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Home My WebLink AboutCRESTWOOD LT 14Crestwood Lot 14 #015-361-06 e Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825"L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 vcvc, v.cLanehorage.ak.us (907) 34-3-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW000411 PiD Number: 015-361-06 Wastewater System: [] New [] Upgrade E) ehhi¢_ McGrath Address: 95.~0 Brip_n .~fr~_c_t lnchnran¢_ AK 9.cJ~t6 ABSORPTION FIELD Phone: Number of Bedrooms; 800--q62-1399 3 5~ Deep Trench [] Shallow Trench ~ Bed ~D Mound [] Other: LEGAL DESCRIPTION .0.6 GPD,a' t0 F~. 14 Crestwood :2 Ft. 8 2-3 F~, 52 Well: [] New [] Upgrade eravMwidth: 3 FI, Numberofl[nes:l [U[sfancebeh'¢eeniines:0 Ft Ft. Ft.833 ~t' i F810/a034PVC ~, A+ Home Svc 10/6/2000 SEPARATION DISTANCES ~ septic ~ Holding U S.T.E.P. ~ Other: T% To Septic Absorption Lift Holding [Public/Prlvat( Manu~urer: Capac{~: Tank F e d Station Tank~ Sewer Line A~chorage Ta~k 1000 w~, 128 155 120 Steel 2 ~w~,~, 100+ 100+ ~ / LIFT STATION 26 *~,,,p o,"~o~M ~t: "Pump e~ leve~ att ~ High water alarm at: 6.7 Foundation Cumin Drain 1 O0+ 100+ Pump Make & Model Ele~ic~l inspections performed by; BENCH MARK 2" Rigid insulation over tank Back Door Threshold 100.0 Engineer's Stamp Inspections podormod by: Pa.Ro.e ERg. Svc Dates: 1"I 0/6/2000 g~7. 2"a~ 0/06/2000 ~~.....~ Depa~ment of Health and Human Semices approval ~<¢~ Reviewed and approved by: / ~. ff~ Date: / ¢ -1 6- DO i ~E~M~r NO, ~O00~l~ AS-3UILi/.~ P.i,D. N~, WASTEWATER ABSDRPTIDN SYSTEM LOT 14 CRE~TWDDD / EXIST'fi DRAIN .... ,~ . :IELD, IN FAILURE,~ .::(~? ~; gVERTER VAL~E TI] RE~AIN ~ REUSE, ~ ~ E3 ~ THRESHHBLD~, i ' [ %::*:: ...... ! k~ '[ ....... I ~ , y. ~ ............ j SYSTE~( -3 ==~C, HBUSE ' ' , : ~ ~ ' ~ EXIST'G ~ U~ ~/%~ ~c ~=,7 mz PERC RATE 16 MIN/IN _~ ~X ........ ~9~ c~ SOIL RATING, aS0 SF/BR ~ '-" " ~ c~ 7~,~ e~,~ 750 ~F RQD ~ $ ~ % ~ DEEP TRENCH, 8,0' EFF, ~ ~[ 49~ ~ ~ TOTAL DEPTH = 11,5' ~ ~'~" ~ 58' LBN[ TOTAL A~EA=838 ~F ................. ? ,.~ PREPARE]) FDR, PANNBNE ENG, SVC,LLC ~'~'~'%~o. CE 8l~9 .¢~ Ms, Debble McGr:th P, B, ~DX 108954 ~.,.~ ,....~ Executor. ANCHORAGE, ALASKA 99510 .~, ....... ~ .... ..~,. ~ 9550 Brlen S~ree~ ~ ......... _,~ ~ Anchor.ge, AK 995t6 a7B-8~18 Phone & 88~~.~~B~. 1-800-968-1399 ~CALE'IATE' ,10-7-007=50' ~ AS-BUILT PERMIT ND~ SW000411 AS-]3UILT DETAILS WASTEWATER A]3SORPTION SYSTEM LOT 14 CREST6/OOD S.D P,I,D, ND~ 015-361-08 ~6 8,0 !DON¥390 C&Work\DRAWING\14crestwood,DWd PREPARED FDR~ Ms, Debble McGr~h Executor, 9550 Brlen Anchorage, AK 99516 1-800-968-1399 PANNDNE ENG. SVC., LLC P, O. BBX 108954 ANCHORAGE, ALASKA 99510 878-8818 PHONE & FAX OATD 10-7-00 ~NOT TO SCALE AS-BUILT MUNICIPALITY OF ANCHORA GE Depatlment of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196660, Anchorage, AK 995'19-6650 ¢07) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 02, 2000 Expiration Date: Oct 02, 2001 Permit Number: SW000411 Legal Description: CRESTWOOD LT 14 Design Engineer: 0062 Pannone Engineering Services Owner Name: DEBBIE McGRATH Owner Address: 9550 BRIEN STREET ANCHORAGE , AK 99516-6448 Parcel ID: 015-361-06 Site Address: 009550 BRIEN ST Lot Size: 45000 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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 ). ( Net 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: Issued By: Pannone E~¢b~eering Services, LLC Consulting Engineers (907) 227-3522 P.O. Box102954 Anchorage, Alaska, 99510 (907)272-8218Fax September 24, 2000 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 14, Crestwood S/D Septic Upgrade Permit Gentlemen: My firm was contacted to conduct a Health Authority Investigate at the above referenced property. The septic system was found to be in failure, having 54 inches of liquid in a 48 inch deep system. A single test hole was excavated on September 16, 2000 for a potential replacement system. The soil report and percolation test results are attached. Ground water was no encountered in this test hole. No bedrock was encountered in the test hole. The lot is approximately 1.03 acres in size. Lot 14 slopes to the west at a rate of approximately i to 2 percent. The proposed installation will be located in the north- central portion of the lot on a fiat area. The proposed location will be greater than 100 feet away from the existing well serving this property and 25 feet from the water sea-vice lines. The surrounding systems are located greater than 100 feet from the proposed installation. The lots surrounding this lot are developed, but do not conflict with the proposed installation. The proposed installation will not impact the future development of the surrounding or existing lots. See attached design. The new system will maintain over six feet vertical separation to the bedrock and over four feet vertically to the ground water. A diverter valve will be installed between the old and new system. Please contact me at 272-82 18 or 227-3522 if you have any questions. ~.....~ ~.,~ ............. Steven R. Pannone, P.E. Attachments: .OESiSN WASTE~/ATER ABSORPTION SYSTEM LOT 14 CRESTWOOD PJ,D, NO, 015-361-06 ~ ..................... ~ELL :IEL~, IN FAILURE~ x") ~, ~IVERTER VAL~E N ~,.. ~,M,=iO0 REPLACEMENT ~ ........ / ~E1- ~EXIST'G SYSTE~I 0 ~ HOUSE EXIST G '1,000~ EXIST'G \./FI I~ PREPARED FOR, Mm Debble MoOriSh Execu~op, 9550 Brlen S~ree~ Ancboraoe, AK gB516 1-800-968-1399 BEDRDDN HOUSE PERC RATE 16 MIN/IN SOIL RATING~ ~50 SF/BR 750 SF RQD DEEP TRENCH, 8,0' EFF, TOTAL DEPTH = 11,5' 50' LONE TOTAL AREA=80O SF PANNONE ENG, SVC,LLC P, O, BOX 108954 ANCHORAGE, ALASKA 99510 872-8818 Phone & Fax ]ATD 9-15-0o I DESIGN ~CALD 1'=50' PERMIT ND~ S~/000134 /JLGLL]I~ ]JE_ I ~31L~ ~.~,S';~'w'ATE~ A~SD~PTiBN SYSTEM LOT 14 CRESTWDDD S,D p..T.~.. ,ND~ 015-361-06 Z C~\Work\DRA~/INO\13cres~wood,))WG I~ONVDq3 NDI/~ENOOJ PREPARED FOR: Executor, Anchopoge, AK 99516 1-800-968-1399 PANNDNE ENG, gVC,, LLC P, O, 3OX 108954 ANCHORAGE, ALAgKA 99510 878-8818 PHONE & FAX ))ATE, 9-15-00 ~'F T-B -~;[~,~LE DESZGN ~OII~ LOG - PERCOLATION TEWI" PANNONE ENGINEERING SERVICES, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PERFORMED FOR: LEOAL DESCRIPTION: OR GM-GP B0H Ms, Debbie McGrath Lot 14 Crestwood S/D Organic- Topsofl Brown Silty Sands and Graveh~ to Poorly Graded Silty Sand aud Gravels DATE PERFORMED: 9-16-00 TEST HOLE )),M,=lOO WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTH? .... DEPTH TO WATER AFTER MONITORINO? D,ry DATE: 9-23-00 EXIST'G 3BE 0 HOUSE EXIST'G1 TANK VERIFIE)) SLOPE HOLE PEROLATION RATE 15 (rain/inch) PERC HOLE DIAM.'ER 6 inche~ TEST RUN BEWTEEN 7 Fl' and 8 FT COMMENTS: Test hole excavated by Carl's Excavating. Test Hole was presoaked before perc test. PERFORMED BY: Steven R. Pannone~ P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. GREA~R ANCHORAGE AREA BORb~GH Department of Environmental Qualitv 3330 C Street Anchorage, Alaska gg§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM '~ ' ' ' ' I"?