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HomeMy WebLinkAboutBIRCH ROAD ESTATES LT 4Birch Road Estates Lot 4 #015-494-04 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page ( of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 05 PID Number: 01 2;,^ 4(4q— OCi Dwelling: X Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New .Upgrade Name: ABSORPTION FIELD [:]Deep Trench [:]Shallow Trench ❑ Bed ❑ nd Address _7LEGAL ❑ Other Phone Number of Bedrooms Soil Rating Total depth fro iginal grade GPD/SF Ft. DESCRIPTION Depth to pipe invert from original grade Ft. ravel depth beneath pipe Ft. Subdivision Block Lot 11 f r r-(A e Fill added above original grad Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total abs tion area Number of trenches Dist. between trenches From Tank Field Tank Line Fe Ft. Well'DO( TANK Septic ❑ S.T.E.P. E] Holding EJ Other Manufacturer Al V\ e' Capacity ( 2 Gal. Surface Water Material ei �_ z &- Number of compartments 2___ Lot Line 0 f 4l NA Foundation(v �+ LIFT STATION Manufacturer Capacity Curtain Drain U K 0L V Gal. Remarks (, Pump on level at Pump off level at High water alarm at �v u AC v in. in. in. Pump make and Electrical Inspections performed by Installer PIPE MATERIAL House to tankTank to 3 U q drainfield 3 (!3 Drainfield CO/MT Inspector C �t �f BENCH MARK (Assumed elevation) /00 ft Inspection EscLocation dates: 2 /5 2°d and description 15,` 61 3a 4m Q COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin2k's Stamp ° Conditional Approval: Date S? e e ae 5..........'' ��t MICHAEL N. ANDLRSCN �•. 9 6th � °•. '�• a ° .� Approved pp Date inspection Kepon_a-i-iz.aoc Permit No. OSP151011 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: BIRCH ROAD ESTATES, LOT 4 I / < % W 1250 GALLON JA 1K WITH BENCH �T� GARAGE SLAB 1 CAR PORT, ROO� ONLY I I I 1 / i i i i PID No.: 015-494-04 I MT1 I i MARK A B C01 8 32 TC01 11 34 TCO2 15 40 CO2 0 C01 I / < % W 1250 GALLON JA 1K WITH BENCH �T� GARAGE SLAB 1 CAR PORT, ROO� ONLY I I I 1 / i i i i PID No.: 015-494-04 I MT1 I i % CCO2 c(, TCO2 C01 01 / EXISTING TANK PUt PEL / I D CRUSHED I ®\ \ ASBUILT SCALE: 1"=50' ��------�� icol TGOT CO2FCO ®O®®®\®`G2 ® 5 � ®®®�� OF 4 ®®®® �9 ��P•••• •• qS ®® AN •49 TH %;0 9 .4 1.250 GALLON ............................... 00 STEEL TANK PO 0 ..... '...................................... .. r ♦';MICHAEL N. ANDERSON 83 4: a No. E 969 a SEPTIC SECTION . N.T.S. ®®®� ®ESS\��®®®® On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151011 Tax Code Number: 01549404000 Work Type: SepticTank None Permit Effective Dates: January 20, 2015 to January20, 2016 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: BIRCH ROAD ESTATES Site Legal Address: BIRCH ROAD ESTATES LT 4 G:2638 Owner/Address: SLOOTER PAUL SURVIVORS TRUST 6001 MOOSE MEADOW LANE CIRCLE ANCHORAGE AK 995161734 Site Mailing Address: 6001 MOOSE MEADOW LANE CIR, Anchorage Lot Size in Sq Ft: 59330 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. 1—1%I� —Date: F MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Darr Sufffvan r ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (1(S ^4+ 14 04 Property owner(s) bawl S (to 8, err Day phone Mailing address G O o ( 1`r( 0o 4. 0 V 1,vt Site address � V-A Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size _c5' q 517 O Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (0 all that apply)❑ Initial 0 Absorption Field ❑ � ., • Septic Tank Upgrade ❑ .� Holding Tank ❑ Renewal Elr � Privy ❑ f" .