HomeMy WebLinkAboutT12N R3W SEC 22 LT 22 S2S2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251092 Work Type: Septic Upgrade Tax Code Number: 01514139000 Site Legal Address: T12N R3W SEC 22 LT 22 S2 S2 G:2636 Site Mailing Address: 4715 E 112TH AVE, Anchorage Owner: CHUGACH CAPITAL LLC 50% & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 4/9/2025 4/9/2026 55275 2 Disposal Field Q 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 Received B "� `� -� ram!-� y: f- Date: Issued By: Date: t � 4 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-141-39 Property owner(s) Dan Potts Day phone 907-322-3267 Mailing address 4241 Tahoe Drive, Anchorage, AK 99502 Site address 4715 E 1 12th Ave, Anchorage, AK 99516 Legal description T12N R3W SEC 22 L22 S2S2 Number of Bedrooms 4 Engineering Firm Forge Engineering Building Permit Number APPLICATION IS FOR: M all that apply) Absorption Field ED Septic Tank Holding Tank ❑ Privy ❑ Well ❑ Not Applicable nN APPLICATION IS AN: Initial EJ Upgrade F] Renewal R THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: Permit/Rush Fees: Waiver Fees: Date of Payment: — Date of Payment: Permit No. 09 Waiver No. April 7, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T12N R3W SEC 22 Lot 22 S2S2 - 4715 E 112th Ave Septic system design Dear On-Site Services Engineer: The owner of the above lot intends to build a 3-bedroom home on the property, but does not have the specific plan completed at this point. They have asked for us to design a septic system with the building location to be determined later. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot slopes very mildly from the east of the lot to the west. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Contours on the plan show the direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached test hole log, plan and section pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251092, Curtis Townsend, 04/09/25 // // // // // / / / / // // // / / // // // // // // // // / / / / CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 1"=40' T12N R3W SEC 22 LOT 22 S2S2 FEET 0 40 80Benjamin Schiller CE 12592REGISTEREDPROFESSIONA L E N GINEER 4/4/25 SEPTIC PLAN PLANNED HOME LOCATION 2CO TH#1 EAST 112th AVE OVERHEAD UTILITY LINE 33' ROAD-WAY EASEMENT (PATENT 1137195) 15' ACCESS EASEMENT (B363 P334) 460 470 CO COMT MT 50' LONG x 3' WIDE, 6' EFFECTIVE DEPTH ABSORPTION TRENCH DECOMMISSION EXISTING SEPTIC SYSTEM PER UPC NEW 1250-GAL SEPTIC TANK EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251092, Curtis Townsend, 04/09/25 T12N R3W SEC 22 LOT 22 S2S2 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 3' 6" 4'-6" 6' DESIGN FACTORS:SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW PERK RATE: 12 MIN/IN APPLICATION RATE: 0.8 GPD/SF DEEP TRENCH SYSTEM 1250-GAL SEPTIC TANK BOTTOM OF TRENCH: 11' BELOW GRADE FLOW LINE ELEVATION: 5' BELOW GRADE 450 GPD / 0.8 GPD/SF / 6 DEEP / 2 SIDES = 46.9 LF TRENCH REQUIRED (50 LF SPECIFIED) GEOTEXTILE FABRIC 6" 4/4/25 PROVIDE ADDITIONAL FILL TO ACCOUNT FOR SETTLEMENT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251092, Curtis Townsend, 04/09/25 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING DEPTH TO WATER AFTER MONITORING 12 2/18 1 2 3 GM (SILTY SANDY GRAVEL) Professional Engineers Stamp: T12N R3W SEC 22 LOT 22 S2S2 2/18/2025 015-141-39 BOB BRADLEY 1 0/16 OB 30 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER PERC TEST LOCATION TECHNICIAN: J. EARLS 3 15/16 0 2/25/25 COMMENTS: SITE PLAN 2 15/16 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 4/4/25 MOISTURE NOTED AT TIME OF DIGGING? 