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Home My WebLink AboutSNOW CREST VIEW LT 28111:0, oaa r MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 C/, 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # D I6 e 1 Ll1— 91-- HAA # "Q\06 n L-644 1. GENERAL INFORMATION Completelegaldescription �_o ! Z¢j SNOL1'/ C12tl-Sl Ull^L✓ Location (site address or directions) 11 2.0 (7 t -I LL/A N t—A-N ra Property owner 4�t;1at-)ls c koritn 4zvme_sDay phone 'b`!'?- 43%9 Mailing address 11 Zyo Lill; a✓i L aN� Lending agency Day phone Mailing address Agent S " roti Day phone 9 7-.2 3-.?,, Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: °2 3. TYPE OF WATER SUPPLY: Individual well Community well 3 Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site _ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. 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 FirmI o�kt etg spvrk.l � PE Phone 79-39 Address o2a ?� ti✓ f 6 Engineer's signature r 6. DHHS SIGNATURE Approved for TWO bedrooms. Disapproved. Conditional approval for Additional Comments M_ _ Date .. ti, A bedrooms, with the following stipulations: Date Z Q . "17 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(RevAM) Back MOA021 RECEIVED r f OCT 01 V99 Municipality of Anchorage GPAUTY OF ANCHORA DEPARTMENT OF HEALTH& HUMAN SERV, �rAt sERVICESDI Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 e (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo i 60 'Sq Cr2.34 V1 QuY Parcel I.D.:14 I 'oL A. WELL DATA �I Well type Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number -•213 L 3 Date completed Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform Date of. sample: B. SEPTIC/HOLDING TANK DATA Nitrate Casing height (above ground) Wires properly protected (Y/N) 9— p.m- Collected by: AT INSPECTION Other bacteria 9— p.m- Date installed UkHA4ov i. Tank size 10.00 Number of Compartments ( Cleanouts (YIN) Y Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) N Date of Pumping 120bol Pumper Awc-, L e93 soo C. ABSORPTION FIELD DATA Date installed Un6ltl Soil rating (g.p.d./ft2 or ft2/bdrm) I System type C -V .10 Length —2-!!-11,,—Width U v Lw— Gravel thickness below pipe Total depth b,2 f' k Effective absorption area `/ Monitoring Tube present (Y/N)—Y-- Depression over field (Y/N) N Date of adequacy test 2 9 lR�i Results (Pass/Fail) r For bedrooms Fluid depth in absorption field before test (in.); J Immediately after Y-20 gal. water added (in.): 5Z it Fluid depthL110_ (ins) Minutes later:_ Absorption rate = p.d. Peroxide treatment (past 12 months) (YM) 114 If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot __ On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation �_ Property line / D Absorption field 1 C? Water main/service line _ I 0,/- Surface water/drainage N /o Wells on adjacent lots N SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: D ;q Water main/service line %y f Property line � _� Building foundation Surface water _ J(2 Driveway, parking/vehicle storage area i v2fJ Curtain drain _ 1`l �iJ _ Wells on adjacent lots lav F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal redords that the above systeifls are in conformance with MOA HAA guidelines in effect on this date. Signature n Engineer's Name VI Date 4 HAA Fee $ (rte' �l Waiver Fee $ _ Date of Payment �� j%� \J Date of Payment Receipt Number2' �' `-� / Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M1 DIVISION OF ENVIRONMENTAL SERVICES�� 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # U & `//-//-- 7 2 HAA # 1`1�'�- L t -n R 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Sno�,C'��f�e s d f�fi' T�zv AP316,� Location (address. 8.rdiee6tioris) Y' (b) Property owner, Ali 1.5 6z h4w4/1 rl FnelepCione : (home) Business Mailing Address _ (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent jud p4l? RP— �a� )4-0 Address Telephone (e) Mail the HAA to the following address: (or check hereo, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms A Single -Family g 3. 