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HomeMy WebLinkAboutMCMAHON #2 BLK 6 LT 13r ri Municipality of Anchorage r" "> -+ On Water Wastewater Program +i! �- -Site and • (907) 343-7904 Page of; bi ON-SITE WASTEWATER INSPECTION REPORT ©c� �© Permit Number: OSP171345 PID Number: 017-361-40 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: AARON & NICOLE HOLMEN ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 3845 KUTCHER DR., ANCHORAGE, AK ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 4 0.6 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot McMAHON #2 6 13 Fill added above original grade Varies -1.66' to 2.08 Ft. Gravel length 2 @ 42' 84 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1008 Ft2 2 12 Ft. Well 100+ 100'+ N NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1500 Gal. Surface Water 100'+ 100'+ A NA Material STEEL Number of compartments 2 Lot Line 5'+ 10'+ NA NA Foundation 5'+ 10'+ Nl\ NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *50'+ NA NA Remarks *None known. Existing field connected Pump on level at in. Pump off level at in. High water alarm at in. with diverter. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer q+ drainfield Drainfield 3034 CO/MT 3034 Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 11/27/17 2nd 11/27/17 Location and description 3'1 11/28/17 4" 11/28/17 Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin OF AZ\ Conditional Approval: Date law, �;• , 9 T.01 ern KENNETH N1 J 'S / Approved Date 1 0pRop 7116 o i esst o��ti eer's Stam inspection Neport_9-1-12.aoc ss�nu AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP171345 McMAHON SUBD 2nd ADD L13 B6 PID# 017-361-40 4 "E 224 23 , co Mt K coF NEW FIELDS Mt ¢, exist. field NEW 1500 TH17-1 as co/GAL S.T. s lit. E _ r ° i wi mt co M Lot 13 3. A—D=11.5' 32,297 s.f. 10 �11a1HC1Cto] A—E=10,0' CN B—E=26.0' GRAVEL DRIVEWAY B—F=42,0' r w loo"88 C—F=60.5' B-6=30.0' aEAi�T o CLZAMMU M C-15=31,0' f W J B—H=30,5' A C—H=31.5' � N 1500 o -GAL m N SEPTIC N B—I=46.5' �r m TANK C—I=52.0' 96.64 c B—J=47,0 0 C—J=52.5' R B—K=60.5' SCALE, NTS — C—K=78.0' U) �\ ®�OFAL4\ m * 4 9 TH 0 ° / I r / � KENNY S / V a ` t CE 711 W� E FESS1011�AV ' TUBE Tb fco 4—BR HOUSE C x " sE 5� MONITOR FINAL GRADE 93,6, FILTER FABRIC,,""" 87,7E SEWER ROCK TRENCH 1 42' — ONITOR TUBE 94.67 FINAL GRADE FILTER FABRIC 87"76 SEWER ROCK 81.76 TRENCH 2 42' — PREPARED FOR: AARON & NICOLE HOLMEN 3845 KLITCHER DRIVE ANCHORAGE, AK 99516 FIELD BOOKS BOUNDARY: N/A STAKING: N /A ASBUILT: KGL DWG. FlLE: ACAD FlLE: FILE COMPUTED: DRAWN: BMW CHECKED: KMD DATE: 12/7 / GRID: SW28. "No.: 17214 MONITOR TUBE Cf) O 41, >1 moo, i- L cK23x, I ORIGINAL GRADE 6' awn 93,76 �iIGINAL GRADE VARIES I T 6' NO GRND. WATER ®SRV. 10/27/17 75,76 BW SCALEi NTS MUNICIPALITY OF ANCHORAGE -0-tcnt On-Site Water& Wastewater Program S g-Igoe1 PO Box 196650 4700 Elmore Road f Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 � r. http//www.muni.org/onsite r. Cpartinum On-Site Wastewater Disposal System Permit Permit Number: OSP171345 Effective Date: 11/13/2017 Work Type: Septic Upgrade Expiration Date: 11/13/2018 Tax Code Number: 01736140000 Site Legal Address: MCMAHON #2 BLK 6 LT 13 G:2835 Site Mailing Address: 3845 KUTCHER DR, Anchorage Owner: HOLMEN NICOLE &AARON Lot Size in Sq Ft: 32297 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 This permit is for the construction of: 0 Disposal Field 0 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 /01/4 -7 Received By: Date: Issued By: kQpLC �_ Date: I X3/7 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-361-40 Property owner(s) Aaron Holmen 303-241-306 Day phone Mailing address 3845 Kutcher Drive, Anchorage, AK 99516 Site address 3845 Kutcher Drive, Anchorage, AK 99516 Legal description (Sub'd., Block& Lot) McMahon #2 B6, L13 Legal description (Township, Range & Section) Lot Size 32297 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) U (w/wo ADU) Septic Tank E1 Upgrade 121Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Si• ere of ► .•-rty owner or authorized agent) i Pe it/Rush Fees: 5"741 Waiver Fees: Date of Payment: /.//304 Date of Payment: Receipt Number: £/ti(eIb Receipt Number: Permit No. CSP l3uS Waiver No. Permit App_9-1-12.doc ▪ +'CTE P ARCTMIRA CONSULTING, INC • caiiNG- 212 E. 5I51 Ave,Anchorage,AK.99503 •`" Office(907)868-3791, Fax(907)868-3793 October 30, 2017 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit—McMahon #2 Block 6, Lot 13 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of this lot is from east to west at a grade of approximately 7- 15% over the septic area. On October 20, 2017 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade with oversized septic tank will serve the existing 4-bedroom single-family residence. We propose to install two deep trenches. Groundwater was not encountered at excavation or at monitoring. The property and adjacent lots are served by private water. 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 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Aft 4 , Kenneth =b! 's P.E. Attachments: On-Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793 WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN McMAH❑N SIBD 2ND ADD LJ; 13 BLK 6 . / L....______.4,0,,,,......:;\ \ f WELL � I \ 1 l i 1 • +-..Mlf SEPTIC / ` , �n.rrr • MVO lal 3 SEPTIC \ _ ,_._ Loi 4 HIREFEMCE T_717 I 13 ��� I wWELL14 �p,= Lot�7 w!. m it 1 SEPTIC .- II, r :. .:. ,... 12, - - 0., x� I ?FLAG PROPERTY LINE SsnPTIC SWELL RADII & EASEMENTS ;PRI❑R TO C❑NSTRUCTI❑N DESIGN DETAILS Scale: 1'= 100' m 4 BDRM X 150 GPD = 600 GPD PAGE 1 OF 2 • NO SLOPES >25% 600 GPD/.6 GPO PER SQ. FT. = 1000 SQ. FT ▪ WITHIN 100' OF (1000 / 2 x (6' GRAVEL) = 84 FT. TRENCH PROPOSED SYSTEM USE 2 TRENCHES - 42' (L) X 2' (W) X 6' (ED) o INSTALL TRENCHES BETWEEN 6-12' FROM ORIGINAL GRADE. 