCHORAGE ,~ ~.! '~'"'7
DEPARTMENT OF HEALTH AND HUMAN SERVICES 0
Envlronmenlal Health Di~lon
825 "L" Street, Anchorage, Alaska ~502, Telephone 2~720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
"~ DISTANCES
~ ~e~ ~ SEPTIC ABSORPTION
Aa~,~ TANK FIELD WELL
LE~L OESCRI,TION LOT LINE
c°t~ ~/~ ~1~ ~ ~/~-~ ~~ FOUNDATION ~5- /
Town~p, ~n~,
A~BUILT DIAGRAM {Show ~bon Of well, ~ephc ~ystem, pro~y h~s, lo~naabon,
TANKS N
~ SEPTIC ~ HOLDING
TYPE OF SYSTEM
~S-FT ~T /
WELLS -,0:_ ~, /
.,, ,,* ,,,,~,,,;b~
~ PRIVATE ~ OTHER (Identify} [ ~, -? ..-I I
~a~,h~t~on (A.B.C) lolal ~pth I ~ to i~'
t ,
~ W~< ;~*~ FTI FT I
REMARKS: ~ ~
[agree fl~ver ~nDneer ng Se~ cos ~,~'
72-013 (3/85)
MUN I C I PAL I ~ Y OF ANCHORAGE
Department of Health &. Human Services
E~5 L Street, Anchorage, Alaska 99501 343-4720
Ii N - S I T E S E W E R P E R M .I T
Pot'.mit Numb~.~r: 87.~8~
Date Issued: 1L/~-_._".~8~
U p g r a d e
(]wn~?r Name: AhlNE CUCITI JAMES A MOEN
Owner Addr~.~ss: S.R. 140 MAN-O-WAR
EAGLE RIVER, AK 99577
Day Pl~one:
694-5615
Parcel Id: 050-2~21.-27
Section: 7 'Iown~hip: lqN Range: 1W
Lot Size 17955 (sq. Ft. or acres)
Max Bedrooms: 'Tbi~ Permit: 4 'ToLal Capacity: 4
SEWER SYSTEMS: Listed below are the options available'to ,yOLI in designing .your
sew~.r ~ystem. Choose the option that best ~its your site.
B E D W. D R A I N
'4.0
~o.0
6.0
5.0
78.0 ~-~.
36.2
138
Depth to F'ipe Bo'Ltc)m (£'L): 4.0
Gr. avel Depth (ft): 0.5
Total Depth (¢t): 4.5
Gravel Width (fi): 21.0
Gravel LEngth (ft): 40.0
Gr'~vel Volume (cubic yds): 51.~2
Soil Rating Llsed (sq t't/bpm): ~8
~,~,. Gr'avcLl ]ength > ,5c) feet v,~:'quires multiple soils tests.
~ Gravel lc)n~th '~ 75 l'~?[.~t requires multiple runs (not. exceeding 75 fL each).
L. IFT STATION: If a lift station is instal, ii:d: a high water alarm must be
connec'l.,ed to the r[~sidence.
SEPTIC ]"ANK: Mir-~imum total s~pt. ic tank capacity: 1.,250 gallons. Each septic
tank m[~s~t have at lease 2 compartments. Depth to top of septic: tank(s) < 4.0
fe~t requirc, s insular, ion over tank(s).
I CERTIFY THefT:
1. I am familiar with the requirements for on-site ~ew[~r's and wells as
[orth by the Municipality of Anchorag~ (MOA) and the State o[ Alaska.
~. I will instal], the system in accordance with all MOA codes and regulations,
and in complianc~ with the d(]sign criteria o~ this permit.
5. I will adhor, e to all MOA and State o[ Alaska requirem[~nt~ [or the set back
di~tancesd Item any existing well, wastewater disposal system or public
sewerag[~ system on this or any adjacent or nearby lot.
4. I understand that' this~, p~.vmit is valid for a maximum of 4 bedrooms. I
al~o understand that the capacity of the total ~yst. em is 4 bedrooms and
any e, nlarg;:~mont ~;ili req~.~ire an additional permit.
