HomeMy WebLinkAboutT15N R1W SEC 5 LT 97
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1
ON -SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241132 PID Number.- 051-082-01
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Cody Lee
ABSORPTION FIELD
❑ Deep Trench ❑Wide Trench ❑■ Bed ❑Mound
Site Address
20895 Birchwood Spur Road
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
3
0.7 GPD/SF
JTotal
2.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.5 Ft.
Gravel depth beneath pipe
0•5 Ft.
Subdivision Block Lot
97
Fill added above original grade
Ft.
Gravel length
45 Ft.
Township Range Section
15N 1 W 5
Gravel width
15 Ft.
Beds: Number of Lines
3
Distance between lines
5.0 Ft,
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
675 Ftz
n/a
n/a Ft.
Well
100'+
100'+
100'+
n/a
25'+
TANK ❑ Septic F01 S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1500 Gal.
Surface Water
100'+
100'+
100'+
n/a
Material
Steel
Number of compartments
2
Lot Line
51+
10'+
5'+
n/a
NA
Foundation
10'+
10'+
10'+
n/a
LIFT STATION
Manufacturer
Orenco
Capacity
250 Gal.
Remarks
Alarm location
Master Bedroom
Electrical installed by
Owner
PIPE MATERIAL House to tank ABS E Tank to D1785
) ( drainfield
Installer
Owner
Drainfield D1785 CO/MTD3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 100.3 ft
Inspeection 1st 10/2/24 2nd 10/10/24
Location and description
ction
3`d 10/10/24 4`h 10/14/24
1st Compartment MH Lid
ON -SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF AL
Conditional Approval: Date
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49 TH
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Septic System
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Steven R. Pannone
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Approved Date /
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Note: this approval does not include well permit requirements.
(Rev 05/02/18)
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NOTES:
PANNONE ENG SVC LLC C.I.(1088)
°.0- BOX 18C7 PA_�ER, AK 99645
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REVISIONS
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11/06/2024
_
RECORD DRAWING
(907j 45-820G FAX (907; ?45 39C
T15N R1 W SEC 5 L97
CODY LEE & MARY DEAN
SITE: 20830 ALLUVIAL STREET
CHUGIAK, AK
SCALE
DRAWN
ACP
P.I.D. NO
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SITE PLAN
NO.
PERMIT No.
OSP241132
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Taylor L. Dosch
No. 189892
R
E
GISTEREDPROFESSIO N A L L A N D S U R
VEYOR
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: OSP241132
Work Type: Septic Upgrade
Tax Code Number: 05108201000
Site Legal Address: T15N R1W SEC 5 LT 97 G:1457
Site Mailing Address: 20895 BIRCHWOOD SPUR RD, Chugiak
Owner: LEE CODY RAY &
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date
c r,
DcImrt]nenr
Lot Size in Sq Ft:
Total Bedrooms:
6/11 /2024
6/11 /2025
108900
Q Disposal Field Q 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
Received By: P C--s-
Issued By: ,
Date:
Dater 1 r� Z 6's a`
3
ON -SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-082-01
Property owner(s) Cody Lee & Marie Dean
Mailing address 2171 Ivan Drive Anchorage, AK 99507
Site address 20830 Alluvial Street
Day phone
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T1 5N R1 W Sec 5 L97
Lot Size -108,900 _Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
Rx
Initial EJ
Single Family (SF)
(w/wo AD U)
Septic Tank
FAI
Upgrade RX
Duplex (D)
❑
Holding Tank
R
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.
3W
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Permit App_'-'- : - I
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O.Box 1807, Palmer, AK 99645
Telephone: (907) 745-8200 FAX: (907) 745-8201
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road
P. O. Box 196650
Anchorage, Alaska 99519
Subject: T15N R1W Sec 5 L97
Septic System Upgrade Permit Request
This is a design narrative for a permit to install a septic system upgrade on the subject property. The proposed
upgrade will serve an existing three-bedroom (3) house. This lot and surrounding lots are served by private wells.
There are currently no wells within 100 feet of the proposed upgrade. The existing onsite wastewater treatment will
be decommissioned per MOA code.
1. Soils: A test hole was performed on this lot by Pannone Engineering Services, LLC on 5/17/2024. Groundwater
was observed during the excavation of the test hole at a depth of 9.5’ BGS, bedrock was not encountered.
Groundwater was observed in the test hole monitor tube after 7-days at a depth of 7.25’ BGS. Based on the
results of the percolation test and overall soils appearance an application rate of 0.7 gpd/SF was used for the
design of a conventional wastewater treatment system in the area of the test hole.
2. Soil Absorption System Design: See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
4. Topography: See attached site plan for area topography. There are no slopes exceeding 25% less than 50ft from
the proposed drain field.
