HomeMy WebLinkAboutSHACKLETON LT 24CMunicipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171318
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑
Name:
Eastaugh Linda Family Trust
Address
PO Box 112227 Anchorage AK 99511
Phone Number of Bedrooms
503-872-4331 3 .
LEGAL DESCRIPTION
Subdivision Block Lot
Shackleton 24C
Township Range Section
PID Number: 016-141-38
Multiple (SF and/or D) Project: ❑ New F* Upgrade
BSORPTION FIELD
❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
F-1 Other
Soil Rating Total depth from original grade
1.0 GPD/SF 10.9 Ft.
Depth to pipe invert from original grade Gravel depth beneath pipe
6.9 Ft. 4.0 Ft.
Fill added above original grade Gravel length
0.3 Ft. 45.0 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION
DISTANCES
5.0 Ft.
Ft.
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
450 Ft
Number of trenches
1
Dist. between trenches
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
11000 Gal.
Surface Water
>100'
>100'
N/A
N/A
NA
Material
Steel
Number of compartments
2
Lot Line
>5'
10'
N/A
N/A
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Icapacity
Curtain Drain I None I Noted
Remarks
Gall
Pump on level at I Pump off level at I High water alarm at
in. I in.1 in.
Pump make and model I Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
Installer drainfield
D3034
A+ Home Services Drainfield D3034 CO/MT
Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft
Inspeection 15' 11/15/17 2nd 11/16/17 Location and description
3°' 4th Bottom of West door jam.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL I Engineer's Stamp
"kk
Conditional Approval: Date
low
. .................
Benjamin Schiller
r �`'• C 1 592. •49 A
ms's • • � �•
Approved �� Date
�.
�t3t
Inspection Report_9-1-12.doc
SHACKLETON LOT 24C
PERMIT # OSP171318
PI D # 016-141-38
' C 7 n-_
UNDEVELOPED
LOT P-112
UNDEVELOPED f
a
!
i
ALTERNATE
SITE
! 1000 -GAL SEPTIC TANK'
cn
E
co ( --ti — —
U i
CL I e !
W
Of
O i JERK #2
U) i ta.t I
J ; / ; I
J I .• i
w ; .i 1.E.... , • f 140.
f rvrrl svz VI/ !
It/
co j
TH#1
MT2 !
CO2
i �.... i
t 4 Oc�
i I
'-- 45' LONG x 5' WIDE, 4'
EFFECTIVE DEPTH
t `ABSORPTION TRENCH
i l
SHACKLETON SUB
i LOT 24C 141,
100' WELL RADIUS
KLATT
0 40 80
FEET
1 "=40'
1 47
! I
_—� -
.... -._...... i - _ - - - ...- - - - - - -
FCO
-,
10.0 21.5
SV1
66:1--
33.8
SV2
70.4
-39:4 _.
2CO
72.7
42.3
C01
81.0
51.6
MTI
83.4
54.4
CO2
46.5
1
39.0
MT2
46.0
38.2
I r:rrT:nln
MT - MONITORING TUBE
FCO - FOUNDATION CLEANOUT
TH - TEST HOLE
CO - CLEANOUT
SHACKLETON LOT 24C
PERMIT # OSP171318
PID # 016-141-38
-V
95.8 FINISH GRADE
OU 2 /— 95.5 ORIGINAL GRADE
88.6-1DRAINFIELD ROCK
84.6
r 45'
78.5
= NO GROUNDWATER 10/02/17
1 --
PROFILE AS -BUILT
(NO SCALE)
�J,
O
U
84.6
I.I.M.
or-
�l
Ir
.... .... .........
•• • .
Benja in chiller '
�Fc •. CE 592 .• ���i
M.r, 3.1,W:
,l\�,PROFESSIONP 4
DEPTH
(feet)
1-
2-
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
1
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650
SOILS LOG AND PERCOLATION TEST
LEGAL DESCRIPTION: SHACKLETON SUB, LOT 2
PERFORMEDFOR: FORGE ENGINEERING
DATE: 11-16-2017 PROJECT No.;
PARCEL ID#: 016-141-38 TECHNICIAN
PERK TEST #2
4C
J. MILLETTE
SLOPE
SITE PLAN
SEE SITE PLAN
WAS GROUND WATER ENCOUNTERED? N O
READING
IF YES @ WHAT DEPTH? —
L
DEPTH TO
WATER
(INCHES)
DEPTH OF WATER AFTER MONITORING: —
0
TEST HOLE PRESOAKED PRIOR TO TESTING:
DATE OF MONITORING: -
P
1:47
E
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
9/25
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
1:47
0
2
1:48
0:21
6
6
9
1:53
0
10
1:54
0:31
6
6
11
1:55
0
12
1:55
0:30
6
6
PERCOLATION RATE: 0.1 (MIN/INCH) PERE. HOLE DIA.—L—(INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: PERK TEST WAS RUN 6 TIMES. INTERMEDIATE RESULTS ARE NOT SHOWN BUT WERE VERY SIMILAR.