,~ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 9950! 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR: ',~4~/>.~ ,~ /~'~'~/.~
DATE PERFORMED:
LEGAL DESCRIPTION:
1
2
3
4
5
SLOPE / SITE PLAN
[
t¢
I
/
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER /[,/D S
ENCOUNTERED? L
O
IF YES, AT WHAT 7 ~'~.~
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
I ~ 1/:77 /o ,..,.,, /-/' - 7 ~ ~ ~a
PERCOLATION RATE .~'"/,~ (minute~/inch)
TEST RUN BETWEEN ¢ FTAND ~ FT
COMMENTS_ ;~ ~,/~Z ~j' I*' fi/~/~ ~-~-
PERFORMED BY: "~ ~ 77239~ CERTIFIED BY: ~~~-~ DATE:
EaCe River, A~
694-5195
72~o8
· ,'e.~-Louis A. I~uterc{' ·
'~"~.C~-~-~4 ;. . ,..,.., ,- ·
.'. · .." .I'T .,: ~' ...."
...... .. ~ .... . ....
.'..;'~". ~ =.~ ' .~o~458
. ~ '. ~ ~ , . ...'~ . :.~.
.'..;? ... ..:.; ,'~.., '. ,: . , .-. , ...... ,?.~ ¢, (.. ~'... '-,~':~
LEGAL:
A.
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LOT se, EAGLE RIVER VALLEY RANCHETTES
GENERAL
1. The septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
5. All materials and workmanship shall meet the Anchorage Department of
Heaith and State Department Of Environmentai Conservation require-
ments.
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified or
modified in the field by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any ad3aoent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan,
any deviation requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
DRAINFIELD
1. The drainfield
2.
4.
5.
6.
7.
8. The septic tank
existing private
community well.
is to follow the natural land contour to maintain
uniform total depth of the trench bottom.
The bottom of the drainfield shall be level, plus or minus 1.5".
The total depth of the drainfield excavation is not to exceed 5 1/2'
at any point.
The sewer line is to replace the existing sewer line that leads to the
existing pit.
The drainfield gravel is to be covered with typar or fabric material.
Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the drainfield.
The area over the drainfield is to be finish graded to prevent pending
of surface water runoff.
and leaohfield must not be closer than 100' to any
well, 150' to any Class "C" well, or 200 feet to any
RECOMMENDED LEACHFIELD DIMENSIONS
GRAVEL DEPTH : ~ 1/2,'
DRAINFIELD WIDTH :
Existing
TOTAL DEPTH : 5 1/2'
DRAINFIELD LENGTH = 60'
Soil Rating = 138
Bedroom Capacity = 4
Septic Tank Size = 1500
***NOTE: SAND FILTER NOT REQUIRED DUE TO PRESENCE OF GM LAYER AT 6-12' DEPTH.
"~ ?-'~ MUNICIPALITY OF ANCHORAGE !
f t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well I Absorption area~ Dwelling / PERMIT NO.
~ Z Manufacturer ~ ~ E ~ Material~ ~ N°' of compartments
Liq. capacity in gallons Inside length Width Liquid depth
~ IF HOME,DE:
~ ~ DISTANCE TO: Well ~ ~ Dwelling PERMITNO.
O ~ ~ Manufacturer~ ~ = Material Liquid capacity in gallons
Q Wetl Foundation Nearest lot line PERMIT NO.
~ ~ Z No. of lines Le~(e~ch lin~ iai lengt~ of lines Trench width Distance ~t~en lines
~ ~ ~ inches
~ ~ Top of tile to finish grade Matedal beneath tile Total effective absorption area
Q inches
O~ Length Width ~l ~ Depth PERMITNO.
~ ~ Type of crib Crib diameter Crib depth Total ef fecti~ absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Oepth ~i,~r Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area{sD
OTHER
PIPE MATERIALS C~S~ I
INSTALLER ,
DATE LEGAL :~ ~
v. 3~78)
__MUNICIPALITY OF ANCHORAGE,..,
Department[~f Health and Environmenta ~rotection
825 ~ Street, Anchorage, AK. 99501
· - 264-4720
· * * HANDWRITTEN PERMIT * * *
Permit #~5~ I WELL AND/OR ON-SITE SEWER PERMIT
Applicant: \//~ ~ ~,~0~ Mailing Address: ~&~/~
Location: 1~//4~v~ Phone Number:~d-c7~;~
~ ~ ~ Lot Size:
Legal
Description %
Type of Soil ~so~tion System Is:
Trench: Drainfield: Seepage Bed: __Holding Tank:
Maxim: N~er of Bedrooms: Soil Rating(sq.ft/br)
~/~/~_ _ The Required Siz~ of the Soil Absqrption System Is: · .
