HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 18 LT 8Permit No.
Page 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 345-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 8, BLK. 18, NORTHWOODS UNIT 4
PID No.: 05106438
of
2
SWING TIES
A, B C
E I es.4' 44.4'1
7
C
9
LOT 8
J)<~ -- WATER I<EYBOX
~;~ - DIVERTER VALVE:
[] - TEST HOLE
· - MONrfOR TUBE
o - SEWER CLEAN OUT
+ - WELL
PROPOSED LEACH FIELD
,-- EXISTIN(~ LEACH FIELD
~ -- DRIVEWAY
~ FRDNT ENTRY DECK SV CORNER
~ A$SUHE9 ELEV · 100.00'
ELEVATIDNS
(NDT TD SCALE)
/DIVERSION VALVE
I",,,,',,.; U,,"-.,'
· '~8t.6'
TE~T
75.0'
TRACT A-1-A
9E.O'
12/28/O,5
MUNICIPALITY OF ANCHORAGE
Deve/opment 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
Upgrade
Date Issued: Oct 27, 2003
Expiration Date: Oct 26, 2004
Permit Number: SW030462
Legal Description~..NORTH .WOOD~;UNIT~4;BEK-18'LT-8~7
Design Engineer: 0848 Eagle River Engineering Services
Owner Name: Charles & Lauri Chambers
Owner Address: 23436 Blue Skies Drive
CHUGIAK, AK 99567-2391
Parcel ID: 051-064-38
Site Address: 023436 BLUE SKIES DR
Lot Size: 28123 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank F-1 Holding Tank I~1 Privy
I---I Private Well
F-I 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: ~~[' ~'~ ~,~~J
Issued By: ~(~~~ ~
Date:/~.,)/2 7/O..~
!
, '09/03/03 11:27 FAX 907~438437 ~0A LAN~. USE ENFORCE~ENT
Municipality of Anch.orhge
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bmgaw St.
P.O. Box 1966§0 Anchorage, AK 99519-6650'.
www.ci.anchorage;ak.us. ,
(907) 343-7g04
ON-SITE SEWER/WELL PERMIT APPLIC/~TION
FOR a SINGLE FAMILY DWELLING
~OOl
Parcel I.D..
Permit Number,SW 0~0~ ~-
Propertyowner(s) d.~/t~/.~$ ,~'/--4h~.F- .C~A-rnk~e-'~---~ Dayphone
Mailing address (1) 'Z"5~'3 ~ GL~/z- s./c~-&-F. ~.To(="' .
Mailing address (2)_ Ct-~[-~ ~F' ' ~ Zip Code
Legal description (Lot, Block & Sub'd.)~~~(~ ~ ~ I ~
Legal description (Section, Township & Range)
'7_ ~ I ?~ . AcresS~,~
Lot
Size
THIS APPLICATION IS FOR:
Sewer Only ~
.Sewer and Well [~]
Sewer Upgrade ~-
THIS PROPERTY CONTAINs:
Hot Tub I"'1
Swimming Pool F-I.
Therapy Pool l'-I
Number of Bedrooms
Well Only. r']
Water Storage i-'l
Jacuzzi []
Water Softening Unit r-I
i certify that the above Information Is ~rrect. I further certify that this application Is being made for a
$ing~ ~m~ls~D/~w~ng a~ is In acc°rdance with applicabl, e MunicilSal Codes.
($1flnature of property owner or authorized agent)
Permit Fees: Waiver Fees:,
Receipt Number: ~ 4¢ ~~ ,ecelp, Numbe~:
(Re~. t ~00) .
Eagle River Engineering Services
Louis Butera, P.E.
Christot, her R. Wood, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
October 23, 2003
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re.'
Northwoods #4, L8, B18
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are all connected to city water, or are undeveloped, allowing
sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance, and no private wells
within 200'.
3. This permit is for replacement of the septic tank and leachfield system.
4. Drainage will not be affected and is not a major consideration in our design.
The existing leachfield will be kept online with the use of a Bull Run diverter valve. This work
will not affect the reserve septic areas on adjacent lots. If you have any questions please call our
office at 694-5195.
Sincerel~/ //.~/) //
Christoplf6fl~. Wood, P.E./
Senior Engineer
L2003\03 -054 S £Fr~cNARP, ATIW.DOC
Eagle River Engineering Services
Louis Butera, P.E.