► �' 1 Private Well ❑ v '' RECEIVED Water Storage ❑ JAN 16 RECD THIS APPLICATION INCLUDES A VARIANCE / WAIVER RECIWORAlty Of Anchorage Building Safety Division I 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. (Signature of property owner or authorized a qnt) a,U f7 I'1 21.1 t4' Permit/Rush Fees: Z "�� fl2a y Waiver Fees: Date of Payment: t tb� Ch)'OL"�Date of Payment: Receipt Number: joy -27- Receipt Number: Permit No. D5 0 S) Of/ Waiver No. G:\Building\On Site\FormsUient FormsTermit App_010411.doc (Rev. 1 /11) r Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 Jan 15, 2015 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic tank replacement Legal: Birch Road Estates, Lot 4 To Whom it may concern: This is a request for a septic tank replacement on the above referenced lot. The leach field was tested and passed but the tank appears to be failing. The lot slopes at about 10 percent to the west with no slopes greater than 25 percent within 100 feet of the site. This new tank replacement will not impact any of the neighboring lots due to this design. Please call me if you have any questions. Sincerely Michael . Anderson, P.E. LAND —_----_---i, --_--_—�' _--_t— _7— EXISTING.,-fl l DRAINAGE FIELDi SEPTJC S \ I \ :H ROAD T:STATES \\ EXISTING TANK, TO BE REMOVEDi AND REPLACED, 4 ROAD kESTATES `\ LOT 5' I 1 I i i PROPERTY LINE - ' J EXISTING WELL 100' RADIUS. = , • \ SEPTIC < r I I r Septic Design Prepared for PAULSLOOTER BIRCH ROAD ESTATES, LOT 4 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 1/14/2015 4601 NATRONA AVE DRAWN: DJR ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-1391 SCALE: 1"=100' ---------- ------------ ---- --- I---- 10' UTILrTY EASEMENT PROPERTY LINE J _ S RCH ROAD ESTATES /-� -\\ LOT 4 E fr X i SEPTIC i' f < _N MT/CO ! j \\ ��8 STING SEPTIC q A 1 REMOVE & REPLACE EXISTING 1250 GALLON I !E i + PROPOSED \\ Irrr i TANK PER THE UBC w �IRAINAGE FIELD r f I w / rrr V ® lir WELL 1 a / ® 3 r i -------'' PROPERLY LINE r —MOOSE MEADOW LAME CIR— Septic Design Prepared for OF PAUL SLOOTER 'w X\ q� C -D, ' BIRCH ROAD ESTATES, LOT �,' 49TH Anchorage, Alaska �••••• •••• •••••••••••••••••• i ��.. P. . f8°•MICHAEL N. ANDEF Michael N. Anderson, L DATE: 1 /1 412 0 1 5 #0�i`• No CE 9469 4601 NATRONA AVE DRAWN: DJR�Q•-,riS�f• ANCHORAGE, ALASKA 99516 (907) 345-3377 / FAX: (907) 345-139.1 SCALE: 1 "=50' ♦����4;; 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 0* ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE XNEW NAME V� ,�{�g ❑``UPGRADE �/lJ ING A13 F�SSo .�3 NO. OF BEDROOMS LOCATION�r ell �� Absorpti n are Dwelling PERMIT N DISTANCE TO: v Y IP- Q facturer n 02 M1q.cj Mater �� No. of avryipartments W ~ Lip it i lions I F HOMEMADE: Inside length Width Liquid depth O Z DISTANCE TO: Well Dwelling PERMIT NO. .j 02 ? FQ- Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well ©y1 CCJJ Foundation t Nearest I t line,- f G �1 PERMIT NO?9,0A1C.! W = LL Z _ P Z x 1. 0 W No. of lines Length oi�pcJ�line (J cNi Top of tile to finis grade 47 y Length Width Total len in� Trench inches Material beneath the inches Depth Distance efivv� nes /v Total effect' e�b�rption area �J PERMIT NO. C9Total oQ F- Type of crib Crib diameter Crib depth effective absorption area w a W ti DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER V PIPE MATE LS D SOIL TEST RATING INSTALLER S ` S REMARKS APPR ED DATE LEGAL 9/l 9/7 '2-013 (tAv. 3/78) �1762'�' L� c 4)7- 0 IV V PA?i L)a }ram>�� �� l `! 7 S" % /}•T � � Z:� � �'.1= L ; �C � � c"i`�: i3�iT7�'v1 �7��m )'j,2 v 5p PA) e �-) .�, & 1—e %7 — )l7 )I7— 2-P? 2,�r•7 — A)y I�LLr ��yy V �- 5o T,EA 46) cll,,rl Al I 5p C LA y LA y G12,A U).= t- w r, yL/ r. ---W CL -Ay 1 6y)Z1.,4V)=L %7 — )l7 )I7— 2-P? 2,�r•7 — A)y I�LLr ��yy V �- 5o T,EA 46) cll,,rl Al I �l k_l r -A :1, 1 |�-"0- "'r'" F_:_ F"N P-4 IC FA C 1 Fl C3 EE DEPARTMENT OFHEHLTH AND ENVIRONMENTAL PkuTECTION . 