1 0/16 30 3 7/16 2 7/16 1 0/16 30 3 8/16 2 8/16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251092, Curtis Townsend, 04/09/25 x LOT 23 UTILITY PEDESTAL REBAR S 00005'00" E 165.00' LT, ii CD O O O O N1/2 S1/2 0 LOT 22 M W N C37 w ASPHALT DRIVEWAY II S1/2 S1/2 LOT 22 - - 54,370 sq. ft.-- SEPTIC STANDPIPES SEPTIC - YS' MANHOLE TEST HOLE POLE I I n GUY I ANCHOR Z w Ia �a Iz gw75 I U) Q g w I Q g� p I Q O i•� M wIz J p IH u w w 0 ------------ -- _-— - - - 15'ACCESS EASEMENT (B363 P334)--- - - - - _-__GRAVEL DRIVEWAY -_- - - v N 00005'30" W 165.00' LOT 21 ---- ---r UNLESS OTHERWISE NOTED, EASEMENTS OF RECORD ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. x Iw xz ILL LU Z LU Q s N H U) Q LU LLB O7 N >M O O O O O ini NOTE DRIVEWAY LOCATION IS APPROXIMATE DUE TO SNOW AND ICE COVER. 0 20' 40' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: S1/2 S1/2, LOT 22, SECTION 22, TOWNSHIP 12 NORTH, RANGE 3 WEST, SEWARD MERIDIAN ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS SHOWN IN RELATION TO THE PROPERTY LINES. DATED THIS 27th DAY OF FEBRUARY, 2025, AT ANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services WWW.FIXEDHEIGHT.COM 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 JOB # 25037 I NO CORNERS SET THIS DATE I SCALE 1" = 40' ~'~MUNICIPALITY OF ANCHORAGE~ Hea % and Environmental Prote Fourth Floor West 825 L Street Anchorage, Alaska 9950] 279-2511, x 224, 225 INSPECTION REPORi' ON-Sil'E SEWAGE DISPOSAL SYSTEM b~R OF DISTANCE ~f _ ~ _MAFFRIAL _~ FROM WELL__~¢_'~ -- MANUFACIDRER INSIDE LENGTH ........... INSIDE WlDllt LIQUH) DEPfH .... LIQUID CAPACITY~ALLONS. ................. - ........ TILE DRAIN FIELD: / TOTAL LENGTH [)EPIH OF FILTER / DEPTI : TOP OF TILE TO FINISH GRADE ~.. MA'[~ RM~L L~ENEA1H TILE SEEPAGE PIT: DIAMETER --.-- OR WIDTH ~_, LENG fill ..... OEPTN Log Crib Rings BUILDING FOUNDATION .... Crib Size: DIAMEIE:~ .... DEPTH_ __DIS-fiANCE FROM: WELL ]OIAt_ EFFECTIVE NEARESq LOT LINE ..... ABS©RPTION AREA (WALL AREA) _____SQ. F'I. Nell /("~ . Class:~.~/~ Depth. Well ~istance To: Lot Bldg:~2~. Sewer Line:/~'--J Pipe M~te~ls: ~,~~,1 # of Bedroom¢:,~__~__ FENMI I NO. flPF'L I CFIN'I' t_OF:AT I ON L_EGF:;I_ LOCKE E~<C:RVA"FING E:OX ±2:L SRA 'rH AVE. I_OT :~;-z 'F±2N R~:W qEC zz _,t, ,_ ~- -4.4 ~.b ...... L.O'f' --,I,sE 44000 SQOARE FEET TYPE FIF ..-:.,_.ti... HB:,LE.E, I iEN SYSTEM tS: ]REN-.H NAXiMUM NUHE, ER OF E~E[:,ROOM':~ = q: SOIL RATING (Sbl FT,--BR. = '125 THE REQUIRED q' ':-; ..... '-"-F '" ~' ' - '-' "= .... _1ZE OF THE ~JIL HB~,JRETIuN -~'r_TEN IS: :'FIE I_ENGTH DIMENSION IS; 'THE LENGTH (IN FEE]") OF THE TRENCH OR DRAINFIEL. D. THE DEPTH OF' R 'TRENCH OR PIT iS THE: DISTANCE BETWEEN ]'HE SURFACE OF THE GROLIND AND THE BOTTOM OF' THE E',.'::CAVATION (IN FEE7'). THERE tS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS; THE MINIMUM DEPTH OF' GRAVE:[.. BETWEEN THE OLITFRL.L PIPE AN[) THE BOTTOM OF THE EXCAVATION (IN FEET). It-~1 D.J C;!! Lit ]; F-.'. E] E-':, .¢----; EJ F' "lf' X C: ']- R I'-41 k:] $ I.=-_ E----' "-- -j_ £.-1 [;-ii ,:Zi L'~ H L.. LJJ li'-41_.. F"AI:::i-<] Fll.~iE F'L. RN'T' ~])F"'I" .t: Eli-4 R PACKAGE PL. RNT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJEC:T 'f'O THE FOLLOWING CONDITIONS: i. EI]"HER a CLASS; I OR Il NSF APPROVE[) PLRN'I' MA'T' BE INSTRLLE[:,. 2. A CONTINUOUS MAINTENANCE AGREEMENT tS REQUIR. ED. iF A HAINTENRNCE AGREEMENT i~ NOT KEPT CURRENT MOLl MAY BE REQUIRED TO ENL. RRGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE StJBJEC'f TO PROSECUTION. "F L--lIE, ,:J 2 :;, X i'-.t'..]~-';F'EIL'.:'IF' ]: C,~-,t$ IFtF-: E F.."E_'i:?L.Ii X c; ,~,,-' '"' ,. BACKFILLING OF ANY _~r_ IE. fi WITHOUT F'tNR/. INSPECTION AND, APPRO'¢F~L E:'T' THIS [:,EPRRTMEN'I' WIL. L 8b .