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Home My WebLink AboutCRESTWOOD LT 16Crestwood Lot 16 #015-061-18 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131246 PID Number: 015-061-18 Dwelling: X Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade Name: STEPHEN MILLER ABSORPTION FIELD ❑ Deep Trench N Shallow Trench ❑ Bed ❑ Mound Address 9650 BRIEN ST., ANCHORAGE, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 5.7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.2 Ft. Gmvel depth beneath pipe 2.5 Ft. Subdivision Block Lot CRESTWOOD 16 Fill added above original grade 1-2 Ft Gravel length 55 Ft Township Range Section Gravel width 5 Ft. Beds: Number of Lines —' Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 1 Dist. between trenches From Tank Field Tank Line 430 Ft' 1 - Ft. Well 100'+ 100'+ - - 25'+ TANK ®Septic ❑ S.T.E.P. []Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1000 Gal. Surface Water 1001+ 100'+ - - Material Number of compartments Lot Line 51+ 10'+ - - STEEL 2 NA Foundation 5'+ 10'+ - LIFT STATION Manufacturer Capacity Gal. Curtain Drain rN.O. N.O. - Remarks EXISTING SEPTIC SYSTEM Pump on level at in. Pump off level at in. High water alarm at I in. ABANDONED PER MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPEMATERIAL Housetotank3034 Tankto3034 drainfeld Installer BTH CONSTRUCTION Dra infield F810 COIMT3034 Inspector ANSON MOXNESS BENCH MARK (Assumed elevation) 100 ft Inspection1�' 8/28113 8/28/13 IELBZ�ationandscription 2nd 3" 8/29113 qOTTOM SIDING NW CORNER COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp A..1v�p Conditional Approval: Date 1�� Co. 9 l� H .. ...... / ... . LA E. SPURKLAND..- 11 00 Approved 'v �+'Vl Date q / 2:13 Inspection HepoaL9-1-Tcr - - - 0 Lor 16 S T W 0 \ / \ APE - IV G 3 BDRM _ SFR nr / ABANDONED EXISTING f SEPAC SYSTEM PER MOA sE CODE R£OUIREMENTS 25 0 25 50 75 100 125 150 SCALE; 1' = 50 FT 31'UKKLANU f:N6IVttKlNUSEPTIC SYSTEM RECORD DRAWING 203 V 15711 AVENUE CRESTWOOD LOT 16 ANCN. AK. 99501 STEVE MILLER BATE, AUGUST 29, 2013 (907) 279-3916 9650 BRIEN ST ANCHORAGE AK 99507 SHEET., 1/2 GRIP. 2438 PERMIT If OSP131246 PIB # 015-061-18 CR£STV0ODLl6.SC50-ASBBVG INSTALLED 3—BEDROOM SEPTIC SYSTEM — INSTALLED 1000 GALLON SEPTIC TANK TRENCH LENGTH 55 FEET WIDTH 5 FEET EXCAVATION DEPTH 6 FEET ROCK DEPTH 2.5 FEET SW/NGT/ES cor 17 A B C 16.5 16.0 D 22.5 17.0 E 26.0 19.0 F 465 62.0 G 50.0 60.0 H 54.0 30.5 I 57.5 33.5 go OF ",,lw NOTE. SLOPES £XCEEOING 25N WERE NOT OBSERVED WITH/N 50 FEET GOWN GRADIENT Of THE PROPOSED �1�P�.•,•••••••••.•....., �1 ABSORPTION RELD LOCATION. I.........4 NOTE} 111[5 IS NOT A SURVEYED PUT. WELL k SEPTIC LOCATIONS TAKEN FROM ON -SNE WATER AND WASTE WATER .............. .... DEPARTMENT DOCUMENTATION. ALL LOCAITONS SHOWN ARE •• „ . , .,,, L SPURKLAND,•• - ti 25 0 25 50 75 100 125 150 SCALE; 1' = 50 FT 31'UKKLANU f:N6IVttKlNUSEPTIC SYSTEM RECORD DRAWING 203 V 15711 AVENUE CRESTWOOD LOT 16 ANCN. AK. 99501 STEVE MILLER BATE, AUGUST 29, 2013 (907) 279-3916 9650 BRIEN ST ANCHORAGE AK 99507 SHEET., 1/2 GRIP. 2438 PERMIT If OSP131246 PIB # 015-061-18 CR£STV0ODLl6.SC50-ASBBVG TN - LC aEV.