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 km =1 &-- &-- 1 1 W44 &.1 UY FWl UNEE x F I" EE 0­11�� - PERMIT NO. ( 790250 ) �]��. Q~}~-7c� ^'j�. APPLICANT PAUL SLOOTER 3109 HMBERGHTE DR. 333 8495 ~'-95 LOCATION OFF BIRCH/115TH ST. LEGHL L4 81 BIRCH ROAD EST S/B LOT SIZE ]9]29 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = .4 SOIL RATING (SQ FT/BR)= 275 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: F": 1 9-4 :1. -1. L.. NEE P-4 lC3i-"F" t-4= Z1' ED Cl K ill"w'NE! 1_ �� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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 TYPE OF THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). L..8 1 F;;�!: 0"::�"K :1 1:1 10 r-4 ��NET = 1.'Is t__��� 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. �14 C) Ko 12 > 1:�����1""1 r.4".E; f:l F1 EE FT ENE Ca Li X K EE 10 BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I:" NEE IQ: 1-1 1: -7- �E 14 F" 1: F..-' I r"l����� I CERTIFY THAT 1: I HM 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 THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE MORE THAN 4 BEDROOMS, '_________________________ H LIC ISSUED BL,-AK—n-1 _______DHTE_ _ YI2 PERFORMED FOR U SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch 6650, Anchorage, Alaska 99502 276-2211 SOILS LOG — PERCOLATION TEST Mr. Paul Slooter LEGAL DESCRIPTION: Lot 4, Block, Birch Road Estates PT Organics, Dk. Brown 0.5' SLOPE 51.- ' _J___ 1 Sandy Silt (ML.) 2 Brown 2.5' -- ,. 3 � a 4 ° 5- 6-0 6 ° v ;1- 7- 7 ° 8- 9- 9 o o/ o 10- 12- 13- 14-. 012 1314 . 15- 16- 17- 18- 191 516171819 -20 COMMENTS Silty Sandy Gravel (GM) w/some cobbles Gray -Brown S1. Moist Grading to Silty Gravel (GM) w/cobbles Gray -Brown S1. Moist ASI No. 02379 DATE PERFORMED: 5/29/79 1 1. (y%%S GROUNDWATER N O L ENCOUNTERED? O Gravelly Silt (ML) P w/ocn. cobble IF YES, AT WHAT E DEPTH? NA 14. Sandy Silt (ML) w/some gravel & ocn. cobble. Gray -Brown j Sl. Moist 15.5' T. D. ' Reading Date Gross Net Depth to Net Time Time Water Drop 1 /29/79 2:10 - t 0.22' - 2 it 2.20 10 min 9' 0,07' 3 if 2:30 10 " 0.32' 0.03' 4 it 2.40 10 " 0,35' ' 5 " 2:50 10 T 0.37' 0.02' 6 3:00 10 0,40' ' 7 " 3:10 10 " 0.42' 0.02' PERCOLATION RATE 36 min/inch (minutes/inch) TEST RUN BETWEEN 7 ' S FT AND 9 ' 0 1 FT PERFORMED BY: S. Shrader CERTIFIED BY: S. Shrader DATE: 5/30/79 Alaska Soils Investigations -008 (7/76) 15' 10' 5' 0' • -� • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 snrE.r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-494-04 1. GENERAL INFORMATION Expiration Date: j cZ — 2 y "/ j Complete legal description BIRCH ROAD ESTATES, LOT 4 Location (site address) 6001 MOOSE MEADOW LANE, ANCHORAGE, AK 99516 Current Property owner(s) PAUL SLOOTER Day phone Mailing address 6001 MOOSE MEADOW LANE, ANCHORAGE, AK 99516 Real Estate Agent Day phi J 2. TYPE OF DWELLING: Q g, ® Single Family (w/wo ADU) aSelo �I' ❑ Duplex r S ❑ Multiple Dwellings (Single Family and/or Duplex) o/ _ 3. NUMBER OF BEDROOMS: 4 y =y' 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: COSA to be releaseCi to the engineer, unless otherwise requested by the engineer. COSA Fee $ y gy � `D Waiver Fee $ Date of Payment q//��12-31p-15- 1i1I� �7� Date of Payment Receipt Number (-I )-Ioq Receipt Number COSA#_ de, C 15100 Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MUKE N ANDERSON, PE Date 06/24/15 6. DSD SIGNATURE kSystem #1. Approved for System #2 Approved for Disapproved. Cis "? � 00 �9r ta�'f rpt ; bedrooms. A\DE 'c,N bedrooms.f�f R?S Conditional approval