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HomeMy WebLinkAboutSKYLINE VIEW #1 BLK 4 LT 6kyline View Block 4 Lot 6 #051-191-25 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 Page ' of www ci.anchorage ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. S��� PID Number. OS 2 - N.m. Zr U C� $} �� efr� Wastewater System: ❑ New —� A"ess ,\ (� ❑ Upgrade y O V 1�qn CL- AA RSO? ABSORPTION FIELD O neap Tr«wr O s,,Nj w T,& c 0 Bea O mo 0 Om« LEGAL DESCRIPTION SPZlm0 Tory D.pm hom «p,rotp.aI, Bio<k L' Ld � swamrm SICv 1. e V;� T arxp R«gI, Seprom Well: ❑ New El Upgrade Cusw.=uM (P 111 A B. CI a«w n..•. . _ I- ' vapor io PPI, Goeom eom pr.aa FJ Ylasa.Jova on.TnN p'.aI, w / wam C-�C'n P" TANK ❑ Holding ❑`S.T.E P. K%e.( 3,\ 0—s-•1 CS LIFT STATION Pura on'NvN .I ar«« Inspections performed by: 15861 S. Birchwood I.P. Rd Dates: 1" R S CYlugMK. Alaska VY 2nd Development Services Department Approval Conditional Approval Date: Reviewed and approved by: (RN () > ) - I, N epi a«m.p Py BENCH MARK �e_e ( Dater �z- O J, f. n•, ❑ Other. . iy 00 GI,r Of t;PmP.lm«n. ,4 xal« ««m n :, ID`i•a FI ...ri 7 ►4J. lb7f FI �nnp n«pM AD Gouty GPM FI FI SEPARATION DISTANCES To From Septic Absorption Lift Holding Tank Field Station Tank ublrJPnvale Sewer Line wan - 75'-t sulsr..wet« lob'+ LN Lro �) 1 Fourda!ron S r� Cul«n pro, R.m s wam C-�C'n P" TANK ❑ Holding ❑`S.T.E P. K%e.( 3,\ 0—s-•1 CS LIFT STATION Pura on'NvN .I ar«« Inspections performed by: 15861 S. Birchwood I.P. Rd Dates: 1" R S CYlugMK. Alaska VY 2nd Development Services Department Approval Conditional Approval Date: Reviewed and approved by: (RN () > ) - I, N epi a«m.p Py BENCH MARK �e_e ( Dater �z- O J, f. n•, ❑ Other. . iy 00 GI,r Of t;PmP.lm«n. ,4 xal« ««m n :, ID`i•a FI ...ri 7 ►4J. lb7f FI PERMIT N0. SW08078 PAGE 2 OF 4 DEVELOPMENT SERV CEScDoJity OF Anchorage EPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.0 Box 196650 • Anchorage, Alaska 99519-6650 • Telephorne (907) 343-7904 • www.ci.onchoroge.ok us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT.6, BLOCK.4 SKYLINE S/D P.I.D. N0. 051-191-25 PERMIT NO. SWO80078 PAGE 3 OF 4 DEVELOPMENT SERV CEScDatity of Anchorage EPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.cianchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT.6, BLOCK4 SKYLINE S/D P.I.D. No. 051-191-25 I j � ,, a ;,gip LOT 1 SEM A--------------- O _ -----10' ---- IU_UTIUTY CASEMENT ------ BUN I r 7 �O IP .• .1 .. MCN I Q c KI y BBt U ;ca.c.at wu --'—I Sr . hpUSC LIVE j PAW SUMAC I I I I I I I j SUMAC DRIVE L ------------------------------ LOT 2A I LOT 2B ENGI R RTAMP 44 IT ..Q .. A•fAelr NB- IA87.9 f i PERMIT no. SWO80078 PACE 4 OF 4 Muni DEVELOPMENT SERV CEScDEPARTMENT nof chora it BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 •Anchorage, Atoskn 99519-6650 • Telephone (907) 343-7904 • www. ci.anchoroge,ok.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT6, BLOCK.4 SKYLINE S/D P.L. No. _051-191-25 MUNICIPALITY OF ANCHORAGE Development Services Department �F o On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 13, 2008 Expiration Date: Jun 13, 2009 Permit Number: SW080078 Parcel ID: 051-191-25 Legal Description: SKYLINE VIEW #1 BLK 4 LT 6 Design Engineer: 0003 S & S ENGINEERING Site Address: 018923 DOGWOOD RD Owner Name: Bruce St. Pierre Lot Size: 91800 SO. FT. Owner Address: 4900 Panalof Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99507-0000 This permit is for the construction of: n Disposal Field n✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ��✓/i��Ln.�iu�z. Date: 6 ! 