--94.3' IDP RM aS &1N aEV-- 8d6' BAH. M..=76.3' Shallow Trench, 5' Wide 55' Long 5,7' Max. Depth 2.5' Sewer Rock NO SCALE Trench Elevation (TyP) — Cleanouts Double Clean outs / 2' Insula tion 2,5 Ft of Septic Rock 1000 GALLON SEPTIC TANK BENCH AMRK W nW MW O A' ASUMD EUVATNIN 100 FEET ISPURKLAND ENGINEERING(( CRESTWOOD LOT 16 I I SEPTIC STST£N RECORD DRAWING 203 W 15TH. AVENUE STEVE MILLER WE, AUGUST 29, 2013 ANCH AK. 99501 (907) 279-3916 9650 BRIEN ST ANCHORAGE AK 99507 SHEET, 3/3 GRIB, 2438 PERMIT # OSP131246 PID # 015-061-18 CRESTWOODL1603-ASEDW6 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131246 Tax Code Number: 01506118000 Work Type: Septic Permit Effective Dates: August 09, 2013 to August 09, 2014 Design Engineer: SPURKLAND ENGINEERING Subdivision: CRESTWOOD Site Legal Address: CRESTWOOD LT 16 G:2438 Owner/Address: MILLER STEPHEN W & SHEILA C 9650 BRIEN ST ANCHORAGE AK 995166448 Site Mailing Address: 9650 BRIEN ST, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 49500 Total Bedrooms: 3 Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By, MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERAWELL PERMIT APPLICATION Parcel I.D. 015-061-18 Property owner(s) STEVE MILLER Mailing address Site address 9650 BRIEN ST., ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) CRESTWOOD LOT 16 Day phone 229-9552 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx� Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) F-1Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: NONE Distance: I certify that the above information is correct. I further certify that this is in accordance with Permit/Rush Fees:JC�JD — np Waiver Fees: Date of Payment: g�a 1 �J CJw_ Date of Payment: Receipt Number: O 3433G Receipt Number: Permit No. 0-,>'P 12Daq la Waiver No. Permit App_9-1-12.doc AAk SPUTM and EnVn hmg Environmental Consulting and Design SEPTIC SYSTEM DESIGN CRESTWOOD LOT 16 Municipality of Anchorage August 1, 2013 Development Services Department On Site Water and Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Septic System Installation Permit Crestwood Lot 16 Ladies and Gentlemen: I am writing to request a septic system installation pen -nit for the above referenced property. The proposed system will serve a 3 -bedroom single-family residence. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No groundwater observed up to a depth of 15 feet below ground surface (7/31/13). Soil Rating. From Test hole 7/24/13 1.2 min/in = 1.2 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/ 1.2 = 125 sq.ft. Total area required: 125 x 3 = 375 sqft Use shallow trench with 2.5 feet effective Minimum trench length: 375/5*0.64= 48 ft. System: We are proposing a 100 gallon septic tank with a shallow trench absorption. The absorption field will be 55 feet long and 5 feet wide and contain 2.5 feet (430 sq.ft. effective) of sewer rock. Soils: A Test hole was excavated on July 24th, 2013. See the attached soil logs. No groundwater was observed up to a depth of 15 feet below ground surface on July 31st, 2013. Ground water monitoring will continue through construction of the septic system. Surface Water: There are no surface waters within one hundred feet of the proposed septic system upgrade. 