HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 1\a
C.)-AOPW�Sl-13a- io
Municipality of Anchorage .•a '�;
e Development Services Department
Building Safety Division
- Onsite Water and Wastewater Program, 4700 S. 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: SWO030200 PID Number: 051-732-10
Name:
Douglas Bartlett
Wastewater System: ❑ New ❑ Upgrade
Address:
P.O. Box 670162 k AK.99567
ABSORPTION FIELD
Phone: Number of Bedrooms:
® Deep Trench O Shallow Trench O Bed b Mound O Other.
LEGAL DESCRIPTION
SWI Rating:
Taal Depth from orginalgm
GPD/FP
FI.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
el depth ath pipe:
G;."I
12 1 North Woods Addn. #3
Ft.
Ft.
Township: Range: Section:
Fig added above original grade:
Length:
Ft.
Well: ❑ New ❑ Upgrade
Gravel width: / 1
\ `
Number of Imes:
Distance between ones:
ll Ft.
FL
Classification (Private. A, B. C):
Total Depth:
Cased to:
Total absor
Pipe Material:
I•
Ft.
FP
Driller.
Date Drilled:
Sialic Water Level:
Date Installed:
Ff
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
FI
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
I Septic
Absorption
Lift
Holding
PublicJPdvate
Manufacturer.
Capacity.
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1250Ga1.
Wall
100'+
100'+
NA
NA
25'+
Material.
Steel
Numbs of Compartments:
2
Surface Water
100'+
100'+
NA
NA
LIFT STATION
Lot ane
5'+
10'+
NA
NA
ue.
Gal
•Toss a urer.
5'+
1 0'+
NA
NA
Pump on leve' aL
Pump o level at:
High water alarm al.
Foundation
In
in
In
NA
' $ 0'+
NA
NA
Pump Make 8 Model
Electoral Inspections performed by:
Cattalo Drain
Remarks:
BENCH MARK
'Added two post-tank cleanouts
lwn an scriphon:
Door sill plate on back of garage
Assumed Elevation:
100 Ft.
Engineer s Stamp
nn
A
'dw�XP��•O ••ACAty I
: •:�9/
.'
KND Engineering. Inc.Dates: lst6/26/2003
*,
.m f„�
Inspections performed by:
,.'„ ,,,. •,
2nd 7/15/2003
Development S ices Department Approval
• .•.... ...
I CE '
I
• i` ;'
r
Reviewed and approved by: Date:?
12/00),
F '•..,•••„� =?..
4% "ROFESSIONP
(Rev.
�
M
h
M
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW030200
NORTH WOODS ADDITION #3 BLOCK 12 LOT 1 PID#051-732-10
'0' 2
/
/
I I I F
I h I EMSTING 1250 _u b, pJ�'
Ij GAL SEPTIC TANK D
O - - BM EXISTING DRIVE
MST= I
I I SEPTIC FIELD i
I I 1
I I I
� � I
SCALE: 1' — 50'
A—C=40.6'
BOUNDARY.
97.62 97.4
STAKING:
B—C-11.6'
ASOMT:
DAIS:
DMC. FILE:
A -D--33.6
W
8
B—D=15.1If
'
nnA—E
00 ORIGINAL GRADE 00
=_
ff`
B—E=—
1250 GAL
A—F=—
B—F=—
SEPTIC
'� TANK
00
/ �I (; Tj
00
R ROCK
°F..�4 1
*:
........... /
KE M. /
CE -7116 a
PftFESS10T11, -Ar
I 00
PREPARED FOR: SCALE: NTS
DOUGLAS BARTLETT
PO BOX 670162
CHUGIAK, ALASKA 99567
FIELD BOOKS COMPUTED:
BOUNDARY.
