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HomeMy WebLinkAboutHANSEN SAND LAKE LT 9C3Onsite File #012-153-35 IR DOC CO dba OPM LLIVAN WATER WELLS BILL � COLE P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Michael Swecker ADDRESS: 3751 W. 74th Ave, Anchorage, AK 99502 Bore Hole Data Depth From To LEGAL DESCRIPTION Hansen Sand Lake Lot 90 DATE: 9-18-20 0 2 PERMIT NUMBER: OSP201279 DATE OF ISSUE: 7-30-20 TAX IDENTIFICATION NUMBER 01215335000 Is well located at approved permit location: ®Yes [—]No Method of Drilling: ®air rotary cable tool Depth of Well: 205' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 205 feet Liner type Static Water Level: 88 feet Recovery Rate 20 ® gpm Fj gph Method of Testing Air Well Intake Opening Type: ® open end ❑open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ❑yes Ono Method of Disinfection: Chlorine 50 PPM Comments: 2 4 4 8 8 22 22 60 60 98 98 109 109 125 125 193 193 205 Casing Stickup Overburden Fill Wood & Boulders Silty Sand w/ Gravel Silt & Sand Clay & Gravel Silt & Sand w/ Gravel Water Silt & Sand w/ Clay Silt & Sand Sand & Gravel Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. ® DOC CO dba BILL8c GOLE ULLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 www.sullivanwaterwells.com Pump Insallati®n Log Well Drilling Permit Number: SW OSP201279 Date of Issue 7-30-20 Parcel Identification Number: 01215335000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 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 Water System Permit Permit Number: OSP201279 Work Type: Well Renewal Tax Code Number: 01215335000 Site Legal Address: HANSEN SAND LAKE LT 9C3 G:2126 Site Mailing Address: 3751 W 74TH AVE, Anchorage Owner: SWECKER MICHAEL E & LORI J Design Engineer: This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: 0 c n t F '• .. fir. ))Dailtiii ent 7/30/2020 7/30/2021 8709 Q 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 Special Provisions: To close out this permit, please submit the following: 1) Well log 2) Pump install log 3) Water sample results for total coliform, nitrates and arsenic. Received By: Date: Issued By: _ 2 Date: 713 v ? 1 �U 5 UH CSF A L TV 00 IF zk HCH 00 RA G Ar Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 PZ,4 7- 76 - 131 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. dra [5-3 Property owner(s) If! ll KE - 'a La—A �uJ�C �-'tZ Day phone 967 -5a9- �S�57 Mailing address 3'751 Wi 7y4 i AU -r--14 Site address 375 ( Legal description (Sub'd., Block & Lot) _ i -52/f k,/J IAk- 4r qC.3 (0:9,1616 Legal description (Township, Lot Size S 70 Sq. F1 Range & Section) Number of Bedrooms _ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El ADU) Septic Tank 1:1 Upgrade Upgrade ❑ Duplex (D) El Holding Tank ElRenewal Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well nX Water Storage ❑ THIS APPLICATION INCLUDES A 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) S Permit/Rush Fees: Waiver Fees: Date of Payment: o' 2 U Date of Payment: Receipt Number: 5 `'� $ (,3 Receipt Number: Permit No. OSio 26127q Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc N, ""'y MUNICIPALITY OF ANCHORAGE oenr 7 • On-Site Water&Wastewater Program No `5; ,, , ;; a PO Box 196650 4700 Elmore Road 4 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,� r. \ "� / http://www.muni.org/onsite __ / 1 chartntent '.