~ LEGAL DESCRIPTION LOCATION~ SEPTIC TAN I~: DISTANCE FROM WELL 1~O I MANUFACTURER INSIDE LENGTH. INSIDE WIDTH '~""~' .~.--/.~__~./ NUMBER OF COMPARTMENTS ~ LIQUID DEPTI~ LIQUID CAPACITY/~::2 G~ALLONS. TILE DRAIN FIELD: / DISTANCE FROM WELL/~ FOUNDATION NEAREST LOT LINE ~<~ /~I~ TOTALoF LINEsLENGTH~-~'-'~'-/~ TRENCH WIDTH-~IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE C~"~"T ~),~DEPTH OF FILTER ~ . MATERIAL BENEATH TILE ~, IN. ABOVE TILE 2- 3 IN. NUMBER OF LINES [ DISTANCE BETWEEN LINES ABSORPTION AREA ~'~ '7~'~,/ DEPTH: TOP OF TILE TO FINISH GRADE WELL: p/.,~ ~,-~.~ TYPE_ ~_ .~! !1~ BUILDING FOUNDATION__ CESSPOOL APPROVED NEAREST NEAREST SEPTIC SEEPAGE LOT LINE__, SEWER LINE__, TANK , SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: ~--~/, ~g~-~ INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: _~/_~'-' ~ _. LOT ~LOPE: REMARKS: ~ ~~ DATE DIAGRAM OF SYSTEM o Form LQ-032 PERMIT NO. MUN I C I PAL I T¥ OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 25i0 E. TUDOR RD. ~ 8NCHORRGE~ AK. 9950? 276-222i ON--S I mE SEWER PERM I m < 76i94 ) RPPLICRNT LOCATION LEGRL pICK ANTHONY BRRR~ &BRIRN STS Li4 CRESTWOOD SUBD 2523 BROOK DR LOT SIZE 278-~644 49500 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER ~ BEDROOMS SOIL RATING THE REQUIRED SIZE OF TME SOIL ABSORPTION SYSTEM IS: DEPTH= Ii LENGTH= 47 GRA%~EL DEPTH= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRE~H OR PIT IS THE DIST~E BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCRVRTION (iN FEET). THERE IS NO ~ET WIDTH FOR TRENCHES. THE GRRYEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND T~ BOTTOM OF THE EXCAVATION (IN FEET). REQU I RED SEPT I C TANK S I ZE= 1000 OALL£i~S BACKFILLING OF ANY SYSTEM WIT~UT FINAL INSPECTION AND APPROVAL BY THIS DEP~TMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DIST~CE BETWEEN R WELL R~ ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T YAL I D FOR ONE YEAR FROM I SSLIE I CERTIFY THAT l: I ~ FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. ~: I WILL INSTALL THE S~STEM IN RCCORD~CE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMO~LED TO I~LUDE MORE THAN ~ BEDROOMS. Deptil F~et 3 ~ - ? 8- 10- 11 - 1E - 13- Was ground water encountered? _.~_.~_~ ..... If yes, at wi~at dep[h? Reading Date Gross T/me Net Time Depth to Writer ............... ~ ................ f ...................... t ......................... 4 ............................... N?t brop ' ?re'rased . ins La I 1 a-['~r~'n'.- -'~S'ei'i~'!le Pi t bra i n F i e 1 d ....... ' .....,-.., ................... -...,,,~.~..., .t..