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Home My WebLink AboutHIDEAWAY ACRES LT 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Lot I''r~' 1 Block ~ ~ l ownshlp, Range, Section M~!enal No ol Compam~lems TYPE OF SYSTEM ENCH ~.] BED / [] W. DRAIN OTHER SO FT Date Installed FT DISTANCES ~'--~'0 SEPTIC ADSORPTION __FR0 ~ ~ TANK FIELD WELL WELL LOT LINE FOUNDATION 7o ' Z C?: AS-BUILT DIAGRAM tShow Iocahot~ Of wed. sephc syslem property hnes. Iourldahon, drp, oway, walol bodlos, elc ) WELLS [] OTHER (Identify) '"-ry~'--p R I VATE FTJ FT REMARKS: 7 ~ '7-1.4/~ Scale: Inspections Pedormed by: IZjc filunicipal and Slate guidelines i,i ellec, ell lifts dale: 1 ¢2'"'"/~/~_ ' .i ?.t'.::~ :..:,I ..I.. F:'I:ii:R IENCi i lqEl:ii:l::i'.S DIES I GI".I ,, VARR :1: I::'Y '1ANKS I I',lTliii:Gl::;: t '1'",'~ []l:,:U'..::ii i ~:~i.'~l') I'::' :1: I...I .... I. N CII...t.) CR I .f3 ,, IqO '1 1 FY Df'IHS I:::'R !:,'.i'.:il::"[:i%:!lON BY II-Ilii E]',.IG.I;l',lEi. iiii:F;:,, THIS ~ ii..:;i F'IEI::;~M .1: !' ;i. ~iil :1 ',!iiSl..IED I:- t:)F~ I HEi: !E X :I: ,"i!i I :I: I",IG :5 Ed~!!:DI':;~CICIM !iil I IqGl.l:i F:'AM I I..Y I.'~ ;: ',>Ii}]',lC;Ii:: ONLY ,, .. , ,,_,-,-3 r-~ ~ ~ pi< 'o~ 4"[;2: ~4~ J -:. / ~ Jz' z'-.o" ~O,jo I, lo,',,-i,:,, tSre .... -'Ali, SEWER SYSTEM 'LOCATION PLAN LOT I BLOCK I , SUBDIVISION ,,, ~:?' "" r:.'T~ ~5):}' :? / '8~$v ~ ~ SECTION/TOWNSHIP/RANGE ,~:>'?, ' : ',,~' ,~5 ,:,~ SCALE, NOTE, ' PROPERTY CORNERS, WELLS, AND SEPTIC ~ c. ,~;~z " . ,,,,o~ot,,;,,,- ., / . SYSTEMS INDICATED IS NOT EXACT. ¢~ - .. n* NORTH / P c,¢ ~/p/%'~' DIMENSIONS INDICATED HAVE BEEN .......... '~ ~r:!'~'f P" -~77~'. DETE¢IMINED BY USE OF CLOTH TAPE AND Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchora§e, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR :~ ~.. LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 DATE PERFOR /~rC ~,'Township, Range, Section: SLOPE SiTE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E ",pth l0 Waler ^,,~r Monitoring? ~ Date: 13 14¸ 15 16-- 17 18 19 20 COMMENTS . .~/(.d/'-) Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND ;~ ./~d ~ -f- /':~:' :z 7', ,/~d .FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: _ 72-008 (Rev. 4/85) oGRE, ER ANCHORAGE AREA BOP'"JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE // /- FROM WELL/(, :(? INSIDE LENGTH - "J ' , OF - COMPARTMENTS INSIDE WIDTH LIQUID DEPTH_ LIQUID CAPACITYI ¥ ')L/~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER __ LINING MATERIALC~ ?Z"(', /"')~RIB SIZE: ---, LENGTH¢ '?", DEPTH /: .~] DIAMETER DEPTH ~i:)/ DISTANCE FROM: WELL BUILDING FOUNDATION -/-'~->. NEAREST LOT LINE ADDITIONAL ABSORPTION WELl_: TYPE :'),//' ,' /) BUILDING FOUNDATION __CONSTRUCTION_ (""/(2~1~/~/(' ~/ , .[ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) CESSPOOL APPROVED NEAREST LOT LINE OTHER SOURCES_ DISAPPROVED NEAREST SEWER LINE_ REMARKS _SQ. FT. SEPTIC//--,/. TANK /~' :D<'' DISTANCE FROM: SEEPAGE ///'~ ' SYSTEM DISTANCES:/ .4 (' LOT SLOPE: REMARKS: Form No, EQ-031 DIAGRAM OF SYSTEM GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4§6! PERMIT NO. SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT MA,L,N~ ADD~ESS INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT._/~2 , DRA~N FIELD . OTHER TYPE AND SIZE OF FACILITY TO BE SERVED /~/.~- ~/~L/~J SOIL TEST RESULTS /~1, //~ ~(/~/Y ///' . NOTE: THIS PERMIT IS NOT VALID ~lTHOUT SOIL TEST COMPLETION DATE ANTICIPATED ~ /~/ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE_ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEEPAGE PIT ~ / SEPTIC TANK TO SEEPAGE PIt WALL /4 / TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD _ -- DIAGRAM OF SYSTEM · DRAIN FIELD. SEEPAGE Pit ~2 ~ '/ ', - , DRAIN FIELD SEEPAGE PIT ~/~'~') /] ALSO CONSIDER AREA WELLS. SEEPAGE PIT /~ / /~_~ t /~,/ , DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD //~ /' SEPTIC TANK, SEEPAGE PIT_ TO RIVER, LAKE, STREAM. 