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HomeMy WebLinkAboutT14N R2W SEC 11 LT 54 LESS N 150'T14N R2W Sec 11 Lot 54 Less N 150' #050-261-23 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: OSP161263 Tax Code Number: 05026123000 Work Type: Septic Initial Permit Effective Dates: September 26, 2016 to September26, 2017 Design Engineer: ANDERSON ENGINEERING Subdivision: T14N R2W SEC 11 Site Legal Address: T14N R2W SEC 11 LT 54 LESS N 150' G:0051 Owner/Address: TROY DAVIS HOMES INC 1689 KNIK GOOSE BAY RD STE 400 WASILLA AK 996547059 Site Mailing Address: 10309 VFW RD, Eagle River Lot Size in Sq Ft: 43858 Total Bedrooms: 4 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. Covered, sealed, and heated to prevent freezing. IsSpecial Provisions: Construction may proceed prior to 7 day ground water monitoring at your own risk. Received By: Issued By: ore, pricy P/346 CO -4'f /%7'6 Chun d f eid 9` o negfa tori oF' ���5 Date: °Ratifier Date: (/ 6/� MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-261-23-000 Property owner(s) Troy Davis Homes, Inc Day phone 250-4989 Mailing address 1689 Knik Goose Bay Road, Suite 400, Wasilla, AK 99564 Site address 10309 VFW Road, Eagle River, AK Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T14N R2W SEC11 LT54 LESS N 150' Lot Size 43,858 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: (Lf all that apply) Absorption Field ❑X Initial Septic Tank ❑X Upgrade Holding Tank 0 Renewal Privy ❑ Private Well ❑ Witer'Storage ❑ ¥#& le THIS APILICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: ❑X TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ( ure operty owner or authorized agent) Permit/Rush Fees: "/b 46 Waiver Fees: Date of Payment: UbJrl/t'D Date of Payment: Receipt Number 0 1?06 Receipt Number: Permit No. OSPl &l a4,3 Waiver No. Permit App_.:- :L� ANDERSON ENGINEERING P.O. BOX 246773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 12, 2016 Municipality of Anchorage Development Services Dept- On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T14N R2W SEC11 LT54 LESS N 150' Septic system design and permit application Dear On -Site Services Engineer: The owner of the above lot intends to construct a 4 -bedroom home on the lot, so we are submitting this permit application for the construction of a new septic system. The lot currently has an existing foundation, well, and septic system. The foundation and well will be used for the new home, but the septic system will need to be abandoned and a new system constructed. The attached site plan identifies the location of the home, existing well, and existing septic, 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 silt with sand and gravel mixed in (GM). Groundwater was found down at 12' and 14', and when checked later had risen as high as 7.5'. The percolation rate was determined to be around 1-2 min/in An application rate of 1.2 gpd/sf was used in the design of the absorption system. We are proposing to place a new 1250 -gallon septic tank with two shallow absorption trenches 5' wide x 38' long x 1.5' effective depth. The elevation of the distribution line will be 1' below the surface for a total depth of 2.5! Soil will be mounded 1.5' above the trenches A minimum of 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the septic system is relatively flat with a slight slope to the