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MUNICIPALITY OF ANCHORAGE
�;'' • f r--- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
r ENVIRONMENTAL ENGINEERING DIVISION
825 L Street-Anchorage,Alaska 99501 Telephone 264-4720
\— / ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME$/��GG - " ( U..5' -z- � 233/ ❑UPGRADE
MAILING ADDR
v< l7 C44tf-111
LEGAL DESCRIPTI
n�iz 111 (s �'' ��
LOCATION /°` / NO.OF BEDRieS
�"� ,g/ rC.4 L�LtO ..,
W II (.� Absor tion ar``a Dwellin ( -1 P RMIT� NAg
DISTANCE TO: f T L}, -�AL���i�fg/ )
ti
r
~a Q Manufacturer ^r eec M e e / No.of compartments Z
W L. L / G
H Liq. apa gallons Inside length Width Liquid depth
/Z� IF HOMEMADE:
D Y DISTANCE TO: Well ` , Dwelling PERMIT NO.
.�L7Z /V
oz< Manufacturer Material Liquid capacity in gallons
I-
O Well Foundation Nearest lot line PERMIT NO.
-r= DISTANCE TO:
W
w LL Z No.of lines Length/ea h Ike Total length of lines Trench width Distance between lines
F-Z W �i
inches
▪F Top of tile to finish grade Material beneath tile Total effective absorption area
cc
o inches
Length 6 ( , Width 22 l 4, Depth ( PEFZN117NceLh
QType of crib Crib diameter Crib depth Tot f �ive absarption area —J
w M� /6 L"
to '`+ DISTANCE TO: Well 14 8uildif founflatgon Nearest lot line go f 4
Class Depth Driller I Distance to lot line PERMIT NO.
65 Ari SZ'/NL
3 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS 1,oP -
VC 54 " ..
SOIL TEST RATING �� GI{
INSTALLER �{ �.... rt ( .
22.
REMARKS J _ 0r. i—i c,
v4-141 1-44.-tp
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APP'OV: DATE LEGAL
1/7
..� /2Pee- e
7 -I 3 (Rev.3/78)
MUNICIPALITY OF ANCHORAGE
Department Health and Environmenta_ rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * HANDWRITTEN PERMIT * * *
,1// W L ItIR ON-SITE SEWER PERMIT / p
Applicant : �LCLICIVS @0kj-0- Mailing Address : f- O
f
Location: N Q' O V 1p.5Phone Number : C9 Ar-r- .,g2.; (
Legal Description: L 4J iq 4 3\GL Ib Lot Size: 4 d
Type of Soil Absorption System Is :
Trench: Drainfield: Seepage Bed : k"---Holding Tank:
Maximum Number of Bedrooms : 3— Soil Rating (sq.ft/br)
The Required Size of the Soil Absorption System Is :
DEPTH ' LENGTH 020 X6O . GRAVEL DEPTH 0/6-- WIDTH
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(HOLDING) TANK SIZE = l� ) GALLONS * *
'ermit applicant has the responsibility to inform this department during the
.nstallation inspections of any wells adjacent to this property and the number
residences that the well will serve.
* # * TWO(2) INSPECTIONS ARE REQUIRED * * *
3ackfilling of any system without final inspection and approval by this department
rill be subject to prosecution.
linimum distance between a well and any on-site sewage disposal system is 100 feet
:or a private well or 150 to 200 feet from a public well depending upon the type
>f public well. Minimum distance from a private well to a private sewer line
_s 25 feet and to a community sewer line is 75 feet. Well logs are required
:nd must be returned to this department within 30 days of the well completion.
)ther requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1
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 re• ire enlargement if
the residence is remodeled to include more that b -dro ms.
^ � �
Issued b
Signed: ('� y : 1
Applica''_ /
Date : -
SWP/024 (1/81)
0 O SOI LS LOG
MUNICIPALITY OF ANCHORAGE
t t DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION
-.)
` , TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
�-' SOILS LOG - PERCOLATION TEST
'7-.7 J
PERFORMED FOR: ./L i ^�� C /JS DATE PERFORMED: �OC ( ,f---I
LEGAL DESCRIPTION: L 2 D / Ir\ )) e (3 ( o
DEPTH 2 // 1 /0 /' SLOPE SITE PLAN
(FE` ,
1
I ': � /-lici ,74 s/4 7T I _ / ✓� //o
U
2I4
6.1) /2 (0i/ pro -
1/4 - - ..e° y -i/øri'iLllow �u .