for bedrooms, with the following ON-SITE By: /tel/ . _� Original Certificate Date: — The niciOchorage_Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10.12.doc If more than 1 septic system is on the lot: COSA Checklist # Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: BIRCH ROAD ESTATES, LOT 4 Parcel ID: 015-494-04 A. WELL DATA Well type Private Date completed SEPT -1979 Total depth 216 ft. If A, B, or C provide PWSID # Sanitary seal (YM) Y Cased to 216 ft. FROM WELL LOG Date of test SEPT -1979 Static water level 40 ft. Well production 40 g.p.m. WATER SAMPLE RESULTS: Well Log (YIN) Wires properly protected (Y/N) Y Casing height (above ground) 20" AT INSPECTION 112812014 43 ft. 5+ g.p.m. Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L Date of sample: 9117/2015 Collected by: Mike Anderson B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 112512015. Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NEW Pumper NEW C. ABSORPTION FIELD DATA -1985 SYSTEM TESTED Date installed 9118179 Soil rating (g.p.d./ft2 or ft2/bdrm) 275 System type DEEP TRENCH Length 82 ft. Width 2 ft. Gravel below pipe 8.0 .ft. Total depth 11.4 ft. Eff. absorption area 1312 ft2 Monitoring tube Y Depression over field N Date of adequacy test 112512015 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 44 in. Water added 700+ .gal. New depth 65 in. Elapsed Time: 4 HRS min., Final fluid depth 54 in. Absorption rate >= 800+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) UNKNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump ofr' level at in.High water alarm level at _ in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1004 Absorption field on lot 100'+ Public sewer main 75'+ Sewer/septic service line 50+ Animal containment areas 1004 SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 1004 On adjacent lots 1004 Public sewer manhole/cleanout 100'+ Holding tank NA Manure/animal excrete storage areas 1001+ Building foundation 5'+ Propertyline 5'+ Absorption field 54 Water main 1001+ Water service line 101+ Surface water 1004 Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main 104 Water Service line 104 Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NoneKnowO Wells on adjacent lots 1001+ F. COMMENTS NEW TANK INSTALLED OUTSIDE OF EXISTING CARPORT G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name MIKE N. ANDERSON, PE Date 0912412015 COSA canary sheet 2.6-15.doc OF At kk .. ...:........... P•� MICHAEL N. ANDERSON i •. CE/ 94 , y THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑ Septic Tank o ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ` 4. DISTANCES WELL TO: Septic/Holding Tank 411)4 Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS kr-APPROVED FOR L�' BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE --�- 0 BY �Z 72.010 ( Rev. 6/79) January 30, 1980 Paul Slooter 3109 Ambergate Drive Anchonage, Alaska 99504 Subject: Lot 4, Block 1, Birch Road Estates Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: {1 The water analysis report be delivered to this office from Chet Lab, 66133 B Street, for our review. {2 A well log submitteddto this department. (3) Expose the well for our inspection to determine proper construction, abso to insure the minimum distance requirements are met between your well and sewer system. Please notify this department for a re -inspection when the noted deswrepancies have been corrected. If there are any further questions, please contact this office at 264--4720. Sincerely, Ai Robert G. Pratt, R.S. Associate Specialist Reza/kas ccs Alaska Mutual Savings Bank 1503 1503 Gest 31st Avenue 99503