HomeMy WebLinkAboutLAMPERT ESTATES BLK 1 LT 7
/og . C
, Municipality of Anchorage Page
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: S~/~/¢~ ~5 PID Number:
Name:
~ ~ ~/y/~ ~l~p/~ Wastewater System: D New ~Upgrade
Address:
~x9~ ~G ~.~ ~o~/~ ABSORPTION FIELD
Phone: No. of Bedrooms:
~- ~ ~ ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
O.
Lo~ Block: Subdivision: Depth lo pipe boltom Item original grade: Gravel depth beneath pipe
Township: /~H Range: /~ Seclion: ? Fill aOOeOaboveoriginalgraOe: Gravel longlh:
0 - / ."
FL
~ --~ Upgrade Gravel wiOlh: ~I/ Ft, / ~/~ Ft.
WELL: D New ~5¢1~/~ ~' Number of lines: Oistancebe[weenlines:
Classification (Private. A,8,C): Total Depth: Cased To: Tolal absorption area: Pipe material:
Driller: ~ ~e Drilled: Slatic Wale, Level: I n ,lalle.: Ft. ¢~ ¢~r Dale installed:
Yield:~MI~ Pump Set at: FI. Casing Height Above Ground:Fl. TAN K
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
TO; Sephc Absorp[ion Lif[ Holding ~b]fc/Private Manufacturer: I Capacity in gallons:
From Tank Field Stai,on Tank S .... Lines~ff
Well /¢¢/ /¢¢1 ~/4 ~/~ ¢}~ Ii Material: 5¢¢~ Number of ~mpartments:
Surface ~/~ ' LIFT STATION ~/~
Water
Line ~0 /p / ~/~ , Size in gallons: Ma..facturer:
Foundation ~ /¢ I ~/~ "Pump on" level at: ~: High water alarm at:
Curtai.Drain ~/, ~ / , -. Pu;~'ectrioal Inspections perlormeO by:
Remarks: BENCH MARK
~ Location and Description:
ENGtNEER~.S ~L
Inspections performed by: ~ Dates: 1st
'
Department of Healt~ Humgfl~Yvices/~ approval , /',~,g~.,o, '~' '~ ...... c~.,~:~.~, :. ~-::.'.?~ ~-,: ,.~.
Reviewed and approved b Date'. / - .L:,_
72-013(Rev 9191} MOA 25
Permit No, ~q'um 9 Y a .25'.¢' Page ,=A. of o~.
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:
PID No.:
N89°59'20'~ 90,00'
LOT 7
APPROX.
WELL
-iF UTILITY E-A~-~E~"T-
S89'57'00'W 90,00'
SWING TIES=
A - C = 8,8
B - C = 44,5
A -' D = 18,0
E - g = 30,8
A - E = 34.0
]3 -- E = 75.0
A F = 43,9
B F = 85,9
SCALE 1" = 50'
· - MONITOR TUBE
o - SEWER CLEANOUT
~,- - WELL
EASEMENT
ELEVATIONS ~ BaTTO. or s~B~m . nEAR ,~' VJN,OV
(NOT T0 SCALE) ~ Assu,c~ ELEV = 100.o0 -~"
o
I~ ,~/ PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE ~' ~
DEPARTMENT OF HEALTH AND HUMAN SERVTCES / }/q~ Q / Z.~r~2~ .
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940255
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:GILLESPIE BRIAN M & DIXIE L
OWNER ADDRESS:20890 OBERG RD
CHUGIAK, ALASKA 99567
DATE ISSUED: 7/22/94
EXPIRATION DATE: 7/22/95
PARCEL ID:05110261
LEGAL DESCRIPTION: LAMPERT ESTATES BLK 1 LT 7
LOT SIZE: 19835 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 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:
DATE:
7-22
Louis Butera, P.E.
Registered Civil Engineer
July 21, 1994
Dan Roth
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
RECEIVED
,JUL 1 1994
tviunic~palh¥ of Anchorage
Dept, Health & Human Services
Re: Lampert Estates Lot 7, Block 1
Narrative
Dear Mr. Roth:
We are submitting additional information in support of our request for an upgrade septic permit
for the above referenced property.