southeast. The new trenches will be constructed parallel to the slope as much as possible. They will be a minimum of 100' from all wells and surface water. There is a stream on the lot to the south, on the other side of the driveway access to this lot (and the lots to the east). The new trenches will be more than 100' away from this stream. There are no records for the existing septic system. The absorption field appears to be located where there are two existing PVC pipes in the ground. The new trenches must be a minimum of 10' from the abandoned field. If, during excavation, the field is discovered to extend beyond the estimated size to be within 10' of a new trench, that portion of the drainage rock must be dug up and replaced with soils from the site. 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 ]91 1 ' . ••.MN.•.••••y I War; CE 92 .•• a ,_110rass0,.%.4* :%\ 0r \( Z> Fq ° q § v1:11: s ±i z >0 % 0-- 2 [ y«. .,0c. m : K \ / y yz > S GV 11]M % T14N R2W SEC11 LT54 LESS N 150' DESIGN FACTORS: 600 GPD Peak Flow Perc. Rate: 1-5 Min./Inch Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: 5' Wide Shallow Trench System 1,250 Gallon Septic Tank 600 GPD / 1.2 GPD/SF / 5 SF/LF * 0.78 5' WIDE REDUCTION = 78 LF Trench Length THEREFORE: Construct 2-39' Long x 5' Wide x 1.5' Effective Depth Absorption Trenches. Flow Line Elevation in Trenches to be 1' Below Original Ground Surface. Total Depth to be 2.5' Below Existing Ground. Provide 2' Cover And Insulation Over Absorption Trenches and 4' Cover Over Septic Tank. Place Flow Splitter Valve to Insure Even Flow to Each Trench. 1'-6' 4' TO GROUNDWATER 6' TO BEDROCK 1'-6" /Insulation 5' 4" Perforated PVC (Holes Down) Drainfield Rock a *. 49111 1' e i IC"" c /�.ra.......». - a s :Beni to J Schiyn a CE -1z592 Zri TYPICAL 5' WIDE TRENCH SECTION NOTE: (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Nearby Wells. Minimum 100' Separation From Surface Water or Streams. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 2 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T 14N R2W SEC11 LT54 LESS N 150' PERFORMED FOR: TROY DAVIS HOMES DATE: 8-24-2016 PROJECT No PARCEL ID#: TECHNICIAN: W. ROBERTS 3 4 5 - 6 7 8 - 9 10- 11 12 13- 14 V 15 16 17 18 19- 20 TEST HOLE 1 OB/OG YELLOW SILT IN/ GRAVEL GM GRAY SILT/SAND WITH SOME GRAVEL BOH COMMENTS• - WAS GROUND WATER ENCOUNTERED? IF YES @ WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: DATE OF MONITORING: SLOPE YES 12' 11.5' 9-9-2016 • 01(49TH i\.*4 ' ll Benj in Schiller AE tIFBF�5,2010 PROF •. 12592 � Professional Engineers Stamp: SITE PLAN SEE SITE PLAN DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 8/24 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 3:17 0:00 0" 2 3:23 6:00 (DRY) 4" 3 3:24 0:00 0" 4 3:31 7:00 (DRY) 4" 5 3:33 0:00 0" 6 3:40 7:00 (DRY) 4" PERCOLATION RATE:1.75 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) 1hST RUN BETWEEN: 4 FT. and 5 FT. TEST PERFORMED BY ANDERSON ENGINEERING. I, BENJAMIN SCHILLER, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: AUGUST 24,2016 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 2 3 4 5 6 7 8 9 10 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T14N R2W SECII LT54 LESS N 150' PERFORMED FOR: TROY DAvls HOMES DATE: 8-24-2016 PROJECT No • PARCEL ID#: TECHNICIAN: W. ROBERTS 11- 12 13- 14- 15- 16 17- 18- 19- 20 TEST HOLE 2 OB/OG YELLOW SILT W/ GRAVEL GM GRAY SILT/SAND WITH SOME GRAVEL BOH COMMENTS- - SLOPE WAS GROUND WATER ENCOUNTERED' YES IF YES @ WHATDEPTH' 10' DEPTH OF WATER AFTER MONITORING: 7.5' DATE OF MONITORING: 9-9-2016 r P•' *:49 A\ •.