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. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department 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 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 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 Telephone 27'1�� Address l `� /a W 33 rd 4VCAg�cl,rz�e 4zt 99-Xp-? Date X0/2 ;7 �aav�ra• 1 444 4 it IF r . • r Cq • 9TH ••� $ t 0.4 060 #60040 ' 6i�gtrt�sr, a91 r 1 %'•. CE - 2251 ••: Z Ar 9 �$?rofessio��,�s 6. DHHS APPROVAL Approved for ,�Z bedrooms by AyzzzDate _1L/o�'rz � Approved— Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA), • Health Authority Approval (HAA) 0\-\ CHECKLIST - FEBRUARY 1984 M o A� 343-4744 � Legal Description: S;IOAJ C'res� Y/ee t 1s -i- .215' 1 Mo��e Y)N`55 �7_/a N X23" 5- A. A. WELL DATA 6 '"' / Well Classifica , 9 C�lzS wsi0 �/.�y�I3 Well Log Present (Y/N) Date Completed Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on To Nearest Public Sewer Line To Nearest Sewer Se Water Sample Col Water Sample Comments Line on Lot IUA, C, D.E.C. ApprovedeN) Yiel Pump Set I on Casing (Y/N) ion Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Date B. SEPTIC/HOLDINGTANK DATA UN Date Installed ! ^fj(cSize -1 600 No. of Compartments 04.1� Standpipes &'I) Depression over Tank (Y/6 Air -tight Caps (9�) Pumping/Maintenance Contact on File (Y/N) Foundation Cleanout &)N) Date Last Pumped g ;for Holding Tank High--W1t6,(Al4rm (Y/N) 1JLA- Temporary Holding Tank Permit (Y/N) A9� SEPARATIP DI,S7ANCf -S FROMSEPTIC/HOLDING TANK: To Water..=Supply lA7ell �°�% To Building Foundation h y To Property Line %� /` To Disposal Field To Water�Main/Service Line, To Stream, Pond, Lake or Major -Drainage Course N0 AR AVoZ Comments Tangy 1 s IOoO galla, �ytee / G .r `� 71v,. L,.sn 7D jay 72-026 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /�G7 �GZ Type of System Design Date Installed Length of Field re•. -f =�L Width of Field Depth of Field 42 1! Gravel Bed Thickness Square Feet of Absortion Area U.�ku-a- — Statndpipes Present ON) Depression over Field (Yo Date of Last Adequacy Test Results of Last Adequacy Test 5-P,1�°d e a�ac; i4 4jez°� �2 Ae o �o SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Building Foundation_ S _ 2:77 Lot 20 �r((`b /J sc/s .K A To Property Line / 0 / n Adjoining Lots To Existing or Abandoned System on >1. O / To Water Main/Service Line z -o r To Cutback (if present)/$ -72 , /P4�� ^/ To Stream, Pond, Lake, or Major Drainage Course > /B o / To Driveway, Parking Area, or Vehicle Storage Area Comments�`ga-K� �Xzw+r.aec� '{.'✓ S'e�,erst, GJIzcLE�.Ayd(,zd%2. tLlnn.r� �f7/rl D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Code N) Comments ?Z-0/ Srr,/s are Dimensions Manhole/ cess (Y/N) . Pump Off' Level at Vent (Y/N) _ "Check Permitted Bedroom Rating Against HAA Request" Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. lk%q� 0� Signed p s ��.•.•.,� Company S' rw�P•°. .°°'�® Date / �� i�� jtl �ineer's Seal P.e.i .. . e• .. p, MOA No. r a ,eieeoee 6"094"46660 0 0 J1 i OY C. REID, JR. •e 1' ° CE - 2251 c Uzi a� (, / � c�J7l 0 �� i� af�1TIPCS 14�,5� Receipt No. Receipt No. v-� ��d� Date of Payment l Waiver Fee: $ Amount: $ Z Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST IIS&ER'S SEAL) A � • /� 0 • •9 r • 1 / � �• �• LY C.•REID, JR. ; d1 w` < • CE -2251 Q �0. fes, �' •• ..... • •' PERFORMED FOR: '4 /as k8 {76wJ'P%7 154avite Cvr'Q, DATE LEGAL DESCRIPTION: ), A 7 Snow off s1- 4 e w Township, Range, Section: DEPTH (iEET)' srria Cs�i 2 3 ; 4 Sa„d7 lea 14 15 16- 17- 18- '9 6171819 20 COMMENTS — SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water After Monitoring?l- Date: /8 - j?u�3� s SITE PLAN Net Time Depth to Water 6- 7 ^• 8 sa. d (s G) Cleo, 9 del 10 ._ • r 12 13-- 14 15 16- 17- 18- '9 6171819 20 COMMENTS — SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water After Monitoring?l- Date: /8 - j?u�3� s SITE PLAN Reading Date Gross Time Net Time Depth to Water Net,,-� Dr6p OEM MEE; ME Reading Date Gross Time Net Time Depth to Water Net,,-� Dr6p PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND FT PERFORMED BY: J ¢ d' I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /0 Za 7/-� 72-008 (Rev. 4/85) STEVE COWPER, GOVERNOR fA J. DEPT. OF ENVIRONMENTAL CONSERVATION .ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: September 15, 1988 PWSI D : 213493 To Whom It May Concern: According to the records on file in this office, the SNOWCREST VIEW NORTH Water System is in compliance with the State of Alaska Drinking dater Regulations. Please note that departmental records indicate that the public water system was installed prior to the 1978 implementation of the Alaska Drinking Water Plan Review regulations. No as—built plans have been reviewed or approved by the department, nor are any necessary. Since the system has submitted acceptable water samples on a regular basis and received a satisfactory sanitary survey evaluation by the department, the system is acceptable under the standards in effect at the time of installation. An official "Certificate to Operate" may be issued upon receiving a complete set of as—built plans. Any expansion of the water system after 1978 will require plan review and the issuance of a "Certificate of Operation" permit. Sincerely, 44 /, Z7�, Michael P. Lewis, PE Environmental Engineer MPL:pkk 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS (✓bf ♦sad' - R �e TIME TIME TIME 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE DATE ,,RL Two ❑ Five ❑ MULTIPLE FAMILY ZZ,,..�� 4, .� "��AJ't CC�D INSPECTOR INSPECTOR INSPECTOR * ATTACH WELL LOG. A well log is required for all wells drilled fEt-- COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY MUNICIPALITY OF A CHORAGL MUNICIPALITY OF ANCHORAGE DEPT. OF IiEALTHTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTWIRONMENTAL Ph:OTECTION 825 L Street - Anchorage, Alaska 99501 ❑ PUBLIC UTILITY AN 2 6 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 C P' V E D R REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ACILITIES � DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. _ 1. PROPERTY OWNER n& MAILING ADDRESS - PROPERTY RESIDENT (If different from above) - PHONE 2. BUYER PHONE - MAILING ADDRESS 3. LENDING INSTITUTION -PHONE - �! } MAILING ADDRESS p 4. REALTOR/AGENT PHONE / ry `�l �` � ,5' G 11 MAILING ADDRESS "---� -, 5. LEGAL DESCRIPTION .)� J Ll (✓bf ♦sad' - R �e STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ER� SINGLE FAMILY ❑ One ❑ Four ❑ Other ,,RL Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled fEt-- COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 54- INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_LOG PERMIT NUMBER DEPTH OF WELL DATE DRILLED RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON -SITE EJ PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E4 ---APPROVED FOR '7-- BEDROOMS L (letter must accompan cer ificate) ❑ DISAPPROVED ❑ CONDITIONAL ATBY DATE 72-010 (Rev. 6/79) 5. LEGAL DESCRIPTION Ylvl ' DEPT. OF HEALTH & MU ICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 41 4 -2 825 L Street - Anchorage, Alaska 99501 • JUL 17 2979. ER-- 'SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 R / (1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER - PHONE *ATTACH WELL LOG. A well log is required for all wells drilled •v:, 3�Y-376 MA LING ADDRESS depth (attach log if available.) 