HomeMy WebLinkAboutSANDY BEACH LT 5t
a
#011-112-13
Municipality of Anchorage u��
Community Development Department Page 1 or L
On-Site Water & Wastewater Program AIM 90 2016
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Nvww.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 161129 PID Number: 011-112-13 ❑ New ■Upgrade
Name:JENNIFER ALEXANDER
ABSORPTION FIELD NORTH/SOUTH
❑ Deep Trench ■ Shallow Trench ❑ Bed ❑ Mound
Address:
7633 WANDERING DRIVE *ANCHORAGE, AK
❑ Other
Phone: No. of Bedrooms:
sail Rating'
Total Depth from original grade:
(907) 230-6680 '*4
1.0 GPDI Ft.
7 & 9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
Gr.1 depth beneoth pipe:
SEE DWG. F.
*3/1.5 & **3/2.5 Ft.
Subdivision: Black: Lot:
Fill added above original grade:
Grovel length:
SANDY BEACH - 5
SEE DWG. Ft.
47 & 38.5
owns Ip: tinge: ec ion: _
-1
Ghnpel width:
Beds Number of lines
Distance tetenn lines:
5 & 5 Ft.
I
Ft.
SEPARATION DISTANCES
Total absorption onto;
301 & 300
amber of tranches:
2
Uel. between trenches:
10+
To
Septic
Absorption
Lift
Holding
Public/Pnvote
From
Tank
Field
Station
Tank
Sewer Linn
50. Ft.
Ft
Well
100'+
100'+
-
-
25'+
TANK ■ Septic ❑ S.T.E.P. OHolding ❑ Other
Manufacturer:
capacity:
Surface Water
100'+
100'+
-
-
ANCHORAGE TANK
1250 Dal.
Lot Line
5'+
10'+
-
-
N/A
Material:
Number of compadmente:
STEEL
2
Foundation
5'+
10'+
-
-
LIFT STATION
Curtain Drain
NONE KNOWN
Manufacturer: c 'y'
Col.
'Pump ori Nuel at
7umP off by
High water cMrm at:
Remarks: PER CONTRACTOR, THE OLD SEPTIC TANK AND CRIB
WERE DECOMMISSIONED PER UPC. -ONLY 18"
(AVERAGE) OF THE 3 FEET OF EFFECTIVE WAS IN
pump Maka h
a«tricol Insp«tions parlormed by:
THE SP LAYER. --ONLY 30" OF THE EFFECTIVE
WAS IN THE SP MATERIAL. PER TIM ECKLUND THIS
DESIGN CHANGE WAS VERBALLY APPROVED BY
ROSS AT THE MOA ONSITE DEPARTMENT. --IT IS A
PIPE MATERIAL
3 BEDROOM HOUSE WITH A 4 BEDROOM SEPTIC
to
House to tank EXISTING Tank k to D3034
SYSTEM
droinInstaller
Drainfield D3034 CO/MT D3034
ARM SERVICES, LLC
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
00.00 Ft.
Inspection
Location and Description:
Dates: 1st 6/14/2016 2nd 6/15/2016
3rd 6/17/2016 4th -
BOTTOM OF TRIM @ SE CORNER OF SHOP
FJxiIMEER'8
Community Development Department Approval
006000
OFA �4p
_o
��
Conditional approval: Date:
ova
9 v 0
............................
0
J f Garn ss.
I-1 D'l7
v�
O Q m E-79 �v
�i26.�1li naov
40�o
Approved: �� Date:
Proresslon_d �
bAECC84 �`�ppp�oo
Inspection Report _1-1-12.doa
PERMIT NUMBER:
OSP161129
RECORD
LOT a
DRAWING
PARCEL ID NUMBER:
011-112-13
40A
1 B C
DB1
75.4
1 76.8 40.8
LOT 6 I
DB2
77.0
78.9 39.7
ST1
78.0
80.4 38.6
ST2
83.0
87.4 33.3
1
D83
84.7
89.7 32.1
/
DB4
86.0
91.0 31.7
/
FS
106.1
112.2 36.8
/
CO1
108.0
121.2 25.9
MT1
109.2
122.4 27.0
/
CO2
117.3
117.8 56.8
/
MT2
119.0
119.5 58.0
x/
CO3
124.2
135.1 43.4
/
/
MT3
122.6
133.4 41.8
/
C04
131.3
133.3 63.8
D81 & DB2
I MT4133.8
136.0 65.3
NEW 1250 GALLON
/
SEPTIC TANK
PER CONVERSATIONS WITH THE HOMEOWNER ON
LOT 6, THERE WAS
BELIEVED TO BE TWO WELLS
ST1
ON THE PROPERTY
AS SHOWN ON THE DESIGN.
