HomeMy WebLinkAboutT15N R1W SEC 8 LT 81A(11Sn Eta)
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Municipality of Anchorage Page f of__
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Name: ~:~Upgrade
~y ~. ~ Wastewater System: ~ New
Address:
~ ~o ~e~~ A~~ ABSORPTION FIELD
Phone~.~/ ~No. olBe~ms: ~OeepTrench ~ShallowTrench ~Bed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION SoilReting: O.~ GPD/Sq. Ft. ~
Lot: ~ ~ ~ Block: Subdivision: Depth to pipe bo~t0m from original grade: Gravel depth beneath~ pipe
Towns~ip:~I~ Rang e~/~~ Section:~ ~ ~,~'Fill added/~ ~tab°ve original~/grade:~ Ft. Gravel length:~ [ ~ Ft.
WELL: Q New~~pgrade ~ravelwidth: ~ /Ft. Number oflines:j iDis~n~ betweenlines: ,__ FL
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Yield:GPM I .,. Icasi"g He'g~Ab°~e G~°und:Ft. TANK
SEPARATION DISTANCES ~s~pti= ~ Ho~i~g ~ S.T.E.P.
~ro~ Tank Field S~ation Tank Sewer Lines ~T~~ ~0~
Material: Number ol Compadments:
Surface LIFT STATION
Curtain 3ump Make & Model ~ Electrical inspections pedormed by:
I
Remarks: ~ ~ ~ ~,~ BENCH MARK
Location and Oescrfptiom ~
ENGINEER'S SEAL
Inspections performed by: Dates: ls "'":~~""~ ' ' "'/
Department of He d Huma~erwces a -, .. ..-
Reviewed and approved by: ate:
Permit No.
~'lA~ c~ ~.0,~ ~" Page ~ of
Municipality of Anchorage
DEPARTMENT OF HEALTH AN[) HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box '196650 · Anchorage, Alaska 995'19-6650 · Telephone: 343-4744
On-Site Wastewater r)isposal System and/or Well Inspection Report
PID No' 0~'/0¢~.4~2
~'2-013 A (2/gl) MOA 25
Permit No. S6J~ ~ ~ ~Y.-~,c2,5'- Page "~ of '~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SFRVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: L~?--~'/,~ ,~- ~> T' I.T'~, f-J/,O
EN~O~,S~'S SSA'
~'v,.....
~ . ~ ·
,
~,~' David ~, Dayton
72-013 A {2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES.
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW930405
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:PALMER GEOFFREY L
OWNER ADDRESS:20429 OLD CRANBERRY DR
CHUGIAK, AK 99567
DATE ISSUED: 9/30/93
EXPIRATION DATE: 9/30/94
PARCEL ID:05109240
LEGAL DESCRIPTION: T15N R1W SEC 8 LT 8lA~
LOT SIZE: 44962 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
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 (iSAACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS: t'
ISSUED BY: _ . .
DATE:
DATE:
/'-I/
D, R. DAYTON, P.E., R.L.S.
~x~i~o~ Chugiak, Alaska 9951~7
20210 Donalar
Lot 8lA, Section 8, T15N, R1W, SM
This project is to install a new 5' wide x 100' long x 6.6'
deep trench with 3.6' gravel depth to replace a failed seepage
bed.
The system will have no adverse impact on wells or wastewater
systems on adjacent lots.
There will be no adverse impact on drainage or reserved areas.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'rEST
LEGAL DESCRIPTION: l.~T'' ~./"~-~ ~ ~', 7~'-N"/U, t'~)~Township, Range, Section: .~¢$
SLOPE SITE PLAN
6
7
8
9
10
11
12
13
15-
16-
17-
18-
19-
20-
WAS GROUND WATER
ENCOUNTERED?
L
IF YES, AT WHAT O
Oeplft to Waler After Oale'
M0nit0rinD? ,//'~ . -
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~1, ~ (m~nute$/~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~-~ ~--~-- Fl' AND ~'~'~'~ F'r
COMMENTS
PERFORMED BY: "P' j~ ' ~)e¥~/T'~') ~)~'" i '~) ~,~¢ -/--~-~' CERTmFY THAT TH'$ TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON 'FHIS DATE. DATE:
72-008 (Rev. 4185)
PEREORMEO EOR: .~--
LEGAL OESCR,ETION=J- -?/A
2
3
4--
9
6-
7
8-
9-
10-
11
12
13
14-
15
16
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
' (ENGINEER'S SEAL)
.. · .,,~.;,~ · :/. ?~..