3 Date: (� �� Municipality of Anchorage --1 Development Services Department Building Safety Division ; .... , On -Site Water and Wastewater Program ` 4700 Bragaw Street ' •' "' P.O. Box 196650 Anchorage, Alaska 99519.6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 - 1 ci I - 2S Property owner(s) tl r o C P_ C'} �) t e- r f e Day phone 23 '-ZV48 Mailingaddress 14gbo 7 V IC, S+ Zip Code —AA 2; 0 —1 Site address 1\1.n_ rn� � Zip Code Cl q 3 (0-1 Legal description (Sub'd., Block & Lot) �- % . t4 'S Kv I I n � V i P 10 k# Legal description (Township, Range & Section) Lot Size %, g00 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank) ❑ Holding Tank ❑ Privy 0 Private Well ❑ Water Storage El Number of Bedrooms q THIS APPLICATION IS AN: Initial ❑ Upgrade X Renewal ID I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwe i sin accordar cewitl applicable Municipal Codes. (Signature of property owner or Permit/Rush Fees: XWaiver Fees: Date of Payment: Receipt Number. (Rev. 11/05) Date of Payment: Receipt Number. S& ROQCRi C. COWAN, P.E. CML ENGINEERS (907)694-2979 rAX(907) 694.1211 June 12,2008 IFALINAUDIONiTY MPnOVN3 MUNICIPALTPY OF ANCHORAGE Development Services Department P.O. Box 196650 StWM&WAiEn Anchorage, AK 99519 MNNEa1ENSION' REFERENCE: Lot 6; Block 4; Skyline View Subdivision #I sPNEn A WATER INSPECDON It is requested that you Issue a permit to Install an emergency tank replacement. The existing tank serving the existing four bedroom dwelling on the referenced property ENGINtEMNG57UOIES has collapsed, and will be replaced with a minimum 1300 gallon HDPE septic tank. ANOnCronrS We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic tank. The construction w[EE arrrcnoN of this system will not prevent any future development on any of the adjacent properties. a rLOav TEST If you require additional information, please contact us. Sincerely, SITEPLNIS noAnoESIGN /7 1 Robert C. Cowan, P.E RCC/bjj SOIL TEST Enclosure rEncounON TEST SrnuC11IML A MEOMrAL INMPECTIONS ONSITE WAS iEWAtEIT OISP0OALS1SiCM DESIGN 15681 S. alrchwood Lp. Rd. — ChuglaIT, AK 99567 SITE—PLAN a� DESIGN I f I i � Z ~ c z rp m , D •�• O m O 7C C7 m p I , npc •T I o� n.0 pmm nmmm 1n ymm 2 .' .` : 1 I f F1 7 N I---1 C 1 5-10Y. yrr-S� C 5-10% /lc v� w DOGWOOD ROAD N m L'J 0C/) N o �_ a� v=nmN i 2-5% I I Z ~ �e �\ D •�• n 7C C7 ' I npc •T I o� n.0 pmm nmmm 1n ymm 2 .' .` : 1 I f F1 7 ..rLL�r yrr-S� C C 00 5-10Y. Z y r ..:•'�: '.I 2 -SX I -. I •O vl s ... = I Nm MM 00 p o � I I I r I � I I I 1 y I I I I I I I I I I I I I I I I I I I I I I I I I I I I I N m L'J 0C/) N o �_ r r o s Z ~ �e �\ D •�• n 7C C7 ' Z •T n.0 i n F1 7 N C 00 � SITE -PLAN I DESIGN r y F------------------ I m ` I � r sjF I o %� � I I 9 n i -i n I a I d O� I � `Y`N��Z- �_i y x I l� I I I I I I I I � A. A —_—_—_—_m O 3 T- N z7 V1 II Ln O N rCrJ m ` r o - �p ; r sjF enS^ %� y I gain n 7C n r a I � o�Q O� cn `Y`N��Z- �_i y x I l� TI A. z CO L 71 tl I C W tTj ss C ox i Ap. CS] —_�--_—_—_—_-----_ ,-lox DOGWOOD ROAD o �n •_••�, R Iii I Igo�i :,II IItl T • ..t a t�.(��' `,,, li Iii r I O 1 1 , -3 ' I I I I � I I 1 , I , I 1 I I I 1 I I I 1 I I I I I I I I I � I 1 I I I I I 1 I I � 1 I I I I I 1 I I I � A —_—_—_—_m O 3 T- N z7 V1 II Ln O N rCrJ m ` r o - �p ; r sjF enS^ D A gain n 7C n a a az � o�Q N z `Y`N��Z- �_i Q �r OY2•Na l� TI A. z I L 71 N C W tTj ss sjF enS^ a^a U'r.` .- ,n gain Yui -".n z a a az � o�Q N N" C..Z `Y`N��Z- �_i Q OY2•Na l� TI A. pON ss i Ap. iNe Rzn z o /—� MUNICIPALITY OF ANCHORAGE / • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT - NAME`K' "F_o VA�CUCt PHONE ._ NEW ajt � j ❑UPGRADE MAILING ADDRESS _ LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS �-- Uy DISTANCE TO: Well I ` S Absorption area Dwelling e PERMIT NO. IL 2Q Manufacturer _ S aterial No. of compartments LU N V. ✓ - rn Liq, capacity in gallons IF HOMEMADE: Inside length* � Width Liquid depth Q \ •�.