Christopher R. Wood, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM - MOA CERTIFIED INSTALLER
LEGAL: Norihwoods ~4, L8 BI8
October 23, 2003
A. GENERAL
1. The replacement septic plan is for a 3 bedroom single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State Department
of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. Ail excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
Any remaining open test hole excavations shall be filled and monitor tube removed.
SEPTIC TANK
The existing sewer piping from the house to the tank shall be utilized.
New Septic Tank shall be a minimum of 1,000 gallon tank of MOA approved construction, insulated,
or place with 4' of soil cover, min.
TRENCH
The trench is to follow the naturaliand contour to maintain uniform total depth of the trench bottom.
The bottom of the trench shall be level, plus or minus 1.5", and shall be located no deeper than 11'
below top of original ground surface.
The existing trench shall be connected to the new system with a Bull-Run type diversion valve.
The trench gravel shall be covered with typar fabric material.
Natural soil shall be placed over the trench to a minimum depth of 3, or 2" ofinsulation and 2' ofsoil.
The area over the trench is to be mounded, or finish graded to prevent ponding of surface water runoff.
Care shall be taken to ensure that the required fill depth is maintained over the entire trench.
The septic tank and leaehfield must not be closer than 100' to any existing private well, 150' to any
Class "C" well, or 200 feet to any community well, and is the Contractor's responsibility to verify.
B.
1.
2.
Co
4.
5.
6.
m
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = (NTE) 11' GRAVEL DEPTH = 7' under pipe, 2" over pipe
TRENCH LENGTH = 54' TRENCH WIDTH = 3'
SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK = 1000 Gal.
Twenty-four (24) hours notice required for all inspections.
~2003\03-054Trench- spec.doc
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Ih.l ne Imp~ov~mlnll on lh~ prop~rl~ Illng o~].C~nl
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O~lid al Anchoro~, AIo~o, Ihl~ ~Ho
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, ,'~ eYI IIo. I
O~,,,r C ,~'...4 /'.'1'8 £ /( $
dob n~. ~. /7~ ~ Book no.
Drowh ~ C.~, Checked
Stall /~.~'
ClI~ gr!d N~Z
Survey Illll
ALASKA TECH
Anchoraqe, Alaska 9~J501
.._ ,.~ ~. ~7~:
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 03-054
Calculated By: CW
Date: 10/23/2003
Legal: Northwoods ~ L 8 B 18
Single Family 3 Bedroom Dwelling
TEST HOLE 1
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom =
Pemolation rate =
Wastewater application rate =
Required absorption area =
Trench width (W) =
Grovel depth (D) =
450 gallons
16 minutes per inch
0.6 gallons per day per square foot
750 square feet
3 feet
7 feet
Required length = Required absorption area / 2 / D
Required length = 750 / 2
Required length = 54 feet
Total Excavation Depth = 10.5 feet
/ 7
03-054_Cal.xls 8:30 PM10/23/2003
PER.ORMED FOR:'E
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:, N'O~'~ {/.Joo~5 J:t'~ (, ¢(, , ~[do TownshiP, Range, Section:
6
7
8
9
10
'11
12
13
14
15
16
17
18
1
3
4
:' SLOPE SITE PLAN
WAS GROUND WATER
DEPTH?
Deplh Io Waler Aller
lilonllorlng7
ENCOUNTERED? ,AJO
=i I I I ·
,,,~./.o/~¢~ I I I I/I I I I I I
Reading
I
Date Gross
Time
Net Depth to Net
Time Water Drop
19
20
PERCOLATION RATE
] ~) {minutes/inch) PERC HOLE DIAMETER
'
TEST RUN BETWEEN ~ FTAND , 7 FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT dN THIS DATE. DATE: ' //~ ~ -.3- '? -- ~, ~
72,,.008 (Rev. 4/85)
/ "~, 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
IP_HDNE I
MAILING ADDRESS
~1 . , ~bsorotion aroa . D~ollin~ ~fi~MIT ~0.
~ Z Manufacturer ~ Material ~ of compartments
Liq. capacity in gallons Inside length Width Liquid depth
/~ ~ IF HOMEMADE: ~ ~
~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
O Z ~ Manufacturer Material Liquid capacity in gallons
Well_ ~ . Foundation Nearest lot line / PERMIT NO.
