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Home My WebLink AboutMCMAHON #2 BLK 9 LT 7 Municipality of Anchorage Page I of 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES .. ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~Nqq02~6, PID Number: Name: ~,~ ymO,dP /-/. ~o~ Wastewater System: ~ New ~ Upgrade Address: ~7~o ~ P~v~ ABSORPTION FIELD Phaa~:- I NO. of B~drooms; ' ~CH~ , ~ ~/~ D Deep Trench D Shallow Trench Bed OMound OOther LEGAL DESCRI PTI O N so, Rating: ~. r GPD/Sq. Ft. Total Depth from original grade:. Lot: Block: Subdiv~ion: 3epth to pipe bottom from original grade: Gravel depth beneath pipe ~ ~ ~~O~ ~.~ / Ft. ,~ Ft. Township:~ Range: ~ ~ Section: Fill added above original grade: ~ Ft.~ Gravel length: ~ Ft. I WELL: ~ New ~ Upgrade Grave~ width: Number of,n~s: Distance b,~e.n,nes: 2~ Ft. 7 [ ~'P~ Ft. Classification (Private, A,B,C): ~[~ Total Depth: Cased To: ~otal absorption area: Pipe materiah ~ Driller: Date Drilled: Static Water Level: installer: Date installed: GPM~ Ft. Ft. SEPARATION DISTANCES ~septi~ ~ Holding ~ S:T.E.P. To Septic Absorption Lift Holding )ubl[c/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~O ~ ~ / Number of Compadments: s~a~e ,~ -- LIFT STATION Water /~O '~ /~ ~ -- Line /O t Foundation ~q' ~' ~ ~ ,,Pump on,,levelat: ~ i H,gh water alarm at: Cu~ain ~ [ Electrical Inspections pe,orme~ Remarks: ~ ~t~ ~ ~~ BENCH MARK Location and Description: } Assumed /~.0~ ~. Elevation: ENGINEER'S SEAL 170~ Eagle RDer La~ Road~ No, 204 ~ .,/~~, ~. ~ Inspections performed by: ~..m. nlver. Alaska ~9577 Dates: 1st T-z~-qq_. / 7~ ~ Reviewed and approved by: , Date: ....... ,,.~.~,, ~-,.~- · 72-013 (Rev. 9/91) MOA 25 Permit No. SW940256 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:McMAH°N SUBD. ADD. #2, BLOCK 9, LOT 7piDNo.; 01736214 i CO !: MT / :: ~ FINAL ~RADE · 89.4' WATER FOUN~ 7-21-94 f / ]BED WELL _OT 7 WAIVER GRANTED 1250 GAL. SEPTIC TANK A FCO 30.0 ?.0 C01 39.5 2~6.0 CO2 41.5 q3.0 CO3 63.0 65.0 C04 67.5 8,4.6 ~T~ 7.7..:~. ~..0 MT2 48.5 64.6 tO0' WELl RADIUS N 4 BDRM HdUS¢. SCALE 1' = 40'i:: 72o013 A (1/93) * PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 0N-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW940256 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SPOLTMANRAYMOND H & OWNER ADDRESS:3750 TAIGA DR ANCHORAGE, AK 99516 PARCEL ID:01736214 LEGAL~ DESCRIPTION: MCMAHON #2 BLK 9 LT LOT SIZE: 25019 (SQ. FT.) NI/MBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PERMIT DATE ISSUED: 7/22/94 EXPIRATION DATE: 7/22/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 A_ND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS unic pality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 22, 1994 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 7 Block 9 Mc Mahon ~2 Waiver Request #WR940042, PID ~017-362-14, SW940256 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 feet from the lot line adjoining Lot 6. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. /Rober~ W. Robinson Civil Engineer On-site Services ljw#7 MUNICIPALITY OF ANCHORA~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# ~Q~q&~)O~ PID#. 017-362-14 HA# Permit Date Received: July 18, 1994 Legal Description: Lot 7 Block 9 Mc Mahon #2 Engineer: Robert Shafer, P.E., S & S Engineering 17034 EAgle River Loop Road, Suite 204, Eagle River 99577 Applicant: Ray H. Spoltman Waiver Requested: Lot line waiver of 5 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: o 3. Other: Waiver is Granted: ~ Waiver is NOT Granted: / List Conditions or Reasons for above: ~ame of Reviewer Rec #: 00115/5668 Amount: $ 115.00 Date Paid: JUly 18, 1994 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EX"rENS[ONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST ROBERT SHAFER, P.E. ROGER SHAFER, P.E. July 18, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: McMahon Subdivision ~2; Block 9; Lot 7 Request you issue a permit to upgrade the septic system serving the four bedroomhouse on the referenced property. WE R~QUEST YOU EXPEDITE ISSUANCE OF THIS PERMIT DUE TO THE UNSANITARY OONDITI(kNS; ~:.