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HomeMy WebLinkAboutROBERT AUBREY LT 7Robert Aubrey Lots 6 & 7 #051-102-38 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 RO. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.O~-/ - /~'~:~-~,5~ (c/¢)'~- 1, GENERAL INFORMATION Complete legal description Lots Location (site address or directions) HAA#/(/7~/-~{~ z//,~ Expiration Date: 6 & 7, Robert Aubrey Subdivision 230-53 Tundra Rose Current Property owner(s) Terrill Angell Dayphone360-435-2742 Mailing address 427 N. 01ymplc Ave., Arlington, WA 98223 Lending agency Mailing address Real Estate Agent_ Mailing Address Residential }ltA., Lynn ]]432 Business B]vd.~ Ste ]6, Dayphone 694-8800 Ea~]e River~ AK 99577 Day phone 4 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: '?/¢t~//Z NUMBER OF BEDROOMS: 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 Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on propedies served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING 17034 Eagle River Loop Ro~d No, 204 Eagle Riveh Alaska 99577 Name of Firm Address Phone Engineer's Printed Name Robert C. Co~¢an DHHS SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for __ Date ~.~'. ......... ~ ~'" t, ".,~-'~ bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date:~_ - ~ © ~ L~ / Original Certificate Date: Reissue Date: 72025 iRev 01 001' Municipality of Anchorage · Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo/- ~o ~ '7 /'~,~-T'~ //'~'~-~' Parcel I.D.: A. WELL DATA Well type Date completed __ Total depth Date of test Static water level Well production WATER SAMPL~ ~~.' Coliform J colonies/100 mi Nitrate Data'sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank~ype/Material $'-~-,,~ ~ ~-/' J ~'~.,,,~.~. Da~e installed ~ ~ Tank size }Oo0 Cleanouts 7~5 FoundatiOh cleanout YCJ D~te 0f pumping ¢ / ~ .& '/o ~ C. ABSORPTION FIELD DATA If A, B, or C provide PWSID # Well Log ~ Sanitary seal __ _ ~/.ir6C~perly protected __ ft Cased to __ ft ....?.p.sidg"~height (.above ground) _ FROM WELL LOG ~ AT INSPECTION ft ft g.p.m __ mg/I Other bacteria__ colOnies/100 mi gal Number of Compartments Depression over tank ~vo High water alarm Pumper ~' A '~ Datein~talied C~/l~/~/ Soilrating (g.p.d./ft2or'~7ES~ ~'~ Length /¢ 0 ft Width 5'- ft Gravel below pipe ~ ft Total depth ~- ft Effective absorption area~'~' fF Monitoring tube Date of adequacy test ~/~-5~/~ a Results-~Fail) System type in. __ Depression over field ~ o For ~ bedrooms Fluid depth in absorption field before test ~P,y in Water added ,C'l (,, gal. New depth ! ¢~." in. Elapsed Time: /o min Final fluid depth '7 in Absorption rate >= /'/,~'0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~v ~,~/~ '~ ~' ~ ~ ~ If yes, give date 72-026 (Rev. 01/00)* D, LIFT STATION Date installed Size in gallons __ -~ M.~ "Pump on" level at __ in "Pump off" level at ___.,.ip,.---~l~h water alarm level at in Datu~ ~-- ~sted Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots ~ Absorption field on lot On ~ Public sewer m..~.._...~ ...