HomeMy WebLinkAboutUPPER CHINOOK ACRES LT 2B
e Municipality of Anchorage __o_____g~
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 '~ ~'
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:. SW030097 PID Number:. 01 5-- 1 63-- 1 63
Name:
BOB JETT Wastewater System: [] New · Upgrade
Address:
11301 HILL DRIVE * ANCHORAGE, AK 99507 ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 346-1999 3 El Deep Trench · Shallow Trench El Bed ElMound nOther
LEGAL DESCRIPTION ,o= ,~,g.. .1.2 a,D/s,, n. ,~, O.pth fram arig,.=6.0g.~.=(MAX) rt.
Block: Lot: Subdivision: Depth to plpe bottom from original grade: Ora~el depth bone~th pipe:
2B UPPER CHINOOK ACRES 3.86 (MAX) n. 2.14
Township: Range: Section: I~1 added above original grade: Grovel length:
- - - SEE DWG. r~ 60 n.
WELL: [] New [] Upgrade 5.0 Rt. 1I -- Rt.
Claee$flcat.;on (Pi'~YQti, .~R,C).' Total De~ Ca,ed To: Total obeerpUon ama: P;pe material:
G./ n. n. 44-1 s=.n. D 3034-/ F-810
Drgler. Dote Drilled: StoUt Woter Level: Ir4tollen D(~e inefl3lled:
~ ~ OWNER 9/19-23/2003
~"'"d: ~ 0,',., II P"'"P S" ~ ,-,. I~''~ "''¥'' ~a''' ~""d''~ TAN K
SEPARATION DISTANCES asepuo [3Holdlng ·S.T.E.P. ElOther
T~.~~o Septic Absorption Uft Holding Publlc/Prlv~te Manufacturer: C~peclt~ In
Tank Field StaUon Tank So,a, U,, ANCHORAGE TANK 1500
Uutedel: Number of comp~t~:
Well 100'+ 100'+ 100'-t -- 25'+ STEEL 2
S~.face Water lO0'+ 100'+ 100'. - - LIFT STATION
Lot Une 5'+ 10'+ 5'+ - S~z. ~n go,ar=: I Uanuf~tur~¢.
-- 1500,ANCHORAGE TANK/ORENCO SYSTEMS
'Pump an' I~vil et: f'Pump orr' lev, i .t: I~gh .~te, ok,r,..U
Foundation 5'+ 10'+ 5'+ - - 42"I 42"I 45"
Pump Make &: Model: rlec~col Inlpec~on~ performed by:
Curtain Drain '" NONEi KNOW~I ' ~20 OSI 05 HHF M.O.A.
Remarks: BENCH MARK
Location and D#criptlon:
· CHANGED TO A 1.2 GPD/SQ.FT. APPLICATION. BOTI'OM OF SIDING NEAR FRONT DOOR
EXISTING SEPTIC TANK WAS COMPLETELY ABANDONED
I AMumed
PER UPC. 100.00
ENalNEER'$ SEAL
OWNER INSTALLED A LIFT STATION THAT WAS NOT REQUIRED.
Inspections performed by: AKWWC, INC. Dates: let. 9/19/20033rd2nd 9/23/20039/19/20°3~ .~ef~ ~~] ~"~'""~'" '~'~{ '?/J ':":'~"":";")'
Development S~.~ ~epar~ment Approval '0{~.~2. L .1.i ......... ...i~,~.=~,~
r,d pprove by:
wo oo, AS B DRAW, ING
· ~ 015-163-29
\ ,, /
/
[~/---- ..... __--
I BLUEBO~D INSU~O~ ~ ~._
~l ' n .B
I /--: '~,~.. _~' % ST2 49.88 65.17 /
/...'~¢/~H~' .~' '% MH 49.50 66.61 /
I .../~Z/ ., N~ 1500 ~ON .
."' m ' ~ BBL2 17.76 31.80
~:,~ ~ ~- C01 49.04 72.94
~NO ~Nn~ ' Mil 71.82 47.99
~ONE~ ~N P~CE C02 109.11 121.16
MI2 107.87 119.38
I
._ D~WN ~:
.............................. co.summs, ~.c.~ ................................ =~ ~/
LOI 2B; UPPER CHI~OOK ~CRES SUBDIVISIO~ .~h~%~. ........... .¢~
~E OF WORK:
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
SW050097 015-163-20
-- //
= TANK
~ N~ 1500 GABON
I~ERI OF BUNG S.T.E.P. TANK I~E~ OF BUNG
AT IN~ = 94.77 ~) ~ AT O~ = 94.63
RL~R ~
TRENCH
GROUNDWATER = 85.92 90.92 (AVG)
~RE~E EL~ION OF
BOSOM OF HOLE = 80.92
~o/~7/2oo, ~ OF A
.... A.J.G.
