HomeMy WebLinkAboutTIMBERLUX #3 BLK F LT 14
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221341
Work Type: Septic Upgrade
Tax Code Number: 01827180000
Site Legal Address: TIMBERLUX #3 BLK F LT 14 G:3136
Site Mailing Address: 4540 TIMBERLUX CIR, Anchorage
Owner: CLARK -BERRY CHLOE K &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft
Total Bedrooms:
�1»cnt
1
llepartmetut
10/10/2022
10/10/2023
35719
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
Veronica Pope
2022.10.10
Received By:*kl�11:43:05 -08'00' Date: I
Issued By: Alfil Date:
3
Community Development Department- r- 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. 018-271-80
Property owner(s) Chloe Clark -Berry & James Berry Day phone
Mailing address 4540 Timberlux Circle, Anchorage, AK 99516
Site address 4540 Timberlux Circle
Legal description (Sub'd., Block & Lot) Timberlux #3, Block F Lot 14
Legal description (Township, Range & Section)
Lot Size 35,719 Sq. Ft. Number of Bedrooms
3
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF) ❑X
(w/wo AD U)
Septic Tank ❑X Upgrade ❑X
Duplex (D) EJ
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST
FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S�I �� Waiver Fees:
Date of Payment: 2- Date of Payment:
Receipt Number: 75P Receipt Number:
Permit No. 05/222 13`-1 ) Waiver No.
Permit App_::- : ._..:c
August 25, 2022
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Timberlux Subdivision, Block F Lot 14
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot would like to replace his older septic system, so we are submitting this
permit application for the construction of a new one. The attached site plan identifies the location
of the home as well as the proposed septic location. No conflicts exist between this proposed
system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot is relatively mild with no major slopes. (There are no slopes greater
than 25% within 50 feet downslope of either the primary or alternate site.) Contours are shown on
the site plan showing the grade and direction of flow. Stormwater drainage will not impact this
septic system. The new trench will be constructed parallel to the slope as much as possible.
Wells on this and adjacent lots are shown. The new advanced-treatment system will be a minimum
of 50’ from all wells and surface water, and the trench will be more than 5’ away from the septic
tank.
Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221341, Deb Wockenfuss, 10/10/22
x
x
x
x x x x Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEER
1"=50'
40' LONG x 5' WIDE,
1' EFFECTIVE DEPTH
ABSORPTION TRENCH
1500-GAL
ADVANTEX TANK
w/ AX20 POD
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
TIMBERLUX #3, BLOCK F LOT 14
FEET
0 50 100
≥10'
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
TIM
B
E
R
L
U
X
C
I
RCL
E
3-BDRM HOME
9/9/22
10'
U
T
I
L
I
T
Y
E
A
SE
M
E
N
T
380
385
390
385
390
395
DECOMMISSION
EXISTING TANK
PER UPC
ABANDON EXISTING
TRENCH
50' WELL RADIUS
≥5'
SEPTIC BED LOCATION ON
NEIGHBORING LOT
LOCATION SEPTIC SYSTEM ON
ADJACENT PROPERTY IS TO THE
SOUTH
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221341, Deb Wockenfuss, 10/10/22
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEER4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK5'
6"
2'-6"
1'
DESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 32 MIN/IN
APPLICATION RATE: 2 GPD/SF
5.0' WIDE TRENCH SYSTEM
1500-GAL ADVANTEX AWWTS
BOTTOM OF TRENCH: 3.5' BELOW GRADE
FLOW LINE ELEVATION: 2.5' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
450 GPD / 2 GPD/SF /5' WIDE * 0.88 RED. FACTOR = 39.4 LF TRENCH REQUIRED (40 LF SPECIFIED)
GEOTEXTILE FABRIC
TIMBERLUX #3, BLOCK F LOT 14
9/9/22
2" INSULATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221341, Deb Wockenfuss, 10/10/22
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
7/1/22 1
2
3
GM (SILTY GRAVEL)
Professional Engineers Stamp:
NO
TIMBERLUX #3 BLOCK F LOT 14
7/14/22 019-271-80
JIM BERRY
11:311
2
3
0
12:02
12:32
2.5' OB
30
Benjamin Schiller
CE 12592R
EGISTEREDPROFES S I O N ALENGINEER7/14/22
PERC TEST LOCATION
TECHNICIAN: L.TIDWELL
1 116
N/A
9.0'
7/13/22
COMMENTS:
6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING
SITE PLAN
1116
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
0 30 15 16 15 16
0 30 15 16 15 16
32
5.5'
10/4/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221341, Deb Wockenfuss, 10/10/22
NILNICIPALI:TY OF, ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
VIAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE ANP REPAIR . R�EtEMENT, herein the. iAGREE viENT" made and
entered.