Township, Range, Section: ~.~.~' ~"~ ~'~'A..J ~/' DC.J
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED7
iF YES, Al'WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~//: /'23 ~-
PERCOLATION RATE /~'.'~__ (minutes/tach} PERC HOLE DIAMETER ~ ~'f
TEST RUN BETWEEN ~' FT AND .~"__FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC'r ON THIS DATE. DATE: ....~'~/~
72*008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'I'AL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Tetephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
-- r/ ' - PHONE
NAME
LEGAL DESCRIPTION
LOCATION ~ . ~.~J ~= ) NO, OF BEDROOMS~
'~- Wet] Absorption area uwemng~_ ~.y. ........
~ i Manuf~cturer ~ ..... -~~-- /~ Materi~2~ / No. ofcompartment~
~'
~9~ DISTANCE TO:
~ -: ~ *vlanulac~urer
'J::~ DISTANCE TO: ~Wel' o~ /e/~ F°unOati°'l Nearest lot line PERMIT NO.
~ ~ m inches
Length ~ 1~ Width ~ IL' Dept,~ (.~ ~/{~'~ ~.,)~e~ ,.. PERMIT.O.~-.~
~ ~ Type ofcri~__ Crib dia~et~r Crib'~ Total effectiveab~i~.~>
~ " Slass
OTHER
:PR VED
Permit ,%
Applicant:
Location:
Legal Description: £or'
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: ~
The Required Size of
__ LENGTH
MUNICIPALITY OF ANCHORAGE
Department ~ Health and Environmenta ~rotection
825 ~ Street, Anchorage, AK. ~9501
264-4720
* * * HANDWRITTEN PERMIT * * *
--'W.F~C~I~~ON-SITE SEWER PERMIT.-~~ c~ . ,
~ "AZ, ~ Mailing Adaress.'~2
Phone Number:,~_~/
Seepage Bed: /--~ Holding Tank:
Soil Rating (sq. ft/br) Z~fi
the Soil Absorption Sy~m Is:
GRAVEL DEPTH - ~:-~~"WI])TH
The length dimension is the length(in 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(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet). ~.
* * REQUIRED SEPTIC(!'~J~]~I,I~rir~ TANK SIZE = ~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee~
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 $ B * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set f~h by the Municipality of Anchorage.
(2) I will ~ns~all th3~/system in accordance with codes.
(3) I z~nde~d t~//~he on-site sewer system may require enlargement if
~he re~/oi~e~ce~/~//remodeled to include more t~a~ 3 bedrooms.
SWP/024(1/81)
?¢STEI'"I. CI..IO0:51E 'THE OF'T]: ON THI':IT E:IEST F ]: TS "/OUR :~;.T.*I'E.
F'EF:hl ]: T.
:E; :[ G N El:;:,:
FIF:'F:'L. :t; E:FII',IT:
MUNICIPALITY OF ANCHORAGE
Department :. Health and Environmenta ?rotection
825 ~ Street, ~nchorage, AK. ~9501
264-4720
· ~Z]I/0 * * * HANDWRITTEN PERMIT * * * ._..Cc.4o~.z~(c~(.x.__
Permit ~__~.____ W~t~--~ND~-0R. ON-SITE SEWER PERMIT
Applicant:~~ ~. ~,C/'(.d Mailing Address: /:)(~Q-~3) 3~ ~'<'~O"C'~t-.._
Location:
Legal Description: L-~/ ~/ ~¥.~ ~/~-/%J~(~ Lot Size: ~ ~// etd) .... _]___
Type of Soil Absorption System Is:
Trench: '~rainfield: ~ ._ Seepage Bedl __ Holding Tank:
Maximum Number of Bedrooms: __~_ Soil Rating (sq. ft/br)
The Required Size of the Soii Absorption System Is:
DEPTH -'~i~ ~ LENGTH yO GRAVEL DEPTH ~--"~ WIDTH
The length dimension is the length(in 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(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet). ~ J'-~ ~-- /.,~-'&.~-~-,.~:_.
* * REQUIRED SEPTIC(HOL-i~'I'NG-)-' TANK SIZE = ~o GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
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. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
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 codes.
sewer system may require enlargement if
I und3~r-.~.and that/~e//~-site
(3) t h~e:dence i/~re~6~e: to
include more
Issued by:
tha~3' bedrooms.
SWP/024(1/81)
Date:
SOILS LOG
PERFORMED FOR:
3
4 --
5
6
7
8
9
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE SITE PLAN
10-
11
13-
14
15
16
18 -
WAS GROUND WATER ~,/~-~ I~
ENCOUNTERED? / ( ~E
IF YES, AT WHAT
DEPTH?