........................ CONSULIANIS, INC. ~ ............ . .....
~ D~CRI~ON:
LOT 2B; UPPER CHINOOK ACRES SUBDIVISION
~E O~ WORK;
AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE -~%~~
MUNICIPALITY OF AIVCHORA GE
Development Sen/ices Department
On-Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 25, 2003
Expiration Date: Apr 24, 2004
Permit Number: SW030097
Legal Description: ~.i~R~CH!NO.O_.K'.A.C..R.ES LTi~2B
Design Engineer: 0041 AK Water & Wastewater Consultan'
Owner Name: Bob Jett
Owner Address: 11301 HILL DRIVE
ANCHORAGE, AK 99516-1165
Parcel ID: 015-163-29
Site Address: 011160 TRAILS END RD
Lot Size: 49466 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field r-~ septic Tank
Holding Tank E~ Privy
Private Well
r--] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
Received By:
Date: "~ ',,~ '0--~
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-163-2cj
Permit Number
Property owner(s) BOB JETT
Mailing address(I) 11301 HILL DRIVE * ANCHORAGE. AK
Day phone 346-1999
Mailing address (2)
Zip Code 99507
Legal description (Lot, Block& Sub'd.) LOT 2B: UPPER CHINOOK ACRES SUBDIVISION
Legal description (Section, Township & Range)
Lot Size qc~/.,//b ~' Acres/So.F~t.
THIS APPLICATION IS FOR:
Sewer Only D
Sewer and Well r-~
Sewer U~3grade []
THiS PROPERTY CONTAINS:
Hot Tub D
Swimming Pool O
Therapy Pool D
Number of Bedrooms
Well Only r-~
Water Storage D
Jacuzzi D
Water Softening Unit D
I certify that the above information is correct.. I fudher certify that this application is being made for a
Single Family Dwelling and is'in accordance with applicable Municipal codes.
ALASKA WATER &: WASTE'WATER CONSULTANTS~ INC.
Permit Fees: .~..z~O. --
Date of Payment: ~'~-~'D.~
Receipt Number: .~.,~ ~i~ ~7;?-~,
Waiver Fees;
Date of Payment:
Receipt Number:
ALASI A WATER & WASTEWATER
CONSULTANTS, INC.
April 21, 2003
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed Septic Upgrade for Lot 2B; Upper Chinook Acres Subdivision
To whom it may concem:
The existing 3 bedroom house is served by a private well and septic system. The existing septic
system consists of a 1250 gallon septic tank and a trench type drainfield. The drainfield is
surcharged and needs to be upgraded. A test hole was excavated west of the existing drainfield.
The drainfield will be designed around the 30 foot radius of this test hole. We are proposing that
a new 1000 gallon septic tank and a 5-wide type drainfield be installed. Comments regarding the
design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that an application rate of 1.0 gallons/day/112
should be used.
o
TRENCH DESIGN."
a. Percolation Rate: <1 minutes/inch
b. Proposed Application Rate: 1.0 gallons/day/ft2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 450 ft2
f. Total Depth: 6 feet (max.)
g. Effective Depth: 3
h. Width: 5 feet
i. Reduction Factor: 0.58
j. Minimum Length: 60 feet long
k Effective absorption area = 517 tt2
3. SURFACE WATERS: There are no surface waters xvithin 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The area for the proposed drainfields is a 10-20 percent slope .running
approximately southeast to northwest; in short, there are no slope concerns.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph! (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
Sincerel~
Jeffrc
Presi
NOTE: A site plan drawing, a design drawing, a soils logs, and a 7 page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
I I
I I
I I
WORLD TOP ACRES I I
S/O; LOT 1 I I
/
/ \ I I
/ J\ %0 I
/ [ I I WORLD TOP ACRES
EXISTING I t I I S/D; LOT 4 /
~ BEDROOM I I I
HOUSE I '~-,P~. I I
I~) I I
~ WORm TOP AC,ES / ~ ~ /
~ S/D: LOT 2 / C-~S~C ~_~D /
EXISTING S~C ~ I I I
~M~ ~ j~ ~ B~ROOM t ~
~ ~ ~ / HOUSE ~ ~ ~
~ .......... ~------~ ........ ~ ~ ....... ~----.
i --~ ........... ~--~ .................... ~--
~s~c~) )~ m /~ ~~ / .~. i~ .