.,into
""as of this L// A DayT of L J,4&4k of'07�! by and between
y herein the "OWNER," and the Municipality of
Anchorage, herein the ` ML`NICIPALITY", in accordance with Anchorage Municipal Code
(AMQ 15.6-5.365. In consideration of the mutual covenants contained herein, the parties to this
A,�,recmcnt ac-,rce as follows:
1. Advanced Wastewater Treatment Systems. The. Ylunicipality grants permission to the
0wzzer to utilize and operate an Advanced Wastewater Treatment System (AZA WTS),
described as Advantex System
located at (legal description)
Timberlux #3, Block F Lot 14
2. Maintenance. Repairs and Alterations.
(0,vner is required to read, understand and initial each section)
Througllort the terns of this Agreement. the Owner shall enter into a service agreement
with. an. A'W'\ TS service and maintenance provider approved by the .Municipality or the
manufacturer's representative. The AW%7TS shall, be maintained in. a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's appro.-,, al for operation in the Municipality.
It shalt be the responsibility of the Ov per during the terns of this flgreement to pay for all
repair(s), maintenance; adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (ty*cally $400 to $600).
Owner agrees that only maintenance and. repair personnel approved by the Municipality,
or the manufacturer's representative i�dll inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
0,N,.zer acknowledges that regular maintenance of an AW,)VTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. OSJ1 8/2018) Page] of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the;manufacturer`s representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an ARTWTS may be
assessed in accordance w-ith AMC 14.60.0' 0.
} Owner agrees to grant the N- 4unicipality reasonable access to test and inspect the
(� ANN W S. The .Municipality will ,give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On-Site Systems Approval.
- Owner agrees that the AWWTS installation and maintenance requirements as provided
TL_jby the AW-WTS vendor/installer and approved by the MunicipalRy are the governing1
szuidelines for the construction, maintenance and repair- of the Owner's AWNYTS.
Owner agrees to maintain remote monitoring of the AW'W TS as required by the
AW WTS approval.
Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWW TS is operational or until title is transferred.
4. Nonwaiver•. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the. provisions, nor in any way affect
the validity of the A;__ Irene or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and. Municipality. Any attempt to amend. this agreement by either an
unauthorized representative or unauthorized means shall be void.
G. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
patties under this Agreement.
7. Severability. Anyprovisions of this Agr cement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
( ev. 05 l8.1)018) Page 2 of 3
OWNER-
By:
�S (signature)
(print name)
STATE OF ALASKA }
').ss.
THIRD1I.MICI.AL DISTRICT }
Date:
The foregoing instrument was acknowledged before me this (e day.of OCA.
20 Ly . �'AW►E SRRy
NOTARY PUBLIC FOR ALASKA
1iIy Commission expires: .51-312-1
NIUNICIP ALITY:
By: lit/ ib azure)
(print name)
NOT,��•:�,,�
9� IC
�FALAS'�p�,,�
Date:
Title:
(rei-. 0.5118120I8) Page 3 of 3
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SEPTIC O z .0.
PIPES i 1 ca
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Lot 12 \ s
10UTILITY
EASEMENTS
Lot 11
PLOT PLAN ___ AS BUILT X SCALE _ 1"__ 50' _ GRID _SW 3136Project No. __22=241A1_ _
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Long Assoc*lates, o n c. (907) 522-6476 Phone
(907) 522-4625 Fax o.0 00
Professional Land Surveyors ken®longsurvey.com
jonathanOfangsurve .com do
�. ..••"'••.. .�.
oD
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I hereby certify that f have surveyed rveyed the following described property. ��,• 104
•49TH
LOT 14 BLOCK F. TIMBERLUX SUBDIVISION — ADDITION No. 3 (PLAT No. 71-240)
Anchorage Recording District, Alaska, and that the improvements situated thereon are POAwithin the property lines and do not encroach onto the property adjacent thereto, that 0
no Improvements on the property lying adjacent thereto encroach on the surveyed ' 'rn- KENNETH G. �LA . .