~--"'~ Public sewer manhole/cleanout S~ervice line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '-¢'- -~ Property line Water main ?o ~- Water service line /0 Drainage ~/~1 Wells on adjacent lots / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / o 'd-- Building foundation )O '-~ Water Service line / ~ + Surface water /'9 o +- Curtain drain ,~ 0~ 4. ¢,~/¢ Wells on adjacent lots loc 4- Absorption field Surface water Water main /o -.-/- Driveway, parking/vehicle storage F. 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 with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 01/00)* 000 MUNICIPALITY OF ANCHORAGE 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 MAILING ADDRESS .HON E [] NEW A?PGRADB LOCATIONLEGAL DESCRIPT~N 6 '~; 7 /'"~ /' ~~'/~ ~'~ ~[~ ~ ~/'~ NOI OF BEDROOMSr ]Wei]..~..~ ( , Ab~.~PCn~ar~ Dwellin~ ~ ~ P 'O. , DISTANCE TO: , .. ~'. ~ J ~= ]Manufacturer/~ M~/~ I ~ IL~.~ i~aHo,s IF HOMEMADE: Inside length J Width ' Liquid depth DISTANCE TO: //~ ~ Foundati~o Total effectiCe absorption area Top of tile to fin~gra~e Length Width Type of crib DISTANCE TO: DISTANCE TO; Building foundation Depth PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO, Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING cc-/z¢ REMARKS TO R 0 M SUBJECT L MESSAGE SIGNED REPLY DATE / / SIGNED RPPLIC:RNT THERESFI HE'.¢ER C:,-.'O S&S ENG. E.R. liK. LOCRTtON E~li F..' L:.'-FI ~: f:I L,EGRL ETS. G,E~:7 ROBERT ~I..tE~REV ]"'¢F'E OF SOIL_ FIBSORPT ]: ON SMSTEM IS;: DRF~:[NF'IELD HRXiMLIH NI. JP!E~ER OF BE[:,ROOMS = :~: SOIL THE i~'.E~UiRE[:, SIZE OF THE SOIL ~8SOF:PI"ION S?STEH IS: L. OT SIZE: i.S';~:5CiC~ SC~LIFtF:E FEET 'THE LENG.['H DIMENSION IS THE LENGTH ,::IN FEET) OF '['HE TRENC:H Of';-'. DRFIINFIEL[:,. TFIE [:,EPTH OF' FI TF.'ENCH OF'. Pi'r IS THE [:,iSTIINCE BETNEEN THE Ext. JF:FF!CE OF THE: GF:OUND RN[:, THE BC)TTOH OF "['HE E?..'C:FI',..,'II'F!ON <IN FEE-:T). THE GF-.'.Ia',?EL [:,EPTH !:S, THE MiNIMUP1 DEPTH OF GF:FI',,,'EL. E,'ETNEEN THE OU.['FF!LL. PIPE RN[:, '['HE BOTTOM OF 'THE E?,CII',,,'IITiON (IN FEET.':,. PERMif. 7' F!PPL!CIINT HFIS THE ?.ESPONS~BIL!T'¢ '¥'0 iNFOF.'.H THIS [:,EPFIF.:.['HENT [.',URING THE IN'.ST~LLIITION INSPEC:TIONS OF P.,N',:' HELLS F!E:,..¥IICEN'F .['0 THIS PROPERT? tiN[:, THE t'.,!UHBEF: OF RESIDENCES THliT '['HE NELL. i,~ZLL. SE~:VE. E:RCKF ILL Z NG OF FIN'?' '.E:?:--.,TEH f4 t '['HE: _ 7' F't NRL :[ NSF'ECT Z O1"4 P, ND IiPF'RO',,,'RL B'T' TFI I £:,EF'IiF.'.T.HENT PJ. IL t ~'""" SUE~,TEC:'F .['O MINIMUM DIS.['RNCE 8ETNEEN F! t.4ELL RND RN? ON-SITE SEP.!FIGE: D!SPOSRL S'-,.'STEPI IS 1~-39 FEE!' FOF.'. Fl F'F..:I',,,'IiTE NELL. OR iSEi .['0 :.:::1~iii1:1 FEE.[' FF:OM FI PI.]E:LiC i.,.IE:LL [:,EPE:NF.':,ING UPON THE T?P[:Z OF PUBLIC NELL HINIPIUM [>IS]"IiNCE FF.:OP1 li F'F.':!VIITE NELL TO li PF'.I',,,'Ii"FE SEi.,.tEF: LINE i("5 ;25 FEET FIND TO li COHHUN:r.T'T' SENER L. INE IF; '.'::"5 FEET. OTHEF..' F;:EL.-,~UIF'.EHENTS HF.¢.¢ IiF'F'L?. SPECIFICIiTIONS ..,aF,l[:, CONSTF:UCTION [:,IFIGF'.F!HS RRE II',,,'IIILRE.'LE TO INSUF::E PF. tOPER INSTRLLII"t'ION. I CERTIF'?' THliT ........ h,.-.:,~.TE .:_',ELL~R.:, liNE:, NE.L. LS; FtS SET :1.' I liH F'RHILIF4. F:: 14ITH THE ~'E".".~ TREI','iENTS F"~F.' ' '-" ,-'" p' '- Pi N'r- ~F'.