~l~ ,~ MUN I 0 I PRL I T~r' OF 8NCHORRGE DEPRRTMENT OF HERLTH 8ND ENVIRONMENTRL PROTECTION 2510 E. TUDOR RDo · 8NCHORRGE· AK. 9-g507 276-2221 L~ELL PERM I T PERMIT NO. < 76~7 ) FOREMOST SERVICE~ 8RIEN STREE¥ L14 CRESTWOOD SUBD 8PPLICANT LOCRTION LEGRL 2523 BROOK DRIVE LOT SIZE 49000 SQUARE FEET MINIMUM DISTRNCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR R PUBLIC WELL. WELL LOGS PRE REQUIRED AND MUST BE RETURNED TO THE DEPRRTMENT WITHIN _?.0 DRYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS PRE RVRILABLE TO INSURE PROPER I NSTRLLAT I ON. PERM I T VRL I D FOR ONE ~r'ERR FROM I SSLIE I CERTIFY THAT i' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF 8NCHORAGE. 2: I WI~L/I~T~THE~STEM IN 8CCORDANCE WITH THE CODES. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _015-361.06 GENERAL INFORMATION Complete legal description'. Lot 14 Crestwood SID Location (site address or directions) 9550 Brien Street Current Property Owner(s). Robert D. & Theresa L. Huff Mailing address Lending agency Mailing address Real Estate Agent Mailing Address HAA _ o L/- O $ Expiration Date:_ ~L-'- ~ ~~ O ~ Day phone .222-2595 9550 Brien Street Anchors e AK 99516 Day phone _ Nell Thomas ~ CB-Fortune Day phone 265-9106 2525 C Street Ste. 100 Anchora e AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2.- NUMBER OF BEDROOMS: ~3 ' 3:' 'TYPE OF WATER SUPPLY: .........Individual Well [] Individual Water Storage ["-I Community Class _ Well [-'J Public Water System [--J TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (Rev. 11/99) Legal Description: A. WELL DATA iCipaHty f Mun o Anchorage, Department of Health and Human serVices ' Divis'i~n of Environmental'Services 'On-Site Services Section' 825"L" Street Room 502 P.O.iBox 196650 A~chorage, AK: 99519-66501 ,- wWW.ci.anchorage.ak.us ,. ~ (907) 343-4744. LOT 14 CRESTWOOD ' Well type PRIVATE Date completed 12111'!976 HEALTH AUTHORITy APPROVAE CHECKLIST Total depth 107.4 ft If A, B, or~ C provide PwsID# .: ~ Sanitary seal y. i .Cased to 107.4' ft FROM WELL'LOG Date of test 121111976 Stati(J water level 30 Parcel I.D.: 015-361-06 Well production 8 WATER SAMPLE RESULTS: Date of sa~mple: 2i1712004 SEPTIC/HOLDING TANK DATA g.p.m; Nitrate 'Well Log Y Wires properly protected "Casing height (above ground) ,AT INSPECTION 2/1712004 'g.p.m 63 24 in. Collected by: Other bacteria" 'Laura R. Pannone ' ' colonies/100 mi Tank.Type/Material STEEL ~: ' Date installed 10/6/2000 ' ",i,, Ta~ksize ~1000~ gal Cleanouts Y Foundatk~n Cleanout Y Depression oVe~: tank N Date of pumping. 9/28/2003 Pumper Around the Clock Pumpinl:! C.. ABSORPTION FIELD DATA' Date i~stalled 10/612000 Soil rating (glp.d./ft Number of Compartments 2 High water alarm N Sys{em type DT Length .52 ft Width ..3 ft .Gravel below pipe .8 ft ~ Total depth '1t ft' "Effective absorptio, n area 833 ~ Monitoring tube ~Y Depre§slon over field No Date o.f adequacy test 211712004 ReSults (Pass/Fail), Pass For 3 bedrooms .. · "i~ Fluid depth in abSorption field before test 3._.~0 in., water added466 gal.~ , New depth35 in. Elapsed Time: 40 min Final fluid depth 30 in Absorption rate >= 450+ g.p,d, Any' rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date (Rev. 11/99)" . N 0°02'40"E 150.00' ( BASIS OF BEARING) 10' UT~ZTY EASEMENT N. O0 02' 40 150.00 (RECORD BEARING AND BRIEN STREET Parcel I.D. 015-361-06 I. 2. NUMBER OFBEDROOMS: Municipali of Anchorage Department of Health and Human Services ~ Division of Environmental Sep,4ces On-Site Services Section 825 "L" Street Room 502 P.O. Box 1966§0 