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci net ANAk SPUMOlmd EHOH�c��MU Environmental Consulting and Design Topography: The ground level slopes at approximately 15% to the west. Waivers: None The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely LM Lars Spurkland, P.E. Civil Engineer 203 West 15"' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net � I I I I I LOT 14 -- _--Li — __--- _ — —— W p --- —F1 -- c I II R E I II IIII IIII G��o� LOT 4 I I I COT 15 E38DRIMLOT 5LOT 6— — I I ©I 'Il I I III LOT 17 lY NOTE: THIS is NOT A SURVEYED PLAT. WELL & SEPTIC LOCA17ONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. 50 0 50 100 150 200 250 300 SCALE. 1' = 100 FT, C7 LOT 22 LOT 21 ❑@J LOT SPURKLAND ENGINEERING CRESTMOD LOT 16 SEPTIC SYSTEM DESIGN 203 V 15TH. AVENUE STEVE MILLER BATE, JULY 29, 2013 ANCH, AK. 99501 (907) 279-3916 9650 BRIEN ST ANCHORAGE AK 99507 SHEET1/3 6RID+ 2438 PERNIT N BSP111OXX PID R 015-061-18 CRESTVDDDLI6.SC1090V6 LOT 16 C W p 0 D CRE J SLOPE - 15X / aa,E - 15X SLOPE - 15X INSTALL 3 -BEDROOM SEPTIC SYSTEM REPLACE EXISTING 1000 GALLON SEPTIC TANK INSTALL DIVERTfR TRENCH LENGTH 55 FEET WIDTH 5 FEET MAX EXCAVATION DEPTH 6 FEET ROCK DEPTH 25 FEET lY NOTE. SLOPES EXCE£ORIG 25X WERE NOT OILS£RV£D WITHIN 50 f£ET DOWN ORIDIENT OF THE PROPOSED ABSORPTION FIELD LOCATION NOTE THIS 1S NOT A SURVEYED PUT. WELL & SEPTIC LOCATIONS TAKEN fROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENU770N. ALL LOCATKINS SHOWN ARE APPROXIMATE. S�� TANK PER MOA N�W X01 - 3XV LOT 17 Bil 25 0 25 50 75 100 125 150 ••��'L•• ?II_.,P\'F.�� SCALE, I' = 50 FT �i ��:��lo SPURKUND ENGINEERINGCRESTTYOOD LOT I6 SEPTIC SYSTEM DESIGN 203 V 15TH. AVENUE ANCN. AK, 99501 STEVE MILLER PA TE.- JULY 29, 2013 (907) 279-3916 11 9650 BRIEN ST ANCHOR46E AK 99507 SHEEP 2/3 6RIIA 2438 PERMIT K OSP1210XX PIB A 015-061-18 CRESTV00BLI6.SC5DBV6 Shallow Trenchl 5' Wide 55' Long 6' Max, Depth 2.5' Sewer Rock 3.5' Cover Trench Elm NO SCALE NO Install IVVU Gallon Septic Tank Bull Run Diverter .Double Clean outs 2,5 ft oP Septic Rock 1000 GALLON SEPTIC TANK ISPURKLAND ENGINEERING I ( CRESTWOOD LOT 16 I I SEPTIC SYSTEM SCHEMATIC 203 W 15TH AVENUE STEVE MILLER PA TE, JULY 29, 2013 ANCH, AK. 99501 (907) 279-3916 9650 BRIEN ST ANCHORAGE AK 99507 SHEET, 3/3 6Rllk 2438 I PERMIT # OSP131XXX PIB # 015-061-18 CRESTWOOBL16,B30V6 Municipality of AnchorageNGI'j"A� Development Services Department Building Safety Division �1 Onsite Water and Wastewater Program ' ' ' H 4Elmore Road 196 � , • , P.O. Box 196650 Anchorage, AK 99507 ' www.ci.anchoraae.ak.us / ....b• • • ' •""' (907) 343-7904 �� n :LA E. SPURKLAND Soils Log - Percolation Test 1i ., 91� ooh Performed For: STEVE MILLER Date Performed: Legal Description: CRESTWOOD LOT 16 Township, Range, Section: Depth 9-0 6>0 10- 0 11- M 12-0 13- 00 14- ©� 15- (swt) G(IIVA WI Sett