~% DISTANCE TO: ~ t~ ~ ~ /~ ~.
~ ~ Z No, of lines Length of each lin~ Total length of lines / Trench wid~h¢ DistanCe ~e~een lines'
~-- ~~ ~/' 0 / 7~ ~ inches
~ ~ Top of ti~e to fini grade Material beneath the
PIPE MATERIALS
SOl L TEST R~G
~. ~..~. · · -~,,,..~, ~,~
?~ ~o. 2225-E
72-013 (Rev. 3/78)
HA~ANN CONSTRUCTION CO., INC,
P.O. Box 617
Eagle River, Alaska 995?7
Oct. 6, 1983
Cory Willis
Municipality of Anchorage
Pouch 6-650
Aachorage, Alaska
Dear Mr. Willis:
MUNICIPALITY OF ANCHORA(~E
~EPT. OF HEALTH &
I::NVIRONM~NTAL PROTFcTION
RECEIVED
Referring to your letter dated October 3, 1983. The subject
septic installations for Lbt 6, Block 1, Hamann Subdivision #~, and
Lot 8, Block 18, Northwood Phase #4. The above lots were installed
with a berm over the septic drainfield, thus raising the finished
grade to a point 1½ feet above the existing grade at the time of
the soils log for lot 6, Hamann Subdivision; and 1 foot above the
existing grade at time of soils log for Lot 8, Northwood Phase #4.
This effectively raises the level of the trench and drainfield to
accepted Municipal limits.
If there is any further question, please contact my engineer,
Tobben Spurkland, who has been in contact with your office on this
matter.
Sincerely,
Robert J. 'H~mann
Hamann Construction Co,, Inc.
October 3, t9~3
tiamman Cons~raction
P, O. Box 617
Eagle River, AK 99577
Lot 6~ Block i, Ha~ruaaa Subdivision ,~].
Lot 8, Block 18, ~orthwooa P~ase ~4
This departraent is unable to accept the submitted as-buiits
for the above on-site installations. Lot 6 is only 4.5 feet
above bedrock while Lot 8 shows tile trench to ~oe 1 foot
deeper than the soils test allows.
If you have any further questions please call the emjlneen',
or ti%is depart~uent.
Progra..'a
'i'o[~be n Spurkland
293 ,,,~. 15til Aveilue
hnchorage, Ar{ 99501
I
MUNICIPALITY OF ANCHORAGE
Department/~'f Health and EnvironmentaT~rotection
- 825 Street, Anchorage, AK. ~9501F~
.- · 264'4720
Applicant: ~ Mailing Address:
hocation: Phone/Number:
I~egal Description: ~ _~ ~/~f~' ~~~t Size:_ _
T~pe of Soil Absorption System Is:
Trench: Drainfield:~7 Seepage Bed: Holding Tank:~
Maximum Number of Bedrooms: Soil Rating(sq.ft/br) ~/~
The Required Size of the Soil Absorption System Is:'
DEPTH 0~l
LENGTH __~l
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(HUt'DTNG) TANK SIZE TM f~OO GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
or,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 1 9 $ 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 re modeled to inc'lude more t~edroo~/ ~
Signed: ~ ~/~-~ .... ~/ Issued by:
Applicant Date:
SWP/024 (1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:,
1
2
~ 3
4
5
6
-- 8
9
10
11
12
13
14
15
164
17
18
19
20-
DATE PERFORMED:
SITE PLAN
SLOPE
COMMENTS
WAS GROUND WATER S
ENCOUNTERED? ~/O L
O
P
IF YES, AT WHAT E
DEPTH?
ReadingDate Gross Net Depth to Net
Time Time Water Drop
/ //..,,..,,- /,,.,,,,,et,,./,,
~ " /Ave .,,,,.,,., ~-,/5, ..
Z " // ,z'r, "
PERCOLATION RATE / ~ (minutes/inch)
TEST RUN BETWEEN '~ FT AND ~ 4 FT
PERFORMED ~Y: /. ~1, ~
CERTIFIED BY: T~,~
DATE:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage. Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ,¢~'~,~&~ '/~z¢~ -~z,,,-~~ _/'~/~-
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Unless otherwise requested; HAA will be held for pickup.
NUMBER OF BEDROOMS: --~ ''~
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 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 in effect on the date of this inspection.