5. Drawing Markings: The Drawings are marked “For MOA Review Only”. When written notification that the
review is complete and no further comments are received from MoA On-Site Department, the note will be removed
and “For Construction” drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at (907) 745-8200.
Sincerely,
SRP
Steven R. Pannone, P.E. F. ASCE
Owner/Civil Engineer
31 May, 2024
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241132, Curtis Townsend, 06/11/24
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Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241132, Curtis Townsend, 06/11/24
PA
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A SCALE: 1" = 4' (8.5" x 11" PRINT)
DRAIN FIELD SECTION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241132, Curtis Townsend, 06/11/24
PA
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COMMENTS: Test hole excavated by GRAYLING CONSTRUCTION.
PERFORMED BY: PANNONE ENGINEERING SERVICES, LLC. I CERTIFY THAT THIS TEST
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES
IN EFFECT ON THE DATE OF THIS TEST.
·<1.0 (min/inch)
·6"
·2 FT AND 3 FT
SOILS LOG & PERCOLATION TEST
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241132, Curtis Townsend, 06/11/24
PA
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2.2. SCOPE OF WORK: INSTALL SYSTEM IN ACCORDANCE WITH THE ATTACHED DESIGN AND SPECIFICATIONS.
7.25 FEET
7.25 FEET
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241132, Curtis Townsend, 06/11/24
ALLUVIAL STREET
BI
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Taylor L. Dosch
No. 189892
R
E
GISTEREDPROFESSIO N A L L A N D S U R
VEYOR
20830 Alluvial Street Subject:
Originator:ACP Checker:
SITE PARAMETERS 1. No angle of repose on backfill material
Weight of Water 62.4 lb/ft3
Weight of Soil 100.0 lb/ft3
Tank Bury Depth 4 ft
TANK DIMENSIONS
Diameter 59.0 in
Diameter 4.92 ft
Length 12 ft
Area 18.99 ft2
Volume 227.83 ft3
Weight 0 lbf
Manholes Yes
Percentage of Tank in Groundwater 100%
BOUYANT FORCES (weight of the displaced water)
14217 lbf UP
RESISTING FORCES (weight of soil & tank)
Is Backfill Material Saturated?NO
Volume of Manholes 25 ft3
Volume of Soil 211 ft3 (Volume of Soil over Tank minus Volume of Manholes)
Weight of Soil 21087 lb DOWN
NET FORCE ON TANK 6870 lb DOWN No Additional Ballast Required
1500-gallon STEP Tank
ASSUMPTIONS
2. 100 lb/ft3 backfill material
3. Tank is empty
4. Tank is completely submerged.
Septic Tank Buoyancy Check
Job Number:SRP
Job Name: Buoyancy Check
Buoyancy Control:
1.4.0' of unsaturated fill above tank resists buoyant
force from groundwater.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Septic System Owner -installer Agreement
The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner
to perform work on an on-site wastewater disposal system to serve that individual's owner -
occupied, single-family or duplex home if the homeowner meets and agrees to the following
requirements:
The property owner and excavation equipment operator may perform work on no more
than one owner -installation project in a 12 -month period.
Owner's projected active involvement with the installation:
All excavation of existing system and removal. All excavation for installation of new septic tank and drainfeld. All installation of new tan
and drainfield. All final grading.
The name of the excavation equipment operator: Cody Lee
4. 1 agree that there will be no monetary compensation for installation services rendered.
The name of the inspecting engineer: Pannone Engineering
6. 1 agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.070.
c. Advance notice given to the On-site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
As owner of (legal description) 1)1`r V A i W &61 s
I agree that the information above is true and accurate.
Owner's printed name: Cody Lee
Owner's signature:
Date: 7/2/24
QQr yl ' f-4 Os P� X1113 0L-
Mailing Address: P. O. Box 196650 " Anchorage, Alaska 99519-6650 ` www.muni.org
/ys-7
R¢ck Mvstrom
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www,ci,anchorage,ak.us
August 10, 1999
Nancy Magnuson
11061 BOULDER CIRCLE
ANCHORAGE, AK 99516-1245
Subject:
T15NR1W SEC 5 LT 97
Permit # SW980362 PID # 05108201
The subject permit #SW980362, issued by this office for a single family well and/or on-site
wastewater system, is due to expire as of 9/16/99.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater systm and a licensed Professional Engineer has inspected
the installation, the original as-built inspection report must be sent to this office for review,
approval and documentation. All inspection reports must be submitted within 30 days of
construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 343-4744.