UPON FURTHER INVESTIGATION THE 'WELL
ST2
TURNED OUT TO BE SEPTIC PIPES. IN SHORT,
THE ONLY
WELL WE ARE AWARE OF IS THE
WELL SHOWN ON THIS RECORD DRAWING.
NDRAINFIELD
FS MT2 S- 100' SETBACK FROM
C0a C SURFACE WATER. IT SHOULD
BE NOTED THAT THIS IS THE
Ta ACTUAL FIELD MEASURED 100'
SETBACK FROM SURFACE
WATER. ON THE ORIGINAL
MT DESIGN WE HAD AN
CO APPROXIMATE 100' SETBACK.
IN SHORT, THE DRAINFIELD IS
100'+ TO SURFACE WATER
AT ITS CLOSEST POINT.
SHED
Efiil - I - 71'
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS - -
0101 E. MOOR RW O. SURE 101 /JRMWGE. M 99501 • P 0 E (907) 337-0179 • FM (907) J -330 • WM9 :
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
JENNIFER ALEXANDER 230-6680 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
SANDY BEACH; LOT 5 L.K.B./D.J.G.
TYPE OF WORK: DATE:
. RECORD DRAWING 7/22/2016
4
CE/- 3!
#4
�114PROFESS\0�' ♦
IAECCBaa 1III III\\Msll,
PERMIT NUMBER: PARCEL ID NUMBER:
'OSP161129 RECORD DRAWING 011-112-13
B
ORIGINAL GRADE
= 92.86
TOP OF TANK —
AT INLET = 94.01
INVERT OF BUNG
AT INLET = 93.39
NORTH
MT CO
STI
2• INSULATION PER CONTRACTOR
r FINAL GRADE = 96.60-97.51
NEW 1250 GALLON
SEPTIC TANK
FINAL GRADE _
92.61-93.12
ORIGINAL GR
r FILTER FABRIC = 89.51
TOP OF TANK
AT OUTLET = 94.04
INVERT OF BUNG
AT OUTLET = 93.26
SOUTH
MT CO
FINAL GRADE _
7 7 /— 89.80-90.07 7Hd1
r FILTER FABRIC rl
GROUP, Ltd
49
..
CIVIL & ENVIRONMENTAL ENGINEERS
/
„
0701 E. WWR 8 . 900E 101 nx0x0MGE. M 99007 • • E (907) W7-6119 • FAY (901) ] 1-320 • rEB91E:....
//
INVERT OFPIPE
PREPARED FOR:
:101
83.54
:rM OF
rro
230-6680
3 OF 3
/jai
CE
ff'•.
LEGAL DESCRIPTION:
BOTTOM
7Z
ONLY OF • •
ONLY • OF
WAS DEEMED TO BE IN
WAS DEEMED TO BE IN
SP SOIL
SP SOIL
RELATIVE ELEVATION OF BOTTOM OF T.H.01 = 73.51
RELATIVE ELEVATION OF BOTTOM OF TH01=76.86 (TH#1 WAS DRY ON 6/14/2016)
(TH01 WAS DRY ON 6/14/2016)
GARNESS ENGINEERING
GROUP, Ltd
49
..
CIVIL & ENVIRONMENTAL ENGINEERS
/
„
0701 E. WWR 8 . 900E 101 nx0x0MGE. M 99007 • • E (907) W7-6119 • FAY (901) ] 1-320 • rEB91E:....
//
ff A.
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
JENNIFER ALEXANDER
230-6680
3 OF 3
/jai
CE
ff'•.
LEGAL DESCRIPTION:
DRAWN BY:
LKB
7Z
SANDY BEACH, LOT 5 p �,
TYPE OF WORK: DATE: ♦•N1 �OFESS�� I
RECORD DRAWING 7/22/2016 If C 44 ��11aa%�*s*�
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP161129
Tax Code Number: 01111213000 6-(�
Work Type: Septic Upgrade 1/�1
Permit Effective Dates: June 03, 2016 to June 03, 2017
Design Engineer: GARNESS ENGINEERING GROUP LTD ro
Subdivision: SANDY BEACH 16
Site Legal Address: SANDY BEACH LT 5 G:2224 2-- .�
Owner/Address: ALEXANDER JENNIFER C &
KENNETH L 7633 WANDERING DR ANCHORAGE AK 995021932
Site Mailing Address: 7633 WANDERING DR, Anchorage Lot Size in Sq Ft: 41100
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must 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 must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B�Cov I®d and 4,eated to prevent freezing.