Anchorage, AK: 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA #_,-/~,%~-~ Expiration Date: GENERAL INFORMATION Complete legal description Lot 14 Crestwood S/D Location (site address or directions) 9550 Brien Street Current Property owner(s) Dabble McGrath, Executor Day phone 800-962-t399 Mailing address 9550 Brien Street, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Janet Daily Day phone 26t -7600 Mailing Address Un/ess otherwise requested, HAA w/Il be held by DHHS for pickup. HAA picked up by: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues CeAificates of Health Authority Approval (HAA) based only upon the representations awen in paragraph 5 by an m~?nd .... professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approvai are required for the transfer of title (except be~veen spouses) on properties served by a single farnity on-site wastewater disposal and/or water supply system, uHr~S also issues HAAs upon request to ho,me owners. Ce,'iificates of Health Authority Approval are ,/slid fcr 90 days from t,he date of issue ¢^,,"r/oFert,~s~ * '~ sen/ed by a private or Class C well arid mav. be reissued with new water sample results less than 30 days old. Certificates are valid '~or ,.,~"~,,.. year for,orocerdes served by Cla~ .A, or B ,,vei!s or a ~u~l,~ .v~,er system, l he ,.,u,~'~' '~',lc,,.a,l,¢;'-', r~,. A, ,.., ,,.., a~ ~ .... resDonsibie ~o¢ errors er omissions in the,~,'*r~¢=~:-,~,o,,*~i,~, engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation based on procedures outlined in the Health Authority Approval Guiddines for this: Health Authority Approval application 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 om site water supply and/or wastewater disposal system is in compliance will} all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eno. Svc. Address P.O. Box 102954~ Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. DHHS SIGNATURE j Approved for ~ Disapproved. Conditional approval for Phone 272-8218 Data 10/7/2000 s...-~7....'?..-~.. ...... ~; .....r ...... ~ ........... ;.%~..~ ...... bedrooms. , : ~,~'~ (~.. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisol7 Well F!ow Advisor,/ Exciretion Date: X Maintenance Agreements Supplemental ungmuef _ Kuport Other Original Certificate Date: Reissue Date:_. Municipality of AnchoR~ G E ~ V I::: O Department of Health and Human ~ervice$ Division of Environmental Services On-Site Services Section 825"L" Street Room 0:~T 0 9 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SEBVlOES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, WELL DATA Well type PRIVATE Date completed ,12/1/1976 Total depth 107.4 ft LOT 14 CRESTWOOD IfA, B, or C provide PWSID # __ Sanitary seal _Y Cased to 107.4 ft FROM WELL LOG Date of test 12/1/1976 Static water level 30 Well production 8 WATER SAMPLE RESULTS: Coliform"~5:2 -- colonies/100 mi Date of sample: /g) / '~/OD SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL fl g.p.m Parcel I.D.: 015-361-06 Well Log Y Wires properly protected Y Casing height (above ground) 24 in. AT INSPECTION 9//21/2000 35 ft 6+ g.p.m Nitrate ¢/.->mg/I Other bacteria "'- O----' colonies/100 mi Collected by: S.R.PANNONE Date installed 10/6/2000 Tank size Cleanouts Y Foundation cleanout _Y Date of pumping Pumper NEW ABSORPTION FIELD DATA Date installed 101612000 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.