~/ ~ross Net Depth to Net
Reading Date Time Time Water Drop
2o-
PERCOLATION RATE {minutes/inch}
PERFORMED BY: ~ ~. ~, [~tll-.llklP,~f.,l~,lt:, CERTIFIED
72-008 (6/79)
/ MUNICIPALITY OF ANCRORAGE
· .! DEPARTMENT OF REALTH & ENVIRONMENTAL PROTI-'CTION
I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska .09501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL DESCRIPTION
~0 TION NO, OF BEDROOMS
J;Ma u agturer Material ND. of compartments
~ , Liq. capacity in gallons IF
HOMEMADE: Inside length Width Liquid depth
, ~ Well Dwelling PERMIT NO.
~ Manufacturer ---- Material - ~uid capacity in gallons
~ ~ DISTANCE TO', Well Near st lot line
~ ~ iN°'°flinesj Length~/~ Foundation~/~, 20--' PERMI~
-- .Top'of~to of each__ lin ~ ,~.~ Trenc¢~h Total effe~4~2sor t,
~ '~ ~ ~--t Total lengt, , ,,es inches Distance b , en Fines
D Mate[iai b~e?~ ~e ~ p 'on area
; Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Buildin~ foundation Sewer line Septic tank Absorption area(s)
OTHER
~OIL TEST RT~
INSTALL~ k ~
72- (Rev. 3/78)
PERHIT NO. < 780950
APPLICFINT
LOCFITION
LEGAL
DELBERT OTTER
CRFINBERRV (CHUGIFIK)
LB1 S8 TiSN RiW SM
LOT SIZE 43000 SQLIFiRE FEET
TYPE OF SOIL. FIE:SORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL. RFITING (SQ PT/E:R.'.,= 120
I'HE REQUIRE[:, SIZE OF THE SOIL FIBSORPTION SYSTEM IS:
[:" E:; F:'-r H :: :i3 L E~2 i'-,I I.] 'T' FI := JSIZ~ L3 I;.: J':l ',,,' E L. g, 1~2 P T t--I == ].~
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
THE DI'"'PTH OF' FI TRENCH OR PIT' IS THE DISTFtNOE BETWEEN THE 5URFBCE OF THE
GROUND AND TWE 80TTOH OF THE: EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OUTFFILL PIPE:
~3ND THE BOTTOM OF THE EXCAVFITION (IN FEET).
,-'RMIT FIF'PLICFINT HAS THE RESPONSIBILITV TO INFORM THIS DEPARTMENT DURING THE
INSTFILLFI'FION INSPECTIONS OF FIN'?' WELLS ADJACENT TO THIS PF.'.OPERT'?' FIND THE
NUMBER OF RESIDENCES THFIT THE WELL WILL. SERVE.
BACKF'ILLING OF FINY SVSTEM WITHGUT FINFIL INSPECTION FIND FtPPRGV~t. BY
DEPARTMENT WILL. 8E SUBJECT 1'0 PROSECUTION.
MINIMUM DISTFINC:E BETWEEN FI WELL, FIND FINY ON-SITE SEWFIGE DISPOSAL SYSTEM IS
:[00 FEET FOR FI PRIV8TE WFLL; OR
±50 TO 800 FEET FROM FI PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.,
O'rHER REQUIREMENTS MFIY FIPPLY. SPEC:IFIOFITIONS FIND CONSTRUCTION DIFIGRFIMS ARE
FIVFIILFIBI,E TG INSURE PROPER INSTFILL~TION.
I C'ERTIFY THFIT
±: I FIM FFIMILIBR WITH THE RE"QUIREMENTS FOR ON-SITE SEWERS FIND WELLS FIS SET
FORTH BY THE MUNIOIPI~LITY OF 8NCHORFIGE.
2: I WILL INSTALL THE SYSTEM IN FICCORDFINCE WITH THE CODES.
:g: I UNDERSTFIND TW8T THE ON-'-SITE SEWER SYSTEM MFIY REQUIRE ENLFIRGEMENT IF THE
RESIDENCE IE~, MODELED TO INCLUDE MORE TMFIN 1~ BEDROOMS.
S I GNE[:,: ....~ ...................