Special Provisions: PRIOR TO CONSTRUCTION: 7 -Day ground water monitoring shall be
completed. If required, an approved change order shall be acquired prior to construction. Results
shall be submitted with the inspection report.
Receiv
Issued
MIS
rP_ ✓elS
MUNICIPALITY OF ANCHORAG
Community Development Department Phone: 9
Development Services Fax: 9(
On -Site Water & Wastewater Program
Mayor Dan Sullivan
0
3-7904
-79} 97
\�9.57E
On -Site Sewer/Well Permit Application <j�' t ��OP
For A Single Family Dwelling v �` '
Parcel I.D. 011-112-13
Property owner(s) JENNIFER AND. KEN ALEXANDER Day phone 230-3902
Mailing address 7633
WANDERING DRIVE *ANCHORAGE
AK
Site address 7633 WANDERING DRIVE *ANCHORAGE, AK
Legal description (Sub'd,
Block & Lot) SANDY BEACH; LOT
5
Legal description (Township, Section & Range)
Lot Size
Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DEWELLING:
(Pall that apply)
Initial
❑
Single Family (SF)
Absorption Field
® Upgrade
(W/Wo ADU)
Septic Tank
®
Duplex (D)
EJRenewal
Holding Tank
❑
❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
Distance: —
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
nnlyyi" Waiver Fees:
Date of Payment:
Receipt Number: po%77 -0% /v� Receipt Number:
Permit No. 05 P)(e I 1 Waiver No.
(Rev. 01/11)
11 000-
aomrMIN
GARNESS ENGINEERING GROUP, Ltd A`vd r
CIVIL & ENVIRONMENTAL ENGINEERS
June 3, 2016
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Sandy Beach; Lot 5
To whom it may concern
The existing 3 bedroom house is served by a private well and septic system. The
drainfield is in a state of failure and needs to be upgraded. Per the homeowner's
request, we are designing a 4 bedroom septic system. We are proposing to install a
new 1250 gallon septic tank and deep trench type drainfield. One testhole was
excavated on the property and the drainfield is designed within its 30 foot radius.
Comments regarding the design are summarized as follows:
1. SOILS: See the attached 2016 logs which show the soil classifications, groundwater
monitoring, and the percolation test results. As can be seen on the attached soil log, the
soils were classified as an SP. In short, a sand filter is not needed, in addition to the soil
log, a soil sample was submitted with the design.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications
3. SURFACE WATERS: There is a lake to the southeast of the proposed drainfield,
however, the drainfield is designed 100+ from the surface water.
4. TOPOGRAPHY: As can be seen on the attached design drawing, the average
topography around the proposed drainfield is 20%.
We are unaware of any adverse impacts this installation would have on adjacent wells
or septic syste s. If you have any questions, please contact us at 337-6179. Thank
you for your asAistance.
Sincerely, I
P.E., M.S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
ROLLING HILL ESTATES;
BLOCK E, LOT 3A
T10N, R4W, SEC 1qe-
NE4NW4NW4NW4, PARCEL 2
/
/ �
ROLLING HILL ESTATES;
BLOCK D, LOT 13
SKNOY BEACH: IeT 6
�. 0 /
\
T12N, R4W, SEC 10, NIICEL 21
\ I
\ N BEACH; LOT
- - - - - - - - - -
� I �
j / \
t I
� SANDY BEACH; LOT 2A
\ \L /
rrrrr,---,�rrrr
SAND LAKE
r r r r r .-• -� .� r r
GARNESS ENGINEERING GROUP, Ltd
:PARED FOR:PHONE NUMBER: PAGE NUMBER:
JENNIFER ALEXANDER (907)230-6680 1 OF 2
.AL DESCRIPTION: DRAWN BY:
SANDY BEACH; LOT 5 L.K.B.