DEPTH LENGTH GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet).. There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE :,~5)d GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection~and approval by this departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that~.bedrooms.~"~
Signe~: Issued by:~~
Applicant
Date:
SWP/024(1/81)
Anchorage, Alaska 99503
I~SPE.C. TION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ,..... . , .
FROM WELL ~-~'-~/-~/I ~LJFACTURER
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY.~
GALLONS.
DISTANCE FROM WELL ~"l~OUNOATION /
NUMBER OF LINES / DISTANCE BETWEEN LINES
ABSORPTION AREA .~"-~ ~¢' SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE..~__MATERIAL BENEATH TILE ' 7c;~. IN. ABOVE TILE
WELL:
TOTAL LENGT.,.~ /
NEAREST LOT LINE OF LINE5 "'"-
TRENCH WIDTH~:~r IN. TOTAL EFFECTIVE
TYPE CONSTRUCTION DEPTH
IN.
DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION.~ LOT LINE__. SEWER LINE TANK__ SYSTEM
CESSPOOL
, OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
P IPEMATERIAL:.P~~.-,
LOT SLOPE:
REMARKS:
DA T F-j/~ --"~3--"-7'~ p P R 0 V E D~
Form EQ-O32
DEPARTMENT OF ENVIRONMENTAL QUALITY pERMITpO.'
3330 'C"STREET ANCHORAGE. ALASKA 99503
TELEPHONE~
SEWAGE DISPOSAL SYSTE APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
~*% SOIL TEST RESULTS
COMPLETION DATE ANTICIPATEDI~
SEEPAGE PIT DRAIN FIELD
NOTEJ THIS PERMIT IS NOT VALID WITHOUT SOIL 'TS:ST
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. I
BEPTIC TANK SIZE TYPE
SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PiT WALL
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD.
SEPTIC TANK· SEEPAGE PIT
TO RIVER, LAKE, STREAM.
DRAIN FIELD
DRAIN FIELD
SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
,. SEEPAGE PIT
· DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT THE ABOVE
DATEDESCRIBED. ~ --~'~-- ~/SYSTEM IS IN A CCORDANCSWITHAppLiCANT.sSAIOsiGNATuRECODE. '~~ ~ ~~
GAAB-HD- I
G,PI",ATER~ ANCHORAGE AREA BOROI:,OHr, ,~
' HEALTH DEPARTMENT , ~
327 E~,GLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ,/~
LOCA.ON
SEPTIC TANK:
MAILING ~---~._~. ~
ADDRESS''''- '~'' ~' -~'""- ,'/~'~;J"~"~ PHONE
LEGAL DESCRIPTION~Z~'2~' ~-~, ~~~
NUMBER OF /
DISTANCE FROM WELL /'¢~"'~"~'/~-~ MATERIAL ~"'~T-~---~-/- COMPARTMENTS
LIQUID CAPACITY /Z~'~:/-O GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH__
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER.
LINING MATERIAL
NEAREST LOT LINE
OR WIDTH /"'~' / LENGTH /~/ /
, , DEPTH
DISTANCE FROM WELL ,'~/"/~'~'/-~/~--~ . BU~LDZNO FOU~DAT O~
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELl ,FOUNDATION NEAREST LOT LINE , OF LINES
NUMBER OF LINES /"'~""~ISTANCE~ ~N. TOTAL EFFECTiVE
ABSORPTI ACU~REA ~ LENGTH OF EACH LI~NE '
DEPTH: TOP OF fILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
DISTANCE FROM WATER
TYPE"~'' "----,~'~-~'J~--:-~ DEPTH ,BUILDING FOUNDATION. ~SAMPLE . NEAREST
NEAREST SEPTIC SEEPAGE OTHER
LOT LINE , SEWER LINE . TANK , SYSTEM , CESSPOOL , SOURCES
DIAGRAM OF SYSTEM
APPROVED
OAAB-HD-2 · '
~' GREATEi~%ANCHORAGE AREA.~DROUGH
llEALTII DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE
NAME OF APPLICANT
RESIDENCE ADDRESS,
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH
PERCOLATION TEST RESULTS, ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
DISPOSAL SYSTEM - APPLICATION & PERMIT
,~"/¢-~'-~;' ./ MAILING ADOBESS ;~,-,~_ PHONE N0.