FIPFL ICRNT DELBERT OTTER
DEPRRTF. JE4'tff~"~.F HERLTH RND ENVIRONNENTRL PROTEOTION
RPPL]ORNT D~LBERT OT~ PO BOX 4q 688 ~5~:L
LOORT[ON ORR~ER~[HLI~[RK)
LEGRL LSi S~'iSN Ril4 SM LOT SIZE 43000 SQLIRRI~ FEET
TYPE OF SOIL RBSORBTION SYSTEM I5: DRRINFIELD .¢~ ,,,
MA~IMUI~ NIJMBER OF BEDROOMS = ~ SOIL RFITING :0~'~
THE REQUIRED .SIZE OF THE SOIL RBSORPTION::,Yi::.TEII '~ '~' IS:
[) PCIP TH==: :IL. 2 L-Ei%IGTI-I= -Ft Ei R If=t '..,." E L_
THE LENGTH DIMENSION IS THE LENGTH (IN FE:ET)
THE DEPTH OF FI TRENOH OR PIT IS THE DISTFINOE
GROUND FIND THE BOTTOM OF THE: EXCFIVRTION (IN FEEl'
TI~ENC;H !.~1 ][ I)TH I
THE OR. RVEL DEPTH IS THE MINIMUM DEPT~O~ ~RFIVEL
PERMIT RPPLIC. RNT HR~ THE RESPOhI~[B[L[T~ TO ~N~ORM
IN~TRLLRTION INSPEOTIONS OF 81 HELLS
NUMBER OF RESIDENOES THRT THE HILL~
-I'~ll) ( 2 ) [ F.ISI)I C:T I OF, IS
BROKFILLINB OF RNY ;Y~TEH WITHOUT :INRL
DEPRRTMENT N~LL BE UBJECT TO
MINIMUM DISTANCE FI HELL R~
t00 FEET FOR R WELL) OR
J,50 TO 2(.~0 FEET FROM PUBLIC
OTHER RE~UI REME:NT~ S
8VRILRBLE TO INSURE
ANS'
:LD.
OF THE
OIJTFFILL PIPE
~PRRTME:NT DURING THE
:'ROPERTY RND THE
UPON THE T'¢F"E OF' PUBLIC 14ELL.
BND CONSTRUCTION DIFIGRFIMS RRE
2: I WILL INSTRLL THE SYST~.M IN FICCORI)RNCE WITH THE CODES.
Z<: I U/4DERSTRND THRT THE ON*.SITE SEHER S~=,TE.M MRY REQUIRE ENLRRGEHENT IF THE
RESIDENCE IS~EMO~[LED ,TO INCLtJDE MORE THRN :~ BEDROOMS
FIF'PLICRNT DEl_BERT OTTER
L.
I CERTIFY THRT ;
1: I FIM FRMILIRR HI'rH THE FOR ON-SITE SEHERS RND HELLS R,?. SET
FORTH BY THE MUNIC:IPRLITY RN~HORRGE.
Steven A. Johnson & Associates P.O. Box 76, Anchora6e, AK 9956?
~H~,.~f - SEEPAGE PIT
Test' P~rformod for __.l~-~ ~.~t,_~J~> ~ ~ate S'tar'ted_~/
Number of~ Bedrooms ~ ...... Ts. nk Pumped .... ~___Yss No
(l) Test Volume (TV) =.~__.Bedrooms x 150 gal/Bedroom = ~"~,fO
(gal/in)
400
600 ...........................
1000 ........ ·
1~00 ...........
· - 18O0 -
(2) System capacity (SC) ~h~ gal'l~ns __gal/in
SP
(/-0 Fluid~ level drop (FL) =
1'able 2
o, ,5 --U-7% ...........
/pay I I ~A T
(6) Flui~ Lost (FL) = SC x 0SP24. - SP )
:P'e'~c,~].a't~on' ~aJte (PR = 6 7 ~alZday/bdrm
8
10
12
14
16
Steven A. Johnson
Box 76
Chugiak, Alaska 99567
Phone: 688-3085
Performed for
Legal Description
Test Pit Location
Soils Log
Percolation Test
I'+o 8
Total dep%h this test
AVERAGE ABSORPTION AREA P~EQUIRED FROM SOILS I~)G =
feet
I~-~' ft.2/bdrm.
~ATE NET TIME (Min.) NET DROP (In.) PERC RATE(Min/in)
Percolation rate
QGR ,
ANCHORAGE! AREA BO, " 'H
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPOR'r ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING AD[)RESS ~1~/~
LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MATERIAl_ .,~'1~ ~ L"
NUMBER OF
COMPARTMENTS
INSIDE WIDTH______ LI(AUID DEPTH
.LIQUID CAPACITY /F__.2~O GALLONS.
SE"EPAG E [)IT:
NUMBER OF PITS f__. DIAMETER 1[~' OR WIDTH (Z, LENGTNZq, DEPTH O'
LINING MAI'ERIAL .... CRIB SIZE: DIAMETER~LDEPTH DISTANCE FROM:
BUILDING FOUNDATION~O~ , NEAREST LOT LINE /~-~ TOTAL EFFECTIVE
WELL
ABSORPTION AREA (WALL AREA) L)~-~"
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE ~¥t CONSTRUCTION__ ~ ~1,~, DEPTH
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE SEWER LINE TANK
CESSPOOL
OTHER SOLJ RCES
APPROVED _ DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM /~(~.l
DISTANCES:
INSTALLED BY:
DIAGRAM OF SYSTEM
PIPE MATERIAL:.
LOT SLOPE: r~ ~ ~ I
REMARKS:
Form No. ED-031
DATE
{ I C.A.B.