'E OF WORK: DATE:
SITE PLAN 5/23/2016
3
NUMBER OF BEDROOMS: 4
GALLONS PER DAY (GPD): 600
PERCOLATION RATE/S: <1MIN/INCH
PROPOSED APPLICATION RATE: 1.0 GI
MINIMUM DRAINFIELD SO.FT.: 600 FTo
1 DRAINFIELD DESIGN:
1 MAXIMUM DEPTH OF EXCAVATION: •7-9 FEET
WIDTH: 5.0 FEET
1 LENGTH: 2 ® 47 FEET (94 FEET TOTAL)
M.O.A. APPROVED SAND FILTER: N/A
I REDUCTION FACTOR: ••0.78
EFFECTIVE: ••3 FEET
ACTUAL SO.FT.: 602 FT'
'
'AS NEEDED TO GET INTO THE SW LAYER
••WE ARE ASSUMING THAT ONLY 18" OF
THE EFFECTIVE IS IN THE SW LAYER
LETTER THAT PERTAINS TO THIS DESIGN. \
TO OBTAIN A COPY OF THE LETTER
CONTACT GEG. BY PROCEEDING FORWARD
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
AGREE TO ACCEPT THE TERMS AND
1 EXISTING 3
\ BEDROO
HOUSEM \
DURING THE TESTHIOLLE XCAVTION ON1 5/17/2016 A \ /
SEWER LINE WAS ENCOUNTERED. ON 5/19/2016, IT
WAS CAMEWD BY ONE STOP SERVICES. APPROXIMATELY \ /
5 FEET FROM WHERE THE SEWER LINE WAS EXPOSED, \
THE LINE BENT 90' AND THE CAMERA COULD NOT GET
PAST THE BEND. IN SHORT, THE LOCATION OF THE /
UNDOCUMENTED SEPTIC SYSTEM IS UNKNOWN. PER �T
CONVERSATIONS WITH JAMES A. CREWDSON, P.E. AT THE
MOA ON 5/19/2016 THE UNDOCUMENTED SYSTEM WILL
BE ABANDONED IN PLACE.
z-
Fy
W
\\20%
HOP 1
1
/ T
MT -
DECK / COT/
/ cM
/ COC
SANDY BEACH; LOT 4
r
NOTE: THE CONTRACTOR SHALL HAVE THE WEST &
EAST LOT LINES, ALL WELL RADII, AND 100 FOOT
SETBACK FROM ALL SURFACE WATER FLAGGED BY
A REGISTERED LAND SURVEYOR PRIOR TO
CONSTRUCTION.
ALTERNATE SITE WILL BE
RE-BUILDLING OF PROPOSED
BE
PER UPC
1250 GALLON SEPTIC
4L DOUBLE CLEANOUTS
AFTER TANK
CRIB TO BE
IED PER CODE
"
NOT H2O LEVEL. PARCEL
IDENTIFIED WARRANTY DEED
PER AS -BUILT SURVEY BY.
GARNESS ENGINEERING GROUP, Ltd
5
9-32M • WE891E: �.9orn�wnpinwrirpe
PAGE NUMBER:
6680 2 OF 2
DRAWN BY:
D.J.G.
DATE:
6/15/2016
:3
1 1
1
I
1
1
E:
40' /
REVISED 100' SETBACK
FROM SURFACE WATER PER
FIELD MEASUREMENTS
NUMBER OF BEDROOMS: 4
GALLONS PER DAY (GPD): 450
PERCOLATION RATE/S: <1MIN/INCH
PROPOSED APPLICATION RATE: 1.0
MINIMUM DRAINFIELD SO.FT.: 450 F
DRAINFIELD DESIGN:
I MAXIMUM DEPTH OF EXCAVATION: 10 FEET
WIDTH: 2.5
LENGTH: 50 FEET
M.O.A. APPROVED SAND FILTER: N/A
EFFECTIVE: 6 FEET
ACTUAL SO.FT.: 600 FT'
LETTER THAT PERTAINS TO THIS DESIGN.
\
TO OBTAIN A COPY OF THE LETTER
DURING THE TESTHOLEEXCAVATION ON 5/17/2016 A\
NOTE: THE CONTRACTOR SHALL HAVE THE WEST &
CONTACT GEN. BY PROCEEDING FORWARD
EAST LOT LINES, ALL WELL RADII, AND 100 FOOT
WITH THIS INSTALLATION, THE ENGINEER,
FROM WHERE THE SEWER LINE WAS EXPOSED. THE LINE
SETBACK FROM ALL SURFACE WATER FLAGGED BY
WELL DRILLER, CONTRACTOR AND
BEND. IN SHORT, THE LOCATION OF THE' UNDOCUMENTED
A REGISTERED LAND SURVEYOR PRIOR TO
PROPERTY OWNER AGREE THAT THEY
CONSTRUCTION.