~---~ ~c~. I ~, i ~.~~ ~ _~-~
~ ~ ~ ~ I/ /.~'~ I '~ROPOSED I
I '~ ~ ~1 ~ml (SEE D~IGN PAGE 2 Of 2) I ~
.... ~/ ., ~ uPP~ CHXNO0~ ACRES t ~----'
~'~-~' --.~ ~ /~ --~__ ~.~'~ xx uPPER CH~.OOK ~C.~
ALPS AVE E I ..........%- ---
. ./ I .~ ~
I ,
~ ~UCK S/D; I ~UCK S/D;
I LOT 2B I
LOT
1
I
~ I
I
.... DA~ < ~- /
4/21/2005 -~=' ~ c .,~
~ .' .g. ~r~
c.J.~. ~' [ ,/~ k- -.
~SI~ ~TER & ~STE~I~TER ,~ ~'~::'~ "~(~ ~ ~ 1~.~ '...~
~--~ CONSULTANTS, INC.--~ ,, ~ · -- -- - ~r -- .
PREPPED mR PHON~ NUMBER: PAGE NUMBm: '~"/l ~ '/ :~~.~
BOB JETT 346-1999 1 OF 2 '4~,~-,,~.,- ~ , ·
UPPER CHINOOK ACRES SUBDIVISION; LOT 2B '- ' ·
~E OF WORK: '~t: e~ "' .
SITE P~N FOR PROPOSED SEPTIC UPGRADE
X I NOTE: THE CONTRACTOR SHALL HAVE THE WEST I /
~ AND SOUTH LOT LINE FLAggED BY A REGISTERED
LAND SURVEYOR PRIOR TO CONSTRUCTION. /
\ /
/
J FIRST 10 FEET OF EXIS'nNG
I DRNNFIELD TO BE ABANDONED TO
· CREATE ADEQUATE SEPARATION / ~1,,
I n~OM PROPOSED c,~J~G~---, ,
· ~ · .p: · :
:~ , /~ ;,. ,.:_.~,~,'" ~' ;;./~.,"~,. -¢- -~ / / BE COMPLETELY FILLED
/"'~' ;-~--,-- /~/' .x~'¢ ~ ~. ~ INSTALL GRINDER
I /~'~/''~'/X./ _~'~'~ '~..\ pd~i~"~,DE CA~GE
' I~'"?J ~t~./X/ .xx' ~ '~. Ir GRAVITY FLOW CAN
'' ' ''' '^ ~. ~ ~__ INSTALL FOUNDATION
I/~!::¢/~.,~; ..,,~' ~ ~ ~ CL~OUT ,~ GR,.DER
~/~.'. '~-"'/.r~.'L1 ~.~, ~ ~ ~ PUMP IS NOT USED
I ..].',~..' 7'0" ~.'" ~ \ ~ ~ ~ PROPOSED 1000 GALLON
~EXISTING DRAINPIELD TO BE ~INSTALL FLOW
'--"PROPOSED DRAINFIELD. EXCAVATE A TRENCH
THAT IS 6 FEET DEEP MAXIMUM BY 5 FEET
WIDE BY 60 FEET LONg. ADD 3 FEET OF
CLEAN, WASHED SEWER DRNNROCK. INSTALL
TRENCH PARA[I.EL TO SLOPE CONTOURS. DATE:~~.~,~.~/_.~.~..~...~.~,~__..~!~,
4/21/200:5
DRAWN BY:
' C.J.G.
6qOI DEBARR ROAD, SUITE Z8 ° ANCHORAGE, AK qgSO/- ° PHONE (~07)537-~179 o P~X (qOT)558-3Z&6 '- 40~
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
LEGAL DESCRIPTION:
UPPER CHINOOK ACRES SUBDIVISION; LOT 2B,
DESIGN OF PROPOSED SEPTIC UPGRADE
AI~SI(A WATER & ~rASTEWATER
,==~'"'='"'"''='""'"'~ CONSULTANTS, INC.~ -,.--.,=--,,.= " ' '.
w ................ I ........
~ .., ",~e' I~i ~, ~.arr. ess:
LEGAL DESCRIPTION: UPPER CHINOOK ACRES SUBDMSION; LOT 2B, vo~?-P. ...., ~ . -~.:.~ ..