,OCAT,ON OF ,NSTALm,ON :~,'-"~'d ~'-~"~ £&- ·
, SEEPAGE PIT ~ , DRAIN FIELD , OTHER
TO BE INSTALLEO BY ~/ C ~ /
TH,S ,S TO SERVE AS ~-~-- . PERM,T TO ,NSTALL A ~,%~.,~, ¢. _..',
: AS OESCR,BEO ,ELOW. S,ZE OF ,N,T TO ,E SERVED. ~ f~ '~
.SEPTIC TANK SIZE /~E(~O~L~TYPE '~L(?-' SEEPAGE AREA TYPEc:~T~~
DIAGRAM OF SYSTEM
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinan, ~t~:t ~ha~t the
above described system is in accordance with said code.
DATE APPLICANTS SIGNATU
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete'legal description
Lot 5B, Eagle River Valley RaDchettes
Location (site address or directions) 18828 Man O War
Property owner
Mailing address
Matt Vogel
Day phone
20249 New England, Eagle River, AK 99577
563-7084
Lending agency
Mailin. g address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
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.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
NOTE:
Holding tank
Community on-site
Public sewer .,.j~
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-O2~{Rev. 1/~l) Froflt MOA~I21
Se
J
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
Address
Engineer's ~'i'gnature
S & S ENGINEERING
1203e E. agie ~iver Loop koad
Eagle River, Alaska 99577
Phone
Date
r'Y.
DHH$ SIGNATURE ~"~/.//~
.. ~/Approved for
Disapproved.
Conditional approval for
~,;~"~' bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
,:I CEIVED
Municipality of Anchorage JUL 1 2
DEPARTMENT OF HEALTH & HUMAN SERVlC~t)~capauTy
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Health Authority Approval Checklist
p.=,,.o.:
If A, B, or C, attach ADEC letter. ADEC water system number
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production .,/.///' g.p.m.
WATER SAMPLE R~S:
Collfo~,~,/ NRmte
Da~f sample:
Date completed J
Cased to Caste
ground)
W/jM(properiy protected (Y/N)
FROM WELLLOG J AT INSPECTION
g.p.m.
Other bacteria
Collected by:
SEPTIC/HOLDING TANK DATA
Date installed ~ Tank size ~ Number of Compartments // Cleanouts (Y/N)
Foundation cleanout ~¥N) y~5 Depression (Y~J /J D HIoh water alarm (y~
Date of Pumping ~~ Pumper ~'-~.. ~
ABSORPTION FIELD DATA
Soil rating (g.p.dJft~or~/bdrm) 75":~'~ S~em~e
/ ~. Total depth
~ve abso~on area ~ ~onEodng Tu~ preseN ~) ~E~ Depre~ion ~er field
Dateofadequawte. ~2¢-~ R.UI~(P~') ~5- For
Ruid depth in a~omflon field before t~t (in.); ~lmmedlately after ~gal. ~ter added (in,):
Ruid de~ (i~) Minm~ late~, /~ ~so~flon rote = /~ ~ g.p.d.
Peroxide Eea~nt ~est 12 mon~) ~ ,~O If yes, gbe date
bedrooms
~'ti/"
72-026 (Rev. 3/96)*
LIFT STATION . P~,~/,~
Date installed
Manhole/Access (Y/N) ~
High water alarm level at* ~ *Datum
SEPA.*TIO. D,STA.CES
SE.ARATION D STANCES FROM WEU_O. LOT TO=
Size in gallons ~
"Pump off" level at*
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~
Public sewer manhole/cleanout
service line Uft station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /~) I .{_ Property line /(~/'~ Absorption field
Water main/service line /~ I./_ Surface water/drainage /('~C)
Wells on adjacent lots
F.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line /~'/1/- Building foundatio;n" //~/4- Water main/service line
Surface water /(~ / ~ Driveway, parking/vehicle storage area .Z~/'~-
Curtain drain Wells on adjacent I~ts
~ oLD Tt~£~i4 u~5 pur/~ c(~.
ENGINEER'S CERTIFICATION a/~.~l ~,.r.~^~ ~r~u~ ~,~ o~ ~y~r~- · ,~z
in ~nfo~an~ ~ MOA ~ guidelines in eff~t on ~is date.