0 Total depth of' systemIs 12' max from original grade. i Total depth of gravel below distribution pipe is 6' . NO PUBLIC WELLS WITHIN 200' OF rn ATEPROPOSEDYSTEM.WELLS WITHIN 200' OF N❑TES 3 PROPOSED SYSTEM EXCEPT AS NOTED, 1, INSTALL 1500 GAL & INSULATE TANK IF <4' COVER. m' PROSEPPOSED WELL EXCEPT AS NOTED. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MINIMUM 27. SLOPE INT❑ SEPTIC TANK. I 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT o WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... A - ` 45 A�� of ALS, W 1 PREPARED FOR: CTER itp AARON H❑LMEN t, � 44 �, � T� � � `� 3845 KUTHCER ➢RIVE ,° E /* 4, 9 i /' * V ANCHORAGE, AK 99516 / / 303-241-306 �4 / / KENNETH D ,S / FIELD BOOKS cauPUTED: !" -ccp CE- Ftv / BOUNDARY:N/A DRAW BMW m '�� '`[\I il aN STAXINa N!/A CHECKED: KMD %\!�, � T/ � ASBUILT: DATE .1r‘ .KGL 10/28/17 d, <�� \ iDFE Sl��r DWD.FILE: rte: SW2835 y4 �'0 `NC�P� `_� ACRD FllE JOB No.: AYEl/!T I NV X36 l FILE 17-214 AK. 99577' WASTEWATER DISPOSAL SYSTEM DETAILS McMAHDN SUBD 2ND ADD LOT 13 BLK 6 ,....,..,...,:iqui ,SLI I ,____V 7 . � Lot 4 ,- _ _ X42 �04 ,_ 3 , _ ir]un _ +;i, I-H17 - 1 ~ � _______ _ 5- 10% 3- 8% ` _ CO INSTALL COs & DIVERTER \:) -........_ , CO INSTALL NEU ; MT EXIST \ in MT 1500— GAL S. T. — 16'J NCH c01 500— GAL LOC. - AS EXIST. SPLITTER _ OL2-232 CO ° T O M ;x N 24.3' O 12'— CO / �'18.0 4 _ BR . Co i SES . X10- 15%/ c,, L / x -\- C) 0 J /1 L.1 ' 0 25. 2' FLAG PROPERTY LINES WELL RADII & EASEMENTS PRIOR TO C❑NSTRUCTI❑N scale: 1•= 20' CLP 41118:416:%&11k'Ilk PAGE 2 OF 2 J .�� OF -9`, PREPARED FOR: CTE DD or<S, ' �` AARON H❑LMEN l'ittliN4)1 �R {C ,o / + 3845 KUTHCER DRIVEsrf,* .4TB /� * ANCHORAGE, AK 99516 �1 *w / 303-241-306KEN - . D S / FIELD BOOKS ca+PUTED: 23 I aE-711. �Wa I8OUNDARr:N/A DRAW BMW m • . �� +1 ti STN(INc: N/A CHECKED: KMD r� ,.iit / 1 17Py ASBV0.T: KGL DAM: 10/28/17 "�„�c- ` Air 1E3 + DWG. FILE: cwo SW2835 CSR 00A %�G.aA�, 4 j �_� AC"D FILE JDB No.: �'4. 1K i 57 e FILE 17—214 4 K.99577 �RCTER�,� ARC 1 ER RA � , OF AL19s ' CONSULTING, INC ,' ; a 212 E. 51 Ave,Anchorage,AK.99503 '7 �; Office(907)868-3791,Fax(907)868-3793 71207 4 t� � `_ '., S�1LiiNC i'ne" 4 p KENNETH M. 7* . / SOILS PERCOLATION TEST 4 f`' 7t s �F�/ /1 L ` :`~i • 2SSI0 P• s Performed for: Aaron Holmen Date Performed: 10/20/2017 \\ Rt.."10411°- Project: McMAHON #2 B6, L13 TEST HOLE// TH 17-1 Depth r 1 to i SEE ATTACHED SITE PLAN FOR HOLE LOCATION 1 Org/OL-ML Was Ground water encountered? NO What depth? NA , Depth to water after monitoring? NA Date? 10/27/17 D Reading Date Gross Net Depth of Net Time 7•ime Water Drop 6 1 10/21/17 1:00 - 6" - 2 1:30 30 min 36/16" 2 10/16" 3 1:31 - 6" SNI-11111;NI -silt deceasing w/ depth 4 2:01 30 milt 3 6/16" 2 10/16" 10 5 * 2:02 - 6" 11 6 2:32 30 min 3 7/16" 2 9/16" 12 7 0, I 8 14 9 5- 10 16- 11 • 17- 12 I K * Water Added B.O.H. 19 Percolation Rate 12 (mitt/in)Perc Hole Diameter 6" HOLE PRESOAKED 20- PRIOR TO TEST Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. GRE.,fER ANCHORAGE AREA BOt,,,.'UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM PHONE ,~'¢Y'1/ SEPTIC TANK: DISTANCE / FROM WELL /~.