ORANN:
STAKING:
CHECKED:
ASOMT:
DAIS:
DMC. FILE:
GRID:
"'AD r -E` 03053.DWGI ''DB H°: 03053
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
1
11
Permit Number: SW030200
y1_0 yvt-
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
r, -.Upgrade
Date Issued: Jun 18, 2003
Expiration Date: Jun 17, 2004
Parcel ID: 051-732-10
Legal Description:tNORTH WOODS UNIT 3 BLK "12 LT. '11'i
Design Engineer: 0070 KND Engineering Site Address: 022839 GREEN GARDEN DR
Owner Name: Douglas C. Bartlett Lot Size: 54322 SO. FT.
Owner Address: BOX 670162 Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567-0162
This permit is for the construction of:
F✓ Disposal Field Z✓ Septic Tank Holding Tank F] Privy [] Private Well E] 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 calling
(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:
Issued By:
Date: / /4
Date: cr/(B&T
Municipality of Anchorage
�. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-732-10 Permit Number SW
Property owner(s) Douglas C. Bartlett
Day phone
Mailing address (1) PO Box 670162,
Chugiak,
AK 99567
Iv ai ddress (2) ? Z� 3� G0,1&
Q a V JQM- hiiip Code
Legal description (Lot, Block & Sub d.) ."de
zya' Q _3 A/
Legal description (Section, Township & Range)
Lot Size 54322 Acres/Sq.Ft.
Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Sigbdiure of property owner or authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: �o�a3 Date of Payment:
Receipt Number: 37 D Receipt Number:
(Rev. 12/00)
1�\T J ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
June 13, 2003
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New Septic Tank Permit — North Woods #3, Block 12, Lot 1
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit for a septic tank
replacement on the subject lot. The existing septic tank has been identified as in failure.
We propose to install one 1250 -gallon septic tank for the 4 -bedroom residence. The
subject and adjacent properties are served by public water.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there. are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
K'1`41U Engineering, Inc.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
NO PUBLLC WELLS VATHM 200' OF
NO PTBVATE WELLS WITMN 200' OF
PROPOSED SYSTEM E)OD PT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL E(wT AS NOTED.
*
rM* * `
cE- 1
�AV
�g310T11`1' e/
1. ABANDON EXISTING TANK.
2. INSTALL 1250 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER.
3. CONNECT TO EXISTING SYSTEM— INSTALL DIVERTER TO SERVICE
EXISTING FIELDS.
4. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS k SEPTICS, LOT LINES, AND OTHER REQUIRED SETBACKS.
PREPARED FOR:
DOUGLAS BARTLETT
PO BOX 670162
CHUGIAK. ALASKA 99567
FIELD BOOKS
BOUNDARY:
STAMM
ASBULT
OW- nLE:
ACRD FILE: nine
COMPUTE):
DRAWN: JSG
°'Etta°" KMD
DATE 13JUNI
a"a NW145
108 N" 03053
Scale: 1"= 100'
PAGE 1 OF 2
Lt&INI,LLU ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
—6111/FAX (907)696-8111
WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN
NORTH WOODS ADDITION #3 BLOCK 12 LOT 1
70" �rn92
QN
D Sss'0
322 4 j �F
N 0 WELLS
P BLIC WATER
JAW
i
�* 4.9
CS-7118Alf
`SS10tt�' eAw
/'
INSTALL
1250 GAL S.T.
ZABEL DIVERTER ,,e'�,
0 N
M
O
.4 =
ABANDON
EXISTING
SEPTIC FIELD
PREPARED FOR:
DOUGLAS BARTLETT
PO BOX 670162
CHUGIAK, ALASKA 99567
FIELD BOOKS DDYPUTM.
DDUNDARl' DRAM/: SG
STAIDNG ' D"CCKED: KMQ
ASBMT: DATE 13JUN
Wx ME ORD. NW145
A AD FRE 03053.DWG ""°' 03053
25 1 25
Scale: 1"= 40'
�qPAGE 2 OF 2
END ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11
11
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
7ON-SITEAGE
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
DISTANCES
Address
TO
FROM
SEPTIC
ABSORPTION
WELL
�. �� b"j o tbZ G-liJ "IG1Sb
TANK
FIELD
Phone(s)
Permit No.