~'.~'L[J'ENT IS BACKING INTO 'l'k~ HOUSE. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation water was encountered at 6 feet and after seven day ground water monitoring water was again found at 6 feet. The area available for the upgrade of this system is restricted by property lines, well radius and the location of the old absorption area. A waiver to the property line of 5 feet and a waiver to the requirement of a maximum width of the bed of 15 feet is required to place the system in the only area available. The property line waiver will not affect any future development of Lot 6 to the west. A 10 foot walkway easement has been provided immediately adjacent to the property line and serves as a buffer between the two properties. A bed design at a 23 foot width is the minimum width that can be provided and provide for adequate surface area for absorption. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you havetave~n~ questions, or require additional information for your STRUCTURAL & . DISPOSAL SYSTEM DESIGN ~ 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~oa o °°~m o z ON-SITE WAS~EWATER DISPOSAL SY$~ CONSTRUCTION PRACTICES E.",3~T,'~tI~nJ~ SPECIFICATIONS R~F_~(ENCE: McMahon Subdivision 92; Block 9: Lot 7 The scope of this project includes the installation of an absorption bed to serve the four bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify its integrity. If of poor integrity, the tank is to be pumped, crushed and abandoned. The existing leachfield is to be abandoned in place. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC ~ANK INS~[~.~ION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page Two McMahon Subdivision #2; Block 9; Lot 7 July 18, 1994 J A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. BED INSTALLATION: Excavate the proposed trench to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (roughed-up) before gravel (sewer rock) placement. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. e Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. Page Three McMahon Subdivision #2; Block 9; Lot 7 July 18, 1994 1. 2e MATerIAL SPECIFICATIONS: Any septic tank proposed for installation must be Municipally approved septic tank manufacturer. The following pipe materials are approved for use installations in the Municipality of Anchorage: constructed by a in septic system J Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved the inspecting engineer. by Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSP~-i'~ONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Page Four McMahon Subdivision #2; Block 9; Lot 7 July 18, 1994 2. The second inspection mst be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carr.y out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project: CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE SITE PLAN . (ENGINEER'S SEAL~ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT (~ ¢ 0L DEPTH? p E Depth to Water After Monitoring? Da(e: J (.,/.7~ ~'") Gross Net Depth to Net Reading Date Time Time Water Drop :09 £ ~,,, ~(~' ;1~ .C" 6~/t'' I~1~ :1~ ~ ~ ~" - - ~ ~ S ,, 6 ~ ~,, PERCOLATION RATE --~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ,~'~ FTAND ,~,~t FT ¢ PERFORMED BY: ~0~ E~)~ ~F I ~ ~n~ ~. ~ I CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE W~t~k~g~AL eU,eEL, NES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GRE/~JER ANCHORAGE AREA BOk.,.dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska ggS03 NAME/,4./, LOCATION INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE ( ~.,.