......
premises and that there are no roadways, transmission lines or other visible J 0
easements on said property except as indicated hereon. �'�► • . 'a-� �L7.D
p
�� ' • • . S-5202.
C3
%off' of'`"�-'�_------ —= = at Anchorage, Alaska �o A • • ..... • • foo
Dated this the NN___ Day ___ , __
ROFESSIONP- a
Opoo ooao
It is the responsibility of the owner to determine the existence of any easements, O
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
MUNICIPALITY OF ANCHOtUXGE
Ht~/~th and Environmental Prot, tion
· Fourth Floor West ky'2
825 L Street
Anchorage, Alaska 99501
264-4720
SEPTIC-lANK:
i:R('rd W: LL _~ :.W',f,LJi /,CiLJREi4 ~ --- L,!& F(::RhiL _~ ...... COMPARTfAENTS ~
, =¢o , LIQUID CAPACITY/~ GALLONS.
'IILE DR/~,IN FILL[): FOTAL LENGTH
~;E E P,"\G E PIT:
Log Crib __Rings__
Crib Size: Dh'\M[] IR _ _DEPTIt ____DISTANCE FROM: WELL
'IOTAL EFFECTIVE
if CARt:S7 tOT LINE ..... Ai~SORPIION AREA (WALL AREA)
_SQ. FT.
;'Tell
C ].a s s :_~_~_ Depth: _
{e]]. Distance To: Lot Line
Bldg: Sewer Line:
Pipe Naterials:
{} ef nedreoms: &¢
Installer: ~gL~¢~_
Roma~:]:s:
F EF.,il I [
FEET
Th'F'E OF E;OIL REr.:5OI';?.E~TION 2;'.r'STE:I"I :[~:;: 'rF:ENCH
.. _ '::..7,q! I- I ,.. E,F ..... ~....,U
,~,11:~:;-:', ]:1"1 M NUhlDEF'. 13f:'
,,_ ,.. ,::,.. ri "'"' ''= . .. ~,~
TH[-Z F'.Er2L.III:::E[:, ~;IZE OF TIIF_.' ;:, .IL ~B::,F_[;.I II_N :~_]EII I
ES:* E F::' "ll-' ~ ..~ :;=:
THE L. ENGTIt D][HEN~SiOIq I£; THE L. ENGTH (:IN FEE:T) OF THE TRENCH OF?. D[;?.FIINF]:EI....D.
]"tie DEPTH OF FI TRENC'II OF.' PIT :IS -rilE DI:51"FINCE DE"I'[,.IEE[',I THE %IJF::FRCE OF THE
GF.'.EIUND ANI]:, ]'FIE: [::OTTOI'4 OFt THE tEXCFI'v'RTION (;IN FEET).
TI. IEF,:E _TS NO L=;ET I.,.Ii'DTH
TIlE GI';;'.FI',/EL DEPTH ]:S THE I'iZNZHUP1 DEPTH CIl:': GI:~'.R',/EL BETHEEN THE OUTFFILL F'IF'E
FIND ']"tilE DOTTOH OF TIIE E',:4CI::I',,,'RTZON (:]:i'-,I FEET).
F?.EE ,l~::-~t~--~ % lt--:fEE E:,
l-Ill_, THE f,.E::, UN=,IE,!I-1 F TO INF'ORH TI. lIE; DE:F:'FiRTHENT E.I..IF.I[' .. TIlE
,.-E.flI FIPF'LIIS:FiI'.4T · :':'- "' ~' .... .,- ., ....
I.k..I._L_ H[...J-.u. EII1 'T'I3 TIII- If _FEF. I F:IND THE
'~I'~STF:ILLF]TION II",I~;F'EECTIIDNE~ ISII:::' I:::lN"i" ~' ,::~ -. -,-. :, ... . .,: .........