5 - `vim TES 41,
6 - -"---'
7 - ..----t_._ fxrS 121/C
y
s p'c Tr 7 `7 /C . --.�-
l�7 c� c
9 -
10 -
1 1 - WAS GROUND WATER e ( L 1
J
ENCOUNTERED?
O
12 - E /7--41 —T-
IE YES,AT WHAT '
DEPTH?
-
13 -
14 -1Reading Date Gross Net Depth to Net
Time Time Water Drop
15 -
4 K s; itO`ler/ t. ;; ,._•-,., - r<' .
18 - 4.3 No. 1.4.5.;°-E •'°-E .: '6Jii
4.19 - %e-Psipej• rrt^;ti`;!
20 - _//4
PERCOLATION RATE _Iminutes/inch)
/� r /� TEST RUN BETWEEN `FT
—A/ND FT
COMMENTS r ' /Af (� a ,,,- 2 l -eqe.
� fccu ar / / /� / 2 (-
PERFORMED BY: • !J `-1•�6�Ne/F�/ /V 4.---- CERTIFIED BY: '( DATE tit-CI C-7 c---7
72-008 (6/79)
t - _
t.
a }AS Er SOILS LOG
MUNICIPALITY OF ANCHORAGE
• ' \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
_','. 1 ) Pouch 6-650, Anchorage,Alaska 99602 276-2221
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: �/4,4...././EL -�liB.0/l//.S/1Zi1/ DATE PERFORMED: ,.....5-/f/B/
LEGAL DESCRIPTION: GOT 7 SEC_ 7-/-_--Tif./ .Q/ AI/ A "-
SLOPE
LOPE r
- —SITE
PLAN
DEPTH TOP S/-,/L
-
•
� �/ , �/Fy -57g r i TLI i I
1Z. ( 1 1
ci I I I - •
0,c. _Ste-rY 2 - / ; s,1,� )/ I 1 1 ! I �
6/0,14/_-z-
3 , i ---+ -1— .. . . __ _i
O. (7./e./< -/ -:- / !_i_i. _1 . . _ ' -1_-
5 - `•i', ,-'//.elle/tG-74- C N
tine1 ,lT -
8 - • . /3o'
9 - 0i --1 - sc..,LC. i/=zoo/
o ;
10 - (-9 G/zdvGt!/.rTE, - _ _
11 - WAS GROUND WATER S j ,
O ENCOUNTERED? , Y ---5- L C �i
O
12Q'sj
IF YES, AT WHAT E 1
13 .
DEPTH? / ,' i I I—i F
14 - Reading Date Gross Net Depth to Net
Time Time Water Drop
15 - OF .1 4. III -• // s//¢ s ¢c( ,'.
16 - _c /• •••' f 9 ' .S:_a
0*49TH `t..
-4 :_,t a1 6-s" ,5-:,s-4* A.i/A/ 3.4,/
r••..•.„•113 z.er# ,5--',3-4
.{.4` S6" , .- e:;. 4rM/ze Z•B//
18 - # c__ . Earl R. Barnard �� 2 a' - g ..- "z-
, /�
's % 7s ' �i s.Z% 6 "oma 4/Ili,/ z-- "
19 - fat-9c••••. .••'••F�� Z-B" h •-e-,‘ "'
20 -
„,4.0
I V:ROF �L+ ,..<72/1 6- -/z 4{/////. 2.0'''
PERCOLATION RATE /- 6 7 (minutes/inch)
TEST RUN BETWEEN FT AND 7 FT
COMMENTS 8.5" S'..4-: AtSe,,, , ''/s, A?E'A AgG'iQ Z3 ',' 'e9.::-.971g .Qec en.f e--,- /t/O�d-
A9AX/M+/Ai 7-.76--,7,47/1 OE�ry to '1 �'L/'- 47?/o/l/,e /j9E- 'EO
PERFORMED BY: /!A/ce' �.4TFS CERTIFIED BY: L ,'R,� /1 1Y,�`V4aATE: ' r / 1q8/
72-006(7/76)
1
0 22- 41 SO SHEETS ,
22-142 100 SHEETS
AMPAO 22-144 200 SHEETS
C
M2/,1 (1/0/.Z .733" -- 5 50 .7
,, o ; OZ
°-
fa
/ y f v
�� \\\ \1 1 \ / N\/r, \ 1
JarrOSb2/Z f`� p o n e Q C P ,Q 00 00 Q C1 0 0 ° on p Q CoA
�/ a ,o0CCI O o P ' ° o P O 0C3 c� 0 0 ' n CJ p cn0 C,
.. \//, v ^ a - O 00 .9 9 '� e o �� Q, oc 1,7
GD
rvg3,, s//I 7111/ h.() 2"/' v.�1 b2'Cdda.a 7Ait fr
aa'bog r eo/1 a-7,/S(v/ Cv.g.0?2//-
/� _
(//c7: 4.4.1'e 07 pr/vs
(-7 7/ ' pt//fry
0 22-141 50 SHEETS
// l 22-142 100 SHEETS
""' 22-144 200 SHEETS
� -7f/ ,_ ' n1 L04/
2.04/cT f d:"
A4 3/A N C/ 70
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dhens 4- 541
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. • ()JrrctfirbBri1LingRCug
by
DOCCo.dba
SULLIVAN WATER WELLS
P.O.BOX 272,CHUGIAK,ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND DEPTH OF WELL __ __
ADDRESS _ STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTION_ DRAW DOWN FT.