*�0 frli t B9✓r,Aijimin Schiller if . t11F\FDPROFESS10Na�' r Professional Engineers Stamp: SITE PLAN SEE SITE PLAN DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: PERCOLATION RATE(MIN/INCH) PERC. HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. TEST PERFORMED BY ANDERSON ENGINEERING. I, BENJAMIN SCHILLER, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: AUGUST 24,2016 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 1.700 ELMORE ROAD ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 PERCOLATION TEST LEGAL DESCRIPTION: T 14N R2W SECT I LT54 LESS N 150' PERFORMED FOR: TROY DAVIS HOMES DATE: 9-21-2016 PROJECT No • PARCEL ID#: TECHNICIAN: W. ROBERTS PERK TEST 2 SLOPE WAS GROUND WATER ENCOUNTERED, IF YES ® WHAT DEPTH' DEPTH OF WATER AFTER MONITORING: DATE OF MONITORING Benj •u in Schiller #1 -*•P••. AEmLs12.2592 .. 7r k�ki P OFES510NP� Professional Engineers Stamp: SITE PLAN SEE SITE PLAN DATE READING GROSS TIME (MINurEs) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 9/21 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 2:08 0:00 0" 2 2:18 10:00 3.60" 3 2:19 0:00 0" 4 2:29 10:00 3.80" 5 2:30 0:00 0" 6 2:40 10:00 4.25" PERCOLATION RATE:2.7 (MIN/INCH) PERC. HOLE DIA. 4 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. COMMENTS. TEST PERFORMED BY ANDERSON ENGINEERING. I, BENJAMIN SCHILLER, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: SEPTEMBER 21, 2016 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T 14N R2W SECT I LT54 LESS N 150' PERFORMED FOR: TROY DAVIS HOMES DATE: 9-21-2016 PROJECT No • PARCEL ID#: TECHNICIAN• W. ROBERTS DEPTH (feet) 1 2 -0404 t* 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 0 TEST HOLE 3 OB/OG GM GRAY SAND WITH SILT AND GRAVEL BOH SLOPE WAS GROUND WATER ENCOUNTERED? YES IF YES @ WHAT DEPTHS 12.0' DEPTH OF WATER AFTER MONITORING: et.t DATE OF MONITORING- tc(3/i . .- tl ,4t .jr 'If F Be min Schiller rttPFss, • AsE L 112592• • ��a e. tkAlkfPROFESSION��� lZkieeekr Professional Engineers Stamp: SITE PLAN SEE SITE PLAN DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 9/21 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 12:33 0:00 0" 2 12:43 10:00 5.55" 3 12:44 0:00 0" 4 12:54 10:00 5.50" 5 12:55 0:00 0" 6 1:05 10:00 5.49" PERCOLATION RATE:18 (MIN/INCH) PERC. HOLE DIA. 4 (INCHES) TEST RUN BETWEEN: 4 FT. and 5 FT. COMMENTS - TEST PERFORMED BY ANDERSON ENGINEERING. I, BENJAMIN SCHILLER, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: SEPTEMBER 21, 2016 ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ‘1/4-4, ENVIRONMENTAL ENGINEERING DIVISION \825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 KV ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME y/�� / PHONE. j✓/ t% /A%s i Ba. wm2/ NEW k'LPGRADE MAILING ADDRESS 6• £o -13t, Ak, I` .7"7j C -1144 G.71 LEGAL DESCRIPTION (.nT sq Se c. I I Tip/,'! PraUJ LOCATION Mile_ /9 rQ,t1 �uay i e iakeas/ NO. OF pEpROOMS ,T /3 eery) SEPTIC TANK DISTANCE TO: Well ! k1077Ls e' ! Absorption area /.5- / welling / 10 PERMIT NO. ,C lq�✓LiaG Manufacturer Mate ' I �,uerat, No. of compartments ottiI Liq. capacity in gallons IF HOM MADE: Inside length Width