Signature ~ ~ - [~ ,. '/~//~, ~ ~ ~, r &.
Enntneer'sN~e ~0~{~ ~ ~4~
HAA Fee. $ ~
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
050-~21-~7
GENERAL INFORMATION
Complete legal description
Eagle River Valley Ranchettes, Lot 5B
location (site address or directions)
19008 Man O' War, EaGle River
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
James & Ann Moen
P.O. ~nw 67~ Petersburg, ~K 99833
Seattle Mortga§e/Henri
560 E. 34th Avenue, Anchorage, AK
N/A
Day phone 772-4401
Day phone 562-5626
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
x
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
X
Public sewer
If community wastewater system, Provide written Confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/gl} F[ont MOAI21
o
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.
99577
Name of Firm Eacjle PJ.ve~ En~'~eerincj Services
Address P.o. Box 773294'. E~gle River. ~
Engineer's signature ~~~
Phone 694-5195
Date_
" 6. D/~,~SIGNATURE
i Approve.d for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
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. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72..025(P~.1~1) Back MOAI21
Municipality of Anchorage ~,~
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~,/~.~5 ~1/,/~ Parcel I.D. 0~0- ~'~J~ ~' q'
A. WELL DATA · ·
W.ell type ,Du/~ t-I~_ If A, B, or C, attach ADEC letter, ADEC water system number
Log pre~ (Y/N) .... Date completed .... Driller ..
Totaldepth "~. Cased to Casing height_ ..
Sanitary seal (Y/N)'"~. Wires properly protected (Y/N) ~ ..
Date of test ' -- ' ' "'' ~ ~ '~
Static water level
Well flow " ' ''~ glp.m. ~
pump level ' ' ' i '
SEPARATION DISTANCES FROM WELL TO: ' 'x~.
Septic/holding tank On lot ..... ~; !9.,~dJacent lots
Absorpiion ~i.e, ld 0n Io, .... .. ~.= on adj., lots
Publicsew?rmain' . ' ' . ' . P[~blicsewer manh°le~!eanout
Sewer service line ' Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
SEPTIC/~ TANK DATA
Date installed /~.70 //~'.~ Tanksize
Cleanou'ts (,Y/N), Y~<~ · .Foundation cleanout (Y/N)
High Water alarm (Y/N) ' ~/~/'~ Alarm tested (Y/N)
Date of.. pumping ' ' 0 ~///.. ~/. ~ 3 Pumper ..,~
SEPAR.~.TION DISTANCES FROM SEPTIC/~ TANK TO:
Well(s) on lot /V/~ On adjacent lots
Foundation
To property line ~ ~/) / Absorption field
Surface water/drainage
72-026 (Rev. 7/91) Fron!
Compartments
Depression (Y/N)
Waterm~ih/servicoline - .~ ~/~ /
CONTINUED ON BACK PAGE
De
LIFT STATION i ' ·:
Date installed r ' ' Manufacturer
Size in gallons ' ' Manh°le/~' _~
Vent (Y/N) "Pump on" level at f "Pump off" level at
High water alarm level ~\~ ;~-/'~' ~'" Cycles tested
Meets MOA electrical codes (Y/N) ~ .
SEPARATION DISTANCE'FROM LIFT STATION TO:
Well on lot ~ On adjacent lots
ABSORPTION FIELD DATA
Dat~ inst~iled 12.'7~ ///~'~ Soil rating
I' ength [/'?, : Width ~ Gravel thickness
Oepre~'~ion (~v'~ field (YIN)
Results (pass/fail) /o/~ 5.5 '
Peroxide treatment (past 12 months) (Y/N)
Surface water
· -~o ~ · Total depth
5,5z ·
Cleanouts present (Y/N) ~'~
Date of adequacy test ~'/~
for "/7c
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
On adjacent lots fJ ~.-0(~ /
Property line / ~; !
/"/~ ~ To existing or abandoned system on lot f-/~'"
Cutbank /~'/"/ Water main/service line '/"
Driveway, parking/vehicle storage area
Welloniot
To building foundation
On adjacent lots f' -~x
Surface water
· Curtain drain ·
E. ENGINEER'S CERTIFICATION
bedrooms
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect, oL~~'this inspection:
HAA Fee $ //7
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) I~ack MOA 21
APPLI('"NT FILLS OUT UPPER HAl'"1 ONLY
Lending Instl~tlon Phone
Address ~/// ~ ~D v,~ ~
~ Multiple Family ' No. of Bedroo~
~ Other
Water Supply
~ Individ~l ' A~ACH ~LL LOG. A w~l log Is requlr~ for all wells drl~ed since June 1975.