52� ,Bei 1.415 .,ic 99soZ. PROPERTY RESIDENT (If different from above) PHONE 2. BUYER If system is over two (2) years old an adequacy test is required PHONE MAILING ADDRESS NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. w 3. LENDING INSTITUTION - PHONE MAILING ADDRESS P .t 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION q 2 9 5-1vew iEW S STREET LOCATION 41 4 -2 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ER-- 'SINGLE FAMILY 00 e ❑ Four ED Other �❑ I_N� Tw0 ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* C]} --'COMMUNITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM CzY 'INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ❑ If system is over two (2) years old an adequacy test is required PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. w 1-11W RY1,17a-717 e'& THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED _ INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING - TYPE OF TANK MANUFACTURER - TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS &1 ---APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompan rtificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) Anchorage, Alaska, 99503 907-279-8056 BY: C✓a�� C' resf 1//pe L/ DEPTH BELOW METER READING GALLONS PUMPED TIME REFERENCE G S NET 71 Zo r John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907.279-8056 REFERENCE: DATE E 7% PERFORMED BY: LEGAL DESCRIPTION: L� i" � Si✓ct�✓cr�s�' 1/'t3=rte DEPTH_DELOW METER READING GALLONS PUMPED TIME R , FE'R CE GALLONS NET ZO Vo �l Z'z:..'7 %Z2 GREATER ANCHORAGE AREA BOROUGH Dgpjartment of Environmental Quality 3330 "C"Vtreet, Anchorage, Alaska 99503 274-4561 Date Received May 12, 1976 ��t Time of Inspection 1:30 p.m. i��f Date of Inspection 5-14-76 - Friday REQUEST FOR APPROVAL OF �• INDIVIDUAL SEWER & WATER FACILITIES FOR V.A. 1. Approval requested by: People's Bank and Trust Mailing Address: 644 West 8th Avenue Phone: 279-7511 2. Property Owner: John Sutherland Phone: 276-1757 Mailing Address: Box 145 Star Route A 99502 3. Legal Description: Lot 28 Snowcrest View Subdivision 4. Location: Lillian Lane 5. Type of facility to be inspected Single Family No. of bedrooms 2 6. Well Data: Individual A. Type C. Construction B. Depth D. Bacterial Analysis 7. Sewage Disposal System: On-site system. A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages rig; ;/i Cl Y 'Etl7 I �.11Ci;�j GREATER ANCHORAGE ARL1`1, BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4§61' c e : 6. Legal Description: Lo®r At , owcetar 4 _ mbiur Location: OFF VLATT Q&b -Tu Rdi4r on DWE WE� - -tu " Re�aT . %9a LLr.'r ®a Li6iiAN We® LA%T 001ASE 0?4 wrr 7. Type of Facility to be inspected: RC&MUCE No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual %� If Individual, number of dwellings presently served I.f Individual, depth of well 9. Sewage Disposal" System Type.of System: Public Utility Individual (on-site) If Individual, date of installation REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA )i� FHA CONV ®® 2. Property Owner: LA A Mailing Address: .100 14905RA,&WCWDay Phone 27(947 7-- 3. Name of Buyer: Alt.' AM i6aky e, Mailing Address: AIFj@x 1510-� Day Phone 4. Name of Lending Institution: abafils fir, Mailing Address: (aY4 CU, 97"AyrjAje,#4, Phone 279®7511 5. Name of Realtor or Agent: 'AS Rit ftf,M�N�A1 Mailing Address: M00 C STqfflMNC".44CbjPhone c e : 6. Legal Description: Lo®r At , owcetar 4 _ mbiur Location: OFF VLATT Q&b -Tu Rdi4r on DWE WE� - -tu " Re�aT . %9a LLr.'r ®a Li6iiAN We® LA%T 001ASE 0?4 wrr 7. Type of Facility to be inspected: RC&MUCE No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual %� If Individual, number of dwellings presently served I.f Individual, depth of well 9. Sewage Disposal" System Type.of System: Public Utility Individual (on-site) If Individual, date of installation Page 2 of two pages - Retest for Approval of Individual :mer & Water Facilities Legal Description Lot 28 Snowcrest view Subdivision Approved Disapproved ApprovalValid for one year from date Greater Anchorage Area Borough, Department of Envi DIAGRAM OF SYSTEM Date 1 Quality II 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. Date SIGNED EQ -034 (1/74) - �..cl C �