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Home My WebLink AboutSAMUELSON LT 8A� 91 4 2 000 1 �� 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 NAME J PHONE NEW //�Q Fill r�l tAR 3qq — �cruenc MAILINGADD ESS LEGAL DESCRIPTION r� Sf�KI LOCATIO ,• �, NO. OF BOOMS v Y DISTANCE TO: Well Absorption area Dwelling PERMIT N X, WwQ I- Manufacturer Material No. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth _jaZ Z DISTANCE TO: Well /- Dwelling PERMIT NO. �� Q w = Manufactur !t Well DISTANCE TO:Lu Foundationy Nearest lot line Liquidp�y in gallons PERMIT NO. LL Z ZW ~ No. of lines Length of each line Total length of lines Trench width inches Distance between lines 1�. O Top of tile to finish grade Material beneath tile inches Total effective absorption area w f7 Length Width Depth PERMIT NO. i F wa Lu Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line J W Class Depth Driller Distance to lot line PERMIT NO. Z' DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIPE MATERIALS SOIL TEST RATING% INSTALLER REMARKS APPRJY DATES LEGAL �M U its 3: M 1: Pa L. :1 -V 113 1=7 AM fit it-!! IF:r�':! ^ TO !E::-.! iE]i� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SUBDIVISION: SAMUELSON 825 L STREET, ANCHORAGE, AK 99501 OR ACR 264-472O PERMIT NO: DATE ISSUED: .� �� ArrLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: CHNS~-113 1: AM: M 1EV7 %AJ1 ll�.E.'.:A*-:�,,': 850059 ��or�� k� 03/11/85 , � LOUANN DIAMOND NEUB�RG �'� P O BOX 670174 CHUGIAK, AK 688�3186 NIA SUBDIVISION: SAMUELSON SECTION: 8 TOWNSHIP: 15N 14532 (SQ.FT. OR ACR IF A LIFT STATION IS INSTALLED I�V AN AR��A ~OVERED BY MDA 8UILDING CODES THEN (1) AN ELECTRICAL PERMIT AND INSPErTI�ON MUST BE OBTAINED^ (2) AS B:ILTS WILL NOT BE APPROVED WITHOUT AN ELECTRI�ALINSPEC-IO� REPORT;ND <3)~nu'�E ELECT�ICAL WORK MUST BE DONE BY A LICEN�ED ELECTR�CI�%. � SIGNED DATE: `~_� APPLICANT: LOUANN DIAMOND NEU� G »y --� �r� ' ISSUED BY�� / vg DATE: �� NIA IF A LIFT STATION IS INSTALLED I�V AN AR��A ~OVERED BY MDA 8UILDING CODES THEN (1) AN ELECTRICAL PERMIT AND INSPErTI�ON MUST BE OBTAINED^ (2) AS B:ILTS WILL NOT BE APPROVED WITHOUT AN ELECTRI�ALINSPEC-IO� REPORT;ND <3)~nu'�E ELECT�ICAL WORK MUST BE DONE BY A LICEN�ED ELECTR�CI�%. � SIGNED DATE: `~_� APPLICANT: LOUANN DIAMOND NEU� G »y --� �r� ' ISSUED BY�� / vg DATE: �� ~- DEPTH TO PIPE BOTTUM WT. 2.0 15 ` 40. OD ~...�� , D9^/ /*M SIZE: VGA OilFT, SOIL POTIA /BR) 91 ** DEPTH PE BOTTOM < 2.0 TI ** DEPTH PE BOTTOM < 3.5 FI.REQ ** DEPTH T PE BOTTOM < 40 MA� ULAr I - ' A LI � ATIO� ** TANK MUS HAVE -11. LEAST TWO C PARTMENTS ..... ..... ..... -... ..... ^� ..... .... ... .\/~ ..... .... IF A LIFT STATION IS INSTALLED I�V AN AR��A ~OVERED BY MDA 8UILDING CODES THEN (1) AN ELECTRICAL PERMIT AND INSPErTI�ON MUST BE OBTAINED^ (2) AS B:ILTS WILL NOT BE APPROVED WITHOUT AN ELECTRI�ALINSPEC-IO� REPORT;ND <3)~nu'�E ELECT�ICAL WORK MUST BE DONE BY A LICEN�ED ELECTR�CI�%. � SIGNED DATE: `~_� APPLICANT: LOUANN DIAMOND NEU� G »y --� �r� ' ISSUED BY�� / vg DATE: �� F ufrucyipaHty 0W- Anchovage r POWrI6-650 ANCHORAGE, ALASKA 99502-0650 (907)264-4111 TONY V NOWT FS. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: Handwritten January 31, 1985 TO: Permit Applicant SUBJECT: Lot 8 Samuelson Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt Supe�`visor p Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 MUNICIPALITY OF ANCHORAGE,, - Departments Health and Environmenta: ?rotection 825 L Street, Anchorage, AK. y9501 264-4720 Permit # # # HANDWRITTEN PERMIT # # # l WE' 1 -� ""�� ON- ITE SEWER PERMIT Applicant: 1, wy6i jng Address: , - a��J Location: Phone Number: Legal Description: ( J0 �(;L,�f� j24 Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: s Seepage Bed:Holding Tank: Maximum Number of Bedrooms: Soil Ratings ift/br) The Required Size of the Soil Absorpt ��'System Is: < rC 1 DEPTH +cS LENGTH_ GRAVEL DEP WIDTH The length dimension is the length(in fee ) o the trench or drainfield. The depth of a trench or pit is the distance e ween the surface of the ground and the bottom of the excavation(in feet). Thi e is no set width for trenches. The gravel depth is the minimum de of g avel between the outfall pipe and the bottom of the excavatit (in fe t . # # REQUIRED SEPTIC(H LDI G TANK SIZE _ GALLONS # # Permit applicant has the resp ns i ity to info t is department during the installation inspections of a y is adjacent o t is property and the number of residences that the well w 1 serve. # # # TWO( INSPECTIONS AR RE UIRED # # # Backfilling of any sy to with ut final ins ec 'o and approval by this department will be subject to p ose ution. Minimum distIrn betw n a well nd a on -s to sew ageAisposal system is 100 feet for a privatll r 150 to 200 feet fr a public 'wd11 depending upon the type of public weM nimum distance fr m a private well to a private sewer line is 25 feet ao a community sewe 1 ne 's 75 feet. Well logs are required and must be d to this depart ent w'thin 30 days of the well completion. Other requirem is may appl Spec'fi a c available to i ure proper nstalla ion. * * * PER SIT EXPI ES DECE construction diagrams are ER 31,19# I certify that: (1) I am familiar with he r quirements for on-site sewers and wells as set forth by the Mun'ci ality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha 3 bedrooms. Signed: Issued by: Applicant f �y Date: SWP/024 (1/81) Permit # Applicant: Location: ,MUNICIPALITY OF ANCHORAGE Department' Health and Environmental "rotection 825 u Street, Anchorage, AK. _9501 � 3/ 264-4720 c l O # # # HANDWRITTEN PERMIT # # # ON-SITE SEWER PERMIT Mailing Address : R0-. /9 Y / 7 /` 1wi - Phone Number: Legal Description: l,01 CY _S6l' kF,1SO/Y Lot Size: — Type of Soil Absorption System Is: Trench: Drainfield: X _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH •Jr ' LENGTH S 2 I GRAVEL DEPTH a`!,��QDTri � I W I The length dimension is the length(in feet) of the trench or drainfield. The depth of a 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 gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # # REQUIRED SEPTIC(HG) TANK SIZE _ /00 U GALLONS # # 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. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100•feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am 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 codes. (3) I understand that the on-site sewer system may require enlarge ent if the residence is remodeled to include more that 3.b rooms. Signed: Issued by: Applicant Date : / i lk-v SP1 /024 (1/81) _ a:_ p F:..