GREATER ANCHORAGE: AREA BOROUGh
SI:WAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
FINANCED THROUGH
., OTHER
SOIL TEST RESULTS
WELL. TO SEPTIC TANK
WATER MAIN TO BEPTIC TANK , SEEPAGE PIT -
DRAIN FIELD
SEPTIC TANK, --/-'~--~ /' SEEPAGE PIT ~ ~/ DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
4 IN,~C~-I ~?~=~AMETER CA.~ST IR.~O~N SIPH~?N PIPES ON SEPTIC 'rANK AND seePAge PiT
GRAVEL ~ACKFILL,
CONFORM TO BOROUGH~~A ~G.~AO~.B~,~,,ULATIONS .... REGARDING INSTALLATION.
LICENSED DESIGNER
ORDINANCE NO, 28-68 AND THAT THE ABOVE
-NOTE:- , If community
attesting to th
72-025 (Rev. 1/91) Front MOA e21
'et system,' provide written cc
and Status of system.'
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 f urther 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.
Name of Firm S b S ENGINEERING Phone 6 °I - a' cl -7 °i
17034 Eagle River Loop Road No. 204
a+ti1..
•'�ita[CS"����.; � �`.� ',+ac f &MV
roved for �� bedrooms
at.>: 3 S'z adK''ud
isapproved gEY .,.c,¢}1° ,-A E'c...-}��.�y*�'%'�f0't't d.
y t f�tge`:
Conditional a proval for bedrooms,, the following stipulations
J ca,►»��:�� k .
A r +"lh �" �' §'int ��'�'�� t !k �.4 - b t'!tN-� g= '� t _ i k w'�Jf: •" �� a. �+t �:.pi4�.� SS "i�R f s.
' ��.} i -'�' �$�%5�.,R��'*�����lii �� y'"+,�.� �y?iit$dt�`��7 .�-�'.tit,f � t r,;.. ;� a .a f v.'�`,i- k�,��"�i�r r+*, .i d -f'� �•,':
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ed
X.
A¢ddit ora Cokmments - s
f
" i
'6i A4
�y I .. Date 9�
CAUTION
,The Muniftality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
ap roval Cwtifi `rt based only upon the representations
7 , ((�� , y p p 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-M (Rw. INI) Back MOA W
MUNICIPALITYOF gNCHO
ENVIRONMENTAL SERVICES p
weA
Municipality of Anchorage
U*j DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 2 6 7996
Environmental Services Division il
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) �?� V c A
Health Authority Approval Checklist tJ
Legal Description:- 6C, �� % /TAI ,Q, /4/. L o r ellY Parcel I.D.:
A. WELL DATA
Well type Ae2-dA7--'r-* If A, B, or C, attach ADEC letter. ADEC water system number
Log present&) igs Date completed 7-2 /— 73
Total depth Cased to 22 `7 Casing height (above ground)
Sanitary seal (ON) Xirf Wires properly protected &N) Y�.S
FROM WELL LOG AT INSPECTION
Date of test r ��
Static water level / d Z
Well production 6 g:p.m. 3,0 g.p.m.
WATER SAMPLE RESULTS: l
Coliform L-1 / % IS Nitrate O 11_74-"� , _ Other bacteria 10 Ll -7
Date of sample: 7 4A1,0 Collected by: S AA10 Y
_7-
B. SEPTIC/HOLDING TANK DATA
Date installed 9- 2-V-73A✓Drank size S-00 X,44 AV#4umber of Compartments Cleanouts ON) y
z �i-83 /sao 14,41 -
Foundation cleanout (Ye Al O Depression (Y/LQ N 0 High water alarm (Y/tq �4/0
Date Vlimping �` x r6 Pumper LBS �u.� i°- "�✓
C. AB$611110TION IFIELD DATA. "
Date iristalled A0 �}' 3 , Soil rating (..d./ 2 r ft2/bdrm) a - System type .rh',41-406 T,eR"HGH
Lenthe `,` Width Gravel thickness below pipe 2"
Total depth _
Monitoring Tube present &N)� Depression over field (Y/O NO
Effective absorption area 2W
Date of adequacy test 7—/-96 Results as ail) 1*4X-(S For bedrooms
Fluid depth in absorption field before test (in:); 40 Immediately afterZ%gal. water added (in.): V
Fluid depth y (ins) Minutes later:
Absorption rate =
71"0 -/- g.p.d.