Sincerely, _
James Cross, PE
Program Manager
On-site Services
enc: Copy of Permit
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box '196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WATER SUPPLY PERMIT
Upgrade
Date Issued: Sep 16, 1998
Expiration Date: Sep 16, 1999
Permit Number: SW980362
Legal Description: T15N R1W SEC 5 LT 97
Design Engineer: 0000 None Required
Owner Name: Nancy Magnuson
Owner Address: 11061 Boulder Cimle
Anchorage, AK 99516-1245
Parcel ID: 051-082-01
Site Address: 020830 ALLUVIAL ST
Lot Size: 108900 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
The existing well (located on Lot 98) serving the house on Lot 97 is to be decomissioned as per AMC 15.55.060
Date: ?~/..~ ~.,~.?~/
A/,L) :Yl .~ D.
ty/¢ ?,4
,
Zac's Well Drilling
And Pump 5erva e ~
PO. Box 119
Palmer, AK. 99645
(907) 745-4877
WEI,I, LOG
100i
DEPTH OF WELL
STATIC LEVEL
GALS. PER MIN
SIZE OF CASING
TOTAL CASING
FT,
rt. TO:&.O,~ n'.
FT. TO' FI'.
FI'. TO. fT
Fl' TO: . FI'.
FP, OM --.. FT. TO: ......... FI'.
FROM: .... FT, '1"0: ....... Fl'.
FROM. ..... [,'1'. TO: FT.
FROM FT TO: FT
FROM' ._...FI'. TO:..,,_.~_..___ FT
FROM ....... FT. TO: I: FI'.
FROM: Fl' TO: " Fl'
FROM ....... FT. TO: FT
....... ..
D6
Tom Fink,
Mayor
unicipality of nchor ¢
Department of Health and Human Services
825 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-8650
September 20, 1988
Mr. & Mrs. William Magnuson
PO Box 770504
Eagle River, AK. 99577
Subject: Lot 97 Sec.5, T15N R1W SM
At this time our office has not yet received written
conformation of the three issues noted in our April 6, 1988
letter. It would appear that you have not complied with the
directive to verify the septic system's adequacy. Also there
remains the void around the well casing and the service line
placement.
As you are aware, these three issues were included as a part of
the judgement by the Magistrate court and must be attended to.
It was our understanding that you had planned to take care of
these discrepancies as soon as the ground had thawed. Until
such time as these issuse are addressed we will continue to view
the well and septic system as in noncompliance.
We therefore, strongly recommend that you contact this office ~s
soon as possible. Our phone number is 343-4744 and we are
located at 825 L St. Room 502.
Sincerely/)
A1 Sundquist, P.E.
Manager On-site Services/ Water Quality,
DHHS
cc: Lee Browning, P.E., Manager Environmental Sevices, DHHS
P,c 2
T4 (S
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LOCATION OF WELL (Please complete either la, lb or Ic.)
la. Borough Subdivision Lot Block b. I/,gtrs.
Anch 97—of_of —of
__
DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol al Geophysicoi Su vtys
Drilling Permit No.
A.D.L. No. !Sfoction No. Tov+nship N Range E�idia15 s� 1 a - Seward
3. OWNER OF WELL Will iant Magnuson
Address: POD 7 050
Street Address and Area of Wall Location
Eagle River , A k. 9 9 5
7 7
2.NELL LOG
Material Type
—_ Gravel
Feet
Surface
To P
0
Below
Bottom
1 0�
q WELL DEPTH: (final) 5. DATE. OF COMPLETION
165 ft. _i 0 - -- 5 -� 87
S. Cable teal E'rRotary [] Driven Dug
Auger u Jetted Ej Bored Other
S i l t y c l ay
10
' 7
_ Silty clay and .Rrave1
1
i 37
I120
7.USEXMMOomestic FJPublic Supply Indusiry
n Irrigation Rechorgv Commerical
Test Wall Other:
Bedrock ad shale
120
d65
--i
—
S. CASING: Threaded [Welded
diam. E in. to 1�d Depth Weight _L] Ibs./ft.
dium. in. to ft. Depth Stickup__ ft.
---
MUNICIPALITY OF ANCHOPAGE
---
9. FINISH OF WELL:
Type: Q-�Le n hole D l o m et e r:---------
Slot/Mesh Size: Lengih:
Set between ft. and ft.
Dackfilling Gravol puck
HEAM
e►r4ReNMENTAL-P-R0TECTI0N—
-
1 --
10. STATIC WATER LEVEL: 28 ff. 10 5 8
Above or F�ERlow land surfaca Do4e
Equipment used:
—
I I . PUMPING LEVEL below land surfaco and YIELD
ft, after hrs, pumping g.p.m.
ft. offer hrs. pumping g.p.m.
12.GROUTING Well Grouted: Yes No
Material: Neat C•rment Other: _
13. PUMP: (if available) HP 1 / 2 HP C
to
Langth of Drop Pip, 15 0 ff. capacity 5 .m.