Liquid depth a J(7Z o z < 2 I- DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well/t� / Foundation ao_30 Nearest lot lint' PERMIT NO.ne 306 No. of lines Length of chi Ione Total IP ' f lines �iJJCC ! Trericf i-,djh t d inches Distance betvvivb�a� /tA Top of tile to finish grade t 3 Material beneath tile �y (!? lP inches Total effect, bsorption area /C/Q 1 SEEPAGE I PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J w Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption creels) OTHER .It CC - PIP MATERIAL / MSrm 3°3�l /2Yc - �-s' Y SOIL TEST RATING iqo I INSTALLERn111 �A l 7— �s LJ�(}Et' .j ,0 REMARKS a I% i�� i (Ng (DeLL n ` ee POT z idd. et ii ''°i_ ._ q 77 ne c9,r ra_}.4 G . liiiiIn: a _04-r stispai-a, 01-)1 A`mCI to W vt ( 1-4 APPROVE DATE LEGAL % k teJ1 &/2 PM 72-dt (Rev. 3/78) MVr4 I C`- I IPFIL. I TY OF= FINC.=HoFcnec DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET: ANCHORAGE: AK. 99501 / c' 264-4720 or -4-s I TE sE WEEP_ tiP.ICxf$AC>E F"EF Pi I T PERMIT NO. •.( 790306 ) ��J din �/ QC$H ISYI S 1JY1 / lY l.l_( fl )L n V. APPLICANT BILL YATES P.0 BOX 243 CHUGIAK RK. 99567 688 9663" LOCATION MILE 14 GLEN HWYIE.R. BAKERY LEGAL L 54 SEC 11 T 14 1 R ltd 5. M. LOT SIZE 33750 SQUARE FEET gitt 9/ a6 79 chic/ TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS - 2 SOIL RATING (SQ FT/BR}= 146 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I5: CaEP'TH = E3 L.EF'-U3TH= 'flt2 OF fl VEL. DEPTH= f5 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS HO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I5 THE MINIPiJM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS NUMBER. OF RESIDENCES THAT THE WELL WILL SERVE. TLIO <2> I r-1SP'EC: T i oNs flF E f=zEQILI I E EC> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. DEPARTMENT DURING THE PROPERTY AND THE MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. P•Etv'm I T E {F" i FBEPI Er. EF? :1 . I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE , RESIDENCE co -e. RE�IO¢ELED TO IPcC UD ec; THANs-C) BEDRQOPIS. -�Q,� . ttWU�R ,t � co "� � � ri `i -•',u °t�.:^- e� J 'tom be (,� • �a SIGNED:_ APPLICANT BILL YATES ISSUED BY (;: 11/4142-.:1)"'“1 CXY\ ' vvv0-6QA3-1" Od" GCC `' c> DATE_'{ 1JA___ V3• SuN%•c- vim:% '. "' ` , �vfl� I ck0 a‘tis- -L\ 2Jjc4L a • &2, »os' Staven A. Johnson 13.0. Box 76 Chugiak, AK 99567 Phone: 907-688-3085 SOILS LOG — PERCOLATION TEST PERFORMED FOR: I )e. ena f.,, s ( f re -Vs � ` 9cL LEGAL DESCRIPTION: / ^v © n Lt®'#. C y SLOPE by,wy s 4i or- col) L(stw.,> s;11-, 1066c l V .,LS+ `.2,00‘11"/111(.1 atwit rtiti-rk st.flt caft.L-eI COP), lodSC ('fl ivte` JVh Ae,..vvvCid4 ,0041. ) ifhn �C-A 4, VUL•>V� Sh Vl``:1 grc.L,e-1 C&? P) M e tl i d t-.4 e^As f. / tine. 4. . J / ()ILL, 1 �,.� icr- o i WAS GROUND WATER ENCOUNTERED? � 0 P E COMMENTS N SOILS LOG o PERCOLATION TEST DATE PERFORMED: (14(y/ ) of f C N r IF YES, AT WHAT DEPTH? I (/ f Si LI ITE PLA 12 io son H O sc,✓►LL= ftt FA Illi` e Rea •' • • Date Gross Time Net Time Depth to Water Net • e • cis I- rear v IL c u:<.