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 ? TO BOROUGH REGULATIONS REGARDING INSTALL/ON. CONFORM LICENSED DESIGNER CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ~SCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ANCIIOR/iGE FAIRkIANKS CONSULTANTS, INC. JUNI~AU R & M NO. 462096 Mr. Harry Foosness 1436 Matterhorn Anchorage, Alaska Re: Test Hole and Soil Log Report for Sanitary System Lot 2 Hideaway Acres Dear Mr. Foosness: We are submitting herewith the test results and our comments regarding soil conditions encountered at the subject site. Thais investigation was performed in accordance with your request of November 11, 1974, and those .procedures outlined in a letter dated September-i[3, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 2 ares for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor mounted backhoe and the test hole was extended to a total depth of 13.0 feet below ground surfade, The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be ~f service to you. Should you have any questions with regard to the above~ please do mot hesitate to contact us. Very truly yours, R & M ENGINEERING CONSULTANTS James W. Rooney ~~ JWR:pjm xc: GAAB Test Hole-1 11~11a74 ]~ ORGANICS ORGANIC SILT 0.0' 0.5' 1.57 SILTY SAND W/SOME GRAVEL (SM) 6,5' SAND MEDIUM TO COARSE GRAIN (SP) NO WATER TABLE 13.0' T.D. NOTE: TEST HOLE EXCAVATED WITH TRACTOR MOUNTED BACKHOE. Engineering 8~ Geological Consultants Inc. _~_.C-HOR A~ FAm~.KS ALASKA Ju~u Harry Foosness Property Log of Test Hole Anchorage, Alaska SCALE 1"=2' IcH~o W.E.D. [~mo~. No. 462096 l~w~ ~o. ][1/13/74 R&M ENgiNEERING & GEOLOGIL AL CONSULTANTS 22g EAST 51st AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99603 TELEPHONE 907-279-0483 TELEX 090--35419 Civil Engineers ' .;,:, ~ ....... ,, .Gee/eEists JAMES W. ROONE¥, P. E. MALCOLM A, MENZIES, P,E,, L,S, JAMES FI. WELLMAN, P.E, July 24, 1973 Land Surve?ors RALPH R. MIGLIACCIO Engineering Geologist. Mr. Carl Luchsinger Box 94, Star Rt. A Anchorage, AK Re: Test Hole and Soil Log Report for Sanitary System Lot 1 & 2 Hideaway Acres Dear Mr. Luchsinger: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of July 23, 1973, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Qua ii ty. A single test hole was put down within the Lot 1 and Lot 2 area for the purpose of defining general subsurface soil conditions for 'the proposed sanitary system. Excavation wa~ accomplished with an auger type drilling rig and the test hol,e was extended to a total depth of 25 feet below ground surface'. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of seA-vice to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, F, & M ENGINEERING & GEOLOGICAL CONSULTANTS James W. Rooney JW?,: p h >:c: G~AB ~/ THI 7-24-7~ SILT~ TRACE TO SOME SAND AND GRAVEL (ML) SILTY sAND, TRACE GRAVEL TAN (ME,) SAND, Med. To Coarse Grain Gray (SP) No Water Table 25.0' T.D. TH2 7-24-73 ORGANIC SILT 0.0j SILT, TRACE SAND AND ,~/ GRAVEL TAN (ML) ') 7.0~ SANDY SIL:F TRACE / GRAVEL (M L) 12.0' GRAVELLY SAND Gray (SP) ,/,~,,)_ 14.0' SAND Gray Med. To Coarse Grain (SP SAND~ Coarse Grain Gray ( SW ) 20.0' 25.0' T.D. No Water Table No~e : Tee'} Holes Extended With Auger Type Drilling Rig. J~ Engineering ~ Geological Consultants Carl Luchsinger Property LOG OF TEST BORINGS Anchorage Alaska MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~)Z',~'-¢~'/' -~::~ NAA # ,.~_.~, ~ ¢¢)_ .,~-)x-~.¢-- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone /'L"~////~ (e) Mail the HAA to the following address: (or check here I~if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family~ Number of bedrooms ~ WATER SUPPLY Individual Well/~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site ~;~ Public [] Community [] Holding Tank E] / Note: If community well system, must have written confirmation from the State E)epartment of Environmental Conservation attesting to the legality and status. 72*025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION Ascertified by my seal affixed heretoand as of the validation date shown below, Iverifythat myinvestigat[onofthis Health Authority Approval 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 flies 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 Fir~' ~,",'¢/-¢" ~' ,¢ :/-','-~-~ Telephone -~ ' '-~ Address ' Date 6. DHHS APPROVAL Approved for .