David R. Dayton P.E.
Name of Firm ~.~'.0 D~..-.=!=r ?..
Chugiak, Alaska 99567
Address ~ ~ ~
Engineer's signature ~/./~'/~ ~'
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Phone
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department'of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS 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
¢0nduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the p?ofessional engineer's work.
72-025(Ray. I/gl) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
IAF~B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
A. Well Data
Well type ~/~,~/Ct
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~/~
Cleanouts (Y/N) ~/
High water alarm (Y/N)
Date of pumping
Tank size ./~ Compartments
Foundation cleanout (Y/N) "// Depression (Y/N)
/f--//~- Alarm tested (Y/N) ,o/'~'/~'/
/ /
,/~//5'?~/ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots ,'u'/~ Foundation /
Absorption field /O Water main/service line
(oo~
72-020 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length 7~;;)
Total absorption area
Date of adequacy test
Width
Soil rating (GPD/Ft2) ~.2. -5'~-~J,~~Z--- System type
Cleanout present (Y/N)
Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Gravel thickness
¥
Total depth ~
Depression over field (Y/N)
for --~ Bedrooms
After test ~-'c~.~/~ _*~'~ ~-
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water /
Curtain drain
On adjacent lots /v//~ Property line /~'~
To existing or abandoned system on lot
Cutbank /.~,~/' Water main/service line /~f
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date ?//~///'~/
HAA Fee $
I::)avJd R. Dayton P.E.
20210 Do-~!~.. 5;~.
Chugtak, Alaska 9956?
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
~ Chugiak, Alaska 99567
20210 Donalar
(9O7)
696-2417
April 9, 1994
ADEQUACY TEST
Legal Description: Lot 8, Blk 18, Northwoods Subd. Addn #4
Date of Test: April 7, 1994
Septic Tank: 1,000 gallon, 2 comparhnent, steel tank
Absorption System: 70' long x 4' wide x 6'deep trench
Soils Rating: 212 sq ft. per bedroom
Requirements: 3 BR - 450 gallons per day
(DHH~ Records)
(DHHS Records)
(DHHS Records)
Test:
Water was pumped into the trench while measuring volume, time and water
levelrise. After the pumping was stopped, the water level drop was measured
at regular intervals.
The results were PlOtted on a graph of t~me and gallons absorbed and
extrapolated to 24 hrs.
Results: .
The system is currently functioning adequately for a 3 BR home.
There was 58" of water standing in the leachfield at the time of the test
on 4/7/94. This indicates that 80% of the leachfield may be surcharged and
therefore the remaining life of ~e leachfield may be limoted.
APPLIC"~IT FILLS OUT UPPER HAL~%ONLY
Property O~n~ /'~'/~x' ~ // Phone
Phone
Address ¢2 /'c;,, Zip Code
/ 2 w' ,"¢ Phone
Type of Residence
¢ingle Family
Multiple Family No. of Bedrooms
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l Icg is required for all w~ls drilled since June 1975.
~.~ommunity For wells drilled prior to that date, give well depth (attach Icg if available),
~ Public Utility
Sewer Disposal /
~lndividual Year Individual Installed:
~Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Datelo-"'7
Inspector Inspector Inspector Inspector
Field Notes: NO ~ j'¢:> r MUNICIPALITY OF ANCHORAGE
-.~ DEPT. OF HEALTH
ENVIRONM2NTAL PP.O~CnON
~., ., OCT
_' : RECEIVED
( '~) APPROVED BEDROOMS *CONDITIONS OF
APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ~'~,,Ta ~' / ~ ~ 3
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
?-tq-¢3 Well to Tank Septic T~k Size
72-023 (3182)
Octob~.~r 10, 1983
Chambers Construction
403 ~'-~. 'iTM
Anchorage, ~%laska 99503
SubDect: Lot 8~ Slock 18 Northwoods Phase iV
Approval ~or the individual sewer and water facilities cannot
be granted until tile ~otiowing items nave be~n completed~
o The permit for the installation ot the on-site sewer system
will expire Dece~ber 3t, 19S3. We have not received the
as-builts o~ the installation in this o~iice. If a private
engineer inspected the syste~'~ please send us the report
for our files and review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
~urther questions, please call this office at 264-4720.
[~incereiy~
Cory Willis
cw67/E2/s