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Home My WebLink AboutANGELA HEIGHTS LT 6Angela Heights Lot 6 #050-283-42 DRILLING BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS ,j o blrv 'J b ,'~ E S LEGAL DESCRIPTION /- DATE-Started ~b',. PERMIT NUMBER DEPT. OF WELL /~? ? 0~ STATIC LEVEL OF WATER FT. / DRAW DOWN FT. [ ~' GALS. PER HR /o~OO KIND OF FORMATION: From ~ Ft. to ,~ Ft. O(-d~/~O~O~''~'~''d From. c~ Ft. to P Ft. ~'dP'U~.~ 6~dO~'Z From 00 Et. to c~O Ft. ff/,,9 From 20 Ft. to~,~_Ft. 5~~ ~' g&gd'i~d~'~- From 2~" Ft. to ~ ~ Ft. ~ ~,~ ~t ~-~//j]Og:"~. From From From From From ~5 Ft. to -~Ft. 5~[~-~,/O ~Ot~, ~ L~od~g'ro~m'3~ From. ~0 Ft. to 7~ Ft. Sd~o/O From__ From c~P Ft. to [ ~Ft. C~ ~'~' ~d~tc/c7~ From__ From [~)~ Et. to /'~OFt. From Ft. to.__.Ft, From From__Ft. to Ft. From From__Ft. to Ft. From__ From__ Ft. to Ft. From From Ft. to Ft, From From__ Ft. to__Ft. From__ From Ft. to Ft. From__ From Ft. to Ft From Ft. to__Ft. Ft. to_ __Ft. Ft. to Ft. Ft. to Ft Ft. to__Ft. __Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to__Ft. Ft. to__Ft. Ft. to__Ft. Ft. to__Ft. Ft. to Ft. Ft. to Ft. Ft. to__Ft MISCL. INFORMATION: DRILLER'S NAME PERMIT NO. [.li_i~-J I C: I ~'RLIT'T' £1F Rr~C:H,JF:R~3E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR 276-222~ F~ELL PEE:£'I IT ( 76277 ) APPLICANT LOCATION LEGAL JOHN JAMES L6 ANGELA HGTS P 0 BOX 755 E, R. LOT SIZE 688-2450 li000 SQUARE FEET MINIMUM DISTANCE BETWEEN A NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 50 DAYS OF 'THE NELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"ER~'I I 1"' ".,,,.'RLI C:. F~]R C~I'-,IE '"r'ERR F'RO~'I I S5~LIE I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2' I WILL I - c ~ ' 'ORDRNCE WITH THE CODES. Municipality of Anchorage Development Services Department Building Safety Div{sion On-Site Water and Wastewater Program 4700 South Bragaw St. P.O, Box 196650 Anchorage, AK 99519-6650 www,ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0~O "~,83 -52 HAA # Expiration Date: ~- tiC- - O / 1. GENERAL INFORMATION Completelegal'description I, ot 6, An,~ela tlei~:ht:s SubdivJ. sion Location (site address or directions) 10123 Chickaloon Street Current Propertyowner(s) Richard & Zlarge L'~,;".: Dayphone Mailing address 694-4494 10123 Chickaloon Street, Eagle River, AK 99577-~3~ Lending agency Day phone Mailing address Real Estate Agent Remax/Debbie Lewis Mailing Address Un/ess otherwise requested. HAA wi//be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 16601Centerfield Dr., Dayphone 694-4200 Ste 200, Ea~le River, Ak 99577 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank [] Community On-site [] Public Sev/er [] The Municipality of Anchorage Deve!opment Services Department (DSD) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professlonal civil engineer registered in the State of Alaska. Cedificates of Health Authority Approval are required for the transfer of titIe (except betv;een spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue fcr properties served by a private er Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Cedificates are valid for cne year for properties served by Class A or B wells or a public water system. The Municipality ol' Anchorage is net responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Health Authorify Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of sb'ucture 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(are} in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of instalIation. $ & $ ENGINEERING Phone 17034 Eagle River Loop Roa,4 No. 204 Name of Firm Address Engineer's Printed Nar~e m Robert C nn~.~n, ?.~. 5. DSD SIGNATURE % X Approved for 4 bedrooms. Disapproved. Conditional approval for .