No. of Bedrooms
WELL
/.`/GaJ
4-�s
---319 ex
x"19
otto0
4
LEGAL DESCRIPTION
Lot
LOT LINE
�
, O1li-
Bloekt
2
Subdlviaion
IQ S
FOUNDATION
Township, Range, Section
F-+
AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
driveway, water bodies, etc.)
TANKS
X1 SEPTIC ❑ HOLDING
2
Manufacturer
65C. I C'-eri a
Capacity in gallons
2�0
Material
No. of Compartments
Z
TYPE OF SYSTEM
/
s
�RENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
original grade
Total depth from original grade
4 FT
`2. FT
Fill added above original grade
Gravel depth beneath pipe
O FT
FT
`
r"v Ir
Gravel length
Gravel width
(0-7 FT
FT
Total absorption area
Distance between lines %
i o12,SO FT
�/ FT
Number of linesSoil
rating
Pipe material
SO FT
q e
Installer V Q
X/
Date Installed
WELLS
I
❑ PRIVATE THER (Identify)
I t
Classification (A,B,C)
Total Depth
based to
- Install
r/A
FT
FT
Date In
ailed:
Leo
11VL-11
7 1 � r,
� �l
REMARKS:
0
Scale:
Inspections Perfon ed -;by:
ENGINEER'S SEAL
V ,I F+� N l.�'V'1
OF
a®. •o•,. .
ire/ ,,('meq
Date: G1„ _ 1 l ' �i 1
���xu OY
G� •Y �1
S & S ENGINEERING
•Y
7 age ver oop oa No certify that 's inspection was performed according to all
s, ,.,Y,,,,Y a,,•v.,,y, ..
i
MunicipalffiWWWPeAkilkill09"te: ?3
w
bart.A.4h�fa '
'
No. 148746 SirY sr'
Health Department Approval: Date:
�ro'�ROFESS
72-013 (3/85)
~ � MUNICIPALITY OF ANCHORAGE
Department o� Health & Human Services
825 L Street, Anchorage, Alaska 99501 343 4720
ON�SITE SEWER PERMIT
Permit Number: 890160 Uograde on/i06
Date Issued: 08/10/89 Engineer Designed
Owner Name: DOUGLAS C BARTLETT
Day Phone:
Owner Addre�s� P O BOX 670162 688 9179
CHUGIAK, AK 99567
�arcel Id: 051-732 10
Lot Legal: Gubdiv i s i on :
N��TH WOODS 4625 Lot: 1 El Icm: to 1 1:2
Section: 4 Townes, i p: ON Range?: 1W
Lot Size 54322 <sq.{t. or ac�es)
Max Bedrooms: This Permit: 4 Total Capacity4
SEpTIC TANK: Minimum total septic tank capacity: 1,250 gallons" Each septi�
tank must have at least 2 to top of septic tank(s) < 4^0
Neet reguires insulation over tank(s)"
PERMIT EXPIRES DECEMBER 31, 1989.
NOTIFY DHHS PRIOR TO INSPECTIONS AT343�4744 OR 343-4681
"
-��NGlNEER MUST VERIFY INTEGRITY OF GEPTIC TANK 1)URIN8 �NGPECT�ON"
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of ADcharage, (MDA) and the State of Alaska.
2" I will install the system in accuirdance /with al MOA codes and regulat. ions�
and in compliance with the design criteria of this permit"
3" I wilI adhere to all MOA and State of Alaska requirementiii� for the set back
distances irom any existing welIq wastewater system or public
sewerage system on this Dr any adjacent or, nearby
4" I underst d th t s permit is valid For a maximum of 4 bedrooms. I
also under the capacity of the total system is 4 bedrooms and
any e.,rilarge-
Signed: DATE:
(Own r
Issued By: DATE: ��--�0-��
/ ��_____��.����_��_�~�_ .............