• _�o< MUNICIPALITY OF ANCHORAGE R„nr
On-Site Water& Wastewater Program \� ��;
r ,, PO Box 196650 4700 Elmore Road y •r_
l Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.orglonsite
j I cpartInt•nr
4"c h o ll'Gt
On-Site Wastewater Disposal System Permit
Permit Number: OSP171318 Effective Date: 11/8/2017
Work Type: Septic Upgrade Expiration Date: 11/8/2018
Tax Code Number: 01614138000
Site Legal Address: SHACKLETON LT 24C G:2630
Site Mailing Address: 171 W KLATT RD, Anchorage
Owner: EASTAUGH LINDA FAMILY TRUST Lot Size in Sq Ft: 25600
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
E1 Disposal Field Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The entire alternate drainfield is not within the 30 foot radius of a percolation test. An
additional percolation test is required at time of construction to verify design of alternate drainfield. Please
submit stamped and signed results with the inspection report. Any changes to the design of the alternate
drainfield shall be reflected on record drawing.
Received By: 11 ( l t i f t'(_ k Date: t / •
Issued By: ahtt&c., j Date: i i 18 ,20
M niddpaH ty of Anchoraue ,.,.,,r s^
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 . Fax (907) 343-7997
http:/Iwww.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
Y'. * ** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV171129 COSA#: Permit#: OSP171318
PID#: 016-141-38
Legal Description: Shackleton Lot 24C
Engineer: Forge Engineering
Applicant: Linda Eastaugh Family Trust
Your request for a waiver to allow insitu to act as filter sand below the absorption field, in lieu of
the required 2.0 feet of filter sand for systems where insitu percolates faster than 1 mpi, has been
approved. See submitted sieve analysis.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all code requirements be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted:
Date: 1\ I f �C 17 Approved by: C C CSL o't Y
Name of Reviewer
****
VARIANCE/WAIVER REVIEW ****
4c)6i89704
OF ANCHORAGE :')
��2 I
MUNICIPALITY OCT 13 2011
0 \1..„,„ tiCommunity Development Department Phone: 907- 704 �h4
Development Services Division Y Fax: 907-343-7997.0 L g
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. O 41-38
Property owner(s) Linda Eastaugh Family Trust, Shannon Campbell Day phone
Mailing address PO Box 112227, Anchorage, AK 99511
Site address 171 W Klatt Rd
Legal description (Sub'd., Block & Lot) Shackleton Sub Lot 24C
Legal description (Township, Range & Section)
Lot Size 25,600 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑x Initial ❑ Single Family (SF) ❑x
(w/wo ADU)
Septic Tank ❑x Upgrade ❑x Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR:
Use of in-situ sand for filter Distance: N/A
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
/''
(Sig ure of pt.'.erty owner or authorized agent)
Permit/Rush Fees: /C1 Waiver Fees: d //;; /2/ ? '
Date of Payment: i6/131/4" Date of Payment: 0/0/0-
Receipt Number: /� 6,30q600 Receipt Number: 036466
b
Permit No. 65PFH31 Y Waiver No. 65v `«-4
Permit App_.-: ::..:c
I`
' GE
► ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
November 7, 2017
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Shackleton Sub Lot 24C
Septic system design and permit application,waiver requests
Dear On-Site Services Engineer:
The owner of the above lot has a 3-bedroom home on the property, but would like to upgrade the
septic system. We are submitting this permit application for the construction of a new septic
system. The attached site plan identifies the location of the home and existing well, as well as the
proposed septic location and alternate site. No conflicts exist between this proposed system and
any wells whether on this lot or adjacent lots. Drainage arrows are shown on the site plan showing
the grade and direction of flow. The drainage pattern in general will not be changed by the
construction.