� DISTANCE TO: Well Dwelling �^ PERMIT NO. O z Q I- Manufacturer Material Liquid capacity in gallons a: wx DISTANCE TO:�]Q©� Well Foundation Nearest lot line PERMIT NO. °1 u. vNo. F' 2 w of lines Len th of each g- me Total len th of I'n s g Trench width 2j (0_inches Distance between lines i' {V Top rile to finish Material beneath rile Total effective af?sotio�n area Lam.. cc of grade �\ (00 inches A- Length Width Depth PERMIT NO. LU Q 1- Type of crib Crib diame r Crib depth Total effective absorption area as LU LU N Well Building foundation Nearest lot line DISTANCE TO: ss Depth Driller Distance to lot line PERMI F NO. J pmca LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST` RATI `\ ©� ^ I� INSTALLER' 4---Jl ILA_ l REMARKS N ~+� L•t t I P OVED DATE LEGALq)al tV`7s 1 , 72-013 (Rev:3/7B) ' RPPLICHNT 2121 ^HHNDHLHR LOCHTION D{���)OD � LEGHL L6 84 SKYLINE VIF.W S/D . TypE OF SOIL HBSUR8TION SySTEM IS� TRENCH LOTSIZE 100188 SQUHRE FEET MHXIMUM NUMBER OF BEDRUOMS � 4 SOIL RHTING (SQ FT/BR)� 100 THE RE:. SIZE OF THE SOIL HBSORPTION SYSTEM IS� MINIMUM DI�THNCE BETWEEN`R WELL HND RNY ON�SITE SENHGE DISPOSHL SYSTEM IS 10� FEET FOR H PRIVHTE NELL/ OR '50 TO 200 FEET FROM H PUBLI '� WELL DEPENDING UPON THE TYPE OF PUGLIC WELL OTHER REQUIREMENTS MHY HPPHTIONS HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION. � 2204 Cleveland Al2chorage, Alaska 99503 Performed ror Ken Lainq ._..R -_..T. r_.:. :_._ ®Date Performed— 8-12-77 Leaal Doscr°intion.-.Lot 6 This Form Renarts Sails toa ryes __ �Percalatian Test _a_ Heath �cTEt Soil Characteristics _w - - R. a 4--- Sandy gravel (GP) 16— Bottom of test hole is— Was l s — ►,1 No Was Ground Water Encountered?� No if Yes, At what Depth? %PJ 04 40 Readin(i I Date I Gross Tine ! rot 'rime i Death to H20 Net Drop Percolation Rate Minute Prni,io;e d Inst'iflifi-6n: Sor.-rlclue Pit Drai+r Field Depth of Inlet 0"ar,'r;ii' to �ioftoll, df Pit 0I `trWnch r�r�t` 15: 1.U0 ,au�re foot hodioom requir.,ed per b--room.from minizs,..,,_. , Data Ccrtified I; coF�S'�x QT,:TQN_TT,,ST Test Performed 0a t4" g -d12 77 3 January 5, 1978 Ken Laing 2121 Chandalar .Anchorage, Alaska 99504 Subject: Lot € Block 4 Skyline View Subdivision Permit; #77705 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar- year basis, as stated on the permit, by authority of Municipal ordinance. if you have drilled the well, a well log should be sent to this department to document the. installation date. if there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section Note: .A well log has been received on the above property. �0_3��fi­-6: F �11�4 II -A f7o 0:7-0�� DEPHRTFIENT HND ENVIRONMENTHL TECTICIN l­;TREET/ HNCH0RHGE, AK99501 2792511 � p' c) ir-41 14^lf� _114FE 17 v�������� F"ERMIT NO. APPLICANT N INQ, 2121 CHRNDHLHR 1865 LOCHTI('IN DOGWOOD LEGHL L, r. 6BK.4 SKYLINE VIEW S/D LOT SIZE 100188 SQUHRE FEET TYPE OF SOIL HBS8RBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS� -1 J. CA������� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR 0RHINFIELCl. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IW FEET). THERFE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMDM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE FXCAVHTION (IN FEET). -A������ H PACKAGE PLHNT MHY BE INS -TAI. LED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1EITHER H CLASS I 8R II NSF APPROVED PLANT MHY BE INSTALLED. 