We have deleted the diversion valve and will abandon the existing trench in place as it
encroaches on the existing water table. Our water table measurement was in June. The water
table is believed to be at its high level at 9.5' depth, and this is supported by our monitoring of
adjacent Tract BI-A, Lampert Estates during May of 1988 (log attached). Therefore we propose
to raise the total depth to 5.5' mid retain the original gravel depth and length, allowing a gravity
system. This is reflected in the attached revised specifications.
If you have any questions please call onr office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C:\WPWIN60\WPDO CS\1994\94-025B .NAR
P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297
Louis Butera, P.E.
Registered Civil Engineer
July 7, 1994
Jim Cross
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re:
Lampert l~states Lot 7, Block 1
Narrative
To Whom It May Concern:
The proposed septic upgrade will have very limited impact on adjacent properties for the
following reasons:
1. Immediate neighbofiug septic systems are all +30' distance.
Reserve space is adequate, due to absorption capacity, and lot size. This is the
second system on this lot and the original will be retained through use of a
diversion valve.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
\C :\WPWIN60\WPD O CS\ 1994\94-025A.NAR
P,O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 . Fax (907) 694-3297
SPECIFICATIONS FOR ON-SITE SYSTEM - REVISED 07/21/94
LEGAL: Lampert Estates Lot 7 Blk 1
1.
2.
3.
General
The well and septic plan are for a single family residence only.
The drawing and/or site plan shall be a part of this specification.
All materials and worktnanship shall meet the Anchorage Department of Health MOA-
DHHS requirements.
All soil tests are advisory to the design and are to verified or modified in the field by the
Engineer.
All excavations and depths are advisory and are to be verified in the field by the
Contractor to meet MOA-DHHS requirements.
It is the responsibility of the Owner to obtain all necessary permits or easements.
It is the responsibility of the Contractor to secure all utility locates prior to construction.
The excavation is to be exactly in the area shown on the site plan, any deviation requires
Engineer approval.
It is always recommended that a surveyor locate the nearest lot line position and the
location of any easements.
gJ
Septic Tank & Plumbing
Septic tank construction shall be a new 1,000 gallon, steel, two compartment tank
approved by the Municipality of Anchorage.
Septic tank is to be installed level on compacted base material at proper elevation to
allow leachfield pipe to invert at 3.0'.
The existing tank is to be pnmped, removed and properly disposed of.
New tank to be provided with cleanouts after tank.
Installation of the new tmlk will require re-plumbing crawlspace piping at new elevation.
Leachfield
Existing trench is to be abandoned in place.
The leachfield is to follow the natural contour to maintain uniform total depth of the
trench bottom. The bottom of the leachfield shall be level, plus or minus 1.5".
The total depth of tile leachfield excavation is not to exceed 5.5' at any point.
The existing sewer line that leads to tile existing leaching system is to connected to a
diversion valve to allow efflnent switching.
The leachfield gravel is to be covered with typar fabric material.
A combination of + 18" soil and 2" extruded board insulation is to be placed over the
leachfield.
The area over the trench is to be finish graded to prevent ponding of surface water
rnnoff.
The septic tank and leachfield must not be closer than 100' to any existing private well,
150' to any Class "C" well, or 200' to any COlmnunity well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 5.5' GRAVEL DEPTtt = 3'
LEACHFIELD LENGTH = 87' LEACHFIELD WIDTH = 5'
SOIL RATING = 0,~: gpd/ft2 BEDROOM CAPACITY -- 3
SEPTIC TANK SIZE = 1000 gallons
Twenty-four (24) hollrs notice required for all inspections
\C:\WPWIN60\WPDOCS\ [994\94-025B.SPC 1
^PPROx,,^r¢7 ]--]--~_
ELL LOCATION
~, ',/ELL LOCk,ON
_ _ '~..._~ ...... L~~:k
~ /5'X 52'
10' UTILII Y EASMENT
~89~57'00'~ 90.00' ~ - TES[ HOLE
· - MONIIOR TUBE
o - SEWER CLEANOUf
NO KNOWH CURfAIN DRAINS + - WELL
PROPOSED LEAOHFIELD
NO SURFACE WATER EASEMENT
LEGAL: LAIvlPERT ESTATES LOT 7 BLOCK I
OWNER' Brian and [Dixie Oillespie
CONTRACTOR: N/A
',
JOB ~ 94-02pi DATE:, 07 21/9 ~ '"-/-~P~
A ExlCLE RIVER ~NGIN~RINC SERVICES ~%~-Lou,s
(aO7) 6?4 51S5 P4,Y.. (?07) 674-3Z77
EAGLE RIVER
ENGINEERING SERVICES
P, O. Box 773294.