~tl.].l T ~'~P' RNC:HORIIC4E. FORTH E .... TFIE .... " ;-2:~ T H]'LL INSTliLL THE S?STEH IN IICC:ORB, IINCE [,JITH THE L.L.F. CP_:.:,. 2:: I _N[,EF::STFtNC, THF!T THE ON-LZ.,ITE SENER S;"r'STEP'I f'fF-~? REC!UIF:E ENLFtRGEHENT IF THE - ...................... IIPF'L ! CliNT ]'H~EfL'EL'E;II .'I,E ............................ ........ 5 6 7 8 9 10 11 12 13 14 15- 16- 17 18 19- 2O , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST SOILS LOG WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: SITE PLAN [] PERCOLATION TEST Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE F/~ (minutes/inch} COMMENTS ~ ,~ /~ TEST RUN BETWEEN · FT AND FT 1¥ OLD /_ o / ¢ i /..ot '-/ ?me ~. Time ,?e Date Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size / ~'~ ~[ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY. Property Owner / ~E~ ~'E~E~ ~ ~ ~ ~o~5 Phone Address Stroot 2ocation Typg,of Residence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Q Other Water Supply Q Individual A~ACH WELL LOG. A well log is required for all wells drilled since June ~ COmmunity 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utilit~ available.) Sew~e Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility:. ~ Holding Tank N TE' THE I[~PECTI~FEE MUST AC~OMPAN~ACH REQUES~ ~BEFoRE PROCESSING CAN BE INITIATED. ~-. P/UNICiPALITY OF ANC!qOP, AG . 'AD,EPARTME. OF ,4~AL_,H AND 8~5 L Street, Anchorac~a. AlasKa 26a~4120 Date Received: 111~177 Thursday PROTECT!ON November 16, 1977 ~:.1 ~i,.OVzk_ INDIVIDUAL SEWER AND NATER I;'ACILIT.LES ~];'ONT'~S'P }:'OR : ,'~-r ~'~ OF - Realtor: Linde will meet you there ~ 1:30 p.m. l. o s i~,c- Sp'_ ompany .L..n~ .... j institution Request: R~ee-t~/Theresa Wilson Star Route A Box 3097 99467 Phone: PhoRe: 277-0543 688-9172 Lot 6 and 7 Robert Aubrey Subdivision 3. Legal. Desc~._pt.., :- .... ~-ion .............................................. ~ ......................... . Single Family Residence: (x~ Multiple Family ResJ.dence: ( ) Number of Beoroom.~: Number ef Bedroems: Three individual Well (x) Well System ConsCruction Co,~i~nun~ty/Puo~c System ( ) 148' Weli Log on ~.~e ( BacheriaI Analysis .~ .- utility ( ) 6. Sewage 'D~sp,A.a~' ' - = ~ System: On-sAte System.. ( ~ Pubiic ~ ' '+' Installer AosorpcAon ..... ~_o. - ' ~O Absorption Area 7 Distances: Le!i %0 Septic tank .... · -~ ~ b iine Absorphion Area to Sewer Lirl~ [qe~z e~e ~_~o ~ ko Nearest Lot Line Department of Health and Fnvironmen'hal ProLection Heques~. for Approval of JndJvidua! Sewer and Water Paci]ities Legal Description: Lot 6 and 7 Robert Aubrey Subdivision Commell{i s: Af fadavit Attached Approved: ~ Disapproved: ~._-,~_.(-_M Let/er Athached: ( ) : o~o ~ IlV~ 1VNOI~VN~]XNI ~03 ION t~6t '~V (ep!$ ~8~;o cas) --O]OIAO~d 19V~]A09 ]3NV~flSNI ON O08Z m~°d S~ ........................... (p,~mb~ oo~ 01418) ~]^113~ ~¥10]d8 31¥~ BO S~]] 1VNO__IIJ. IQQV BOJ $~OI^I~]S 3Q03 dlZ QN¥ 3J.¥15 "O'd (e~elsod snld) ~O(:--'II¥1N 031-11/B30 ~JO.J /dl333~] P MUNICIPALITY OF ANCHORAGE ~'~, DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - ~1; h, REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: -G'rt~O, VA FHA CONV X 2. Property Owner: fO)qd~/J '~-~ e' t~ ~-S~ Mailing Address: , (,~ .