~6 Length 52 ft Total depth 11 ft Date of adequacy test __ 1000 gal Number of Compartments _2 Depression over tank N High water alarm N Width 3 ft Effective absorption area 833 ft2 Results (Pass/Fail) __ Fluid depth in absorption field before test NEW in Elapsed Time: __ min Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) (Rev. 11/99) NEW Water added in System type DT Gravel below pipe 8 Monitoring tube Y Depression over field L For _3 bedrooms gal. New depth in. Absorption rate >= __ g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in"Pump off" level at Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 128 Absorption field on lot 155 Public sewer main N/A Sewer/septic service line 120 in Manhole/Access High water alarm level at ____ in Meets alarm & cimuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout. N/A Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/NOLDING TANK ON LOT TO: Building foundation 6.7 Property Pine 40 Absorption field 12 Water main 100+ Water service line 50 Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 29 Building foundation 26 Water main 100+ Water Service line 50+ Surface water 100+ Driveway, parking/vehicle storage 50+ Curtain drain 100+ Wells on adjacent lots 100+ F, COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E, Date 10-7-00 HAA Fee $. Date of Payment Receipt Number _/~ 5¢/ (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number Department of Environmental Qualify 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Decen%ber 8, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. l. Approval requested by: Alaska Bank of Commerce Mailing Address: 712 West 4th Avenue Phone: 279-5641 2. Property Owner: Howard M. Smith Phone: 278-3644 e Mailing Address: 2523 Brooke Drive Legal Description: Loca ti on: Lot 14 Crestwood Subdivision 5. Type of facility to be inspected ~J~. Well Data: A. Type Indi.~idual Single Family No. of bedrooms B. Depth 107' C. Construction ~~~ D. Bacterial Analysis , - ~- Sewage Disposal System: On-site system, ~mn~x%L 7~I~LI. A. Installed 1976 2 C. Septic Tank: D. Seepage Pit: l. Size ~ 2. Manufacturer 1. Absorption Area ~ 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages MUNICIPALITY O__F ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CM Re VA 2. Property Owner: HL~Lt Mailing Add ress:c-~- 3. Name of Buyer: )~/~11 ~ FHA ~CO____N_¥ y Mailing Address: 4. Name of Lending Institution: Mailing Address:"] 1 _~ 5. Name of Realtor or Agent: %'~Qy3~ - Mailing Address:/~ ~ ~ ~--~~/'~ Phone: f 6. Legal Description: v/'~) Z~ kocation:~ ~1 ~ Day Phone: Phone: ,_'~ ~ ? - Type of Facility to be ,nspecte~~? & Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently served If Individual, depth of well //~ .~ No. Bdrms. C'~_ Individual Sewage Disposal System Type of System: Public Utility Individual (on-site).~.. Page 2 of two pages - Re~_st for Approval of Individual ~ er & Water Facilities L4gal ~escripti0n Lot 14 Crestwood Subdivision ' - - ~- ~'~" V ' ' ' A~ppro~ed ~ Disapproved Date /'-- 7--7~ Approval ~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operatin§ satisfactorily. SIGNED Date EQ-034 (1/74)