EAGLE RIVER, ALASKA 99577
Phone 694-5195
Lc~nperh Estahes Lob 7, Blk i
SHEET NO ..... OF ......
CALCULATED BY L.B. DATE 07/21/94
CHECKED BY L.B. u^~e 07/21/94
SCALE
Three Bedroom Single Residence - REVISED 07/21/94
3 BR x 150 GPD = 450 GPD
Tank Size = 1000 4- (3-3)(250) = 1000 gallons
PerColation rate = 20.9 minutes per inch
Application rate = 0.6 gpd/fi2 (trench)
450 GPD + 0.6 = 750 fl2
750 ft2 + 5' (width) = 150'
150' x .583 (length factor) 87'
Trench Dimensions
Length = 87'
Width = 5'
Gravel Depth = 3'
Total Depth = 5.5' (max)
\1994\,
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Ataska 99502-0650
SOILS LOG -- PERCOLATION TEST
7-h'Z
1
2
3
4
5
6
7
8
9
10
11
12
13-
14
15
16
17
18
19
20
COMMENTS
Z, G,?I~¢,'~
DATE PERFORMED:
Louis/\, I~uterd ¢
Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S~TE PLAN
s
IF YES, AT WHAT L
DEPTH?
P
E
Del31h Io Water Afler ,.
Monlloring? /0 Dale:
Reading Date Gross Net Depth to Net
Z' ¢4 ) r Time Time Water Drop
/ ¢- ?-¢¢ m, q¥ ~ c~,,,~ ~-? o1/d- ~ ~ ,,
3 " _o,'q~ 70, .... ~q B~ ~ ~"
PERCOLATION RATE ~0, '?
TEST RUN BETWEEN ~', 5-
-- (mmutes/incl'0 PERC HOLE DIAMETER
-- FTAND ~7,.¢-'"
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82§ L, Street, Anchorage, Alaska 90B01 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
DATE PERFORMED: '~/~/~
SITE PLAN
WAS GROU
ENCOUNTE
DEPTH?
Reading
PERCOLA]
WATER
AT WHAT
Reading Date Gross Net Depth to Net
Time Time Water Drop
,, cs,
RATE /~, 7 {minutes/inch)
TEST RUN BETWEEN '~- FT AND ~ FT
PERFORMED BY:
72-OO8 (6/79)
Eagle River Engineering Services
F. O. u0x /[a294
Eagle River, AK 09577
694-5195
DATE:
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
LEGALfi~.ESCRIPTION
Manu f*ctu rer¢~R Mater;~.~ No, of continents
DIOTANCE*~:o,u Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
D,STANCE TO: Well ~_~ / ~ F°undati°~o/ '~*"'t'°~e ~ ~"~r~'°'Fo5~
No, of lines/ Lengthy~inel Totalle~ines Trenc~ inches Distancobetw~7~
Top of tile to fieish grade~ .... ~r'~ Benbath tile ~ ~ inches Total ef~ption area
Length Width Depth PERMIT'NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line ~eptic tank Absorption area(s)
OTHER
..
__ t~'F
~~ DATE LEGAL
72-04 v. 3~78)
PEF:'.I"I:( T NO.