^'CHORpVE On-Site Water System Permit Permit Number: OSP191145 Effective Date: 5/7/2019 Work Type: Well Initial Expiration Date: 5/6/2020 Tax Code Number: 01215335000 Site Legal Address: HANSEN SAND LAKE LT 9C3 G:2126 Site Mailing Address: 3751 W 74TH AVE, Anchorage Owner: SWECKER MICHAEL E & LORI J Lot Size in Sq Ft: 8709 Design Engineer: Total Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: To close out this permit, please submit the following: 1)Well log 2) Pump install log 3)Water sample results for total coliform, nitrates and arsenic. . ri , 1 Received By: i __c., f Date: S / Issued By: i / / Date: 19 MUNICIPALITY OF ANCHORAGE . , ,r Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D.O62- L S 3 3 5 (30° Property owner(s) 1►C�f� L I /ok, 4:0EveR Day phone 9'67 -5;29- ,56-7 Mailing address J751 (I'ESr 7��N�¢VC / 4-11,(74/e/ die(o t die 99SOa Site address Elf t14 ,f / ,, , / Legal description (Sub'd., Block & Lot) 4)1- 9 C3 1/4n si71 fife thk— 42cCi Ao i Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial Single Family (SF) ❑ (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A 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: $22 5 b a Waiver Fees: Date of Payment: 4,Q1 �OI9 Date of Payment: • Receipt Number: ,p I� 1 I Receipt Number: Permit No. Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc W. 73rd AVENUE (ROAD NOT DEVELOPED) o 0 N 89'59'30" E 72.50' Li. m o z z 0 o — 0 0 o CA m— w LOT 9C1 ° LOT 9C2 n1 D (/) _ rTt f N K N) o m O --t N) N t / 1 '—� LOT 10 1930" E 72.50' i 20' WIDE UTILITY EASEMENT q f •—I LOT — — r~1clL 9C3 Ale posr 6.1 11. Z L CJ o 12.0 °' °' 16.0 0 t O m o O c `r CA —II N Co (O / / N O/%/ EXISTING I BUILDING, D = 8.0 ,4.0 �,,...=,e':> CF A/ 0�, * O� ��� !�0� rr, 0 LOT 9C4 ���.• TH r\ •7 OO No z N N T• ::::. o Q • 32.2 •. l... 0 N w .•........• •• •. .... • w V '••An ho y P. o ., . o Q ` ..............:..... . • Qki(" ' . S •—9020 ••'J)4 :.:::::::D.RIVE:.:::.:.:::.:.Co. 4ata o �qo....'•..... /)e_l, �,0` 10' W:.UTI ITY. ASEMENT 011 N 89'59'30" E 72.50' () CA o - SQ-L-04?it,(1,4A, He le 0 CYli — NOTE: W. 74th AVENUE 1) THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. Legal Description: AS-BUILT Ordered By. Mike Swecker Lots 9C1 & 9C3, Legend: Set Fnd septic Standpipe SO •':;:Asphalt;:;:`;;';:;•j 5/8"RB W/CAP 0 5/8" RB o Water Wellco 135=mo Hansen Sand Lake Addition Fence—X—X— ••••• "Overhan Oh 3.25" AL.MON. MONUMENT Wood Deck Light Pole Art �i EXCLUSION NOTES: It is the owners' responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. NOTE: Under no circumstances should any data hereon be used for construction or for establishing property lines. LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS SURVEY CERTIFICATION: LANTECH has conducted a physical survey of this 440 West Benson Boulevard, Suite 200 Phone: 562-5291 thereonyas are ithin the propertyown on this ilinesand andthat no encroachments existother situated Anchorage, Alaska 99503 Fax: 561-6626 than noted. Plat: 70-131 Grid: SW2126 Dote: SEPTEMBER 4, 2007 Drawn By: TM Work Order: 2006LH21 0 Fb/Pg: 693/70 Scale:1"=30' Checked By: APH MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907)564-2762 BLOCK/LOT/TRACT LT 9C3 SUBDIVISION HANSEN SAND LAKE Cr WASTEWATER CONNECT PERMIT DATE OF APPLICATION SCHEDULED COMPLETION DATE TAX CODE 1215335 GRID SW2126 AS -BUILT STREET ADDRESS 3751 W 74TH AVE OWNER SWECKER MICHAEL E MAIL ADDRESS 8419 HEATHER CIR ANCHORAGE, AK 995020000 06-3830 09/05/2006 12/31/2006 X SINGLE FAMILY MULTI -DWELLING No. APTS_ COMMERCIAL PHONE CONTRACTOR 'UNKNOWN Cu v. ASSESSMENTS Repair Existing Service X Main Line Extension X On Property Only City Tap Have Been Levied Hydrant Only 50' or Longer To Be Levied Main Tap - To Property Line Only Comments: Main Tap & On Property Connect Row No. Disconnect R & R - Main Tap Only Owner Staff CONNECT SIZE 4 " ISSUED w cdf INSPECTION FEE PERMIT FEE $ 54.00 $ 48.00 PAID CASH CHECK # $ 0.00 OTHER DEPOSIT $ 0.00 INSPECTED BY REIMBURSABLE TOTAL $ 102.00 p LS��S ` , DATE /1 `/Op NUMBER REMARKS