=,UE, JEL.] TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL. AND ANY ON-SITE SEWAGE DISPOSFIL SYSTEM IS :t00 FEET FOR FI PRIVA'f'E WELL OR 200 FEET FOR a PUBLIC WELl... OTHER REQUIREMENTS MaY APPLY. SPECIF'ICRTIONS AND CONSTRLICTION DIAGRAMS ARE AVAILABLE TO INSORE PROPER INSTALLATION. i CERIlFY I"HR'I ±: I AM FAMIt_IAR WITH ]'FIE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AE; SE1' FORTH B'¢ THE MUNICIPALITY OF ANCHORAGE. 2:: I 14ILL iNS'TALL THE SYSTEM IN ACCOR[:,RNCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER S'¢STEM MAY REQUIRE ENL. RRGEMENT IF THE RESIDENCE IS REMODELED TO INCLODE MORE THAN 2; BEDROOMS. Vi:. 0 CONSULTING GEOI_OGIS¥ Performed for Location ~c~- ~ ~g_ SOILS LOG Soil Type Water Level Remarks 4 16 18 2O Total Depth of Excavation Groundwater ~. Not Reached Depth, if Reached Classification Method Visual Sieve Analysis () Material at Total Depth Bedrock ~ Not Reached Depth, if ReacheR Gary F. Player, Consulting Geologist ~ ,, APPLIC ~IT FILLS OUT UPPER HAt/J'~ONLY Address ~.) (Y', A L- [-~ ./ ~.~. (~ , Zip Code Lending Institution Address Zip Code Realty Co. & Agent ~O p~,5~ / ~-~ ,){~ %~X ~zx ~ ~ t-~ ~ Phone Legal Description ~ Wate~ Supply 'lndividual A~ACH WELL LOG. A w~l Jog is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public UBJity: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Insp~ctor Inspector Field Note~,;. ~1,~. MUNICIPALITY OF ANCHOr( /.~~- DEPT. OF H~ALTII ff~ ~~ ENVIRONM:NTAL P~OTECrlO ,)j)~ DEC '1 o . CEIVED (~ APPROVEO BEDROOMS /~ ~ --~ ( ) mSA~PROVEO 8oils Rating Dale ~wer Installed Well TO Absorption Area Well Log Received ;~ ~ ? Well to Tank 8eplic T~k Size / ~ ~ ~ 72-023(3182) ALASKA [1UII OrlmI rITAL COrITI OL InC. DECEMBER 14 1983 MR. SUTHERLIN 8301 BRAIRWOOD SUITE 101 ANCHORAGE AK 99502 SELLER - SCOTT LAMKIN BUYER - SUBDIVISION - T12N R3W SECTION 22 S 1/2 S 1/2 ADEQUACY TEST FOR SEWER SYSTEM BLOCK - 0 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 375 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 500 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 500 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 2 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 12/16/83 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1001 IS ADEQUATE FOR THIS 2 BEDROOM HOUSE. 1200 IJJesl 33r~1/~uenue, Suil¢ [~ · Anchordqe, AI.skQ 99503 · (907) 276-1361 DATE RECEIVED INSPECTION APPOINTMENTS T_{,MI~ TIME TIME DATE DATE DATE I NS p E CT~,~ ~,~_xX. INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION DEC 1 0 1979 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~~ DIRECTIONS: Complete all parts on pa~e 1. Incomplete requests will not be processed. Please allow ten (q O) days for processing. MAILING ADDRESS PROPERTY RESIDENT (If different from above) / PHONE MAILING ADDRESS ~3, LENDING INSTITUTION /~- 5. LEGAL DESCRIPTION [ R-%o I STR EE~' LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Other__  Two [] Five Three [] Six 7. WATER S~PPLY ~ I NDIVI DUAL* * ATTACH WELL LOG. A well Icg is~d--~r~l wells drilled [] COMMUNITY since June 1975. For wells dri¥'~prio.r_t__oo that_~, give well [] PUBLIC UTI LITY depth (attach Icg if available.) 8. SEWAGEAGE/DISPOSAL SYSTEM ~ '"~ INDIVIDUAL/ON-SITE** f YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY , . 1. 