FIPF'L I CFINT
LOE:FIT I EIN
LEGFIL
E:,EF'RRTMENT r HERLTH RNE:, EN',,,'ZRONMENTRL '3TECTZON ~,~'~
825 *" L STREET.,264-472:40Rf'ICHORRGE' AK. 99.....,t LAGS_ ¢~x~-~ ~(
,' 800427 ',
LYL. E OE:ERG -,R E,O,: .... ELco: ''
PETERS CREEK
:LOT 7 BLK I bAr'PERT ~
: _,.[~E i'a:RA[~ Sfi:IURRE FEET
E_TRTE;, LOI' c' =
T'¢F'E OF :50IL BBSOF.:F'TION SY'=;TEM IS: TRENCH
MA;:'::IHUM NUltBER OF' BEDROOMS
SOIL F.:RTING ,::SQ F'T,..'BR::,= ±65
THE F.:EQUIREB, SIZE OF ]'HE '=;OIL FIBSORPTION SYSTEM IS:
U.:, E: F' 'T l-I .... ,",E: L. [{ i'-.~ L3 T ~-~ = 4 2 (3 I~-?. RI '.,,." E L. £:, E I:: T' I-4 =:= ¢:_%
THE LENEiTH DIMENSION IS TNE LENGTH (IN FEET;, OF THE TREI'.,ICt4 Of::'. DF.:RINFIELD.
TFIE DEPTH OF FI TRENCH OR PIT IS THE [:,ISTRNCE BETI,.IEEN THE SURFFIE:E OF Tt4E
GRour.][:, aN[:, ]"HE: BOTTOM OF THE E;,.',CFIVRTION (IN FEET).
THERE IS NO SET I,,II[:,TH FOR TRENCHES.
THE GRAVEL [:,EPTN IS THE MINIMUM DEPTH OF GRFI',,;EL_ E:E'I".b~FEN THE OUI'FFILL F'IF:'E
FIN[:., THE BOT'/OM OF "f'14E E,'.'<CAVATION (IN FEET).
F'ERMIT FIF'PLICRNT FIFIS THE RESPONSIBILITY TCi INFORM THIS DEPFIRTMENT DURING THE
IN::xlTFILLF-tTION II'..ISPECTION".'F, OF FIN't' HELLS FIDJFICENT TO THIS PROF'ERTY FIND THE
NUI',IBER OF RESIDENCES TI-.IRT THE WELL 14ILL SERVE.
............... "f"ll..4C, ..'.2 2 .'-, I I'-.~i;F"EC'T' I 01'-,t2; FIF..:E Ir;-':EC-:.~U I
BFICI<FILLII'4G OF aNY SYSTEM 1.4ITHOUT FINFIL INSPECTION FINr':, FI[:'PRO'¢RL BY THIS:;
[.',EF'RF.:TI'flENT HILL BE SUBJECT TO PROSEE:UTION.
r,'l]:l'.,lli','lLIl','l DISTANCE BETWEEN FI !dELL FIN[:., Ri'.,IY ON-SITE SEI4AGE DISPOSRL SYSTEM IS
:tO0 FEET FOR R PRI'v'FITE HELL OR 2.5A TO 200 FEET FF.'.OM R PUBLIE: HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL
I',IINIHUH DISTFINCE FRor,1 FI PF.'.I',,,'RTE !.4ELL TO FI F'F..'I..VRTE SEHER L:[NE IS 25 FEET FII'.,I[:,
TO R COHHUNITY SE!-,.IER LINE IS 75 FEET,
.klELL LOGS FIRE REQUIRED, RND MUST BE FF,'ETURNE[:, TO THE E:,EPRRTMENT L4ITHIN 7.:0 [)RYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS MaY FIPF'LY. SPECIFTE:FITIOi'4S FIN[:, CONSTRUCTION E:,ZFIGRaMS RRE
FI',/FIII..FIBLE TO IN::;URE F'F..'OPER II'.,ISTFILLFITION.
F" E R P'I Z T' EZ ::-:: F" ~ F: iF: % g, E C: E i'.1B E F." g 1 .. :IL, £4, :_-,:
I C:EI:;.:TIFY THFIT
1: I RI',1 FFIMIL..IFIF.: I.,lI'rl-.I THE REQUIREMENTS FOR ON-SITE SEWERS aND HELLS as SET
FORTH BY THE MUNICIPALITY OF FINCHORFIGE.
2: I !4ILL INSTALL THE S"r"=;TEM IN FICCOR[:,RNCE HITFI TFIE CODES.