1 r-
EJuhm. L_, Jet Q Contrifieal EDOther o
14 . P. E M A k K S : ------ •— — -- —� c
Production or 4 GPM
16. WATER WELL CONTRACTORS CERTIFICATION:
15. Woior Tomperdture ° F Ci C
This well was drilled under my jurisdiction and this report Is true to the best of my knowledge oral beiiof;
Magnuson Drilling AA 538.5
Address:
POfeName
B770504 Eagle River, Ak. yg`%'V°°' License Number
Signed
Data: O c t. 10,
Authorlied Reprosentat
Form 02-WWR (II/BI) Copy Distribution: WHITE-Stote DGGS, Pi,1`C-DHNi !r, "'taNARY-Cus?timer
To Whom
It May Concern:
Sept. 30, 1987
In 1981 I installed a septic system on my property, Lot 97,
Sec, 5, T 15 N, R 1 W, Seward Meridian. The 1250 gal tank
was purchased from Greer Tank. The septic system is on the
east side of the house approximately 5 ft. from the foundation.
Gravel depth at the site is 7-8 ft. deep. The tank is cover-
ed'with clean gravel plus clean fill. The leech line is com-
prised of 4" PVC and runs 80 ft. to the crib which is 4 ft. by
8 ft. by 4 feet deep. There are two clean-outs~ one next to
the house, and 'one near the end of the tank.
The house is a 3 bedroom, 1½baths home.
George Ondola
Tom Fink,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
April 6, 1988
Mr. & Mrs. William Magnuson
PO Box 770504
Eagle River, Alaska 99577
Subject: Citation issued on Lot 97 Sec. 5, T15N R1W SM
In accordance with a directive from this department, the
hand dug well, located in the crawl space of the residence
on Lot 97 of Section 5, T15N R1W SM, has been abandoned and
filled in. The old well pump has been removed and a new
well was installed on October 10, 1987.
At this time it would appear that you are complying with
the order from this department to provide safe potable
water; however, three issues pertaining to the directive
from the department still remain unresolved. These are:
1) The water service line from the new well needs to be
properly buried; 2) a large void around the new well casing
must be filled; 3) a requirement issued at the time the
well permit was applied for, to have a civil Engineer
verify the septic system adequacy, must be met. Once the
septic system has been verified for adequacy, then the
dwelling can again be occupied.
It is our understanding that you plan to take care of these
discrepancies as soon as the ground thaws. When these
items are resolved, the department will consider the new
well as acceptable.
Sincerely,
/
Gus Andress, P.E.
Manager On-site Services/Water Quality Sections, DHHS
cc: Lee Browning, P.E., Manager Environmental Services, DHHS
4.
None
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503
274-4561
Date Received ~n+~mhn. ~ 1O~
Time of Inspection 2:00 p,m,
Date of Inspection, September 5, 1973
REQUEST FOR APPROVAl. OF
INDIVIDUAl. SEWER & WATER FACILITIES
FOR
Conventional
Aoproval Requested By: Roy Ondola
Address~ 3811 Minnesota Dr. #4, Anchorage AK 99503
prooertv Owner: George Ondola
Phone, 279-3334
Phone, 688-2227
Hand dug well being used.
Drilled B. Depth
203'
C. Construction 6" Casing
7. Sewage Disoosal System:
A. Installed B. Installer
C. Septic 'rank: 1. Size 2. Manufacturer .......
O. Seepage Pit: 1. Size8'x8'x6' 2. Material,Loq C~ib --
E. Disposal Field; Total Length of Lines
Distances:
A, ~ (.11. To: Septic Tank
, Nearest Lot Line
Foundation to Septic Tank
D. Bacteria] Analysis' Satisfactory .~
, Absorption Area 50' , Sewer Lines
, Other Contamination
'> Absorption Area
Absorption Area to Nearest Lot Line
Well Data:
A. Type
Legal Description:. Lt 97, Sec 5, l]5N, R1W .
Location: 500' N from Ju____..nction of N. Birchwood L@ & Spur Road.
Type of Facillty to be Inspected:~]n~l.e FamiLY Dwellin~
Number of Bedrooms; Three (3)
Request for Approval of ~ndivi~ual Sewer ~ Wate~ Faoilit~s
Page Two
9. Comments~ Sewer s~A,tem consists of cesspool only. , Cesqpnnl nnly ~' f.om ,
well. Hand du9 also be.in9 utilized. ,Tq,be aoproved: (l) Install new sawer , ,
__s~stem 100!, from well~,(2) Abandon hand duq well,,
Approval Valid for p~ Year From Date Stqned
Greater Anchorage Area Borough,~DeFartment of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for appreval to be a true
and accurate representetion of the subject sewer and water facilities loceted at:
Signed Date