~ NUMBER OF FROM WELL /O~ MANUFACTURER ~¢~.'¢~.MATER,AL,--.----------- COMPARTME"'""S 7 INSIDE LENGTH / INSIDE WIDTI+''''/ LIQUID DEPTH J LIQUID CAPACITY/',,,,,~-..,g~(~ALLONS. / ABSORPTION AREA , SQ. FT. LENGTH OF EACH LINE ,~1 DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ""~ IN. ABOVE TILE G O IN. TWyEpLEL~ CONSTRUCTION DEPTH __ BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE SEWER LINE__ TANK__ SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: ~-47 SEWER LINE DEPTH: Form EQ-032 ,. DIAGRAM ~OF SYSTEM B~oo~1 DATE ~,~APPROVED ~ m~ ' G.A.A.B. [ TI ME DR ILL LOG CASING SELF DRILUNG START 914 East 78th Avenue ANCHORAGE, ALASKA 344-9242 COMPLETE DATE NAME ADDRESS C;TY TIME WELL LOG STATIC LEVEL DEPTH PHONE WELL LOG GPM - YIELD PERMIT NO. aPPLICaNT W DITTBRENDER LOCATION TaIGa DRIVE L. EGAL k.' ," b - L-".._ t:~. ,:: 77:t34 ) ' //~:~(_]A~/l~-~_oQ,~__7.7 L~Uf¢(]' ~L _- S SRR 80,':.-': 4'76'~ ...... 4. -,..., ....... L7 89 MCMRHON SUBD aDDN ~2 LOT S I ZE 7 ~.3EIEiE~ SL.]IJaRE FEET TYPE OF SOIL aE,=,_EBTION S'¢STEM IS: 'FRENCH MAXIMUM NUMBER OF BEDROF'MS = 4 SOIl_ RATING ("_'5!;! FT,.."BR)= .:L,~ .... ,-:.E ElF - '- - -' '- T "-' "-' ' - I S: THE REi;¢_IIRED SI"- ]'HE SOIL HB:,URFI_ON _-Y_-,~fEfl THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH (DR [:,RBiNFIELD. THE DEPTH OF R TRENCH OR PIT IS ]'HE [:,ISTaNCE BETWEEN THE SURFACE OF THE GROUND aND THE BOTTOM OF THE EXCa~,,'RTION ,::IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRa',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL. BETI4EEN THE OU'TFaLI_ PIPE aND THE BOTTOM OF THE ENCa',,,'aTION (IN FEET). BACKFILLING OF RN'¢ SYSTEM WITHOU]' FINAL INSPECTION aND aPPROVaL BY ]'HIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN Ft NELL aN[.', aN9 ON-SITE ~;EWRGE DISPOSAL S'¢STEM IS .1E1£4 FEE]' FOR a PRIVATE WELL OR 2L--~L.-1 FEET FOR .R. PUBLIC WEL. L. WELL LOGS aRE REQUIRED aND MI..IST BE RETLIRNED TO THE DEPARTMENT WI'T'HIN ]:¢..'.~ DaYS OF THE WELL COMPLETION. SPECIFICATIONS aND CONSTRUCTION DIaGRaMS aRE RVFtILaBLE TO INSURE PROPER INSTaLLaTION. F' E F4:: Lr-1 ][ T "-.." FII L T IT.:, F ,] F-". ,3 ~"-.~ E "-.-" E R E.". F F-'.' C, IP"ii ][ ~..T, ~.; E] ~F_' I CERTIFY' THaT :1.: I aM FRMILIFIR WITH THE REG!UIREMEN'FS FOR ON-SITE SEWERS aND 1.4EL_L'Z5 aS SET FORTH B~/ THE MUNICIPALITY OF aNCHORaGE. 2: I NILL INSTALL THE SYSTEM IN aCCORDaNCE WITH THE CODES. 2':;: I UN[.',ERSTRND THFIT THE ON-SITE SEWER SYSTEM MR'¢ REQ. UiRE ENLARGEMENT IF 'THE RESIDENCE IS REMODELED TO INCLUDE MORE THaN 4 8E[.',ROOMS. aPPLICaNT W DITTBR. ENDEF D?-' ~rtment of Health and Envlronme? i Protection Anchorage, Alaska 99507 '- 276-22-~2~ S()II~S L()(; - PI'~I{()I,ATI()N TEST Performed [or ~ '~t'~r~ ',)nte Performed ~-I-~'~ lhis form reports; Soils 1o~ ~ Percolation ~est Dep th Feet 4- 5- 6- 1- 8- 9~ ll - l~l - Was 9round water ellcountered7 ~./1,~ ...... ~ yes, at what de.~th? ' Reading Date Gross T~me Ilet T~me UopU to Water Net i~rop Percolation rate minute. -Proposed ins tall a~}~? --~a~e Pi t Dra i n Fi e Id I)ui)[h of Inle~ .................... . Denth to bottom oF pi t or trench ......................... ~..