~ ~mmunity For wells ~ill~ prior to that date, give well depth (attach log If available).
~ Public Utility
Sewer Disposal
Indlvidml Year Indiv~ual Installod: ~ t~
Public ~llity When ~t~ to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Dar2 t ~t
~- ~-~ ( ~ ,_,~
Inspector Inspector Inspector Inspector
( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL
CONDIT~NAL APPROVAL'
Soils Rating Date ~wer Installed Well To ~orptio~ Area ~ W~II Log Recelv~
~ovember 19, 1982
Joe and Jill Pekala
P.O. F3ox 11024
Spokane, Washington
99211
Subject: L - 5 B Eagle River Valley Ranchettes
Approval for the individual seuer and %~ater facilities cannot
be granted until the follo%~ing items have been completed:
The septic tank pumped %~ith a receipt submitted to this
department.
A four (4) inch cleanout needs to be installed to the sep-
tic tank.
A four (4) inch cleanout needs to be installed to the
leaching area.
An adequacy test needs to be performed on the existing
leaching area. This test %~ill determine if the system i~
adequate according to ~lational Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our revie%;.
Please notify this Department for a reinspection ~4hen the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
RP229/p/EI!
Enclosure
Robert C. Pratt
Associate Environmental Specialist
TECH ENGINEERS, INC.
CIVIL · SANITARY
November 19, 1982
Joseph R. Pekala
P.O. Box 11024
Spokane, WN 99211
Re: On-Site Sewer System Adequacy Test;
Eagle River Valley Ranchettes
Lot 5-b,
Dear Mr. Pekala,
During the three day period from November 16 through
November 18, I performed an adequacy test on the septic
system at the above listed address. Using the criteria
for a four-bedroom house, _the existing lO00~allon septic
t~k is too small. The absorption system, although designed
~or a three_bedrObm house, was able to pass the adequacy
test for a four-bedroom house.
The residence is on a community water system and
sufficient pressure and volume were available to use this
source for the adequacy test. On the first day 650 gallons
were discharged into the system at a constant rate of
10 gpm. The rate of rise of the tank water surface was
monitored along with the rate of fall after the water was
shut off. On the first day the system was able to contain
the surge, although the tank neared overflow. On the
second day the water level was measured and was found to
be the same as the previous day. The surge test was
repeated and this time the tank did overflow after 470
gallons entered the system. This is 72% of the total test
volume of 650 gallons. On the third day I checked the
water surface in the tank and found it to be the same as on
the first day.
Using the rate of rise and the rate of fall data
gathered in the two surge tests, I was able to calculate
a system absorption rate of 7 and 6 gpm for the first~and
second days, respectively. It is my opinion that this
abs~tion rate is adequate. The surge capacity is marginal,
but I think it is also adequate. On the first day the
system contained 100% of the surge and on the second day
it contained 72% of the surge. For the two days tested,
the system contained an average of 86% of the surge. This
is above the 80% value which is the pass/fail criteria
recommended in the regulations.
13 LE DOUX LANE · EAGLE RIVER, ALASKA 99577 · TELEPHONE (907) 694-3574
'Adequacy Test
J. Pekala
Page Two
I have been provided with a receipt which shows
that the septic tank was pumped on October 7, 1982.
If you have any questions, please do not hesitate
to call.