_�
MT-
3
ISTA
AN `
d
SCALE
_�
MT-
3
ISTA
AN `
d
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES` "`" �" �ab�>»�•»
825 "L" Street, Anchorage, Alaska 99502-0650
$46wd A. Shw$w
SOILS LOG — PERCOLATION TEST No. 1437 f
V, 114
PERFORMED FOR:C J 1�.` DATE PERFORMED: I
LEGAL DESCRIPTION: L 2-- I '51Na`p-fl-I W2a25Township, Range, Section: � 6t3 iat
Gf_E•PTH Ak-- .7, SLOPE SITE PLAN
(FEE -H
2
0
3 ^
5 •.
4-
6-
7 7
r
8 Or
9
10 `�
WAS GROUND WATER
vninn.,nirco vr�� n
11 (� S
IF YES, AT WHAT L
O
DEPTH? p
E
V
13 �� Depth to Water After
Monitoring? Date: 21— _e— (�q
14-
r
15-
16--
17
516 17
18-
19-
Reading
819
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
20 k
PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN Ce FT AND '? FT
COMMENTS
PERFORMED BY: 17034 Eagle River Loop Road No, 2044
ate* KIVOr,*Im8ka 99577
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUID •N
72-008 (Rev. 4/85) Ll-�
—,---CERTIFY THAT THI T $T_W SORMED IN
ON THIS DATE. DATE: if PE F
UNIt•: LEGAL
L���y 30 83 lVoiWODas is i�-K z La f i
72-013 (Rev. 3/78)
I r!s pec�a b'Y � a-r-C�►
MUNICIPALITY OF ANCHORAGE
�.
T-83 01 t
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
1.
57Cv2 sKa g
PHONE
MAILING ADDRESS
a
4-466 2831
❑UPGRADE
7 &I 'D
LEGAL DESCRIPTION
N1QA\wL_)0asTir— g�ock I'et Lei` 1
LOCATION
�sNO.
`Peers C re e K
OF BEDROO
S
U Y DISTANCE TO:
W
Absorption area Dwelling
ln.
PERMI N0.
no)
Z Manufacturer
a Q Greev Material
ran�wr� %Z
w
wF
Liq. capacity e I
No. of compartments
in gallons Inside len gWidth
��b IF HOMEMADE: th
Liquid depth
��Z DISTANCE TO: Well Dwelling
PERMIT NO.
2zF Manufacturer
Material
Liquid capacity in gallons
� Well
w = DISTANCE TO: M rn �.�.� Foundation - Nearest lot line
In
PERMIT NO.
j LL Z No. of lines hb� ib
b Trench width
F- Z w J Le gth of each '. ®f Total length of liWj
Distance tween lines
b IW L ches
Top of file to finish rade .�� -
i ----- Material beneath file
Cr' 6
a _ 3 /Z inches
�
Total effectiv/absorption area
0,
W Length Width Depth ='"
a�h '
O --"-
PERMIT NO.
a a Type of crib Crib diameter Crib depth
W Total effective absorption area
LU
H DISTANCE TO: Well Building foundation Nearest lot line
Class Depth Driller
_j p Distance to lot linePERMIT
NO.
LU
DISTANCE TO: Building foundation Sewer line Septic tank
Absorption areas)
OTHER
PIPE MATERIALS
Pvc
SOI L TEST RATING
16 D' %o
INSTALLER
S• C\rC. S ICQ g
REMARKS
1f 1
� CaVti�Or rry)avYiatea ��.7..�. over'
'PrviCL
i
e
UNIt•: LEGAL
L���y 30 83 lVoiWODas is i�-K z La f i
72-013 (Rev. 3/78)
I r!s pec�a b'Y � a-r-C�►
MUNICIPALITY OF ANCHORAGE
Departmentr__"� Health and Environmenta7"11rotection
825 Street, Anchorage, AK. 501 ,"e
264-4720
Permit , �► # # HANDWRITTEN PERMIT # #
'� Akin
,�-UR ON-SITE SEWER PERMIT /� /
Applicant: �Qe.,, , , Mailing Address : /"� QlC µSQ(
Location: p`p' Pho/p e Number
Legal Description: 10%Size:
Type of Soil sorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) 1 & R
The Required Size of the Soil Absorption System Is:'
1 (
DEPTH LENGTHy _ 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).