~._. COI~HENIS ~ t'1(~ 0,10 (6/74) , DA~E RECEIVED · :~' INSPECTION APPOINTMENTS tCz)c~4 q~l~ 4e~(~ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALI~ OF ANCHU~E ~UNIOIPALITY OF ANOHO~AGE DEPT. OF H~ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~IRONMENTAL PROTE~ION ENVIRONMENTAL SANITATION DIVISION Telephone 264:4720RECEIVED REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI~EOTIONS: Complete all parts on p~ge 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. 1. PROPERTYOWNER . J PHONE I MAI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER . PHONE MAILING ADDRESS 4. REALTORJAGENT J PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ;TR LET LOCATI ON S. TYPE OF RESIDENCE [~SINGLE FAMILY F'q MULTIPLE FAMILY NUMBER OF~BEDROOMS_ [] One [~"Four [] Two [] Five [] Three [] Six [] Other 7. WATER S__~I~FLY ~ L--u3 INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~INDIVI DUAL/ON-SITE~ [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ~)~,j~ 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 Connect[on Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or []Holding Tank Size: 1/ ~ ~-~ If Tank is homemade SOILS RATING give dimensions: TYPEOFTANK MANUFACTURER ZqJ 0 I')~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~ APPROVED FOR ~, BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) ~'~, MUN I C ! PAL ~ TY OF ANCHORA~ DEPARTM .... T OF HEALTH AND ENVIRONME, AL PROTECTION 825 L Street, Anchorage, AlaSka 99501 279-2511, ext. 224 or 225 ~'nO-q~pO~'l¢,, Date Received: July 18, 1977 #].: Time #2: Time #3: Time Date Date Insp Insp REQUEST FOR APPROVAL ~F INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska National Bank of the North Mailing Address: Pouch 7-010 Calais II Phone: 278-4581/274 - 2, Property Owner: Wilbur/Gloria Dittbrender Phone: 349-2235 Mailing Address: 3. Legal Description: Lot 7 Block 9 Mc Mahon Subdivision ~2 4: Single Family Residence: gx) Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Three Well System: Permit # Construction Con. unity/Public System ( ) Depth of Well Well Log on File ( ) Bacterial Analysis On-site System (x) Public Utility ( ) Installed Installer Manufacturer Soils Rate Materiai Individual Well (x) Sewage Disposal. System: Permit ~ SeptJ. c Tank Size Absorption Area Distances: We].]. 'to ~' · Sepu].c Tank to Sewer Line Nearest Lot line to Nearest Lot Line to Absorption Area Absorption Area Department of Health and Environmental Protection Reques% for Approval of Individual Sewer and Water Facilities Legal Description: Lot 7 Block 9 Mc Mahon Subdivision #2 Comments: Affadavit Attached: Approved: ~C Disapproved: Letter Attached: ( ) Date Date Department Worksheet: MUNICIPALITY OF A[ICHORAG[ '~.:,,.~,:,.u,~.;,,:>,:'~:.,'::i'. //['-~ J Department of Health and Environmenta'l · - ' ,m'- .... : ' " "' "'"-""~ I" ' ,' .TlOb~ ff~'::'f'2'~-",./ 825 L Street, Anchorage, Alaska .9950'~'" ....... ?~':,~,..~[f~/'.:/ 279-2511, ext. 224, 225 ..... :~<equest for Approval of Individual Sewer and Water Fac].lltles Mailing Address: ~'"/~ .,~ /,~.~,~,/.~ ~,~.~. ' Phone: Name of Buyer.'//~0~~~:~: '-{-- Mailing Address: 4030 Lore Road Space#15 Phone: 344-2707 Lending Institution: Alaska Nat!onsl R~n~ of the North Mailing Address: Pouch 7-010 CalRis II Anch. Akl Phone: 278-4581 Ex ~4 e Realtor/Agent: Ma~y T.o. C~ny Marston Real EstaRe Mailing Address: 2804 W. Northern Lights Blvd. Phone: 276-2804 Legal Description: ~.M~M~h~n #2 S/D Street Location: N.H.N. Taiga Dr_lye__. o Single Family Residence: (x) Number of Bedrooms: 3 Multiple Family Residence: ( ) . Number· of Bedrooms: Ware,: Supply: *Individuai Well (x) If Individual We!l,. well de~eb If Co~nunity System., name of system Public/Conmmnity System Sewage Disposal System: On-site System (x) Public System ( ) If On-site System, date of ' · n~,~.allation: *NOTE: A well lo9 is required on ALL wells drilled since 6/75.. 3/77