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HomeMy WebLinkAboutGRANITE VIEW BLK 11 LT 6 014 30'L Tom Fink, Mayor Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 October 24, 19~89 Stephen L. and Adrienne S. Pavish 9141 Claridge Place Anchorage, Alaska 99507-3942 Subject: Lot 6 Block 11 Granite View Subdivision Dear Mr. and Mrs. Pavish: This office recently processed a Health Authority Approval for Lot 5 Block 11 Granite View Subdivision. During our review we noted that your water supply well does not meet the required 100 f'oot setback requirement from the septic system on Lot 5. There does not appear to be a significant risk of your well being contaminated by the septic system on Lot 5. However, we do recommend that you resolve this problem as soon as possible. There appears to be two solutions available for resolving the existing separation distance deficiency; 1) relocate your well, or 2) apply to this office, through a registered civil engineer, for a setback distance waiver. This office will gladly provide any information and/or assistance that you may need. Our office phone number is 343-4744 between ~e hours of 8:00 a.m. through 4:30 p.m. Sincerely, /,/ I ~ J~/nn Smith, P.E. P~ogram Manager On-site Services RWR/ljm:175 t MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99503 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [] NEW ! E~'I~PGRADE LEGAL DESCRIPTION ~ ~ DISTANC[TO: Well~ {.00 t I%bs°rpti°n/.oarea ~ Dwelling+ /~ e PERMITNO~/¢ 3 ~ ~ ~: Manuf, urer:~ . . . . Mat No. ofc?mpartments Liq. ca~ci ._ ~ IF HOM[MAD[: ~ Insioe~en~tn~ Width kiquiddepth ~ ~ DISTA~Cfi TO: ~dl D~ollin~ ~[~IT ~0. · O ~_ ~ Man.~r~ufact~ ~ ,~-~ ~_~ Material ~ ............ Liquid capacity in gallons D Well Foundation r Nearest lot line~ ~ PERMIT NO. ~--~ ~ No. o,oiines~ ~ Length of each/linea Total length of lines/~ Trench width~z ~inches Distance be~e:c~es ~ ~ ~ Top of tile to finish grade Material beneath tile ~ ~ ~ i~ Total effective absorption area Length Width Depth PERMIT NO. m ~ ~ Buil~i~fo~tion Nearest lot line - =-~ ~ D~STANCE TO: ~ C~s ~ ~ Depth Driller Distance to lot line PERMIT NO. ~ Absorption area(s) ~ Bui]dingfoundation Sewer line Septic tank /~) O / ~ O ~ DISTANCE TO: OTHER ~ PIPE MATERIALS )~ ~ SOIL TEST RATING , ~ ~:>¢~ ; J-',, ! , ,, i REMARKS ~ ~ / [ I A~ ~ ~ DATE LEGAL PERMIT NO. 8PPLICRNT L. OCRT I ON LEGRL 8050 OLD SEWRRD ~44250t NRNC:Y DOWER (CENT. 9i4i CLRRIDGE LOT 6 BLK !t GRRNITE VIEW LOT SIZE 20000 SQURRE FEET TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDF.:OOMS = 4 SOIL RRTING (SQ FT/BR)= 250 THE REQUIRE[:, SIZE OF THE SOIL RBSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET.'." OF THE TRENCH OR DRR!NFIELD. THE DEPTH OF ~ TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFBCE OF THE GROUND RND THE BOTTOM OF THE E)~CRVRTtON (IN FEET.".'. THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRMEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E',,.,',CRMRTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERME. BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVFIL BY THIS DEPRRTMENT HILL BE SUBJECT TO PROSECUTION. MINIMLIM [."ISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE D!SPOSRL SYSTEM IL=.; ±00 FEET FOR F4. PRIVRTE WELL OR i50 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTFtNCE FROM Ft PRIVFITE WELL TO FI PRIVRTE SEWER LINE IS 25 FEET RND 7'0 R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MFIY RPPLY. SPECIFICFITIONS RND CONSTRUCTION DIRGRRMS RRE RVRIL. RBLE TO INSURE PROPER INSTFILLRTION. F'EF-':I"] Z T' E ;:-:,' F' ~ [-;-."ES [:,E C:Ef'IE:EF-: -----:: ±.- I CERTIFY THRT !: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIF'RLITY OF RNCHORRGE. 2: I WILL !NSTFILL THE SY'-]TEM IN RCCORDRNC:E W. ITH THE CODES. 2: I UNDERSTFIND THFIT THE ON-SITE SEWER SYSTEM MFtY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. ...... T'g'~l lED, E:Y [,F~TE ~Z .... V4, 0 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 G£QRGE M. SULLIVAN, MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31', 1980 Dennis Rehm Co., Inc. Star Route A Box 1134 Anchorage, Alaska 99507 Permit ~ 800633 Subject: Lot 6 Block 11 Granite View Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, / / /~ Senior Environmental ~p~cialist LNB/ljw enc: Copy of Permit SWP/057 DEPRRTMENT '"c ~,-'-,. HEALTH RND EN"/I RONMENTRL ,F~r<OTECI' I ON :=:25 '" STREET., ANCHORAGE.. AK. 95 ::L 264-472',-~ ,,PERMIT NO. ( 80062:2: ) APPLICANT LOCATION LEGAL DENNIS REHM CO. INCORP SRR BO~ ti~4 NADINE ST. LOT 6 BLK l~ GRANITE VIEW SUB LOT SIZE ~49-4545 20000 SQURRE FEET TYPE OF' SOIL. ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SD FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [;,EP'rH= ± ~---'~ LE~.IGTH= ±~ ,]RR%-'EL DEF'TH= 6 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E~CAVATION (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). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEF'RRTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T~-~C, .:.' 2 ~. I ~'-~"_-]PEC:T ]~ C,I'-,~_~. R~."F F...'E,_--". ~J I F~E[:. BRCKFILLING OF RNY SYSTEM WITHOLIT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R NELL RND RNY ON-SITE SENRGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR &50 TO 200 FEET FROM R PUBLIC: NELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF-:~4 I T F ~--:,"F' I F-: E'--.~i [-',EC:EP4E:EF.: -a'::l.., I CERTIFY THRT · : I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTRLL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. S I GNED: HF'P~ [.ENNI=, REHM CU. INL:URP ISSUED B~_'_t~__~ .... [:,RTE V4. 0 ~. ,~. GRE:'~ER ANCHORAGE AREA BOF'~UGH ' ~.' ' ' ' . ~]~']~}j} Department of Environmental Quality ..~d~)~ 3330 C Street y ~'~'~ Anchorage, Alaska 99503 · ~ INsP~ECT~ON REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ --''~"'~'7 ~ .... i,¢rA-ILING ADDRESS .~~,~* ygd,~. /~/"~ LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE EROM WELL ~5 INSIDE LENGTH ~;/~ NUMBER OF MANUFACTURER t/'V~ ~ be-- M AT E R I A L ~'~t,t3/,~ .~ ~'~., COMPARTMENTS ~ ~-~ INSIDE WIDTH ~ LIQUID DEPTH ~ .LIQUID CAP/~'CITY_ /(--,cOg)/ GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER__OR WIDTH /~'~;_ LENGTH /..~,..I DEPTH LINING MATERIAL ~ CRIB SIZE: DIAMETER ~-~' DEPTH ~'~ ' DISTANCE FROM: WELL BUILDING FOUNDATION,~O * TOTAL EFFECTIVE ~/ . , NEAREST LOT LINE ~-~ j _ . ABSORPTION AREA (WALL AREA),~ SQ. ,FT. ADDITIONAL ABSORPTION WELL: T',,PE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES. DISAPPROVED _ NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: A~dF PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SEWAGE GReATEr ANCHORAge ArEA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99~03 TELEPHONE 274-456! PERMIT NO. DISPOSAL SYSTEM m APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH COMPLETION DATE ANTICIPATED NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST 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 TO NEAREST LOT LINE. TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH D~AMETER CAST iron SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BO/ROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For ~ ~' ~'~C~,J~o~ Legal Description: Lot ~ Block // This Form Reports Soils Log ,~ Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet 3-- 6-- 13-- 14t~ Soil Characteristics Was Ground Water Encountered? /~o Dated Performed ~-/~ Subdivision ~q~,'.-?~ ~ Percolation Test If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth'to Bottom of Pit or Trench'' COMMENTS: Test Performed Date Certified BY: Date: DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE / 338 OENALI STREET September 26, 1974. / MACKAYBUILDIIVG-ROOM850 ANCHORAGE £9501 Mr. Les Bucholz Dept. of Environmenta Quality Greater Anchorage Area Borough 3330 C Street Anchorage, Alaska 99503 SUBJECT: Lot 6, BIk ~-Granite View Subdivision Dear Mr. Bucholz: Based on the well-logs and sketches provided this department along with the grout seal used on the well, this department has no objection to the waste disposal system as proposed by Sebring Bui ders on the subject lot. Yours truly, Regional Environmental Engineer ~ · ~ o , DATE RECEIVED · : . ' INSPECTION APPOINTMENTS ~ ~ T, ME T, ME ,~y / T,ME / DAT~ ~ ~ ~ / DA~. ~ / / MUNICIPALI~ OF~NCHORAGE ~UNI~[PALITY OF ANCHORAGE DEPT OF [:'-~,L~I & 825 L Street - Anchorage, Alaska 99501 ..... ENVI RON~ENTAL SANITATION DIVISION Telephone 264-4720 .o.A...OVA o. DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed, Please allow ten (10) days for processing. PHQNE PROPERTY RESIDENT (If different fr~m a~ve~ ~ MAI LING A~R ES~ B. LEGAL DESCRIPTION TREET LOCATION TYPE OF RESIDENCE j~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER ~yPPLY ~' INDIVIDUAL* /~)<~'¢"~'~' ~ COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One ~' Four [] Other [] Two [] Five f/~, ~-4-rr~-~ [] Six *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ;~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-01 0 (Rev. 6~79) ~ ~'~'~ ..... ~; THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM I-q INDIVIDUAL/ON -SITE EZiPUBLIC UTILITY Connection Verified F-]Septic Tank or E~ Holding Tank Size: /~(~20 If Tank is homemade give dimensions: TYPE OF TANK NUMBER OF BEDROOMS [] ONE E~' THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line °~ ~ ' s.wer Abso~Area Line [] OTHER Nearest Lot Line U cipali o Anchov 4 e 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264 4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION August 22, 1980 Rod Thompson % Cindy Dennis Star Route A Box 1134 Anchorage, Alaska 99507 Subject: Lot 6 Block ll.'~ranite View Subdivision Approval for the..-indlvidual sewer and water facilities cannot be granted until the following items have been completed: (i) The water analysis report by delivered to this office from Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this department. If there are any further quss¢ions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: National Bank of Alaska Pouch 7-025 99510 RE2 REID ENVIRONMENTAL ENGINEERING 5RA BOX '1584R ANCHORAGE, ALASKA 99507 (907) 344-'I 205 276-i361 MAY 2x{, :L980 MUNICIPALITY OF ANCHORAGE DEPT. OF k'.-ALTH & ENVIRONMENTAL F:LO [ECTION ROD THOMPSON ~. 0 X .,.,:~,:,'-,:~ PO '"" ' ";' ....... [,kAY 9, ? 1980 RECEIVED SELLER SAME SUE:D]'.V]".S:LON-..GRAN]CTiE: VZEW E:L. OCK-I i LOT-6 THE: TYPE OF' AE:SORF. i,'T]:ON SYSTEH ]:S Ar.~.~ N:['t'I"I AN flr~z.A OF THE: QUANT:[TY OF NATE:F~ AE:SORE:ED i)UR]JNG THE TEST NAS :l.~5 THE SO:~LS RAT]:NG OF THE: SYSTEN AT CONS]'RUCT:~fON NAS 150 AND NON :IS 88 SQFT/ E~E:DROOH~ THE REQU:ZRE]) AREA FOR A 3 tE~EDROOH HOUSE :ES 26zf SQJ::'T* EI(:)HEE HAS 288 SQF:'T~ E:ASCD UPON THE: ]"EST DATA THE: SYSTEH ]:S ACCEPTAEfi-E: FOR A .10 N E ~ ,) ANCHORAGE CESSPOOL PUMPING Star Route A Box,:144 ANCHORAGE, ALASKA 99502 344-2632 or 344-2453 Mr. Rodney Thompson P. O. Box 2333 Anchorage, Alaska 99510 " - RE.CEIV O Upon receipt in full please 1/30 /"* Invoice ~1901 63.00 / . '~ _.~ ANCHORAGE CESS~L PUMPING !~ E E SE-.'E£E E S-;£E F.S-ZEEEEE-ZE'Z'ZLE<-S:~S: :~E ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ................................................................ ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ............. ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received / o ./~ ~-///~--' Time of Inspection ~.'oo .- ?.'~o .~.~- Date of Inspection ,o /,~o//7~ 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ~ ?~ 7~Phone: Phone: Type of facility to be inspected~2~, ~-~4Asz~ Well Data: A. Type .~~ B. Depth C. Construction No. of bedrooms D. Bacterial Analysis 0.~. [//~/?~ Sewage Disposal System: A. Installed B. Installer C. Septic Tank: 1. Size /.ooo oro~_. 2. Manufacturer D. Seepage Pit: 1. Absorption Area ~<Zo¢p~/ 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank 2'~' Absorption area /o©~ , , Sewer Lines , Nearest lot line ~o~ , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) PaQe 1 of two oaees GREATER ANCHOP, AGE '~": ' ~,,~,, BOROUGH Department of Environl¥1ental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES .2. Property Owner: ,' l~ail ing Address: 3. Name of Buyer: Type of Inspection: CNRO VA Lawrence J. Sebring FHA CONV XXX ,,$RA Box 1540C Rodney J.. Thomspon _ Day Phone 34~30'69. ~.~ailing Address: 1008 West 16th Avenue Name of Lending Institution: National Bank 'of Alaska ~ailing Address: P. O. Box 3-3859, AnchOrage~,.Ak.Phone Name of Realtor or Agent: .. n/a Mailing Address: Phone _D.:y Phone 277-8834 279-25~6 Legal Description: Lot 6, Block 11~ Granite View Subd., Anco. rage, Ak. Location: 9141 Clar~dge Street - this property:.is off of Abbott~Road : .Type of Facility to be inspected: Water Supply Type of Supply: Public Utility Ind:vidual If Individual, number of dwellings presently .served if individu~l, depth of ~ell 106' Sewage Disposal-System Type.of S~stem: Public Utility If Individual, date of installation' Single family No. Bdrms. 2 XX 1 Individual (on-site) XX Not known P~ge 2 of two pages - Re .~st for Approval of Individual 'er & Water Facilities Legal~Descri ption Comments Approved b/Z~J~ Disapproved Date ~! ~oval 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)