The test holes placed on the lot indicate silty sand. No groundwater or bedrock was found down
to 17'. The percolation rate was determined to be less than 1 min/in. We took a sample to the lab
for analysis, and the attached result shows a composition of 84% sand. We are requesting that
these in-situ soils be accepted as a sand liner, instead of bringing in 2' of filter sand for the rapid
percolation rate. The existing soils will act as more than 2' of filter sand- there are no additional
threats to health and safety by approving this waiver.
An application rate of 1.0 gpd/sf was used in the design of the absorption system. We are proposing
to place a new 1000-gallon septic tank with a deep absorption trench 5' wide x 45' long x 4'
effective depth. The elevation of the distribution line will be 3' below the surface for a total depth
of 7'. Soil will be mounded 0.5' above the trench. A minimum of 3' of fill will be placed over the
absorption trench and 4' over the septic tank.
The ground surface on the lot slopes mildly toward the northwest, between 1-5%, and there aren't
steep slopes on any portion of the lot. The new trench will be constructed parallel to the slope as
much as possible. It will be a minimum of 100' from all wells and surface water,and more than 5'
away from the septic tank. The alternate site is located a minimum of 10' away.
Although it is hard to tell exactly where the existing tank sits, according to the paperwork on file
the tank is less than 100' to the well, between 50-80' away. The new tank will be placed outside
the well radius.
If the system is constructed as designed, it will have no adverse impact:
• On the wells in the area or those to be constructed in the future.
• On existing septic systems in the area or those to be constructed in the future.
• On reserve space, either surface or subsurface, on any lots located in the area.
• On drainage patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Benjamin Schiller, PE
of 4142i
100
� Benl in Schiller :
��9F,• CE12 2 �`1'/'
PROFESS10*a te
I LOT 24A \\
cnw
UNDEVELOPED \)
i
LOT 24B
UNDEVELOPED
ALTERNATE •
SITE PROPOSED 1000-GAL
cn
_ SEPTIC TANK i LOT 240
(c.f.))-
1
w �" i i
O i \ r _.,�� EXISTING y \ i
/ t SEEPAGE PIT \1 i r'/-
/ .-2Ca • v SV . ' ,' (ABANDON) 140. ��Vl
Z w10.0 i EXISTING / 1 r�
g ,. SEPTIC TANK
1: 0TH#1 90 C1 (DECOMMISSION)
i i
Q C0 1/ ;
• .•7111 1
al i
p c
A
45' LONG x 5'WIDE, 4' I
EFFECTIVE DEPTH ^144.0
\ABSORPTION TRENCH
'1 / 7,,
SHACKLETON SUB 1
LOT 24C . iii( \
y ,, ,,. ,, .,, . \ ..
\ ....
100'WELL RADIUS
--- y \ _. --
KLATT ROAD
NOTE:
�_.����X\\ NO SURFACE WATER WITHIN 100'OF THE
...19:7-c .9r.. :48 a� PROPOSED SEPTIC SYSTEM
j*•' 1H• 1\ *'.37 ' NO CONFLICTS WITH WELLS OR SEPTIC
p.•..�►.•.•pr....
••• � SYSTEMS ON ADJACENT LOTS LEGENC
�/ •• " Benjaminhiller : / MT-MONITORING TUBE
Ir PF••. •AEL 12592 .•�• 0 40 80
cslF••:1:"1"1:••;_`c � FEET FCO-FOUNDATION CLEANOUT
!`l „DPROFE5S10N' TH-TEST HOLE\ANN":' 1"=40' CO-CLEANOUT
SHACKLETON SUB LOT 24C
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 0.5 MIN/IN 1000-GAL SEPTIC TANK
APPLICATION RATE: 1.0 GPD/SF
450 GPD / 1.0 GPD/SF / 5.0' WIDE * 0.50 REDUCTION = 45.0 LF TRENCH
THEREFORE: CONSTRUCT AN ABSORPTION TRENCH 45' LONG x 5' WIDE x 4' EFFECTIVE
DEPTH. FLOW LINE ELEVATION IN TRENCHES TO BE 3.0' BELOW ORIGINAL GROUND
SURFACE. TOTAL DEPTH TO BE 7' BELOW EXISTING GROUND. PROVIDE 3' COVER OVER
TRENCHES AND 4' COVER OVER SEPTIC TANK. OR INSULATION WITH 2' COVER.