2. H CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MHINTENHNCE HQREEMENT IS NOT KEPT CURRENT YOU M8Y BE: REQUIRED TO ENLARGE THE SOIL RBS0RPTION SYSTEM HND/0R YOU MAY BE SUBJECT TO PROSECUTION. BHCKFILLING OF HNY SYSTEM WITH0UT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PRO, ECUTIQN. MINIMUM DISTHNCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICHTIONS AND CONSTRUCTIDN DIHGRHMS HRE HVHILHBLE TO IN5URE PRQPER INSTALLATION. ��F-_7 �7—. ���M I E: F�. --t- J��� I CERTIFY THAI' 1� I HM FHMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPAI-Al TY OF HNCHORHGE �� I WILL INSTHLL THE SY5TEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTAND THHT THE SEWER SYSTEM MRY R�0UIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. .... .... ... —~~`~—~�--~~~ APP("ANT KEN L11 .3 L~� ~-7 AND WELLS AS SET ENLARGEMENT IF THE M -W DRILLING, Inc. n• --P: O. -Box 4-1728 • 2811 Dawson A C 907-279-1741 ANCHORAGE, ALASKA 99509 2� DRILLING LOG ell Owner I4ayne Monday _ Location (address of: Township, Range, Section, if known; or distance main Skyline View Subdiv #1 i i e of casing 6 Depth of Hole 177 feet Cased to 8 feet l vatic water level 10 ft. (2114 XQ (below) land surface. Finish of well (check one) open end ( X ) ; Screen ( ); Perforated ( ). Describe screen or perforation None Tell pumping test at–L-1—gallons per ` (minute) for 1 hours with 10O%_ _._ ft. of drawdown from static level. late of completion—IA-hay 74 lepth in feet from round surface 0 5 TO 9 --5-To 9 Tn 177 -TO- O --TO- TO TO WELL WELL LOG Give details of formations penetrated, size of material, color and hardness Silty Gravel: cobbly Ile athered Bedrock Bedrock: greenstone, water leaps in sporadic fractures 5. LEGAL DESCRIPTION DATE RECEIVED 1 INSPECTION APPOINTMENTS S TIME TIME U TIME on revQrse) 6. TYPE OF RESIDENCE 0 DATE DATE DATE — INSPECTOR INSPECTO INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE RRFNNFppT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTKT�KUN�YtENTAL Pf:OT[CTION 825 L Street - Anchorage, Alaska 99501 • AUG 1. ENVIRONMENTAL SANITATION DIVISION Telephone 7.64-4720 RR�rr � REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SfWEf X L�TES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Equitable Relocation Management, Inc. 0 -IR YEAR ON-SITE SYSTEM WAS INSTALLED. MAILING ADD14ESS (Previously Kenneth and Judith Lain PROPERTY RESIDENT (If different from above) - PHONE - Dogwood and Sumac - Chugiak 2. BUYER PHONE Kathleen and Richard Larkin 688-3119 MAILING ADDRESS P. 0. Box 601, Chugiak, Alaska 99567 3. LENDING INSTITUTION - PHONE Alaska Bank of Commerce, Eagle River Branch 1694-2021 MAILING ADDRESS P. 0. Box 1185, Eagle River, Alaska 99577 4. REALTOR/AGENT - PHONE Susan Gallion, Dynamic Realty 694-9630 MAILING ADDRESS P. 0. Box 681, Eagle River, Alaska 99577 5. LEGAL DESCRIPTION Lot 6 Block 4 Skyline View S STREET LOCATION Dogwood and Sumac (See map on revQrse) 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY CA INDIVIDUAL* * ATTACH WELL LOG. A well lag is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM N INDIVIDUAL/ON-SITE** 0 -IR YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY _ 1. / I� L tthin A6JlaCat o _A4 -PI NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCES ING SAN BE INITIATE[). u 72-010 (Rev. 6/79) Ct_.)nQ(..Y go 19b. L c'o S. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS Subdivision TIME TIME TIME _ 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE r DATE 4 Oil ❑ Two ❑ Five ❑ MULTIPLE FAMILY ` t A_tA;1S� INSPECTOR INSPECTOR INSPEC��Q\R I 1 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH G DEPARTMENT OF HEALTH & ENVIRONMENTAL PROWW8yMENTAL PRUf'CTION 825 L Street - Anchorage, Alaska -99501 • APR 2 4 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 7.64.4720 RR ��)) WATER AND �EI�ER��CILTTES REQUEST FOR APPROVAL OF INDIVIDUAL DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (t0) days for processing. 1. PROPERTYOWNER Kenneth and Judith Laing PHONE 688-2750 MAILINGADDRESS P. 0. Box 337 chulzi@R Alaska. 