~OX ~.0~*'1)~/2lt~,;:z~, ~ Day Phone 3. Na e Buyer:. ¢ Mailing Address: ~'¢2z/~6~ ~-a~'/zu/0(/(,/'' ~/L-:-/;.',/~/,~j~¢,~,g~e. Day Phone ~.~'?- ~/~/./ 4. Name of Lending Institution: ~ ~J'~znz' z4/~,gz-~L~.~ 0/~'. Mailing Address: ,'%.9.O / ~' ,.~, 5. Name of Realtor or Agent: //~/'~ ,.~x-zf/L~-~J'' .) Mailing Address: ~'-/¢ ~¢'/- //(//~/TS~zk-/s Phone ~ ?'-/~dSZ-/.-.~ Phone Legal Description: 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 EQ-037 (1/74) 4~iKY] , Individual No. Bdrms. Y Individual (on-site) ! ! ~ 4S 469 PART 3 WILL BE RETURNED WITH REPLY February 9, 1978 Joel De Vote ~udsman ?~nvironmental Services Manager On-site Sewer Lot 6 and 7 Robert Aubrey Subdivision In response to your telecon of February 8, 1978, concerning the above subject, I bring to your attention to the following: Municipal Code ~lapter 15.65.050 SeRtiqTaz~ A. ~No person shall cause or p~rmit to be const~'~ct~d or installed any s~ptic tank %hat does not comply with at least the minimum requirements of the Manual of Septt_.c__TankPractices, Public ~{ealth S~rvice Publicat-~K ~61 ~-~6f'-pages 35, 36 and 37 are attached. A standpipe is allowed instead of a manhole per the manual d~awings ~d we con~ider it to be an absolution but minimum necessary requirement. The least that could be done to the existing system would be the installation of a standpipe to the septic tank so the system could be approved° Joseph S. Blatr~ Environmental Services ~4anager JSB/ljn attacl~.lents November 29, 1977 Ronald Wilson Star Route ~ox 3097 Chugiak, Alaska 99577 Subject: Lot 6 and 7 Robert Aubrey Subdivision This office now has additional information showing a septic tank being located on the subject property. Although, we will not require you to expose your septic9 tank, we will require a standpipe be installed, so that the tank can be p~]ped for maintenance purposes. Item three(3) ~ the first paragraph and the remaining parts of the letter sent to you on Noven,ber 18, 1977 are still in effect. i~TE: Percolation test must be performed by R & M Engineering° If th~me areaany further questions, please contact this office at 264~4720o Sincerely, Robert C. Pratt, Sanitarian RCP/lJh cc~ Spokane Mortgage Company 3201 C Street, Suite 250 99503 Linda Switzer }Iome State Realty 517 W~st Northern Lights Boulevard 99503 1977 Ronald Wilson Star l~ute Box 3097 Chugiak~ Alaska 995~7 Subject~ Lot 6 and 7 Robert Aubrey Subdivision ~he request for approval on %he sewer and water faoi!ities th_s time~ on the subject property can not be approved at ~ for the following reasons~ (1) No evidence of a septic tank~ which is a requiremel,t. (2) if there is a septic tank, it will need to be uncovered so that we can verify its existence and have it pumped so that the size can be established. (3) A percolation test must be perfo~%~l on the existing ~esspoo! to determine its adequacy~ See enclosed handout° If the cesspool does not me~t the minimum daily flow re¢~irement an upgrade of the system will be needed. The installation o~ a septic tank will nee~ %0 be ~n~lude in thet uf}grade if there is not a tank on the property. Before any construction begins a pe~it