* * REQUIRED SEPTIC(+i�G) TANK SIZE _ /00 0 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 u 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.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more tha 3 bedroonys.
Signed: _ Issued by:
ppli a t � (�� �
Date: 4A
SWP/024(1/81)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: . 3t(ti��u�e {_Lr,lS�i DATE PERFORMED:_ 1A_T �t 83
LEGAL DESCRIPTION:
DEPTH fiC)Cjr -c�2t`l SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
COMMENTS
4•15-
16-
17-
18-
19-
20-
COMMENTS
C—prl
541�-
WAS GROUND WATERS
ENCOUNTERED? U L
0
P
IF YES, AT WHAT - E
DEPTH?
tAb5 (liatm - /' /
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Ian
x:57
120
V V
o nu /
.52
Y
Hzo
d�7; 5
o'70
O'!l/
//'yy
V
155
s//
20
� li9
•��
�i
'60
/
PERCOLATION RATE! /(mmiinutes/inch)
-�
TEST RUN BETWEEN FT AND _s.G :G_ FT
PERFORMED BY:
�y- n CERTIFIED B
72-008 (6/79)
�'l[Ir}ijC�
Time
APPLII""�NT FILLS OUT UPPER HAS' ONLY
Property Owner f
��.��� „' (�{f?'
4
Phone
Mailing Address
Date
Zip Code --
Buyer
C�
Inspector
Inspector
�M.
Inspector
Address
Field Notes:
s. Zip Code
Lending Institution
'CONDITIONS OF APPROVAL
-
Phone
Address -
Well Log Received
Zip Code
Realty Co. & Agent
Phone
Address
Zip Code
Legal Description 140 �
j 1 ` �%�, (�j
j j
r"�v,--hI-h /O()d s )Dha,a�e—
,..
Street Location
Type of Residence
1�i Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
❑ Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Sewer Disposal
fd Individual
_
Year Individual Installed: ICIS13 _
❑ Public Utility
_
When Connected to Public Utility:
❑. Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
( ) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
BY:
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size
Time
APPLI�VT FILLS OUT UPPER WA ONLY
Proper�,.Owrier '
Phone
T & D Construction
Mailing Address
Box 2524 Palmer, AR Zip Code 99645 745-2731
Buyer
( _9
Address
Zip Code
Lending Institution
-
Phone
Address
Zip Code
Inspector
Realty Co. d Agent
William Schlegel - Totem Realty, Inc.
Phone
1 2_� tSL �S
724 E. 15th Avenue Anchorage, AK Zip Code 99509
272-0571
Address
RECEIVED
c�
Legal Description
Lot 1, Blk..12 Northwoods Subd.. III.
Street Location
Marshall Street
Type of Residence
Date Sewer
C� Single Family
Well Log Received
Multiple Family
No. of Bedrooms 4
❑ Other
Septic Tank Size
Water Supply
❑ Individual
/
ATTACH WELL LOG. A.well log is required for all wells drilled since June 1975.
if
5e Community
•�
For wells drilled prior to that date, give well depth (attach log available).
E*'` Public Utility
Sewer Disposal
IX Individual
- Year individual Installed: 1933
❑ Public Utility
- When Connected to Public Utility:
❑ Holding Tank
-
NOTE: THE. INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
( _9
Date
Date
Date
Date
q
Inspector
Inspector
Inspector
Inspector
1 2_� tSL �S
Field Notes:%SGk,tS:� MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTf! ,
ENVIRON"'17 ' TAL PROT2CTION
RECEIVED
c�
p
APPROV��BEDROO��MS(� CIS ITIONS OF APPROVAL
PR
( ) CONDITIONAL APPROVAL' ♦ L.�""vr~ w �,
DATE (A-}` C�.r
BY:
Soils Rating
Date Sewer
Well To Absorption Area
Well Log Received
^Installed
-2 !� ��
Well to Tank
Septic Tank Size
"-V'3 J. ' I" '3 * l / -'", s
0
I