99567 PROPERTY RESIDENT (If different fro above) PHONE Dogwood at Sumac 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT Susan Gallion / Dynamic Realty PHONE 694-9630 MAILING ADDRESS P. 0. Box 681, Eagle River, Alaska 99577 S. LEGAL DESCRIPTION ��- L 6 B 4 Skyline View Subdivision STREET LOCATION Dogwood and Sumac _ 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One n Four ❑ Other [� SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY [N INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM IM INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010, (Rev. 6/79)'�) '�o /l `b j 10- eTC0 � t tom' M) fI �t 1 fdLp�.Nyt� CHORALE j S. LEGAL DES TION MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF AN DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PRO rECTION • ENVIRONMENTAL ENGINEERING DIVISION NOV 1 � 1978 Telephone 264.4720 _ ((^^ ryt`, REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEG61 ®. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, - - - 1, PROPERTY OW ER / PHO�zNE Cl Two ❑ Five ❑ MULTIPL.E FAMILY MAILINGA D ESS -�— PROPERTY RESIDENT (If different from above) PHONE *ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY 2. BUY PHONE depth (attach log if available.) / 8. SEWAGE DISPOSAL SYSTEM �/ MAILING ADDRESS v' -3. LENDING INSTITUTION - - _ _ PHONE - n /� MAILING ADDRESS - - - - 4. REALTOR/AGENT f PHONE MAILING ADDRESS S. LEGAL DES TION STREETLOCATION 6.-TYP F RESIDENCE UMBER OF BEDROOMS SINGLE FAMILY ❑ One _ ,;D-�Four ❑ Other Cl Two ❑ Five ❑ MULTIPL.E FAMILY ❑ Three ❑ Six 7. WATER SUPPLY DINDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY Oi>^ c�� depth (attach log if available.) / 8. SEWAGE DISPOSAL SYSTEM �/ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ❑ PUBLIC UTILITY If system is over two (2) years old an adequaa test is required by this Department. NOTE: THE INSPECTION FEE MUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ,G-VIV to, 101 THIS SIDE FOR OFFICIAL USE ONLY - - - - - - - INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE - - DATE - DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: - - - - - 1. TYPE OF RESIDENCE EJ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO - ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_ PERMIT NUMBER e DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM =INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified_ PERMIT NUMBER DATE INSTALLED INSTALLER =Septic Tank or ❑ Holding Tank Size: I a$© If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTALABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area - Sewer Line - .Nearest. Lot Line Absorption Area to nearest Lot Line - - - 5. COMMENTS �PPROVED FOR _ BEDROOMS ' ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE - - - - BY (Title) J� LEGA-DESCRIPTION - - - - - - - 72-010 (Rev. 6/79) 1 K q � �Cli7tr9� THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER of BEDROOMS l SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO FOUR ❑ SIX 11 2. WATER SUPPLY PERMIT NUMBER ❑ INDIVIDUAL DEPTH OF WELL Cl COMMUNITY DATE DRILLED ❑ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY DATE INSTALLED Connection Verified INSTALLER ❑Septi Tank or El Holding Tank 17 Size: . t) If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELLTO: O '1-� ��r� Absorption Area to nearest Lot Line 5. COMMENTS Eb APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must acco phi y certificate) ❑ DISAPPROVED DATE / / G BY 72-010 (Rev. 6/79) 1 K q � �Cli7tr9� V/&w 72010 (Rev. 6/79) Dp THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER of BEDROOMS ❑ ONE ❑ THREE ❑ TWO ❑ FOUR ❑ FIVE ❑ OTHER ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED - 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified _ PERMIT NUMBER DATE INSTFlLLED INSTALLER - - - E:1 Septic Tanlc<or El Holding Tank Size:.,/ -D If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL - 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. 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