DATE-Started Ended GALS. PER HR
PERMIT NUMBER KIND OF CASING __
KIND OF FORMATION:
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. From Ft. to _Ft
From Ft. to Ft. From -___ Ft. to Ft
MUNICIPALITY OF ANCHORAGE
From Ft. to Ft. From Ft. to DEP1FtOF HEALTH &
ENVIRONMENTAL PROTECTION
From Ft. to Ft. From Ft. to Ft.
From Ft. to Ft. From Ft.to 1144Y 191986
From Ft. to Ft. From Ft. to____R EC E I V E D
From Ft. to Ft. From Ft. to Ft.
From Ft. to Ft. From t. to Ft.
From Ft. to Ft. Fri i 4 Ft.to Ft.
From Ft. to Ft. FroJn Ft. to Ft.
From Ft. to Ft. V y �D 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
MISCL. INFORMATION:
DRILLER'S NAME
0 0 ,
• MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720 c
Application Date 5///Q
1. GENERAL INFORMATION
(a) LegDescription (include lot, block, subdivision, section, township, range)
ece- Z /O VL : .) 614--J
Location (address or direction` )
/ y 7 - 4
(b) Applicant Name I A J.,___41.4,01.4.24,_Telephone: Home If-34/SS- Business —177-3Syer
Applicant Addres/ (To. 0/y 70 'S'5"3 c-;� a,.2 /p9s- 7
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer 0 ; Other 0 (explain);
(d) Lending Institution "A-7W1� •u�n...Telephone /�
Address czo-q,c, — /� 00/ P` z'`'e,,'-,"-J
(e) Real Estate Company and Agent D
Address
Telephone
(f) Mail the HAA to the following address:
S&S ENGINEERING
SR B 196X
EAGLE RIVER,AK 99577
2. TYPE OF RESIDENCE
Single-Family kr Multi-Family 0 Other
Number of Bedrooms .g
3. WATER SUPPLY
Individual Well 0' Community 0 Public 0
Note:If community well system,must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public 0 Community 0 Holding Tank 0
Note:If community well system,must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION • '
As certified by my seal affixed hereto and as of the validation date shown below,I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes,ordinances,and regulations in effect on
the date of this inspection.
S&I ENGINEERING
Name of Firm SR B 196X Telephone
Address EAGIE RIVER,AK 995/7
Date MAY I 7 1986
„� Of A t,,�s%i
Ise A. Shwlec ; cL'ii
i`�
,•.• Flo. 144r-k :`,A
V` •• * '1/4,&M
6. DHEP APPROVAL •
Approved for f1''"e �� V �'`'�e— bedrooms by � A .23P-1-1"--•' Date s—ZQ —vo
„-------
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued.The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
•
MUNICIPALITY OF ANCHORAGE(MOA)
MUNICIPALITY OF AIiAARi AUTHORITY APPROVAL (HAA)
DEPT. OF HEAL
ENVIRONMENTAL PROTECTcNECKLIST- FEBRRUARY 1984
264- 0
Mpg( 191986 Legal Description: L Z �.4�i ,///4Ls s`
A. WELL DATA RECEIVED
s, r ^%
Well Classification E If A, B, C, D.EE.C. Approved (YIN)
Well Log Present (93.0---- Date Completed /--.5/ Yield ,S-6/ 14
Total Depth /0 1 7« Cased to /C) ' / Depth of Grouting
Static Water Level ' 7/0 ' Pump Set At /‹
Casing Height Above Ground Z n f Sanitary Seal on CasingNPN)
Electrical Wiring in Conduit apd)' Depression Around Wellhead (af '
Separation Distances from Well: J.s�
CI
To Septic/Holding Tank on Lot f� / ; On Adjoining Lots S
To Nearest Edge of Absorption Field on Lo Y /Z0' ; On Adjoining Lots �0
To Nearest Public Sewer Line /-(/� To Nearest Public Sewer r
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ¢I S ef-t 4.tN E. -Lug! b ; Date -•-•"/,-.9C9
Water Sample Test Results ,S-Ac---ri4. A;k--- - r-.,'C. Y
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed /Z-/Z.- 8/ Size I ZSb No. of Compartments Z
Standpipes Air-tight Caps6'N Foundation Cleanout (N6{
Depression over Tank.( // Date Last Pumped