3:: I UNDEF..'STFINg', TFIF'~T THE ON-SITE SE!dER SYSTEH MFIY REQUIRE ENLFIRGEMENT IF' THE
F.".ESII)ENCE IS REMODELE[:, TO INCLU[:,E MORE TFIFII'.,I -'.': E:E[:,ROOMS.
%0/2
O&E
ENG,,4EERING & DEVELOI
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
,vlENT CO.
Russell Oyster
694-2774
SOIL LOG
Performed for: Name:_. L Y/_-
Mailing Address: ~--~*~ o
Legal Description: L¢'r ¢, ~z:¢c~
Earl Ellis
688-2280
Depth (feet)
Soil Characteristics
0
1
3__
4__
5
9__
l/IL
5;0 /
PLOT PLAN
13__
14__
15__
16__
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
Performed by:
No ~' If yes, what depth
Drain Field _
PERC. TEST
by
DOC Co. dDa
ClPALITY OF ANCHORAGE
VJ~DEPT, OF HEALTII & '
ENVIRONMENTAL PROTECTION
SULLIVAN WATER WELLS
P.O. BOX272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
SEP 1_ 9 1980
RECEIVED
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
ERMITNUMBER
Ended
7
I)EPTH OF WELL
S'EATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From__Ft, to.__Ft,
From Ft, to , Ft,_
From _Ft, to__Ft
From__Ft. to Ft
From--Ft. to Ft,
From Ft, to , Ft,_
From Ft. to Ft,_
From Ft, to Ft.
From__~__Ft. to Ft~
From__.Ft, to Ft.
From__Ft. to__Ft,
From__.Ft, to Ft.
From__Ft, to___.Ft,
From Ft. to .Ft.
From____Ft. to. Ft.
From Ft. to Ft.
From __Ft. to Ft
From__Ft. to__Ft.
From_ Ft. to .... Ft..
From Ft. to Ft
From____ Ft. to_____ Ft
From ____: Ft. to__Ft.
From Ft. to____Ft
From Ft. to Ft.
From Ft, to~__Ft,
From___ Ft. to _Ft.
From___.Ft, to____Ft.
Frmn__Ft. to____Ft
From ...... Ft. to____Ft
From ___Ft. to Ft.
From_ __Ft. to____Ft.
From Ft, to Ft.
From Ft, to Ft,
From Ft. to___
MISCL. INFORMATION:
DRILLER'S NAME
D,~ I t:'RECEIVED
~NSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
NSPECTOR INSPECTOR INSPECTOR~
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501 ENVIRq); g,', fi,, ,'~ ..... ~j ~_ rlON
ENVl RONMENTAL SANITATION DIVISION
Telephone 264-4720
31RECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten {10) days for processing.
1. PROPERTY OWNER ~ PHONE
L YLE OBERQ~ 688-3405
MAILING ADDRESS
SR ~f2 Box 5~6 Chug~ak, AlaSka ~9567
PROPERTY RESIDENT (If different from above) PHONE
PHONE
2. BUYER
Brian and D~xle ~H~espJe 224-5744
MAILING ADDRESS
P.O.Box ~40~ Sewa~d~ Alaska 9~66~
3~ L~NDINGINSTITUTION ] PHONE
NATIONAL BANK OF ALASKA
MAILING ADDRESS
30~ W. No~the~n Lights Blvd. Anchorage, A~aska
~, REALTOR/AGENT ~ PHONE
~oyce Ga~dne~ D A VAUGHN co., 6~4-4242
MAILING ADDRESS
P.O.Box ~928 Eagle RJve~, Alaska 99577
5. LEGAL DESCRIPTION
Lot 7 B)ock I Lamperf. Esf~ates
-~TR LET LOCATION
Elsie Streel;/Oberg Field
6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS
[] One [] Four [] Other____
[~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~ Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well Icg is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach Icg if available.) ~-~1~ R'r- ~/O~4~ ~F~;'47
B. SEWAGE DISPOSAL SYSTEM
[~ INDIVIDUAL/ON,SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEI).
72-010 (Rev, 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
1, TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SIX
[] OTHER
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3, SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [] Holding Tank
Size: )~:~(;;) If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
MANUFACTURER
MATERIAL
Septic/Holding Tank Absorption Area J
Sewer Line
INearest Lot Line
5. COMMENTS
[~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)