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 []INDiVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER •SepticTankor •HoldingTank L~,'~ I t~ -~ -] Size: ~/~) O If Tank is homemade SOILS RATING give dimensions: TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~ CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED 72-010 (Rev. 6/79) ~ MUNICIPALITY~F ANCHORAGE DEPT. OF'I;~ALT~I :& DEPARTMENT OF HEALTH & ENVIRONMENTAL PRC~I~(~N,4ENTAL j::KO~ECT  825 L Street - Anchorage, Alaska 99501 E.VIRON~ENTALENGINEERI"GDIVISIO" APR 9 D79 Telephone 264-4720 RECEIVED ~E~UEST FO~ APP~OVAE OF I~DIVIDUAL ~ATE~ A~D 8EWE~ FAOlLITIE8 MAILING ADDRESS PROPERTY RESIDENT (If different from above PHONE 2. BUYER PHONE NAILING ADDRESS 3. LENDIN~INSTITUTION ~ [ PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for ail wells drilled [] COMMUNITY since June 1975.' For welts drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ,~ INDIVI DUAL/ON-SITE** [] PUBLIC UTI LITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE eNL. CATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE iNSPECTOR INSPECTOR INSPECTOR DIRECTIONS; 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMSER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLEO [] PUBLIC UTI LITY ConoectiOll Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE ~NSTALLED E~]PU BLIC UTI LITY Connection Verified INSTALLER E~]Septic, Tank or [] Holding Tank Size: IIO0 IfTankishomemade SOILS RATING give dimensions: TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line [] APPROVED FOR . . BEDROOMS [] CONDITIONAL APPROVAL (lette~r must accompany certificate) [~ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78) . ~.~NVIRONMEN'I _~ PROTECTION I!~[~ · 11 ' ' ?~chorage, Alaska 9950]. ~;11, ext. 224 or 225 Date Received: #1: Time ~ .... [~2: Time ~~_ Date ~r_~5 Date ~-~m~.~% Jul.y 19, 1977 #3: Time _~ ]~_D Pn% Date Insp __~. ?.~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Coast Mortg~_g.e Mailing Address: 4797 Business Park Boulevard Phone: 279-0665 ~' ~ George/Marjorie Blake__ 2.P.:_oper~y Owner: Phone: 344-4702 Mailing Address: Star Route A Box 1729 ~95_q~ Legal Description: T12N R3W Section 22 S½ S½.~ .,,xeo3_dence. (x) Single Family TM Number of Bedrooms: Three Multiple Family Residence: ( ) Number Of Bedrooms: 5. Well System: Individual We]-]. (x) Permit # __./~J~l Depth of Well Construction Sewage Disposal System: On-site Permit # ~,~'~- Installed Septic Tank Size~_f~_--_ Community/Public System ( ) 140' Well Log on File Bacterial Ant lye is ~_~ System ~ Public Utility ( ) ~/7~ ' Installer~ ~¢ Manufacturer ~ Absorption Area Distances: Well to Septic Tank ! to Sewer Line /~ Nearest Lot line to Nearest Lot Line Soils Rate ,/~.'~ Material ~ to Absorption Area /~ ? ,~/~.~_ Absorption Area P~ge ~o Request for Approval of Individual Legal Department of Health and Environmental Protection Sewer and Water Facilities Description: T12N R3W Section 2.2__S~ S~~ Comments: Affadavit Attached: ( ) Letter Attached Department Worksheet: 7~/Jl'~l ' , .- /'~u~p~,~v ~c ~eUORAGE ~ ' ~,, '~%1 'Departmen, oz Health.an, Env~ronmen.tal ~ro,eccZon .' .. ~~/'' '825 L Street, ~chorage, Alaska 99501 ' ._ ~[k~7~]/ 279-2511, ext. 224, 225 "3' ~equest for Approval of Individual Sewer and Wa~er Mailing Address: Phone: o Name of Buyer: Mailing Address: Lending Institution: ai ing Address: Phone: Mailing Address: ~0) ~(), '(~clcfAo~.,rd_~ &~ Phofe: ~?O-?G,/ Legal Description: Tla ;~ ~3a} _ .~ <m ~ ~ ~&. Street Location: Single Family Residence: ~ Number of Bedrooms: ~ ~-~'~' Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: * Individual Well ~Q Public/Conununity System ( ) If Individual Well, well depth ~ If Community System, name of system 8. Sewage Disposal System: On-site System ~) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled sznce 6/75. 3/77