HAVE READ THESE SPECIFICATIONS AND
THE UNDOCUMENTED SYSTEM WILL BE ABANDONED IN
AGREE TO ACCEPT THE TERMS ANDI
BEDROM
HOUS \
w /
J/
%
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E.TWORROAD. SURE 101•ANCMg E,AKORSOi•PHONE(BW)33i81i0'FA%ry0>�]9W3aB•WEBBRE:vwx.pameunpnevingmm
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: SANDY BEACH; LOT
PERFORMED FOR: JENNIFERAND KEN ALEXANDER DATE: 5/17/2016
DEPTH
(feet) TEST HOLE #1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
ORG/FILL
SOIL
CLASSIFICATIONS
ORG
ML
CL
OL
MH
CH
OH
GW
GP
GM
GC
SW
SP
SM
SC
d'o-s
3•:•;c
': �'• :
SP
DEPTH TO DATE
GROUNDWATER
DRY 5/17/2016
DATE READING CLOCK I NET TIME I WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES))
ABSORBED 5 GALLONS OF WATER IN LESS THAN 1 MIN 2 TIMES I
19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 5.5 FT. AND 6.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: DAVIDGARNESS PERCOLATION TEST PERFORMED BY: ERIKWIDGER
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEBFOR4ED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z
ILIL
-s:,
GREATER A CHORAGE AREA BQROUGH
Department of Environmental Quality
( 3500 Tudor Road, Anchorage, Alaska 9950'7 279.8686
1
P' Date Received 7�z
p ` Time of Inspection ,3/30
Date of Inspection 7/.Z-�l ;u
REQUEST FOR APPROVAL OF
TNDIViDUAL SEWER & WATER FACILITIES
FOR
1. Aoproval Requested By:��i.
Address
Phone: ,3 -:rz fi / 3
2. ZroPerty Owner :
Phone e
3. Legal Description:,/„
4. Location.
5. Type of Facility to be Inspected:�/m� Number of of Bedrooms:
6. Well Data:
A.
Type--
ype—
C. Construction t
7. Sewage Disoosal Svstem:
B. Depth
D. Bacterial Analysis�(�,� '
A. Installed _ `, 6 �� B.
C. Septic Tank- I. Size 6 2.
D. Seepage Pit: 1. Sizej/ X(o ?_,
Installer
Manufacturer
Material _ _
E.. Disposal Field: Total Length of Lines
8. Distances:
A. Wel). To: Septic Tank '
1 .,.SIO_ Absorption Area SU Sewer Lines
Nearest Lot Line� QQ , Other Contamination_
B, Foundation to Septic Tank'C�' Absorption Area
t� C- ,
C'. Absorption Arc�j to Nearest Lot line �3 p
Request for Approval of dividual Sewer & Water Facilit
Page Two
9. Comments:
Apr,roved llisapproved6 e
Date
Appro Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
ww:. u.x, v =u v Lue inrormation contained in this request for approval to he a true
and accurate representation of the subiW sewer and water facilities located at:
Signed, Uate�
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
J - Date Received___
X, .,
J ) Time of Inspection
/ _
Date of Inspection
G'O I REQUEST FOR APPROVAL OF
I T IVIDUAI. SEWER & WATER FACILITIES
FOR�r moi'%E
l.. Approval Requested By: / "YI.L�Li�� � L% /12�
Address:
" u
2. Property Owner:
3. Legal Descripti
4. Location:
Phone:
6
1 '11 A ..
5. Type of Facility to be Inspected:�r
Number of Bedrooms:
6. Well Data:
A• Type_..._._..-....__._
C. Construction��
7. Sewage Disoosal System:
A. Installed
B. Depth
D. Bacterial Analysis
on
C. Septic Tank: 1. Size
B. Installer
2. Manufacturer
D. Seepage Pit: 1. Size 2. Material
E.Disposal Field: Total Length of Lines
B. Distances: /
A. Well To: Septic TankA Absorption Areae—, Sewer. Lines
Nearest, Lot Line , Other Contamination ,
B. Foundation to Septic Tank `, Absorption Area
C. Absorption Area to Nearest Lot Line
Zequest for Approval of Individual Sewer & Water Faoilities
Page Two
Approved Disapprove Date--,/ y -D
Approval Valid for One Year From Date igned
Greater Anchorage Area Borough, Department of Environmental (duality
DIAGRAM OF SYSTEM
uUl��Ir .Lbk, 61le inrormation contained in this request for approval to be a true
and accura!:e -enrosentation of the suhiect sewer and water facilities located at:
Signed Date
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