Peroxide treatment (past 12 months) (Ya
Al a
If yes, give date
72-026 (Rev. 3/96)"
D. LIFT STATION
Date installed' '�" �-� Size in gallons 3 O
Manhole/Access,ON) Yi5S "Pump on" level at* Ar %z, ""Pump off" level at*
High water alarm level at*Ng^,z Aea. .4r rrAtg *Datum 0 07-7-Ce-,
o
'o, zNt T,
Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
ep Iding tank on lot ` On adjacent lots D
Absorption field on lot ,/O O r f On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line 7S_ ! Lift station
SEPARATION DISTANCES FROM EPTI OLDING TANK ON LOT TO:
Foundation r4 /7' i Property line d e- Absorption field
Water main/service line Surface water/drainage /00 �4 _ Wells, on adjacent lots'/ /1
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: r
Property line 2S' �� - Building foundation �� �f Water main/service line
Surface water %CJ O' Y— Driveway, parking/vehicle storage area
Curtain drain N o N Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
I certify that i have determined thru field inspections and review of Municipal records t 2s are,
in conformance wifh M A H delines " effect on this date:
Signature * 9
Engineer's Name IPo i,R r C• o
R08�Rr. CCCINAN��
Date
7 � o1 f4 � � f CE-88 I
HAA Fee $Waiver Fee $
Date of Payment Date of Payment
Receipt NumberReceipt Number
72-026 (Rev. 3/96)*
96 09:20 CT&E ESI ANCHORAGE 4 9076941211
NO. 3. Z..
CT&E Environmental Services Inc.
Laboratory Division >•sriiirr�a�it► irir�irel►s►rr.�r.�r
`eater Analysis Report for Total Coliform Bacteria 100 W. Potter Drive
Anchorage, AK 9951
C.'CTIONSONREVERSE SIDE BErQRECOLLIEC'TINOSAMPLE Tel: (907) 562.2343
Fax: (907) 561-5301
N1 UST BE COMPLETED BY WATER SUPPLIER
LID, (- WATER SYSTEM T.A. 9
`'. N/ATE rvATER SYSTEM
l ,(e✓ulls Send Invoice
—P-7: unc On1iC{ggRW
69y�rz,1
.-':JntiVrr ax 4M er
,,�
-- -- ,tau zip o��
;ul Reluff, ❑ Send Invoice
7 T.— C76ntovt nafne
Mill Zp Clade
C DATE EE
Month
eat ;5,en)nic (for} ouytinc Samplc
re f, o o,
s'. t_a)1f- \TION
CA),AIO. Lor VIA
� A u C r -r
F17 -LI
Day Yen
0 Treated Water
1W Untreated Nater
Time rBy
lected
Collected
Xv o y
11 Ptcaac Priur
TO BE COMPLETED BY LABOI2A7::>r''
Analysis shows this Watcr SAMK-E to
Satisfactory
o Unsatisfactory
O Samplc over 30 hours old, results I
be unreliable
o Sample too long in transit samp;c
not be over 48 hours old at exani4i .
to indicate reliable results.
new sample via special delivery t wi i.
Date Received S
Time Received
a
Analysis 13agan t1 727
Analytical Method:
,a—Membranc s'i'
a MMO-n-tuC
Number of colonies/[ 00 ml.
L//ab Ref. No,
Result"
Sent to A.D.ES.C.
Anch Fbks Jun
Dute: Timc,
Client notified of unsatisfactory .•e:j',:3°
Phoned Spoke with
Dutu: 1 imc,
BACTERIOLOGICAL WATER ANALYSIS RECORD
)INIO-MUG Result: Total Coliform E. Coli
",'jcml)rttnc Filter. Direct Count ColoniestlGo ml
Verillcation- LTB - 13GB COLIFIRM _ r-NrC e 7 ,, w,"..
A ecal Coliform Confirmnti(in 01)-OrlrerY!",i
rrin;tl Membrane Filter Results Coiirorm1100 mi
Deported by -ft Date 7 Time ... G " _[,(� hrs
11
JS Member of the SGS Group (Socidtb Gtn6rele de Surveillance)
T . FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN. MISSOURI. NEW ,JERSEY. OI -X. v
CT&E Environmental Services Inc.
'AztL Laboratory Division iiiiiiiiiiiiiiiioiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii
Laboratory Analysis Report
CT&E Ref.# 962740.962740001 Collected Date 07/08/96
Client Sample ID SEC.,T.15N,R.1W,L.81A
Matrix Drinking Water Technical Director: Stephen C. Ede
PWSID 0 Released B3!5--��m `
Sample Remarks:
Parameter
Nitrate -N
Total Coliform
Results QC PQL Units Method Allowable Prep Analysis Init
Qual Limits Date Date _
0.100 U 0.100 mg/L EPA 353.2 07/09/96 EMB
cot/100mL SM18 9222B 07/08/96 TAV
U Undetected
LT Less than
GT Greater than
D - Secondary Dilution
J - Below the calibration range
c
200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301
3180 Pager Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
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D. R. DAYTON, P.E., R.L.S.