5--6 —86
Pumping/Maintenance Contract on File (Y/N) /s/4_ ; for —
Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ( Z.--c• To Building Foundation
To Property Line 20 t } To Disposal Field
A-
To Water-Ahairn`Service Line �� To Stream, Pond, Lake, or Major Drainage
Course 1P
Comments
Page 1 of 2
72-026(11184)
C. ABSORPTION FIELD DATA •
Soils Rating in Absorption Strata /Z S °Mt Type of System Design
• Date Installed /Z-/Z - S / Length of Field Zid
j
Width of Field Z-7 Depth of Field I Ti
iI
/- Gravel Bed Thickness
Square Feet of Absorption Area b/ t P Standpipes Present(.]
Depression over Field (Y Date of Last Adequacy Test S-- /Z�' G
Results of Last Adequacy Test Sf.-T/S ,,4-C 7--0.Gr
Separation Distance from Absorption Field:
Z
To Water-Supply Well /7o To Property Line °
To Building Foundation Z.-/ r� To Existing or Abandoned System on
�� I -
Lot ; On Adjoining Lots
To Water tvillif,/Service Line 3`� To Cutbank (if pr sent)
To Stream/Pond/Lake/or Major Drainage Course
��Aa--
To Driveway, Parking Area, or Vehicle Storage Area 30 , .-
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at 1 (� Vent (Y/N)
Tested for 1'� Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked,verified,or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S&S ENGINEERING Date MAY 17 1986
Companyslt B 196X MOA No.0-5-'m.? ...7s 0 v4��`'�t�
EAGLE RIVER AI5 99577 ••••,* 4
it
Receipt No. -3c�S -1- `'`t\ 'C, ;�� . k •.....i.S
• c2 '. •
Date of Payment J I a\- 0 * 49D-.! ',/ * F,
Amount: $ (�S ��� � �, � •.•. ?
o►al�lbsbwt A. 51•ier S14 Q
IIS ��"• No. 1457-V •o• ,�,
Page 2 of 2 ,at`fz,•- \,..' A.
72-026(11/84)
Municipality P.O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
of k (907) 264-4111
Anchorage IFF TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH&HUMAN SERVICES
May 30, 1986
Robert A. Shafer, P.E.
S & S Engineering
SRB 196-X
Eagle River, Alaska 99577
Subject: Lot 2 Daniel Subdivision
Waiver Request, WR86-060
Dear Mr. Shafer:
Your request for a waiver of the required 100 foot separation between
the subject lot and the septic tank on the adjacent property (Lot 1)
has been granted. The required distance has been waived to 95 feet.
This waiver is valid for the existing three bedroom single family dwelling
only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
-ettytit
p
r.
' ROBERT A.SHAFER
CIVIL ENGINEER
A / 694-2979
May 17, 19 k 6 MUNICIPALITY OF
ANCHORAGE
DEPT. OF HEALTH &
fyC
ENVIRONMENTAL PROTECTIOP(
E t
RIVER.AL
HEALTH AUTHORITY MAY 1 1986
APPROVALS
MunLc-Lpa Lty o6 Anchorage RECEIVED
Department of Health and Human Services
SEWER&WATER 825 L Street
MAIN EXTENSIONS Anchokage, A-easfza 99501
ATTENTION: Steve Morn-L6
SEWER&WATER REFERENCE: Lot 2; Dan.LaIs Subdivision
INSPECTION
Request you appkove the attached Health Authority AppLLeation and issue
a waiver oti 95 beet hon.Lzontae separation distance between the wet
and the septic tank onp•the adjacent propvcty. The septic tanfz t a.- seated
ENGINEERING STUDIES w,i.th water ti. ht cou LLvi s.,,pThe to a na h in the area A envtaete
AND REPORTS 6.lat. The static wa-ten .levee in the weft is approx-cmateey 40 Beet below
the sunbace. The strata between the water levee and the suk6ace cons.is.its
mostly ob clay and gravel. with the water being pnov.ided nom saturated
sand stone at a depth os approx-c.mateey 162 lieet much o.6 the strata between
WELL INSPECTION
&FLOW TEST the static wa vc .levee and the watvc source .is blue clay, silt and graved.