- ff-119 _ -F =..8_o 09 F-- 6=9 P-4 C-11-•1 u. - Fe F- g R3 EZ � DEPARTNENT1` OF HEALTH AND EN %-' I RONMEN•dTt=IL PROTECTION ::.2. "L..`" STREET: AI`-IORf`lGE: Al" 99501� 6,'1---4.720 : f1NCH RAGE 694-21<l EAGLE RIVER F>E=Ft1'1:E T I140. -.1*`! 1;: 0 APPLICANT: L01-1ANN N,IE-LIEU IRG PHONE: AI -"-DRESS: M,, CF -1U GiAP".. F-[-"-. 9,'---,567 _EOAL DE'SC R I F'T I OP -d - ' LIE:C? I VISION: 'SAMUEL'•?ON BLOCK: NA LOT: '_ 4.OT" :c;I,-:EE:: 0 SQ. FT. TOWINSHIP RANGE: - SECTION: — MA'X I C'11_Il•'1 I'di-IMDEr: !_;f-' OE1-'1ROCq'1S 0 SOIL RATING — 0 0 0 -dam!. FT. /BR) LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING ','OUR SEPTIC S''=TEC'1. cHO!_C E_ THE. OPTION THAT OE_,T FIT,:-- YOI_IE: 'SITE. i C F=F: T" I F 'r' THAT: :1. 1 Af,l FAMILIAR C..}ITI-I THE REQUIREIIENTc7 FOR OPd-• ,ITE. _,EWER'S AND WELLS AS _,ET FORTH Pi THE fR..l 1C:IPALIT4' OF f"iNC:FIORAaE AhID THE STATE OF ALASKA. 2. I WILL I h• STALL 'T 'HE 'f•'r'STEC I It -4 ACCORDANCE t=J I TH THE CODES AND HAVE RECEIVED A COPY OF THE CODE ' ;l it li'1t=fF:"r' AND D I AGRAN ATTACHMENTS WHICH IS PAI -:T OF THIS FT'.—'RI,,I I T. -.. I UNDERS IFAND THAT T'HE Of' --SI T'E SEWER S'�S 'TEt'1 C'1A', REi !I_II RE ENLARGEMENT IF THE RES I DE -.'T l. -:E I : ; RE PIODE1_E D TO INCLUDE MORE THAN lei . BEDRCO_q-i_;. PER11 I T FIF'PL. I CANT 1-1;=1S THE: RESPONSIBILITY TO INFORM PERSONNEL NEL DURING THE INSTALLATION' INSPECTIONS OF AP•d'"r' WELLS ADJACENT I-0 THI'S PROPERTY tiP"aD FHE Nl..111OER OF RESIDENCES THAT THE. WELL WILL. SERVE IF A LIFT :STATION I C. IPdF FAL..LEC:: AN ELECTRICAL F'EF:C'1IT AND IYdSF'EC:TIOPd MUST BE riBTA I hIED. Fl -;--BU I L.TS C;AYdNOT BE AF'PRO'v ED Id I THFIUT AN ELECTRICAL INSPECTION REF='ORT. THE ELEC:TTRIt_:AL. WOP.T` I'll IST BE. DOP•-IE BY A LICENSE[:, ELECTRICIAN. F1PPLICa-NT: L+.-tl_It=,N,1P:1 NEUE,hIRG ISSUED i -, DATE: Tom: /14/"I3 TYPE OF SOIL HBSORPTION SYSTEM IS MAXIMUM NUMBER OF BEDROOMS = ] 40p#�#� C. SQIL RATING (SQ FT/BR)= 6.00 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� C. V FEE P, "T"�� lqj�- 72. THE ��411 g=- �41�� LENGTH (IN FEET) OF THE TRENCH , HEHLTH MND �NVIRO��ENTHLr~�OTECTIGN / -�� -R�' IS THE DISTANCE BETWEEN THE SURFHCE ^ ` 825 ` STREET' HNCHORHGE/ HK GROUND HND THE , 264--4720 ?~Aa THERE IS NO SET WIDTH FOR TRENCHES. �� 1IT^NO. ( 820519 ) GRHVEL DEPTH IS THE MINIMUM &M.ICANT TODHYS REAL ESTHTE PO BX 6]] ER AND LOCFIT ION OF WE (IN FEET). 688 ]999 LEGAL L.T. 8 SHMUELSON S/D LOT SIZE 15000 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS MAXIMUM NUMBER OF BEDROOMS = ] 40p#�#� C. SQIL RATING (SQ FT/BR)= 6.00 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� C. V FEE P, "T"�� lqj�- 72. 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 SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTIQN (IN FEET), THERE IS NO SET WIDTH FOR TRENCHES. MINIMUM DISTANCE FROM H PRIYHTE THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BGETWEEN THE OUTFALL PIPE AND THE BOTTOM OF WE (IN FEET). OTHER REQUIREMENTS MAY HPPLY� SPECIFICHTION5 �to! �On,': ��EE-E� AND CGNSTRUCTION PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO �NFORM THIS DEPHRTMENT DURING 7HE INSTALLATION INSPEC TJONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THHT THE NELL WILL SERYE. -.... -T- W 1 Ulm �_":m 1 04 05 W FIE 1:1 W I CM 104 15 5=1 FOR YEEE FEE Q-9 1 