~ bedrooms by Approved ~. Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Hea, lth Auth,.0rity Approval (HAA) ~!i~.',~'/ki i I, ~Hl~'C~i§3% F~EBRUARY 1984 :','i:~.~4744 Legal Description: A. WELL DATA Well Classification Well Log Present (Y/N) /~/ . Date Completed (/4 ~o,~,,~. Yield Total Depth¢(~' Cased to _~;.l' ' & Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) ____ Static Water Level ,-~ '¢ Casing Height Above Ground ~ * Electrical Wiring in Conduit (Y/N) .~/ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ](~O r To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ To Nearest Sewer Service Line on Lot Water Sample Collected by (."~-~'li/fl~/ / Water Sample Test Results ~i~,/~ ~/.~( /--/Cd- Z-¢~t ~,/ / Comments Pump Set At /__,.),1 /~o '~,¢,-, Sanitary Seal on Casing (Y/N) F Depression Around Wellhead (Y/N) ; On Adjoining Lots ~'/~" ; On Adjoining Lots j~/ //~- To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed /42/7.~ Size_/d..,d-£-' Standpipes (Y/N) y . Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) l~,( ~/"-I Holding Tank High-Water Alarm (Y/N) /~./ /.~ No. of Compartments ~'/ Foundation Cleanout (Y/N) Date Last Pumped / ;for J(../ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [ L~C.? To Property Line ~._. _d_2 ¢ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation 7'0 Disposal Field ¢o Comments 72-026 IRev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /,-? / /6 / Width of Field ~ L ~ ,, Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~¢ l~'~f/;.~ Type of System Design / Length of Field ~E.) ~ Depth of Field /,Z ' Gravel Bed Thickness ~ ' Statndpipes Present (Y/N) V' Date of Last Adequacy Test / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation '7~. Lot / TO Water Main/Service Line//(~ To Property Line -~"~" / To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parkir~g Area, or ,Vehicle Storage Area Comments .,/'~,-'"~.~;~ ~.~/[-'-/'~'"*,n /~ //~/~',~" Date Installed ~ - Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level Tested for X Meets MOA Electrical Codes (Y/~ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permi~t~ I certify that}/h/~ inspection. /// Signed Company ' ~-~ Date MOA No. td Bedroom/Rating Against HAA Request** ~e~checke/d,/~e~fied, or conformed to all MOA and HAA Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7t88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ct on the date of this Engineer's Seal NORTHERN TESTING L. ABORATOR E$, 600 UNIVERSITY PLAZA WEST, SUITE A FAIRBANKS, ALASi~A 99709 907-479-3115 2505 FAIF[BANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY CLIENT .~PRIVATE WATER SYSTEM Mo. Day Year Purchase Order No, SAMPLE TYPE: [] Routine Zip Code [] Special Purpose [] Check Sample (for original contaminated sample with lab reference no. Sample Time No. Location Collected 2 3 4 5 6 7 8 9 10 [] Treated Water /~Untreated Water Collected by Laboratory Ref, No. Signature of Representative FOR LABORATORY USE ONLY CASH CHAflGE TO BE COMPLETED BY LABORATORY Received at: ~Anch. [] Fbks. Date Received Time Received Next Sample Due COMMENTS: SATISFACTORY UNSATISFACTORY RESAMPLE OTHER BACTERIA TOO NUMEROUS TO COUNT U R OB TNTC Direct Verification Count LSB BGB Result' Comments *No, of To:o:m Colonies per 100 mis. i CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Colifo?~ Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PRIVATE WATER SYSTEM Name f ~..~_~%,., "% .f~'~Ph°ne No. /g Address City State Zip Code Mo, Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose .) [] Treated Water [] Untreated Water SAMPLE Time NO. / LOCATION Collected 3[ I 4[ I Collected B TO BEC COMPLETED BY LABORATORY s shows this Water SAMPLE to be: /~SJ Sl:isfactory [] U 3atisfactory Sa nple too long in transit; sample should not be over 30 hours old at examination to(indicate reliable results. Please send new sample via special delivery mail. Date Received ll-tO- Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref, No. Result* J J J Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC OB = BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:. Direct Count Verification: LTB BGB Final Membrane Fj~t~'~ults _.