„ oyI (ft /n tit C, J 't n rrt' -:atm c r. T11. J� r P P lc Ii H O sc,✓►LL= ftt FA Illi` e Rea •' • • Date Gross Time Net Time Depth to Water Net • e • PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT it ME12f�O hA&OQPrrn l kR& I IE -Qu RI) E-A wi `OGS = 1,3c4i1/in r c PERFORMED BY: c4 coo, v,Sen" CERTIFIED BY: %�,� A /^U,...,—... DATE: (e I /61 ) 1 q in 1) MUNICIPALITY OF ANCHORAGE PROTECTION - " `-' ' 3 FACILITIES' 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL • 825 L Street - Anchorage, Alaska 99501 I. (1ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing. 1. PROPERTY OWNER -7—/' /� / r70MR S 1J 24 PnJ O MULTIPLE FAMILY • Three I• Six PHONE 699 -am r MAILING ADDRESS R 6 SD //25— `�l- ,3 . re"— '4( `/`9-57 PROPERTY RESIDENT (If different from above) //McA4/ i3eatt L1/7p Li ,u INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is required PHONE X70 26o/ 2. ---Bt €W .4g -Ar -e --f - 414S%4 /?4f -e J/4' <.NC. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. PHONE MAIL GDDRESS .-- AN© %3'�/ 21; 9, Z e ,f� t P3 /, , 22572 3. LENDING INSTITUTION (/ PHONE MAILING ADDRESS Qn va�1!y K 1 ce 4. REALTOR/AGENTPHONE 1 1 riNfT w a r J CAS MAILING ADDRESS - Zli o 13A ke 5. LEGAL DESCRIPTION t ' 1/1 &10) o/ COi'/0/y',jy fec/7O•s €ei✓ 6// 77/9c) !e -s7 A / STREET LOCATION fil / t /3 Xz c2<] C/e,w /? 6. TYPE OF RESIDENCE NUMBE F BEDROOMS Co Fi,c't.e`te e4 C- • One ■ Four OtheL y4..Q . ■ SINGLE FAMILY /31_ , t;u3- O Two MI Five O MULTIPLE FAMILY • Three I• Six 7. WATER SUPPLY IS. INDIVIDUAL*' *ATTACH WELL LOG. A well log is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well • PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is required • PUBLIC UTILITY by Department. this NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) A/��D5 drp5et•5,A VQy LSTA ) z/c /���L HIS SIDE FOR OFFICIAL USE ONL INSPECTION APPOINTMENTS DATE RECEIVED TIME 9 . , torn TIME I:e3n PM TIME I:SO Pin DATE -9 L. DATE 6 -II -7R (i h.. . - DATE .6-I-78 a../.. INSPECTOR �� y INSPECTO PPC(4 INSPECTOR car&b„' DIRECTIONS: 1. TYPE OF RESIDENCE O SINGLE FAMILY E MULTIPLE FAMILY NUMBER OF BEDROOMS O ONE IN THREE IN FIVE ■ OTHER O FOUR • TWO ■ SIX 2. WATER SUPPLY El INDIVIDUAL PERMIT NUMBER DEPTH OF WELL • COMMUNITY DATE DRILLED • PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM • INDIVIDUAL/ON -SITE PERMIT NUMBER DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER • Septic Tank or • Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: 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 I �T / , I -SI 'i?a 0 z "Y, /02_ ^ L /%c) z. C 7( S • APPROVE�FOR ,' �p BEDROOMS A • CONDITIONAL APPROVAL(lettermust accompany certificate) O DISAPPROVED DATE BY (Title) a 246 LEGAL DESCRIPTION 72-010 (Rev. 3/78) ? rMUNICIPALI`l`Y OF ANCHORAc. DEPARTM_ OF HEALTH AND ENVIRONMEI ), PROTECTION 825 L Street,'Anchoraae. Alaska 99501 264-4720 #1: Time 7/ f,(0, Date 2,/2,Q/7$- Insp ?e»T% Date Received: 2/x//281 #2: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES �,?f//� 4/ -lan G,cS/-;Zz1`f 1. r a 'nerlia- r itu_tion. Request:. / v0 C5A/ Jl /HGF. i Max-Ying Address: 1* j4o-n-s-- Ao. 333- o SK -s-6 Phone: 2. Property Owner: Mailing Address: 3. Legal Description: A/a ,&0.cdD OG S YS/t"dl 4: Si.,le Family Residence: ( ) Number of Bedrooms: Multiple Fam'tily`•esidence: ( ) Number oms• Post/ale 4-1-'i 6 cG4 or,es ,� t 'A5# ��tt 5. Well System: Individual well ( ) Counity/Public System ( ) Permit # Construction Depth of Well Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System ( ) Public Utility Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line to Nearest Lot Line Nearest Lot line Absorption Area ca.$ 7484.f/ /roar 0,c f�� P p;7vrets l9cce#7:464;