~~ Chugiak, Alaska S9567
20210 Donalar
696-2417
August 12, 1993
ADEQUACY TEST
Legal Description: Lot 8lA, Sec 8, T15N, R1W, S.M.
Date of Test: August 11, 1993
Septic Tank: 1000 & 500 gal. steel tanks
Absorption System: 30' x 40' seepage bed
Soils Rating: 125 sq. ft. per bedroom
Requirements: 5 BR - 750 gallons per day
(DHHS Records)
(DHHS Records)
(DHHS Records)
Test:
The seepage bed was tested by repeatedly pumping water into the
bed via%the'lift station. The volume, time and water level in the bed
were measured. After pumping was stopped, the water level drop was
measured at timed intervals.
The results were plotted on a graph of time and gallons absorbed
and extrapolated to 24 hrs.
Results:
The seepage bed is currently functioning adequately for a 5 BR home.
D, R, AYTON, P.E,, R.L,S,
~]t~x~[~ Chugiak, Alaska 99567
20210 Donalar
696-241'7
August 12, 1993
WELL FLOW TEST
Legal Description: Lot 8lA, Sec 8, T15N, R1W, S.M.
Date of Test: August 11, 1993
Well Depth: 245'
Static Water Level: 155'
Requirements: 5 BR - 750 gallons per day
Test:
The well was tested with the existing pump through an outside hose
bib. Volume, drawdown and time were measured at regular intervals.
Results:
The well produced 778 gallons in 210 minutes at an average flow
rate of 3.70 gallons per minute.
The maximum drawdown was 23'. The well recovered 18' of the drawdown
within i hour.
The well is currently producing adequately for a 5 bedroom home.
COMMERCIAL TESTING ar ENGINEERING CO.
ENVIRONMENTAL LAE~ORA'T'ORY SERVICES
5633 B STREET
ANCHORAGE, AK 99518
TEL: (907) 562*2343
FAX: (907) 561-5301
O~,.'[eL'ed Bi/ : Ropoyk Colgp:l e't;eO :~)8/~ 0/93
P~;o;)ect Nolae : Co].].eckcd ;08/05/93
Member of the SG$ Group (Soci~t~ GOnOrale de Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OFIIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
MUNICIPALITY OF ANCI4OFIAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRU FECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR FIEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ._~ _,
GENERAL INFORtVIATION
(a)
(b)
Legal Description (inclede lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name ~. ~//~;¢' ~ Telephone: Home D~2:Z-¢"-, ___ Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/budder.~q:; Buyer E.I; Other L~ (explain);
(d) Lending Institution Telephone
Address
(e)
Real Estate Company and Agent
Address
Telephone ..............................................
["¢~tI the FIAA to the following address:
TYPE OF RESIDENCE
Single-Family/~ Multi Family []
Number of Bedrooms '~ ....
Other
WATER SUPPLY
Individual WeIl~_( Community ~,1 Public [~
Note: If commun ty well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsito?~" F)ublic [] Community [] Holding Tank F_]
Note: If community well system, must have w~itton confirmation from tho State Dopartmont of Environmental Conserwition
attesting to the legality and status.
5. ENGINEERING FIRMPROVIDINL .,iSPECTIONS, TESTS, !:ILE SEARCH, DA, AN[) INFORMATION ' ' '
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 shows that the on-site water supply and/or wastewator disposal system is safe, functional and adequate
for tile number of bedrooms and type of sb'ucture indicated berein. 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 ie effect on
the date of this inspection.
Name of Firm
Telephone
Approved 'x Disapproved ................. Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and t:nvironmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in i)aragraph 5 above by aa independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their Iending
institutions in order to satisfy certain federal and state requirements. 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 tbe
professional engineer's work.
Page 2 of 2
WELL DATA
Well Classification
Well Log Present(C~/N)
Total Depth
Static Water Level
~UNICIPALITY OF ANCHOP~GE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT, OF HEAD~-I &
HEALTH AUTHORITY APPROVAL (HAA) EN~I~Nf~ PROfEClt~
c. c UST- OEO 0
264-4720
Legal Description: ~1~[:~~
c~. If A, [~, C, D.E,C, Approved (Y/N)__
Date Completed _~ - 2'~-4 ~ "~'~ Yield
Cased to ?-'BT ~ Depth of Grouting
~'~ Pump Set At L-)~~,4''-,
Casing Height Above Ground ~'~ ~'' Sanitary Seal on Casing
Electrical Wiring in Conduit (Y,f¢~_'~.,,.~ ",~-.- ~'~P¢¢'~¢, Depression Around Wellhead (Y/'~
Separation Distances from Well:
To Septic/fC~ldirig Tank on Lot ~ ~=.¢~ I ¢¢ ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lpt ~. ,:~'-F ; On Adjoining Lots
To Nearest Public Sewer Line ~ /~' To Nearest Public Sewer
Cleanout/Manhole V ~/~, To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~ E:~ ~-,~t~__::~=,¢~l,~; Date ~! ~-2~-~
Water Sample 'rest Results
Comments ~¢'~_%.~ ,--/l~-%,.r'~ "1~=¢-~,'r Z~-:r,,,5~%-r~-~.~,
SEPTIC/~ETtlNG TAN[( DATA
Standpipes ~.'~/N) Air-tight Capsd~/N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Mel~rrg- Tank:
To Water-Supply Well
To Property Line \
To Water Main/Service Line
Course __ t,5/~.