~ MANUFACTURER ~""/'"" "'¢~ "~')J¢~1 A T E R I A L INSIDE LENGTH_ INSIDE WIDTH LIQUID DEPTH NUMBER OF 2-.-.-.-.-.-.-.-.-~ ~ ~"'~--~ i COMPARTMENTS LIQUID CAPACITY *"-'~ GALLONS. TILE DRAIN FIELD:--~"-/~.~/...)C/~ ' DISTANCE FROM WELL Jl ~) rFOUNDATiON NUMBER OF LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH / NEAREST LOT LINE '~'~"J OF LINES ¢.~ '7 DISTANCE BETWEEN LINES TRENCH WIDT IN. TOTAL EFFECTIVE O ~) 7 SQ. FT. LENG TH OF EACH LINE ~ ,,.~ ]~ -..~%~'k.g_/~W...~l.. '~ ~ DEPTH OF FILTER ~-~"'-/ MATERIAL BENEATH TILE ~ ABOVE TILE '~ IN, TYPE _ . , CONSTRUCTION BUILDING NEAREST FOUNDATION__ LOT LINE CESSPOOL ~yg¢~- , OTHER SOURCES APPROVED j.// DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEWER LINE__ REMARKS SEPTIC /,~/-.) fSEEPAGE , TANK ~"~'~ SYSTEM DISTANCES: ,,/g ,/~ ~/~:~0 '/ INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: Form LQ-032 DIAGRAM OF SYSTEM ,li l..: J::i "J '] i'l'j ........................ . ...... ?jf;:]l::.:,, ;11 J'"J(JJ"i J",JJ...!Jl"jl{iiJ}iiil:;;:. I]];1F [~':[i;T:,j:;i:.lil;1(Tiij"'j:.ii~; := ~ :.j~:;lil) ]'t ];~'tziT ~ ~"u:i ~:;:" ~:;~ ........ "j'HE j J:::'N'VI'H [:';1;J"iiENS];ON T':::; 'r'..~; i...EN(]fi';1"H ,' I~'.,~ FEET) ,,r' "jHi:' DEF:'TH i-il:: ~:::j ...... "' ' . ~ r :~:. ~ ..4- ~"~l:;;' :, i' T T ,::; THE E:' :t; S';1"Fff',i(:;:i:i:. !]~i~:;;:i]]l!...ij"4j;]:, F::ff',l[) 'T'HiE E',()T"J'OFJ OF 'J"HiE jE;:':;E:FCv'I:4T.i;(J!J",J ()]i",i '! hH;:.[~:l::. ........... ~"::7 ..... J",JO SET J.'.J:[DTJ'"i I:::'(]ll~: I-~, .[ ...... .r, ....!~'*' "t"HE{ i]~il:;J~i:;Y,,,:~!]j., i;;:: i]~; l:::' "J" i'"l ..... 'r ':::; 'T'HE 7i ;1; i"4 Z Ni...ii,'i l....,..:.,'-,c:'u;:"'"[...i,, l];)~:::' ;]I:;:I::I',-,:FI i:~HE'I'b.iiEIEN I:::iND "'"' i : ?,t:::. l::~ f';1'T"i" "~ I'"i r"l!::' 'r'l-.tl[;] ....... I ~' : ' ...... ~::.,',L.,' , · .. ";il",i ':; ;1: N i:::EET ). i'"i ]; i",i ;i; i"i Lii"'i ;;~.i]:!i!~i]i i::E(E:"!' l:"t;;d:?, t::I Pi:;;: ;1; Vl:::i'i"lii~ i41iEl..L. OJ:;;: ;;;i:l;;_"i!;i!l I::;'li:.(ET F'O!:;;: I::t j::;:!.!E',I....];(;;: i.'.iiE L.L.i..O (:iif:~; (])F THE i.,.ii!Ei..i... :iil;F:iE C: ]; J::' ]; C:t:::i T :i; N % T ¢::! L.i..i:':l T :!: (3 N. :.i.' )] !:::i)"1 i:;:Fi!"i;(J..]]F;1i:;?. ]"' i.!l::: i i-~ J!~l~'r: -J"HFi] I II. ,,-:. 2.: ); i4 ;i] i...L ]; i",j:i~f;'T!~l~.i... TI'"iEi] ;;ii:: ;1; i..!N!)iiB:;?.i~i;'~?~;:]/ Ti'"!i:::F!" '1'HIE E~N""ri~; ;1] TiE :~il;EJ.,.iij~: ?'?STiEi"i i"iI::i'¢ i:RiZ(;!ij;1;i:;i:E iEI",iL.F::ii;?.(]iI!!i]"'ilEt",I'T :(i:::' THE :!!; ii; (]iNiED: _. ~i:;;: i:::Z :~i; ]]E:, El; iq E: ~'i~.;1 !'"~i ..~i::' E:, '( ~' i ', i "'":'" :'" '~"":'"'~i!"'i"l' CONSULTIN~ ~EOLOGIST SOILS LOG ~erformed for De~h (feet) Soil Description -'t2- -14- -20- Total DepthJ_~feet in ~ Was gro~undwater encountered ~-~ ? Wha~ depth Depth to bedrock ~ ~--© . How determined ~ Respectfully submitted, Gary _~. Player Consulting Geologist WATER WELL LOG WELL OWNER LOCATION L FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 SIZE OF CA~ING ~",,DEPTH OF HOLE/~?