must be obtained frcm~ this office and if additional seepage area is needed a soils test (see enclosed ~ist) will be needed prior to the issuance of the If t~re are any further questions,pplease contact this office at 2~4-4720o Sincerely~ Robert C. Pratt~ Sanitarian cc: Spokane ~ortgage Company 3201 C Street~ Suite ~90 9~503 Lin~a Switzer ~lome State Realty §17 WeSt Northern Lights Mr. Ron Wilson SR Box 3097 Chugiak, Alaska 99567 Subject: Adequacy Test on Existing Sanitary System, Lots 6 & 7, Robert Aubery Subdivision, Peters Creek, Alaska Dear Mr. Wilson: On December 29, 1977 we conducted an adequacy test of the sanitary system on the above mentioned property. The test consisted of monitoring the liquid level in the standpipe as 105 gallons of water were added to the system. The following table summarizes the measurements: Time Liquid level below top of Standpipe (feet) Meter Reading (gals.) 9:45 6.30 13359.1 9:55 6.10 13384.1 10:09 6.10 13409.3 10:25 6.15 13434.5 11:05 6.20 ~r~ ~/ 13475.1 ~ The meter used for the test was a Rockwell 5/8" Standard water meter which~~0~ had been previously calibrated by R&M Consultants, Inc. ~ Assuming that a 3 bedroom residence will house 6 people, the average load on the system can be expected to be 450 gallons per day or .31 gallons per minute. During the test 105 gallons of water were accepted into the system in 75 minutes, equal to a rate of 1.4 gallons per minute. From our measurements, we can conclude that the system is disposing of effluent at an adequate rate. ANCHORAGE FAIRBANKS JUNEAU VALDEZ WASILLA December 30, 1977 Mr. Ron Wilson Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this test or if we can be of further service. Very truly yours, R&M CONSULTANTS, INC. Lynne Kosikowski Staff Geologist Robert L. Schraeder Associate RLS:LK/kah City .I STATEMENT ~ a~ GREATER ANCHORAGE AREA BOROUGH (~-~°' Department of Environmental Quality ~,~p~n 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~m~ ~ Date Received February 17, 1976 ~p~ Date of Inspectioq ~-~-Q~. ~,o~P REQUEST FOR APPROVAL OF ~- ~. Y ~ ~ INDIVIDUAL SEWER & WATER FACILITIES ~/~;~ FOR ~ V.A. I 0 requested by: Mailing Address: Phone: Property Owner: Scott G. & Deborah S. Helgeson Mailing Address: Star Route Box 3097 Chugiak 99567 Phone: 688-2069H/279-2506 x 19 3. Legal Description: Lots 6 and 7 Robert Aubrey Subdivision Location: off Glen Highway Type of facility to be inspected Single Family No. of bedrooms e Well Data: Individual A. Type C. Construction ~7--~(x~/)/~L](, Sewage Disposal System: A. Installed 1963 C. Septic Tank: 1. D. Seepage Pit: 1. serving 3 dwellings B. Depth 167' D. Bacterial Analysis On-sit~ system. B. Installer Size 1,000 2. Manufacturer AbsorptiOn Area ~/~/O~/~ 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line ~-~ , Absorption area Other contamination Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Paoe 1 of two oaoes ~t for Approval of Individual ~' '~r & Water Facilities Pa of tWo'~pages - Re [ , Description Lots 6 and 7 Robert Aubrey Subdivision Comments Approved Disapproved 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, EQ-034 (1/74) Date ~//~ 