EE:� BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION FIND HPPROVHL BY THIS DEPHRTM0NT NILL BE SUBJECT TO PROSECUTI8N MINIMUM DISTANCE BETWEEN H WELL HND HNY ON-SITE SEWHGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIYHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIYHTE WELL PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SENER LINE IS 75 FEET. OTHER REQUIREMENTS MAY HPPLY� SPECIFICHTION5 AND CGNSTRUCTION FIRE RVHIMBLE TO INSURE PROPER INSTALLATION. M 15 KIN FEE W M 101 EEO KEE F& �too �� I CERTIFY THAT 1: I HM FHM ILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPHLITY OF HNCHORRGE W I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE COD�S ]� I UNDE�STH�� THRT THE ON�S�T� ��WE� SY15TEM MHY REQUIRE ENILHRGEMENT IF THE RESIDE SIGNED�.- ........ ........w '''^'� �m~"~� � �5 �� 4c � ��'/� �r IX 4W.0 -1146P 441P 4N CP»m-,�� MUNICIPALITY OF ANCHORAGE • +� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST _'tR�$OILS-LOG ❑ PERCOLATION TEST PERFORMED FOR: Low AAA/ A/rGtiauj" DATE PERFORMED: .� LEGAL DESCRIPTION: / f'i7� � Si'4JM//>,r) S/PN ( splgw? f?&'vi4i 1C- 1 4" 2 �MI a 3 5 �5_ 0/,tf�,c s -;�` 51 L-T�1' U✓` 10 ` 11 WAS GROUND WATER ENCOUNTERED? 12 D`T`T-v ova t4�or e IF YES, AT WHAT 13 DEPTH? SLOPE 16 `d ^ 17 ; ,' iis.uurt r -Il}nr,r a t 18- 19] 8 19 20 COMMENTS 72-008 (6/79) SITE PLAN ■■■■■■E11 NMI DOW UZZMEN M_ ■■■ W■■■.■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE / `r (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFI DATE: March 27, 1985 PO U F, 1 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Peter B. Neuburg Lou Ann Neuburg Post Office Box 670174 Chugiak, Alaska 99567 Subject: Lot 8 Samuelson Subdivision At the request of your excavator, Steve Skaggs, we will grant and extension to our previous order. The extension will give you until June 15, 1985 to either reconnect to the existing holding tank or install a new sewer systems. In either case, we will require proof that the old cesspool has been properly abandoned. Please contact me if you have any problems with meeting the new time frame at 264-4720. Sincerely, Susan E. Oswalt Engineering Tech III SEO/ljw unicipanty Anchorage March 6, 1985 POS -,-1 6-650 ANCHORAGE, ALASKA 99502-0650 (907)264-4111 <� � TONY KNOWLLS. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Peter B. Neuburg Lou Ann Neuburg Post Office Box 174 t Chugiak, Alaska 99567 Lbly r6�� r Subject: Lot 8 Samuelson Subdivision As we discussed over the telephone today, your continued use of the old cesspool on your property is a violation of AMC 15.65.080 and 15.65.020(A). You must immediately pump the cesspool and disconnect the line, and reconnect the wastewater line to the approved holding tank. In addition, we will require that a written pumping contract be submitted to this office and that you provide proof by inspection that the above change has been made. The soil test on file is adequate for use in obtaining a 1985 permit for installation of a new sewer system. I appreciate your cooperation. If therel.are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Engineering Tech III SEO/ljw €A�s u PC.-I'H 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION June 28, 1982 T0: Whom It May Concern Subject: Lot 8 Samuelson Subdivision The above subject lot, due to lot size and well locations could only use a holding tank for sewage disposal. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. Buchholz Program Supervisor LNB/ljw f PO,_ 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION June 24, 1982 To whom it may concern Subject: Lot 8 Samuelson Due to lot configuration and location of sewer system, a holding tank was installed and approved by this department. Robert C.. Pratt R.S. Associate Specialist RCP/mag f by DOC Co. dba SULLI"N WATER WELLS _ - P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND' ADDRESS LEGAL DESCRIPTION f :`` ! f T r 3 DDATE - Started � i Ended � g PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. From From Ft. to Ft. Ft. to Ft. From—Ft. to From Ft. to Ft. F1R(J� Ft. From - - Ft. to-Ft.- oFt.From' From-Ft. to1F From Ft. to Ft. From From,/ Ft. to Ft. From—Ft. From Ft. to r f Ft. rs From Ft. to Ft From Ft to . Ft. From Ft to Ft. k From Ft to r`.. ,= Ft. From • Ft. to '- ` F Ft. From Ft. to—Ft.- From—Ft. o Ft. From Ft. to- From—Ft. o From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From—Ft. to Ft. MISCL. INFORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT DRAW DOWN FT. GALS. PER HR s - KIND OF CASING' From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From -Ft. to Ft From Ft. to Ft.PGD OFP i-. FromIPA1T�,� lit: r t10N From F1R(J� Ft. From Ft. to--- o_—FromFt. From-Ft. to1F 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 DRILLER'S NAME E= - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 25 ,.L,. STREET, ANCHORAGE, AK. 99501 264-4720 PERN'1I T N-d� �. ( 8 2il-: 7 ) APPLIC:ANaT WA'TNdE rOUSINEAU LOCATION LEGAL LC: SAMUELSON•d PC i Bili 279 CH1 G I RK 99567 688-3999 LOT SIZE 999999 SQUARE FEET MINdIMUM DISTANCE BETWEEN A WELL AND ANY ON'a—SITE SEWAGE DISPOSAL SYSTEM Is 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC= WELL.. MINdIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO A C_OMMUNIT'r SEWER LINE I= 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INaSTALLATIONd. I C=ERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWER_. AND WELLS H_• SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I' WILL INdSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 5I GNED : »_ ll'`��'��Gf6L —A'1( A''FLICANT ba 'TNE C=OIISINEHIt t/cY'GATE--» »»_» !I___EGB»»� -! V4. 0 '.re ': rime < 3 Date Date Date In ector Inspector Inspector Comments Conditional Approval qq !,0-'o Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner JAMES AND AGNES SAMUELSON Phone Mailing Address Buyer PETER AND LOURDETTE NEUBURG Address Lending Institution R AL i dR E VT, INC. Phone P. 0. BOX 1748, Eagle River„Alaska 694-4533 Address r Realty Co. & Agent TODAY'S REAL ESTATE Phone ' 0. BOX 279, 'Chugiak, Alaska 99567. 688-3999 Address Legal Description Lot 8, Samuelson t Scenic Swa Y Street Location Type of Residence 3 ffSingle Family ❑ Multiple Family No. of Bedrooms ❑ Other Wateyr Supply ATTACH WELL LOG. A well log is required for all wells drilled since June Individual ❑ Community 1975. For we]Ls3drilled prior to that date, give well depth (attach log if b ffeelt ❑ Public Utilityavailable. Sewage Disposal Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: XXHoldin Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.