~T. ~A$ED TO /~ 7 FEET OF DRAWDOWN. FT. REMARKS DATE COMPLETED ~.// PUMP TO BE SET AT to to , to __t O , to, tO J Development Services Department Building Safety Division On -Site Water Wter Program B 4700 rngaw Street P.O. Box 196650_ Mark Begich Anchorage, AK 99519-6650 Mayor www muro orq/ons�b (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal Description Pro erty Owner Name & Address: /Ic, In A, lt0tt is— c1 L-13 Pump Installation Date: 916/07 Pump Intake Depth Below Top of Well Casing: 1XV feet Pump Manufacturer's Name: ZeR KLCX Pumphlodel: i37?41p ►SO ss3/ Pump Size 1/Z hp Pitless Adapter Burial Depth: %0 !feet Pitless Adapter Manufacturer's Name: RIA Pitless Adapter Installer: )U/,q Well Disinfected Upon Completion? 0 Yes ❑ No Method of D' infection: Commen s• Pump Installer Name: i0"r L Acv Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMK-''~ OF HEALTH AND ENVIRONMEN~-~!- PROTECTION 825 'L Street, Anchorage, Alas~& 9950]. 279-2511, ext~ 224 or 225 #1: Time ~:~9 a.m. #2: Time Date Received: June 22, 1977 #3: Time Date 6-23-77 Thurs Date Date Insp Pratt Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Amfac Mortgage Mailing Address: 705 West 6th Avenue Phone: 277-8588 Property Owner: Charles E. Jackson Mailing Address: Star Route A Box 1582N Phone: 344-0491 3. Legal Description: Lot 13 Block 6 Mc Mahon Subdivision Single Family Residence: ( Multiple Family Residence: Number of Bedrooms: four Number of Bedrooms: Well System: Permit # Construction Individual well ~ ) Con. unity/Public System ( ) Depth of Well 167' Well. Log on File ( ) Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (~ Public Utility ( ) Installed Installer Manufacturer Soils Rate Material 7~ Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two ,~ ~ Department of Health and Environmental Protection ~-' Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 13 Block 6 Mc Mahan Subdivison Comments: Affadavit Attached: ( )// Disapproved: Letter Attached: Date: Date: ( ) Department Worksheet.: MUNICIPALITY OF ANCHORAGE '~~ Department of Health and Environmental Protection //'q~9~'~ ' 825 L Street, Anchorage, Alaska 99501 ~%~)) 279-2511, ext. 224, 225 .... ~--~-Request for Approval of Individual Sewer and 1. Property Owner: ~'~?~2~- )~' .,~ ~7 ~._)4~ Mailing Address: e Name of Buyer: Mailing Address: Phone: Lending Institution: Mailing Address: Phone: Realtor/Agent: Mailing Address: Phone: Legal Description: Street Location: e Single Family Residence: Multiple Family Residence: Water Supply: *Individual Well If Individual Well, well depth (/~'~Number of Bedrooms: ~/ ( ) Number of Bedrooms: (~/Public/Community System / 2 If Community System, name of system ( ) 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 since 6/75. 3/77