7/x~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA XX 2. Property Owner: Scott G. and Deborah S. Helqeson FHA CONY __ Mailing Address: St. 3. Name of Buyer: n/a Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 688-2069 home Rt. Box 3097, Chuqiak, Ak. 99567 Day Phone 279-2506 ext. 19 work n/a Day Phone n/a Phone Phone 6. Legal Description: Lots 6 & 7 Robert Aubrey Subd. Location: off the Glen Highway - see attached map. 7. Type of Facility to be inspected: SRF 8. Water Supply Type of Supply: Public Utility No. Bdrms. 3 Individual × If Individual, number of dwellings presently served If Individual, depth of well 167' Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site) 1963 - 1000 ,gal. tank EQ-037 (1/74) 3. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 Date Received___~t ]~. lq79 T~me of Inspectlon_.__lO:o0 ~_m Date of Inspection Oc~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WA/~.R FACILITIES FOR Cony Aoproval Requested By... Smiley's Realty Address: 1086 Eagle River Phone: 694-2115 Prooertv Owner: Carl Dashnow Phone: Legal Description: Lot 6, Robert Aubrey Subdivision Location: Mi. 21 Glen Hyw Type of Facility to be Inspected: Single Family Dwelling Number of Bedrooms: Three (3) Well Data: A. Type Drilled Depths_ 167' , C. Construction 7. Sewage Disoosal System: 'Bacterial Analysis· Satisfactory A. Installed 1963 .- B. Installer C. -Septic Tank: 1. D. Seepage Pit: 1o ~o Disposal Field: Distances: A. Size lO00 Gals2. Manufacturer-TUCK Size 8xlOxl2 2. Material Lo9 Crib Total. Length of Lines Septic Tank 60' , Absorption Area 110' Well To: , Nearest Lot Line Foundation to Septic Tank , Sewer Lines 30' , Other Coritamination "~ AbSorption Area Absorption Area to Nearest Lot Line R~,q.;,e~t {'or Appr'gval of Individual Sewer & '~ater Facilities ' ~age Two g~ Comments: {, / Aporoval Valid for One Year From Date Signed ~Gre~er Anchorage Area Borough, DeDartment of Environmental Quality DIAGRA~A OF SYST~ 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 located at: Signed INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) Water Analysis: ~ W~ 11 data: houses, ba~n, d~ainage ditch, etc. Sewage disposal system. a. Age of system ~.~, . b. Septic ta~k capacity in gallons, /~,lO0~_,.' :~ ..... , c. Na., of septic tank manufact,,'., 1. If "home made" show dia~am on reverse Side'of this fo~. d.' Disposal field o~ seepage pit size and t~e ~ ~/~ - 1. Distance to prope~y line to house fo~datlon e, Percolat ionx Test f. Percolation Tes~ performed by Use the reverse .side of this form to show dla~ram. Diafram should include · %he following information: p.~operty llnes~.well location, house location,~. ~pt~C tank locatlon, disposal area location, location of percolation test, a~ direction of ground slope· 9. The hAfor~ua.tion on this form is true and correct to the best of my knowledge. Signature of Appl cant 9. ~-~-~ T~O BE FILLED OUT BY HEALTH DEPART~.fENT PERSONNEL ........ e above described sanitary facili~ies are hereby approved, s_~u~_~iect to the ~611~in conQUerors: Conditions: ~~ The above described sanitary facilities are disapproved for the following reasons: CPJ: cw approval.