PERFORMED FOR: BOB JETT DATE: 4/14/2003 qh ~'~ "'. ' :E t7953, .'""&~'~'~
q~,e/._ ' ........... · ¢_~o~
FILL/ORGANICS I'I'ESI HO[.[ # 1 I
SOIL CLASSIFICATIONS ~
' \,~. / ~EXIST]NG
~Jow ~ ORG J -x .,~./"7"3 BEDROOM
r'"'"""~"~ ..... ~ _~' / HOUSE
~ GP IMC ........ _~_....,_.=~===.,2~___7/ .................
................. ¢ ..... / ...................
GC OL
°~ SW MH
-',"~ SP CH
. DEPTH TO
GROUNDWATER DATE ,
14.0' 4/74/2003 /, / ' xx I
SEPTIC
11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIHE (HINUTES) READING (INCHES)
12 4/15/2005 1 2:07 - 6- _
2 2:10 .3 O" 6"
13 GM/SM . 3 2:11 - 6- _
tl i JJJJIJ(HARDPAN) 4 2:15 4 o- 6-
14 5 2:15 _ 6. _
6 2:19 4 o- 6-
15 7 2:22 - 6. _
16 8 2:27 5 o- 6"
9 2:28 - 6. _
17 10 2:33 5 o- 6-
· 11 2:33 - 6. _
12 2:38 5 o- ;i 6-
19L_1 , . PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6, (INCHES)
'~,~J':;,~J :,
TEST RUN BETWEEN 4.0 FT. AND 5.0 FT. ,
20 A FOUR HOUR PRESOAK WAS PERFORHED: [] YES [] NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: MATt FISHER
COMHENTS:
PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 4-
DEPTH TO
GROUNDWATER DATE
14.0' 4/14/2003
11.0' 4/21/2003
GRE ER ANCHORAGE AREA BOE,,bGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOJg~L S~'STEM
SEPTIC TANK:
FRoMDISTANCEwELL /'¢g'~ ~ ~ /
z~, ~,/ NUMBER OF
MANUFACTURER MATERIAL COMPARTMENTS
INSIDE WIDTH
INSIDE LENGTH
LIQUID DEPTH
LIQUID C A PAC I TY/x'~'~ '~:~) G A L LO N S.
TILE DRAIN FIELD:
DISTANCE FROM WELL /~-~- FOUNDATION ~"~O I
NUMBER OF LINES / DISTANCE BETWEEN LINES . .
ABSORPTION AREA /~:>(~ SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE ~4~"'1 DEPTH OF FILTER
MATERIAL BENEATH TILE
NEAREST LOT LINE /O ''~/'''''oFTOTALLINEsLENGTH /~ (~,e,) O I
· ~'//'~ TREN(~H WlDTP~'IN. TOTAL EFFECTIVE
IN. ABOVE TILE J'J IN.
WELL:
TYPE
BUILDING ~.~.,
FOUNDATION
cEssPoo,
APPROVED
CONSTRUCTION
NEAREST ~ NEAREST SEPTIC
LOT LINE /~'~ ~j' SEWER LINE /g)£) ~' TANK
OTHER SOURCES
DISAPPROVED REMARKS
DEPTH
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY: ~ ~/~
SEWER LINE DEPTH: ~ !
REMARKS:
DIAGRAM OF SYSTEM
Form LQ-032
M-~r'V DRILLING, Inc.
Box 4-1224 · 1310C International Airport h~oad
(907) 274-461]
ANCHORAGE, ALASKA 99509
Well Owner
Location
DRILLING LOG
Alaska Enterprises
(address of: Township, Range, Section, if known; or distance
Use of Well Dom
main road
Size of casing_ 6" Depth of Hole_
Static water ]eve] 10 ft.
Screen ( ); Perforated (
40 feet Cased to 40.5 feet
(below) land surface. Finish of well (check one)
).
open end ( x );
Describe screen or perforation None
Well pumping test at 10 gallons per
of drawdown from static level.
Date of completion 2.3 Sept. 1075
(minute) for~ hours with
100
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 TO 10 Gravel, med. & silty
10 TO__ 20
20 TO_ 40
TO_
.TO_
TO_
_TO__
TO_
.TO_
TO
TO
TO_
_TO
ft.
Water Qravel
Silty gravel~ mad.