411=1111=1
I1X
III
2'-6' =111 II I H ISI I i
-1 IS _El 1E1
El 1H1H1 t_11
I
1= 11-111=111-11 I-111-1
':' 4" PERFORATED PVC (HOLES DOWN)
V_V_,:; DRAINFIELD ROCK
/:,:,:/
5,� 4' TO GROUNDWATER
6' TO BEDROCK OR IMPERMEABLE LAYER
5-WIDE TRENCH SECTION
..„4.46,1
44
SCALE)
/��Q•'' _)A ��+/
*:49TH /\ - /
NOTES: ... .� ▪*
GRADE AREA OVER TRENCH TO DRAIN AWAY ,,,,fir
MIN 6' SEPARATION FROM BEDROCK / Benja Schiller ▪ r
MIN 4' SEPARATION FROM GROUNDWATER 1002, AEL12592 •����
MIN 100' SEPARATION FROM NEARBY WELLS +0c114;•• FESsti0
MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS \����
MUNICIPALITY OF ANCHORAGE _���\\�\/��,
DEVELOPMENT SERVICES DEPARTMENT s�P'(�G°••4:SI��I+#
4700 ELMORE ROAD ANCHORAGE, AK 99519-6 650 e.'. 44� *!+:4149 �
SOILS LOG AND PERCOLATION TESTF.
1 1,.•• Benj• • in Schiller
LEGAL DESCRIPTION: SHACKLETON SUB, LOT 24C �+�cf, �09 125922 ••�•��/
PERFORMED FOR: FORGE ENGINEERING ��l�E�PROFESS1�Np" .
DATE: 9-25-2017 PROJECT No.:
��\\\�tb'
PARCEL ID#: 016 141-38 TECHNICIAN:
J. MILLE I i E Professional En_'neersScam.:
DEPTH TEST HOLE 1
(feet)
1 k.,44:,t4,-ii-," SLOPE SITE PLAN
2 -
4r� PIAN
5 ....14:;;,.3 SILTY SAND (SM) SEE SITE PLAN
11
7 k�'-•• . � Yrs
�.��<s. ,
•ty,),..-fir.)
9 4V14
1
Fe.�tx `u
,,,17::,;Zi'.e WAS GROUND WATER ENCOUNTERED? NO
1O 01140,
W}i:y;y -
P?�t� r••. ! IF YES(u WHAT DEPTH?
`" ''�;�`Nei•+ DEPTH OF WATER AFTER MONITORING: NONE
�5?'lft DATE:OF MONITORING: 10/2/17
,. E
12 ,:; :.
.:'z'•t,:.;, DEPTH To
=�'= ':r GROSS TIME NET TIME NET DROP
13—^'.'t'` (g"" DATE READING WATER
,� �,,;�4 (MINUTES) (MINUTES) (INCHES) (INCHES)
14— •"'z'O9/25 TEST HOLE PRESOAKED PRIOR TO TESTING:
r.�=r�`�rer 1 2:41 0
15 4-64. .
16-4 2 2:45 4:01 6 6
� d,',4* `i. BOH •••••
17 9 3:04 0
18— 10 3:09 5:02 6 6
19— II 3:10 0
20 12 3:15 5:02 6 6
PERCOLATION RATE:0.83 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
COMMENTS: PERK TEST WAS RUN 6 TIMES. INTERMEDIATE RESULTS ARE NOT SHOWN BUT WERE VERY SIMILAR.
NORTHERN GEOTECHNICAL ENGINEERING, INC, / TERRA FIRMA TESTING
Ilk • Laboratory Testing Geotechnical Engineering Instrumentation Construction Monitoring Services Thermal Analy.,i.:
PROJECT CLIENT: Forge Engineering %GRAVEL 0.0 USCS SM
PROJECT NAME: 171 4 4-W.Klatt %SAND 84.0 USACOE FC N/A
PROJECT NO.: 4841-17 %SILT/CLAY 16.0 %PASS.0.02 mm N/A
SAMPLE LOC.: %MOIST,CONTENT 8.9 %PASS.0.002 mm N/A
NUMBER/DEPTH: 17-S-1 UNIFORMITY COEFFICIENT(Cu) UNKNOWN
DESCRIPTION: Silty sand COEFFICIENT OF GRADATION(Ce) UNKNOWN
DATE RECEIVED: 9126/2017 ASTM DI557(uncorrected) N/A
TESTED BY: CH ASTM D4718(corrected) N/A
REVIEWED BY: RJPC OPTIMUM MOIST.CONTENT.(corrected) N/A
PARTICLE SIZE ANALYSIS ASTM D422/C136
u&WIVE OPENING M WtlaFS 1 1.18.SIEVEsuiastE I 111DRoat7ER SIEVE ANALYSIS RESULT
100 6 , IS w 112 MI * r. � aw lata otic
SIEVE SIEVE TOTAL% SPECIFICATION
90 J SIZE(nun) SIZE(U.S.) PASSING (%PASSING)
80 -� I 152.40 6"
70 76.20 3"
' - - 38.10 1.5"
,o(i) 60 • -, 19.00 3/4"
50 -�— - - 12.70 1n"
+ .. 9.50 3/8"
cO 40 4.75 #4 100
°4 2.00 410 100
30 -" - 0.85 #20 100
k" 20 - 0.43 #40 96 _y
0.25 #60 80
10 0.15 #100 48
0 I -'-I 0.075 #200 16.0
100 10 1 0.1 0.0! 0.001
GRAIN SIZE(mm)
HYDROMER RESUL`!'