BUILDING NEW HOUSE. MAY USE EXISTING ON PROPERTY SERVICE AND MOVE CLEAN OUT PERMITTEE (Please Print) *SAME AS OWNER MAIL ADDRESS , SIGNATURE / ,,A/00 7 . PHONE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Original DATE SCHEDULED g I I I TIME 11. M4A INSPECTOR � � p, VARRE LL SUBDIVISION HANSEN SAND LAKE BLOCKILOTITRACTLT 9C3 INDICATE NORTH i D L� isE s SIZE MAIN: TYPE MAIN: DEPT AT MAIN: AT PROP. LINE: 91 CONNECT LOCATION:I CSF E p L COMMENTS: 1� IE -� CUT W1� A 1J S, l `dSEAL 9 C.0 . INSPECTED BY: P� DATE: 9 p(o N N CY afto N a 9 r r wr •{ 'r r wr y4 yfi + t �r ,* 1fL J *` +T ' ; �{ } . Y z- Ft }� r { . r r r r • T r r = • s 1' S•f w r 1'r TAX CODE No. inj 2 -15 3 - a5 st PROPERTY MUNICIPALITY GRID No. OF ANCHORAGE —SEWER UTILITY Name Address Plat No,-- S u b do z:s%A-,,o7 . Sr Residential (Z Commerial El Lot AcctNo :.? Block Industrial ❑ No. of units am CONNECT46 Main Tap On Property El Permit No,. -I Size _._� ,Type 4i. - / , Drawing No., Size Malin " Type, x • p Depth at Connect _ 17 Insulation ❑ Cleanouts Type Connect Agent, Sm'Cc>,jn,.5-; Inspector Comments Date Connect Location -411 FQ -s4- enk -P t.'YI, N.� ASSESSMENTS L.I.D. No. Private Dev. No. Subd. Agreement No.,--azZ1s2 L5/�o Sewer Agreement O No. P.T.E. ❑ Roll No., DYE TEST Positive El Negative ❑ N.S.A. .❑ Date Page No. M.H. No. Billing Cycle Tested B y Comments 5 I I ti 4 do t 0 z Q) q4 i , Gam' OL y� ` }#lt i# . i'+`=mss �. r��, #+r;. + F -� -#� ^ 'r�+a :+ '.+s'e' " aF..r�"`....sy+r- s c . a t��i T ` �F•—" ..�i+7.M� J.31 �lt1 I It sjuawwoo 9104uoW 10JIU03 10 u011oO01 Moys qojqjS 413 uo��o�o� au�� a�inaaS «J11�3d0�ld NO rTl 'x'�'�` •'. — ■� Y �. rte /i r� � .� 77 . . ...* � �a� .1 i �. �� •} ib� . A ,!� . ..� a • ? i F F ; f *. hf K �E Y a r i. iR .+'f iY f '� ' k 4'r� A jw '7.� w *'t %rrt `} r. �'-'t r z+l�'S is;�F JS} wR, f x}14 frY� ►itit� TAX CODE No. GRID No.- MUNICIPALITY OF ANCHORAGE —SEWER UTILITY PROPERTY: Name Address, Plat No. Subd.,HQ& el.s.P*yi 5e.%, &n 1 Residential D Commerial. O Industrial CONNECT ma- Acct.No �►-0�4 Lot 9 c -3 Blo No. of units it r Main Tap On Property El Permit No. Size `/ TypeZ. Drawing No. Size Main Type Depth at Connect Insulation ❑ Cleanouts Type Connect Agent-5-ypi i ` 4- tonC-c>,n--az+ Inspector Comments- <:?a ' -P '` --�' / - - - - Connect Location ��' c��� �- � �-F �. � Q ASSESSMENTS= L.I.D. No.—,Privat Sewer Agreement D e Dev. No. Subd. Ag No. P.T. E. ❑ Date J'Ljlv P-.-? reemenfi No. ���,� 1,SI �r o. Roll No. DYE TEST: Positive El Negative Q N.S.A. D Date Page No. M.H. 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ANCHORAGE, ALASKA 99501 279-2511 'N? 839 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE EROM WELL £ LIQUID CAPACITY /~/~/._?C~3 GALLONS. MAILING ADDRESS .'3 7.~J ~/ ?J~ ~;'L PHONE MATERIAL _c~ ~'.~;/ /~.,~/'~ ~,?/~:~t,/~(,~ 7'??COMPARTMENTsNUMBER OF j _~ LIQUID INSIDE LENGTH '~ INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER OF PITS / LINING MATERIAl NEAREST LOT LINE. SEEPAGE PIT: OUTSIDE DiAM~ OR WIDTH ,, LENGTH ,/ , DEPTH D CE FROM WELL , G FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: y ~-~ TOTAL LENGTH DISTANCE FROM WELL '~ , FOUN~D'A% . NEAREST LOT LINE , OF LINES NUMBER OF LINES DISTANCE BETWEEN LIN~S -- ___TRENCH WIDTH ~li~. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF~ CH LIN  DISTANCE FROM WATER WELL: TYPE ,"z;-'J J/,? ~}~ I'(~ DEPTH ~' , BUILDING FOUNDATION. "- SAMPLE_ --- ., NEAREST NEAREST __ SEPTIC SEEPAGE OTHER LOT LINE .... , SEWER LINE . TANK ~"- , SYSTEM '~- , CESSPOOL. ~ ., SOURCES DISTANCES: DIAGRAM OF SYSTEM - ; :: ! ._ ~., : ~ GrEa,ER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL OUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99E02 TELEPHONE 279-86S6 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO.. INSTALLATION Of SEPT C TANK SEEPAGE P T ~ DRAIN FIELD , OTHER , FINANCED THROUGH ~// ~' [/ TO BE iNSTAlLED bY COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPT,OTANKS'ZE" area S,ZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK '~'! FOUNDATION TO SEEPAGE Pit ~'~ ~° . DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT Wall / ~'*- / · SEEPAGE PIT ., DRAIN FIELD SEPTIC TANK TO NEAREST LOT LINe. WELL TO SEPTIC TANK DRAIN P[ELD WATER MAIN TO SEPTIC TANK . DRAIN FIELD //~ z SEPTIC TANK, . SEEPAGE PIT ALSO CONSIDER AREA WELLS. .. SEEPAGE PIT SEEPAGE PIt /f~-~/~'~ j . ., DRAIN FIELD TO RIVER, LAKE, STREAM. DIAGRAM OF SYSTEM CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH~.~EGULATIONS REgarding iNSTALLATION. · ' HEALTH AUTHORITY , OR [/ LICENSED DESIGNER , CERT,FY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER aNCHORAGE AREA ~OROUGH ORD,NANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE· '~'~'¢' / APPLICANTS SIGNATURE . G~-'TER ANCHURAGE AREA BOROUG~,~, 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For Betti Baker Legal Description: Lot Block This Form Reports Soils Log × Lot 9 - C3 Date Performed 1D/?l/71 S u b d i v i s i o n Hanson Sand Lak6 eP-~-F?O 1 a t i o n Test Depth Feet Soil Characteristics Brown clayey silt (ML) Was Ground Water Encountered? Gray silty fine to medium sand (SM) no If Yes, At What Depth? Reading Date . Gross Time I Net Time Depth to H20 Net Drop ! ~e~colation R'ate Minute Proposed Insta]'lation: Seepage Pit x Drain Field Depth Of Inlet COMMENTS: Depth To Bottom Of Pit Or Trench 250-square feet of drainage area is required per bedroom with the cr. ib set at depth of from 2.5 to 8.5'. lest Performed By R. E. Carlisle ' Data Cert'ified By:National Testing Svs. Inc. Date: . # OIZ 153=, ,5? 00o GAAB HD~ G,~'C~TER ANCHORAGE AREA BOR¢'~-~'",H HEALTH DEPARTMENT 327 EA~LE ST. ANCHORAGE, ALASKA 99501 2/9-251 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MA,L,NG 37. / 74 ADDRESS _ PHONE SEPTIC TANK: D,STANCE FROM WEL' LIQUID CAPACITY ',.~ ~/~)- )t~":-~ ~ GALLONS. SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEARESI LOT LINE 1- ¢1-c OUTSIDE DIAMETER MATERIAL ~/~(~/'J'~'~ L'~ /~J ''~ NUMBER OF COMPARTMENTS /v, c', INSIDE LENGTH. INSIDE WIDTH LIQUID DEPTH C X5/~ 774/~i OR W[DIH ~ DISTANCE FROM WELL ~'-- /,Z. / E-13-7 / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) , LENGTH . DEPTH BUILDING FOUNDATION TILE DRAIN FIELD: DISTANCE FROM WELl FOUNDATION , NEAREST LOT LINE NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES. IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TIL~' IN. ABOVE TILE]__ WELL: TYPE ,J,Jt~zlC~b ~-,,],~'. DEPTH LOI LINE ~ 7/ NEAREST SEWER LINE ~7~"~ DISTANCE FROM ///_~// / WATER , BUILDING FOUNDATION. SAMPLE SEPTIC ~'/' ., £ SEEPAGE ~',~'~/~,~/~, CESSPOOL TANK, ~')~'/N , SYSTEM NEAREST OTHER SOURCES DISTANCES: A-:p~ f'zi ! / -~ ~=~:3r L~a"T ~ g DIAGRAM OF SYSTEM . ,~.~ -.. GREATEI _tNCHORAGE AREA . )ROUGH CaseNo.-- HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS LOCATION OF INSTALLATION LEGAL DESCRIPTION L~'~ ~ C ~ ~ ~/~ " APPLICATION TO INSTALL: SEPTIC TANK ~ ,SEEPAGE PIT ~ ~I~RAIN FIELD , OTHER FINANCED THROUGH ~e k-~ TO BE INSTALLED BY PERCOLATION TEST RESULTS ~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS /~, Z~)L),C"~'~/ ,PERMITTO INSTALLA / AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE DISTANCES: Health Authority 51',o ~,~ ~J TYPE ~,//')~/d'~SEEPAGE AREA .TYPE DIAGRAM OF SYSTEM that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described/////~//~~system is in accojAance~ with said code. .... ADDI If'ahlTq ql~hlATIIR