'~l..ll'lE,~..p.. (cfi:. I-:.I:._,IDENL. E.-, TFff:FT THE HELL HILL
H!NII'ILIM DISTFfl',ICE E':ETHEEN FI HELL FIND RN"? Oi",I-C;ITE ff;EHRGE E:'I'.SF:'OSFtL S¥'.~VFEH
±00 FEIET FOR R PI;:I'v'RTE: HELL..~
:!1_58 TO 21Z:iE~ FrEET FF:Or'I 19 F'LII3LIC HELL DE:F:'EN[:']:NG UPON THE: T'.,-'PE OF: PUBLIC HELL..
NELL LOGS FIRE REC!I_IIF~:ED Fii'.,~[:, HU'.¥T DEE F?.ETURNED 'T'O THE DEF'IgI:¥1"HENT I.,.ItTHIN
Fi',/FiIL. FIL:~LE: TO IN:E;.,LI[':?.E F'F:tEff:'EF:: ZNL:TT'FILLFIT]:ON.
I C[;RT]:[':",' l'tla'l''
1: I RM FFIHIL. IFIF?. I,.IITI'I THE t~:EQUtl;;'.EHENTL:'; FOR ON-E;I-FE SEI.qERS FIND WEL[_.~2; RS SET
FORTH [?.d TIdE HUN I C ~ F'F:IL ]: T'T' OF F]NE:HOF'.IaGE.
2: I NILL. lhlSTRLL THE ?gS'TEH tN fgCCOF~DFINC:E HITH THE CODES;.
2:: I LINE:,EF:STFIND 'f'HFIT THE ON--2 HER SW~5"I"EH HR"r' REC!UIF'.E ENL_FIRGEP1EEINT IF TIlE
R:ESIE:,ENC:E :~DEI._ED TEl 'THRN 4 E:EDF'.OOHS.
I_., I El..
De,~ ?ment of Health and Environment{ 7rotection
2516 E. Tudor Road
Anchorage, Alaska 99507
276-2221 ~-? ~>-~'/(
SOtI,S 1,0(1 I'I';IIOI,ATION TEST
.................... ",
Legal Description:
This form reports: Soils log. Percolation Lest
De p t h
Feet
11 -
12-
13 - ~--
14 -~ ~:
Was ground watar encountered?
Reading Date Gross Ti me
If yes, at wi~at depth?
Net Time Depth to Water Net Urop
-Proposed instal,la-E~[Jh¥ '-~¥e~¥.qe Pit ___. Orain Field
Depth to'~b¥O:O¥--o¥-'pi~ or trenci,
~ Depth of Inlet ................ - ..............................
. ~_~APPLii' ~NT FILLS OUT UPPER "A~~ ~ONLY
Buyer
Address Zip Code
Lending Institution ~ J~ ~ ~ ~ ~ )~-~ ~p~.& t~ Phone
Address ~ ~ ~,/ [~ /~ ~ ~ ~ ~,~ ~,~ /~,':/ ~ r2 ~ ZipCode
Legal Description ~ ~ ~ / ~ ~ ~ C /{ /;' ~m~ L~
Type of Residence
' Single Family
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A well log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ PubPc Utility
Sewe~ msposal /
~ Individual 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.
Dale Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
~.~ ~ DEPT. OF H~.i',LTII &
;._2 /~/~ ENVIRONMENTAL PROTECTION
OCT 7 ~'~"
RECEIVED
D ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) CONDITIONAL APPROVAL*
DATE ~ [ ~ [ ~ -- ~ ~
Soils ~ng~ 0 Date ~wer Installed Well To Absorption Area WeB Log Received /~
~ ~ ~ ~ ~ WelltoTa~k Septic T~k Size ~ ~
72023 {3182)
ALASKA eI/ufRoiqm rlTAL COF1TROL SeRb' ES, IJqC.