1 -- CUSTOMER
ANCHORAGE Area bOF: H
DEPARTMENT OF ENVIRONMENTAL QUALITY
NAME OF APPLICANT ~ ' 8I ~ ~/~ ~L~t ~ MAILING ADD~S~ ~': ~ ~ PHONE
Type AND S[ZE Of FACILITY TO BE SERVED ~ ~ ~~ f~I~ / ~)~ {JE /~A~ [ U ~
FINAL INSPECTION: 24 HOUR NOTICE F~EQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL (~UALITY AUTHORITY Will BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS ~ ~ DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PiT , DRAIN FIELD
SEPTIC TANK TO SEEPAGE P;T WALL
SePTiC TANK ., SeEPAgE PIT . , DRAIN ~]ELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /~ ' SEEPAGE P'T
DRAIN fieLD ~~ ~ ALSO CONSIDER
AREA
WELLS.
WATER MAIN TO SEPTIC TANK SEEPAge PIT
DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST ~RON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSS]NG gAP OF
EXCAVAT]ON 5 FEet INTO UNDISTURBED SO~L.
4 INCH DIAMETER CAST IRON ~]PHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
DATE ~ APPLICANT'S SIGNATU~
GREATER ANCtlOI<hGE AREA DOROU(,,,
Department of EnvironmenLa] Quality
3330 "c" Street
Anchorage, Alaska 99503
SOILS LOG PEROI,ATION TI']ST
Performed for ~,~',~, &l*~'~S Date Perform~_d
Legal Descrip~o~]]-Z~]~ ~~r _~~ ~' ~
This form reports: Soils log ~ __ Percolation test
Depth
~eet ,?'m ~,~tL. _ ~, !! ~ ...........
6
]0 -~
ll-~
12-~
13- ~
Was ground water encountered?
__~___ If yes, at what depth?
Reading Date Gross Time Net Time Depth to Water ~t Drop
Percolation rate minute.
-Proposed 'installa~-~-~h?~-.qe Pit Drain Field
Deptl~ of Inlet Depth t6'~-t~-f-i)it or trencit ~_
EQ-040 (6/74)
logs fo~ ~ew~l ~ells ~rili~d ~f~er J~ lg ~or ~tch no
Susau ~. Os.alt
MUNICIPALITY OF ANCHORAGE
MUNICIPALI'~;)' OF ANCHORAGE
DEPT. OF t'TALTH &
DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECT~JiRONi~,ENTAL ~ ~ '"£CTION
825 L Street - Anchorage, Alaska 99501
~ ,7t7CI
ENVIRONMENTAL ENGINEERING DIVISION APR ~
Telephone 264-4720
DIRECTIONS: Complete all pa~s on page 1. Incomplete reques~ will n~ be proce~ed. Please allow ten {10) days for processing.
PHONE
1. PROPERTY OWNER
JAMES B. GROTTS 34471256
MAILING ADDRESS
Post Office Box 10-362, Anchorage, Alaska 99511
PROPERTY RESIDENT (If different from above) PHONE
Hill Drive, Anchorage, Alaska
'2, BUYER PHONE
Robert C. Jett 274-3104
MAI LING A DDR ESS
Post Office Box 4-2577, Anchorage, Alaska 99509
3. LENDING INSTITUTION
First National Bank of Anchorage
IPHONE
(Mtge. Loans Dept. - Cindy) 276-6300
MAILING ADDRESS
Post Office Box 720, Anchorage, AK 99510
4, REALTOR/AGENT
Williwaw Realty
PHONE
277-6793
MAI LING A DDR ESS '
Post Office Box 4-qq, Anchorage, Alaska 99509
5. LEGAL D CRIPTION
Lot ~, Upper Chinook Subdivision
STREET LOCATION
Hill Drive at Chalet Drive and Alps off Hillside Drive
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One ~ Four [] Other__
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
~ INDIVI DUAL* * ATTACH WELL LOG. A well log is requ'[red for ali weLls drilled
[] COMMUNITY since June 1975, For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~]X INDIVIDUAL/ON-SITE**
[]] PUBLIC UTILITY
**If individual/on-site, give installation date 12/75
If sy .................... 9ars-c,_ en-a~tost-i~
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDFNCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR I~ SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED '
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC
UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: /~.~---7~ If Tank is homemade SOILS RATING
give
dimensions:
TYPE OF TANK MANUFACTURER ~.~
TOTAL ABSORPTION ~-EA MATERIAL
4. DISTANCESwELL TO: Septic/Holding//~) 0 Tank Absorption..~,,/~Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~'APP ROV ED FOR ['~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
DATE BY (Title)
72-010 (Rev. 3/78)