~,..~ Reported By ~ -- Time: = Too Numberous To Count Other Bacteria PAF:~T I OF' 2 RE:MAINDE:R TO FOLLOW Collform/lOOml Coilform/100ml & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order $ 10415 Date Report Printed: NOV 15 88 @ Ii:S9 Client Sample ID:HIDEAWAY ACREAS LOT 2 PWSID :UA Collected NOV lO 88 @ 13:00 hrs. Received NOV 10 88 @ 14:20 hrs. Preserved with :4 DEG, C Client Name : CORWIN & ASSOC Client Aect : CORWINP P.O,# NONE REC'D Req $ Ordered By : Analysis Completed :NOV Il 88 Send Reports to: Laboratory Supe~vi~_:STEPHEN C. EDE 1)CORWIN & ASSOC Special Inet~uct: Chemlab Rei ~: 3412 Lab Smpl ID: 2 Matrix: WATER Allowable Parameter Tested Result/Units ~lethod Limits NITRATE-N 2.7 mN/1 EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY W. HERS&N. i Tests Performed ' See Special Instructions Above UA=Unavailable ND- None Detected "See Sample Renmrks Above NA~ Not Analyzed LT-Less Than, GT-Oreater Than !i)3330 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality "C" Street, Anchorage, Alaska 99503 274-4561 Mailing Address: Property Owner: Mailing Address: Legal Description: Date Received Z-/~ Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: ~___~.~ 4. Location: /V/¢~/ /~~~. be inspected 5. Type of facility to No. of bedrooms Phone: Phone: 6. Well Data: A. Type ~ ~~.~.__ C. Construction 7. Sewage Disposal System: A. Installed ~L'779/ C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: ~ B. Installer ~E~z)~) ~X. Size lZ-~'~,~',,9'~ 2. Manufacturer ~~2/,~/,~ Absorption Area ¢¢/¢~/¢/~ 2. Material Total length of lines 8. Distances: / A. Well to: Septic tank __/'~ , Absorption area _/~_6¢) ' ., Sewer Lines ___, Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1174) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environlnental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WAl'ER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV x×xx 2. Property Owner: Harry Foosnes Mai.ling Address: 3906 Locarno Dr._~ Anchorage [)ay~ Phone 277 3794 3. Name of Buyer: L. Jane Sutherland & Virginia M. Blanchard Mailing Address: SRA Box 95L~ Anchor_age AK Da_y Phone 272 4401, Ext 249 (offi( 4. Name of Lending Institution: Coast Mortgage Co. Mailing Address: 4450 Business Park Blvd, Anchorag% AK 99503 5. Name of Realtor or Agent: n/a Mailing Address: Phone 274 9504 Phone 6. Legal Description: Lot 2, Hideaway ~MMKI[ Acres Location: NHN Hideaway Trail. 7. Type of Facility to be inspected: 8. Water Supply 'Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual If Individual, date of installation 1975 Sin£1e Family NO. Bdrms. 3 XXXX (on-site) XXX EQ-037 (1/74) Page 2 o'~ two pages - Re st for Approval of Individual er & Water Facilities Legal Description Comments Approved · -, c~ ~'?' ' '~,~UD 1 sapproved Date Approval.Valid 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) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279~.8686 Date Received Time of Inspectlon_~//3; : ~ /'] il):) Aoproval Requested Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & '¢qATER FACILITIES FOR Phone ,. ,, .. ,- Prooertv Owner: Leqal Description: ~</: .! ~. ? ,~ ( .": ,' ' .... ~,:," Location: '.'. ~ Type of Facility to be Insoected: Number of Bedrooms: >. ~ ~ .~( / Well Data: C, Construction 7. Sewage Disoosal System: C, D, Septic Tank: 1, B. Size_~~ 2. Seepage Pit: 1o Disposal Field: Depth ............ Bacterial ,, .~., Instal ]er~_~ Total Length of Lines Distances: A, Well To: Septic Tank¢/~i' _, Absorption Area , ?~earest Lot I.ine ~2r/ , Other Contamination Absorption Area to Nearest LotLine .... , Sewer Lfnes Request for Approval of Individual Sewer & Water Facilities Page Two 9, Comments~ Aporova] Valid for One Year From Data Signed Greater Anchorage Area Borough, De?artment of Environmental Quality DIAGRA~J OF SYSTEM / , ! t certify tibet the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities located Signed Date