Vernon L. Roelfs//P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTIO~N¥1RON:v''ENTAL
825 L Strait - Anchorage, Alask- ~9501
FEI] 8 8 19t9"
ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete ill part~ on Palll 1, Im:;ompIIt~ rlqo; will not I~ PI, Pll iIIcm~ t~n IIOI days for pmceuing,
1, PROPERTYoWNER I PHONE
..- MAILING ADDRESS
I PHONE
PHONE
PHONE
16. LEOA.L OE~CRIPTION
I STREET LOCATION
' 6. TYPE OF RESIDENCE
~' SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY
[] INDIVIDUAL'
~ COMMUNITY
· , .[] . PUBLIC UTILITY
6. SEWAGE DISPOSAL SYSTEM
NUMBER OF BEDROOM~ .z : :: .-
~ One ~ Four ~ O~er
D Two ~ Five
~ ~ree ~ Six
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
d,,epth (attach log if available.)~ , , ,
If system is over two (2) years old an adequacy test is required
by this Deparlment.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
724)10(3i78)
: . THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
-~ SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] IN~I'VIDUAL DEPTH OF WELL
~ COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVEO
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~ INDIVIDUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
'~Sel~tic Tank or [--I Holding Tank
Size:~ If Tank is homemade i SOILS RATING
give dimensions: ~
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption A~ea to nearest Lot Line
5. COMMENTS
~PPROVEDFOR~J -.~ BEDROOMS
[Z~ONDITIONAL APPROVAL (letter must acc~pany certificate)
DATE 9'--/~-- /'7 BY ,~-,,~.., - ,' / /
LEGAL DESCRIPTION
72~)I0 (Rev. 3/78)
· * u cipaliWAnchor ¢O
POuCr~ 6-650
ANCHORAGE, ALASKA 99502
(907) 279-2511
GEORG'E M. SULLIVAN,
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
{825 *'L" Street}
MarCh 5, 1979
Frank~Marlene Rouleau
Box 140 Man-O-War
Eagle River, Alaska 99577
Sub~e~t: Lot 5B Eagle River Valley Ranchettes Estates S/D
Approval for your individual sewer and water facilities will
not' be granted.until the following items have been completed:
(1)' ~he septi6 tank is pumped with a receipt submitt6d to
this office.
(2) ~ four(4) iinch cast iron cleanout be installed to the ' ~eptic.tank and leaching area..,
Notify this department for a re-inspection when descrepancies
have been corrected. If there are any further questions,
please contact,this office at 264-4720.
Sincerely, , ,
Robert C. Pratt, R.S.
Associate Specialist
cc: Valda Dra~e % Dynamic Realty
501 West Northern Lights Boulevard 99503
DEPARTM.,~.[ OF HEALTH AND ENVIRONMEr' IL PROTECTION
279-2511, ext. 224 or 225
Received: May 25, 1977
#1: Time 9:30 a.m. #2: Time #3: Time
Date 5-26-77 Thurs. Date Date
Insp Kennedy Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Peoples Bank and Trust % Kathy
Mailing Address: Pouch 7-007 99510 Phone: 279-7511/246
e
Property Owner:
Mailing Address:
William F. Railing
Phone: 863-1293
3. Legal Description: Lot 5B Eagle River Valley Ranchettes Subdivision
4: Single Family Residence: ~) Number of Bedrooms: 3 ~>
Multiple Family Residence: ( ) Number of Bedrooms:
Se
Well System:
Permit #
Construction
Individual well ( ) Community/Public System ~
Depth of Well Well Log on File ( )
Bacterial Analysis
e
e
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x~ Public Utility ( )
InstAlled J~]°--~3~-~ Installer
/~6~3 -~D Manufacturer
Soils Rate ,,~'~ Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1917
1. Type of Inspection: VA
2. Property Owner:. WILLI~! F. RAILING
FHA CONV X
Mailing Address: UNKNOWN
Name of Buyer: JAMES D. DEAVER
Day Phone:
Mailing Address:.. Box 104 Colville Street, E.R. Day Phone: 864-1293
~ Alaska 99577
Name of Lending Institution:. PEOPLES BANK & TRUST COMPANY
Mailing Address: Pouch '7007, Anch., AK 99510 Phone:: 279-7511 ex. 246
5. Name of Realtor or Agent:
Mailing Address: Phone:.
6. Legal Description: Lot 5B, Eagle River Valley Ranchettes
Location:
NHN Man O War Street, Eagle River, Alaska 99577
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
SINGLE FAMILY No. Bdrms. 3
COMMUNITY
Public Utility.
,Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
Public Utility
UNKNOWN
Individual (on-site)
x
72-003(3;~6)
Pa'ge Two '
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5B Eagle River Valley Ranchettes Subdivision
Comments:
Affadavit Attached: ( ) Letter Attached: ( )
Approved:~ ~~-~Date: ~-~--~ ~ "'
Disapproved: Date:
Department Worksheet:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received ~ugust 3, 1976
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
v.ao
l. Approval requested by: Lomas & Nettleton Company
Mailing Address: 4449 Busin.ess Park Boulevard Phone: 274-7661
2. Property Owner: Willim~ Railing
Phone:
Mailing Address: % Selective Realty, John Powell & Pat Hubbell
3. Legal Description:
Lot 5B Eagle River Valley Ranchettes
4. Location:
5. Type of facility to be inspected
6. Well Data:
A. Type
e
Single Family
P~kblic Utility
C. Construction
Sewage Disposal System:
A. Installed
C. S~ptic Tank:
D.. Seepage Pit:
E. Disposal Field:
No. of bedrooms 3
B. Depth
D. Bacterial Analysis
On-site system
1974 B. Installer
I. Size 2. Manufacturer
1. Absorption Area 2. Material
Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
, Absorption area
., Other contamination
.., Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
' A",UNICI?ALITY OF
DEPT. O~: H-:.",LTH .~,
MUNICIPALITY OF ANCHORAGE l-:l',,vl:,O,~,,.Er,,]," "" ' ' ~.L ,~&CT!:CTIO,N
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ,~r..~,;" 1976
REOUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES R E C E J V E D
1. Type of Inspection: CMRO
2. Property Owner: William Railing
Mailing Address:
3. Name of Buyer: Allen
VA × FHA CONV
Day Phone:
Mailing Address:5631 B College Drive
Day Phone: 274-9551
4. Name of Lending Institution: The Lomas & Net'cleton CO.
o
o
Mailing Address: 4449 Business Park Blvd. Phone: 274-7661
Anchorage, Alaska 99503
Name of Realtor or Agent: Selective Realty- John Powell & Pat
Mailing Address: P, O. Box 1065,Eagle River Phone:
Alaska 99577
Legal De~ripti0n: Lot 5B E{%gle River--Ranchettes
694-9524
Location: Eagle River
7. Type of Facility to be Inspected: /~'11~ ( )
No. Bdrms. 3
Water Supply
/
Type of Supply: Public Utility./~
Individual
If Individual, number of dwellings presently served 1
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation ,/~.7/~
Individual (on-site)
72-003(3/76)
Page 2 of t~ pages - Re~!st for Approval of Individual . .~Yer & Water Facilities
te~!l De)6riptton Lot .5B Eagle ILLver Valley Ranchettes
Con~mn~
Approval ~Valtd for one year f~m date signed
Greater Anchorage Area Borough, Department of Envtro~ental Quality
DIAGRAM OF SYSTEM
I--cert'%fy t~'t the tnfomatton contained in this request ~r approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNEO Date
£q-o)¢ (1/7¢)
~,uqUa~ ~3, ~97~
~aglo l~Lver, ,&leoka 99577.
'SubJoct: ,Tot $-B F~agl~ PJ.vor Va.l. loy ~n,-~,',~e, tten
~ o~fl~ at 276.2221, ~~ 286.
1975
4.X
9'~$77
Sub:~ect: Lo~ 5-~ ~agle ]~/ver Valley _.~._~_~ttee;
Lustallat~Gn o~ ~ s~mndpipes is required, am/ a
ed~e~k of the ~£luid level '~n the seel~ ~lt will
~ Mae.
If thet:e are further quest, tons, plmme
t:.~.s of~£1ce at: 276-2221, extfms~.on 286.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received Jul~ 7~ 1974
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approvallrequested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
FHA
Soo. k_eane Mort~aa~ae
W 8th A~chnea_ae gg501
3nhn Jame~
River AK
Iht RR Fn~I~ Rtver Vnllmy Rnn~hat~a~
~n O' Nar Road
Phone:
Phone:
277-0543
5. Type of facility to be inspected
6. Well Data: C~ii,iunity (Dan Bell)
A. Type
C. Construction
Sewage Disposal System:
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Single
No. of bedrooms 3
B. Depth
D. Bacterial Analysis
1970 B. Installer Dan Bell
1. Size 1000 gal 2. Manufacturer Ste~l Fab
1. Absorption Area 13'x16' 2. Material Concrete
Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
C. Absorption area to nearest lot line
, Absorption area
Other contamination
, Absorption area
24'
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
. · P~ 2 of two' pages - Re,.est for Approval of Individual ...~er & Water Facilities
Legal Description
Comments
Disapproved
ApprovalValid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)