I COBBLES GRAVEL I SAND I I ELAPSED DIAMETER ETTOTAL%
SILT or CLAY TIME(MIN) (men) PASSING
Comm Fins Coarse Medum Pose 0
0.5
MOISTURE-DENSITY RELATIONSHIP ASTM D1557 2
4
145 - — - -- __ _ 8 --
15
14030
. �... t 60
3 135 _� . 250
1440
2 130
HYDRAULIC COND. „
125 - (ASTM D2434)
q DEGRADATION N/A
120 '_ _.. - " -- (ATM T-313)
_—— PLASTICITY INDEX N/A
115 -- ASTM 4318
0 2 4 6 8 10 12 14 16
MOISTURE CONTENT(%)
The testing services reported herein have been performed to recognized industry standards,unless otherwise noted. No other warranty is made. Should engineering
interpretation or opinion be required,NGE-TFT will provide upon written request.
11301 Olive Lane - Anchorage,Alaska 99515 • Phone:907-344-5934 • Fax,907-344-5993 . www.nge-yi.com
GAAB-HD-I GREATER ANCHORAGE AREA BOROJJ;GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME L `� k�� ��"� ADDRESS AX PHONE -
-ADDRESS
LOCATION s`_ F ' LEGAL DESCRIPTION�')e-0
SEPTIC TANK:
DISTANCE FROM WELL MATERIAL
INSIDE LENGTH 8 INSIDE WI
LIQUID CAPACITY Look- GALLONS.
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS 2— lew",
NUMBER OF
07OAd COMPARTMENTS
OUTSIDE DIAMETER r OR WIDTH
LINING MATERIAL—CetA.,'� _ i r . DISTANCE FROM WELL
2
LIQUID y /t
JI
DEPTH
1
LENGTH , DEPTH
BUILDINGFOUNDATION,
NEAREST LOT LINE %' ` TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL_
NUMBER OF LINES_
ABSORPTION AREA
FOUNDAT
CE BETWEEN LINES
FT. LENGTH OF EACH LINE
NEAREST LOT UNE-
-TRENCH WIDTH
TOTAL LENGTH
OF LINES ,
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE
WELL:
�t/ DISTANCE FROM WATER
TYPE A- fs�f_6 DEPTH Z j BUILDING FOUNDATION. SAMPLE , NEAREST
NEAREST SEPTIC SEEPAGEOTHER
LOT LINE , SEWER LINE , TANK , SYSTEM , CESSPOOL , SOURCES_
DISTANCES:
1�_ e3' '�o
DIAGRAM OF SYSTEM
(�K
DATE _q
/ APPROVED HEALTH AUTHORITY
GAAB-HD-20. ANCHORAGE AREA __.�'OROUGH Case No.�
HEALTH DEPARTMENT
327 Eagle t Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT a`Tia�- �ij/J -y MAILING ADDRESS �J- PHONE ND.� �SS�
RESIDENCE ADDRESS ,C1De 2� LOCATION OF INSTALLATION
LEGAL DESCRIPTION �W �z GO T 2-
APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT k""' , DRAIN FIELD , OTHER
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH �� TO BE INSTALLED BY
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION Zjk� � —p—
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS hW. 4444 /-1 , PERMIT TO INSTALL A `��til� �9rY�C22 2fr
AS DESCRIBED BELOW. SIZE OF UNIT TOB SERVED
SEPTIC TANK SIZE IV01 TYPE6e SEEPAGE AREA TYPE
DIAGRAM OF SYSTEM
.4UV�, 'YID,
I certify that I am familiar with the requirements of Gr
above described system is in accordance with said code.
DATE .. % APPLICANTS SIGNATURES%
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