It -.6 aur opinion that the hon.izontal sepanat-Lon distance between the
wet on this pnopenty and the sept-Le tank on the adjacent property .is
SITE PLANS adequate and the hon.-zon a..e separation distances pnescrd.bed by 1SAAC72.021
are not requ.ined in this case.
16 we ' • be o6 6urther svcv.i.ce, please contact us.
ROAD DESIGN S-L vneey
1d.
SOIL TEST i' � A, SHAFER, P.E.
1rRO
R' Vss
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN SRB 196X EAGLE RIVER,ALASKA 99577
0
ri5.• nyri4, .
• N�� ROBERT A.SHAFER
� '� �� CIVIL ENGINEER
/ A694-2979
May 22, 1986
fq
CEf RI V ER.Al.PS�,P
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY DEPT. OF HEALTH &
APPROVALS ENVIRONMENTAL PROTECTION
Mun.LcLpatity o6 Anchoaage MAY 2 31986
Depaatment o6 Health and Human Seay.Lces
SEWER&WATER 825 L Staeet
MAIN EXTENSIONS Anchoaage, Atasfza 99501 RECEIVED
ATTENTION: Steve MoxvL6 ' . ' -
SEWER&WATER REFERENCE: Lot 2; Dan,Lats Subdivision
INSPECTION
This Le-tten, pnovLdes additional Ln6onma i.on to oak Le--tek dated May
17, 1986 in accoadance with oua telephone conveasat.ion dated May 22,
1986. In accordance with .Ln6oamation avaitabte, it appeaas that a peached
ENGINEERING STUDIES watea table could be aestin on Q cls aavet to ea at a aox.cmatet
AND REPORTS 9 y, g y pp y
8 beet and may have a seasonae high watea Levet at appaoximatety 5 beet
below the sua6ace o6 the ground. This wa-ten, table is assumed to Stow
in the same d..aection as the scope o6 the gaound on -the sua6ace. Though
-the area -i.s aeeatcivety Etat these .is a gen ee scope in the oposAte dAaect-Lon
WELL INSPECTION
&FLOW TEST 6aom the wep D.
16 the above assumption is coaaect and the watea table should become
pottuted 6aom a 6a,ieuae in -the septic tank on the adjoining paopeaty
SITE PLANS the watea should kun away 6aom the we—U casing, theae6oae e2Lm.Lnat.Lng
any poss.LbAPity o6 contamination aaound the well casing. It should
also be noted that the blue clay indicated on the wat tog between the
depth o6 65 and 142 beet wAIL paov-Lde an adequate seat and is at .feast
equal to a non-sha.Lnfz concrete gaout-i.ng.
ROAD DESIGN
16 we may be o6 6uathea seav-i.ce, please contact us.
S.Lnc ety,
SOIL TEST
_VA
/'08 . HAFER, P.E.
PERCOLATION
I
'P .-S/46
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN SRB 196X EAGLE RIVER,ALASKA 99577
i ime� Time .e ( l
Date Date Date
--Z6e_tez, 4eA7 s.`"2 2--
Inspector Inspector Inspector
r, a �
Comments Conditional Approval �f
14-0-0 Not
CeNLO...tj
rextkoet,
64)9-
3
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
1 Property Owner Phone
G.S.K. CONSTUUSTRUCTION
Mailing Address 6105 A-3, Palmer, Ak 99645 745-2553
Buyer Jerry & Frances Judd
Address P. 0. Box 39, Chugiak, AK
Lending Institution Phone
1st National Bank of Anchorage
Address 4th & G Branch
Realty Co. &Agent Phone
W Totem Realty, Inc./William J. Schlegel
Address 724 E. 15th Avenue, Anchorage, AK 99501 • 272-0571
Legal Description
Lot 7, Section 8, T15N, R1W, S.M. 5 •
Street Location Birchwood Loop Road G.. 2 eP/J 4/
Type of Residence
k; Single Family
❑ Multiple Family No. of Bedrooms 3
❑ Other
Water Supply
j1 Individual ATTACH WELL LOG. A well log is required for all wells drilled since June
❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if
❑ Public Utility available.)
Sewage Disposal
tl Individual Year Individual Installed: 1981
❑ Public Utility When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.