~.qifl~rin§ $ ~t~uironmcnl~l Studies
DECEMBER 1 1983
STEPHEN & KAREN CHRONISTER
2031 BELAIR DRIVE
ANCHORAGE AK 995803
SELLER - STEPHEN & KAREN CHRONISTER BUYER - C. BERRY
SUBDIVISION - TIMBERLUX BLOCK - F LOT - 14
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 675 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
1200 ~Jesl 33rd Auenue, Suile J~ · AncJ~orage,/~loska 99503 · (907] 276-i361
October 19~ 1983
So A. Chronister
Star Route A Box 4'77-Y
Anchorage, AK 99502
Subject: Lot 14~ Block F, 'i'imberlux Subdivision
Approval for the individual sewer and %.;ater facilities cannot
be granted until the follo~ing items have been completed:
~ The septic tank pumped with a receipt submitted to this
department.
o An adequacy test needs to be performed ou the existing
te,~ %;ill determine if the system is
J eaching area. 'i'h is ~
adequate according to ~ational Standards. A listing of
private firms performing the test is enclosed. '.~his report
needs to be sub]nitted to this office for our review.
Please ~lotify this Department tot' a reinspection ~;hen the
co~cted. If there are any
noted discrepancies have been .... ''' ~"~
~ -' . 264.-4720.
[urther questions, please call t~is o_fzce at S inmerel~
Jim ~oberts
Associate E~%vironmcntai Specialist
jR54/ej/E2
Lee Chronister
'i'o t e~ i~ealty
724 E. iSth
Anchorage~ AK
99501
~U~!CIFA~ i~:/ O' : ,-.'~'r'..~,or.. ,AGL': ~UNICIPALI~ OF ANCHORA~
DE~, OF HEALTH &
ENV~ROf4MEt4'F~,~ ENG ~EER g~ D V S ON
OCT 6 1978
Telephone 264-4720
FOR APPROVAL OF INDIVIDUAL ~h ~,' ':: ~ 'f, Fl .
.............................................................. ~'~?~
JS-f'f~:E E'F ~OCATIOH ~
J' ~] One L~ Four E~I Ortner
I ~ SING~,EFAMII-Y ~] Two ~ Five '-'
J ~ MULT, PI_E EAMILY [~J Three L~J Six
I ~ INDIVIDUAL* '~'ATTACH WELL LOG, A well Icg Cs required for ail wdb dril[ed
'[~3 COMM UI',IiTY
since June 1975. Fo we s c r ed pr or to that date, give
~ PUBLIC I.J'l ! L ITY depth (attach log if available.)
~-// ~ ............. ~ ...... ** **if individua',/on-site, awe ;nstal!ation dace .
If system is cve~ two (2) y~ar~ oki ar, adequacy test is required
~] PtJ¢l_lO UTILITY by this Department.
THE INSPECTION FEE MUST AOCOMPANV EACH h[:,~ JEST ~EFOR- * ~O~.~..~.~. ~= ..AN ~.. JT
TIIISSIDE FOR OF£1CIAt. USEONLY
INSPECTION APPOINTMENt, S
'1'1M L: ~iM [: ...............................
DIRECTIONS:
UAYE ........................ nA K[; .............................
1. I'YPE OF RESIDENCE f,~tl[,¢~[][ ti OF 8~I}ROf.hViS
[%] SINGLE FAMILY O ONE F~.] THREE [~ FIVE [Z/ OTIIER
[Z] MUI.T!PI_E FAMILY F~3 TWO E~ FOUR [-~] SIX
, 2. ¢:AT,~:,., 3lJ, , LY -
~-) INDIMID/JAL DEPTII OF WEt. L
[2] COMMUNITY
[7~ PURl. lC UTILITY
Cormcclion Vr~,'ified ~d6'-~ED ............... %
L-EiINDIVI DUAL~()N -SITE
[_~ P(I[~ [.IC UTILITY
C_]Septic Tank or [~] Holdin(i Tank
Size.:. ~ _~_..~"'~___ If Tank is hon-[en~ade
5. COM[\~ENTS
................ ........
I;~/API~I~()VED [:OR .__.4,_ .... 13EDROOMS
[~.] CONDITIONAl_ APPROV/',.17JIettFr must accompany cm tific3te)
~DISAI'PROVED