Comments
Page 1 of 2
72-026(11/84}
Foundation Cleanout (Y,f~_
; for
Temporary Holding Tank Permit (Y/N) _
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~,-¢.. ~ ~ ~ ~.y-2~
Width of Field '~¢2~'''
Square Feet of Absorption Area
Depression over Field (Y~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ ~
To Building Foundation ,.....~:~l ~
Lot .,~ ¢=,.I ~.~_._
Type of System Design
Length of Field
Depth of Field _
Gravel Bed Thickness
~ Standpipes Present ¢~N)
Date of Last Adequacy Test
To Water Main/Service Line 'L~ ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ,.~:~_) I jo._
To Cut~ank (if present) ~/~
Comments
D. LIFT STATION
Datelnstalled ~'~'~ I --~--~ Dimensions "-.~] ~::::~,,.4~, ~ ~t ~
Size in Gallons ~ ~ ~ ~ Manhole/Access~/N)
"Pump On" Level at ~'~ ~ ~'
~ 0¢ ~- "Pump Off" Level at ~ ~.
High Water Alarm Level at ~ Vent ~N)
Tested for ~ Pumping Cycles during Ad~cy Test. Meets MD~
ElectricalCodes~¢~ ,~h~ ,~ ~,~ ~ Q~ ~~
Comments ~ ~o~ ~ ~ ~¢ ~Ol~ ~'~ ¢
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have ch, ecked, verified, or conformed to all MOA and ICAA guidelines in effect on the date of this inspection.
$ & 5 E ~gmeer/ng
Signed SRO3 ,g&~ Date
CompanyEagle Rive~- A asl~..,.~.95.~.~' MOA No
Receipt NO. ~'-~-¢' ~_
yme,t
Page 2 of 2
72-026(11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVI FIONMENTAL PROTEC'i'ION
825 L Street - Anchoratm. Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEFI FACII~ITIES
DIRL-'CTIONS= Complete all parts on page 1. Incomplete requests will not De processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
MAi LiNG A. DDj:{~SS-,~) (~' .- , ·
PROPERTY RESIDENT' (If-different from abovel
2. BUYER
MAILING ADDRESS
3. LENDING INSTITUTI/ON
PHONE
PHONE
PHONE
MAILING ADDRESS
4. REALTOR/AGENT,
5 7'7
MAILING ADDRESS
5, LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
~ One ~ Four
~ SINGLE FAMILY
~ Two
MULTIPLE
FAMILY
~ Three ~ Six
7. WATER SUPPLY
INDIVI DUAL~
COMMUNITY
[~- PUB LIC UTi LITY
8. SEWAGE DISPOSAl. SYSTEM
.~' INDIVIDUAL/ON-SIT[:**
[~ PUBLIC UTILITY
[] Other
* ATTACH WELL LOG. A well Icg is required fei' all wells drilled
since June 1975. For welds drilled prior to that Gate, give well
aepth (attach ~og if available,)
'*If individual/on-site, give installation date
If s~stem is over two (2) ,/ears old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING (;AN BE INITIATED.
72-010{3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
I. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~3 INDIVIDUAL/ON -SITE 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
[~T;]'~APP R OV E D FOR .~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title) J
LEGAL DESCRIPTION
72-010 (Rev, 3/78)
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PLATTING OR PLANNING AND ZONING CASE REVIEW
CASE NUMBER S-4838
PETITION FOR
DATE RECEIVED
REZONING
SPECIAL EXCEPTION
VACATION
RE6UBDIVISJON
OF R.E. Johns, Jr. & Assoc. for Plat of Lots 8lA & 8lB
---the subdivision of Lot 81, Sec 8, T15N, R1W, S.M. Ak
located in SW 1/4 NE 1/4 Sec 8, T15N, R1W, S.M. Ak
containing 2,40 acres
COMMENT TO PLANNING BY
MaS 23, 19780R MEETING OF June 7, 1978
COMMENTS:
ENVIRONMENTAL SANITATION:
PUBLIC WATER NOT AVAILABLE
Cases
PUBLIC SEWER NOT AVAILABLE TO SERVICE PETITION AREA.
ENVIRONMENTAL ENGINEERING:
71-014 (9/76)
78 ~