~ Date '3,./~'/¢ / .,. ;.% .~..~ .......,v ~'_ ,~ ~t2<~.,'. .............. bedrooms, with the follow ng stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory . Well Flow Advisory X ,/ Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Mpnicipality of Anchorage Development Services Department BuOdtng Safety Division On-Site Water & Westewatar Program 4700 South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomge.ak.us (907) 343-79O4 Legal Descrtptlon: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST Well type If A, B, or C provide PWSID # '""' d.pth/5 . ' .. cos. ta FROM WELL LOG Static water level Well production WATER SAMPLE RESULTS: Well Log (Y/N) Casing height (above around) I Z'~ln. AT INSPECTION Coliform _.O .colonies/100 mi. Nitrate ;3. et" mg.A. Other bacteria O~ colonies/100 mi. Date of sample: ~ Collected by: ~','~'. ~' ~ ~'1 ~J~.....~...I ~'J ~' B. SEFrFIC/HOLDING TANK DATA Tank size __ gal,. Number of C(N~partments __ Foundation cteanout t'Y/N) Y/N) Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ABSORPTION FIEU) DATA Date Insi~ii~t~ .... ~.~il Length fl. Total depth -- ft. Date of adequacy Fluid depth in ~ (g.p.d./ft~ or ~/bdrm) Width fl. ~ Monitoring tube -- Results (Pess/Fail) mfore test in. Water added Final fluid depth in. System type Gravel below pipe Depression over field For bedrooms gal. Now depth in. Absorption rate >= g.p.d. An~ (past 12 mo.) (Y/N & typa) If yes, give data D. UFT STATION Date installed ~ ~xf Size in gallons - on" level at~f'~. 'Pump off' level et 'Pump Datum ~" Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alam~ & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WE~J~' ON LOT T0:~ '! lots ~//////'V/~r Septic tanldlift station on lot NXA - : - On adjacent lots ,,~ ~' Absorption field on lot /~ On adjacent / Publlo sewer main / ~O V- Public sewer manhole/oleanout / ~ If.. Sewer/septic senace line. ~' ~- ~ Holding tank - ~//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line ~ Absorption field Water main __ L W~ · Surface water Wells on adjacent lots SEPARATION DISTANC~,F~OM ABSORPTION FIELD ON LOT TO: Property line /"' Building foundation _ Water main ~ Water Se~/je~ne Surface water ~ Driveway, paddng/vehicle storage Curt~ drain. . Wells on adjacent lots COMMENTS G, ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance wfth MOA HAA guidelines in effect on this date. Engineer's Printed Name Date Waiver Fee $ Date of Payment Receipt Number FE~-14-L:~01 09:~ ~ ENGIta:.~..~ItIG ~ Gc~.l !.211 ,~__ CT&E Environmental ServFcee Inc. 2.08 O..~O0 mg/L ~EPA 'l~o.o I0 rr~x 02,/O?JO I S;C3. ¢~d/lOOmL SMIB 922Z8 02~7/01 YAP 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 6; Angela H~ights Subdivision; Location (site address or directions) 10123 Chick~oon Street, Eagle River Property owner Mailing address Du Pon~ Relocation Company Day phone Lending agency Mailing address Day phone JACK W~_'/TF AgentKa~hi 0P_m.x_ *_ead Address 10928 Eagle River Road, Eagle River, Ak. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Day phone 99577 694-5500 Individual well X× Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 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. $ & $ ENGI~F.~!NG Name of Firm ,?n-~4 =,.?. ~,,~? L=o~ i~o=,~ ~,~,, ~.,, · Phone Eagle River, Alaska 29577 Address Engineer's signature DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bed rooms. bedrooms, with the following stipulations: Additional Comments Date 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 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKMST Legal Description: ~ /~, /~'-t~C'--L~' ~'~. ~t~' Parcel I.D. WELL DATA Well type '~¢-~',~ Log present motaldepth Sanitary seal ~N) If A, B, or C, attach ADEC letter. R[CI VEL: ADEC water system number Date completed (~ - / '~- 7 L,, Driller ~ ?: Cased to ,~'C) ' ~" Casing height I Z. Wires properly protected Q/N) FROM WELL LOG AT INSPECTION Date of test ~ -' I ~ - 7 ~, ~, - / ~. - '~ / Static water level / D / ' /~ I ' Well flow /~ ~',~/~ g.p.m. __~..~ 4- g.p.m. Pump level /~ /.J~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~/~ Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform C Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depre~ High water alarm (Y/N) Date of pumping SEPARATION DISTANCES_ER'Old'SEPTIC/HOLDING TANK TO: Well(s) on lot ~ On adjacent lots Foundation To pr~ Absorption field Water main/service line 72_0~J.~e water/drainage - 26 (Rev. 3/91) Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ Meets MOA~es (Y/N) SE.~ION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Manufacturer "Pump off" level at Cycles tested Surface water Date installed Soil rating System type Length Width Total absorption area Depression over field (Y/N) Gravel thickness Cleanouts present (y/N) Total depth bedrooms Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) ~ · SEPARATION DISTANCE FROM A~N FIELD TO: Well on lot ,-~ On adjacent lots To building found~ On adjace~s~ ~~r~ti~r fo~ate o~ If yes, give date Property !ine To existing or abandoned system on lot Cutbank Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date ~70~ ~ E~t~ P. iw~r Loop Road No. 204 Eagle River~Alaska.. ~5_7_.~ HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALISIS REPORT BI $~J~LE £oz Ig)RKozdezt 35214 Date Report ?zinted: 3U~ 1S 91 e 12:SS FAX: (907) 561-5301 Client Sample ID:L6 ANGELA H~S. Client Name :S & S ENGINEERING PWSlD :UA Client Acct :SNSENGP Collected JUN 12 9i { 20:00 hrs. BPO ! PO { NONE RECEIVED Received JUl{ 13 gl ~ 15:00 hrs. Req t Preserved with :AS REQUIRED Orde{ed By :R. SHAFER A~lyets Completed :SUN 14 gl Ser~] Reports to: Laboratory Supex_v~so~J.'E?HEN C. EDE i)S ~ S ENGINEERING Released 2) mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm mmmNmNmmNmmem · mmmm mmmmmmmNmNNNmmmmm{ · mmmmmmmmNmmNmNmmmmmm m mmmmmmmmmmmmmmmmmsmmm Chemlab Ref t: 912716 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 1.6 mR/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: I Tests Performed * See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Y~n, GT-Greater Than ~,~SGS Member of the SGS Group (Socidtd Gdndrale de Surveillance) MUNICIPALIT~ OF ANCI~ORAGI~ DIVISION OF ENVIRONMENTAL HEALTH DEPAKTHENT OF ~_.4LTH AND Ehw~IROh~NT~ P~OTECTION APPLICATION FOR ~ALTH AUTHOKIT~ APPROVAL CERTIFICATE General Information Application Date (a) Legal, Description (i~nclude lot, block, subdivisiou~..section, township, range) Location (a~dress or directions) Applicants Address (L~.//'?9'h ~/ Telepho.ne - Home Business (c) Applic_a'nt is (check on.e) Lending Institution ~-~ ; Owner/builder Buyer ~--~ ; Other ~ (explain); Telephone (f) ~I =h~ ~ =o ~h~ follo~u~ ~dr~ss= 2. Type of Residence Single-Family,.~., Number of Bedrooms Multi-Family ~ Other (dascribe) 3. Water Supply Individual Well ~ Community ~--~ Pubiic ~ Note: If community well system, must have written confirmation from the State Department of ~nvironmental Conservation attesting to the legality and status. 4. Sewage Disposal (C '"'~ q'Z','<4- ) Mote: If community well system, must have -written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Firm Providing Insp~ct.ions~ Tests~ File Search~ Data ~nd InformaCiom certified by my seal affixed hereto and as of the validation date shown below, I 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date .- ~'- DHEP Approval Approved for ~/-?~/./i' bedrooms Approved .~,~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPKESEKr- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN II;DEPEKOENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) Ra4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUI~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF /-,NCHORAGF: DEPT. OF HFALT'I & ENVIRONM~F~ TAL F';:~ 1985 RECEIVED Legal Description: /_~-- /~ If A, B, c= C, D.w..C. A~oved~/~) Well Classification Well Log P~esent ~/~) Total Depth /,~:~' "~ '~ Cased to Static Water Level , /~gf ~ Casing Height Above Ground /~..~'~-. Electrical Wiring in Conduit ~/~! . . Separation Distances f~cm Well: To Septic/Holding Tank cn LOt .... ./~/~ To Nearest Edge of Absc~ption Field on LOt To Nearest Public Sewer Line ~--, z- · ~ D~pth of G~outing ~ .... Sanitary Seal on Casing ~/~) De[z.~essio~ Around Wellhead ~f~ Date Completsd /%4//~,~,; On Adjoining LOtS / To Nearest Public Sewer Cleancut/Manhole /~.' ~- To Nearest Sewer Service Line on Lot Water Sample Test Results Cc~ents B. S.E~IC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) Air-tight Caps (Y/N) Depression over Tank (Y/N) Date Last P~ Pumping/Maintenat7 Contmact on File (Y/~) . / To Water-Supply Well To Property Line To Water Main/Se=vice Line Course Com~nts No. of Ccmpartments, . Foundation Cleanout (Y/N) Tank Permit (Y/N) To Building Foundation To Disposal Field To St=earn, Pond, Lake, c~ Major Drainage Receipt % Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Dep=ession over Field (Y/N) ~ ~te~/~st Adequacy Test # Results of Last Adequacy Te~st. ./V /f/ Separation Distance f~n Absc~ptio~/FiWld:/ To Water-Supply W~ll 'To P=operty Line To Building Foundation To Existing ct' Abandoned System cn Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank(if present) .. To St=earn/Pond/Lake/c= Majo= Drainage Course To Driveway, Parkin~ A~ea, c~ Vehicle Stc=age A=ea Comments D. LIFT STATION Date Instailed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions · Manh/ / o ss (Y/N) les du~ing Adequacy Test. M~ets MOA Comments on the date of this inspection. '** Check Pem~itted Bedrocm Rating A~ainst HAA Request I certify that I have checked, verified, c~ confomned to all MOA HAA Guidelines in effect Signed Company ,: .. .8RB 196X ..... · KB1/d5/s Date -~-~-~ ~ MOA No. ~ [Page 2 of 2] MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: --_.~0 Mailing Address: 3. Name of Buyer: CMRO VA FHA CONV. Mailing Address:. 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: (~,0~- (/o Location: Day Phone: Phone: Phone: U Y Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. ~ .Individual Individual (on-site) 72-003(3/76) GREATER ANCHORAGE AREA BOROUGH Department qfEnvironmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Eagle River A~e~gm~ Date Received December 8, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR %:~p.m. 12-9-/~6 Thrusday Jke~n%dy Cony. Approval requested by: Mail ing Addre'§s: Phone: 2. Property Owner: John & Virgina James Phone: 688-2430 Mailing Address: Post Office Box 733 Eagle River 99577 3. Legal Description: Lot 6 Angela Heights Subdivision .4. Location: Chickaloon Street off of Eagle River Road ~5. Type of facility to be inspected Single Family No. of bedrooms 3 Well Data: A. Type C., Construction Individual B. Depth ~ ., ~ ~'.t38' D. Ba.~'t%rlal~ Analysis 7. Sewage Disposal System: Public utility A. Install'~ed 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 Page 2 of two pages - Req for Approval of Individual S~ r & Water Facilities Legal Description Lot 6 Anqela Heiqhts Subdivison f l']fl -.'. ' . . .~/ - Approval ,~d for one ye~ rom date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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)