CSP) GAO. 1 1 COMMENTS PRESOAKED WAS GROUND WATER ENCOUNTERED? NONE a IF YES, AT WHAT DEPTH? — L Depth to Water After o DRY P Monitoring? DRY Date: 7/31/13 Reading Date Gross Time Net Time Depth to Water Net Drop 7/25113 10:45AM 0 MIN 6.000" 0.000" 7/26/13 10:51AM 6m25s 6.000" 6.000" 0.000" 7/25/13 10:58AM 6m50s 6.000" 6.000" 0.000" 7/25113 11:05AM 7mOOs 6.000" 6.000" 0.000" 7/25/13 11:13AM 7m00s 6.000" PERCOLATION RATE 1.2 (minulesfindt) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 4 FT AND 4.5 FT PERFORMED IN ANSON E WITH S I � � CERTIFY THAT THIS TEST yJAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIP L ID INES IN EFFECT ON THIS DATE. DATE: �� ., GREA-mR ANCHORAGE AREA BORI,-dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT'ON-SITE SEWAGE DISPOSAL SYSTEM NAME DIC -1 �hT�Ohq MAILING ADDRESS as 3 �.oe kS t gip' PHONE'a78- -36 `/l�' LOCATION1 Q��n � LEGAL DESCRIPTION [.6T lG CR€S7'U-0OOh SEPTIC TANK: DISTANCE NUMBER OF FROM WELL IDA' MANUFACTURER �►-�-¢�' MATERIAL StAkEl COMPARTMENTS �- INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 100'0GALLONS. TOTAL LENGTH DISTANCE FROM WELL 0_FOUNDATION _NEAREST LOT LINE `Eao OF LINET 450(a NUMBER OF LINES l DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREAgao SQ. FT. LENGTH OF EACH LINE I/ DEPTH OF FILTER `/ DEPTH: TOP OF TILE TO FINISH GRADE � MATERIAL BENEATH TILE -1I. ABOVE TILE T IN. WELL TYPE CONSTRUCTION Uf%d&'"- C"St' BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE , SEWER LINE , TANK_ CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED DISTANCES: ®`' INSTALLED BY:�4��A SEWER LINE DEPTH: PIPE MATERIAL: 'tel\ AST LOT SLOPE: T� ` "` V REMARKS: Form EQ -032 REMARKS DEPTH DISTANCE FROM: SEEPAGE SYSTEM_ DIAGRAM OF SYSTEM M�i1'"+i I Er I FAL- I TY C)F DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION, r \ 2510 E. TUDOR. RD.., ANCHORAGE. AK. 99507 276-2221 Awa— I TE :SEWEFZ PEF;?_M I T PERMIT NO. C 76196 ) APPLICANT DICK ANTHONY 2523 BROOK DR 278-4644 LOCATION BARRY & BRIAN STS LEGAL L16 CRESTWOOD SUBD LOT SIZE 49500 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FTrBR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E:-EF''TH= E3: :M:B C3FZF-'l%-PE-L_ C}EF'TH= _'5 THE LENGTH DIMENSION IS THE LENGTH CIN 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 CIN 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 CIN FEET). rti czr= aT T r- T-s:=l"K NCZ T fir= 7T 12110 1PI G11:4L_Lr_rt-.1"=. 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 200 FEET FOR A PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F:'EFRM I T SAL. I C} F=C3FZ iC "E: keE:F•if_?' F= FZC31M I f�_ �4JE 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. S I GNED : tL clG. APPLICANT DI ANTHONY ISSUED BY -- - ----`- ---J----DATE--------------- GRLATER ANCHORAGL ARLA BOROUGH Department of 11 " nvironmental QL ity 3330 "C" Street Anchorage, Alaska 9M3 PEROLATIONTEIST Performed for 7 -- --er(j ic es Date Performed Legal Dcscrip-�-jun: 12-7 This form reports: Soils --- ' Percolation test Depth est Depth Feet 92 2- 3 4 5 M. 7 10 12 - 13 - X1_7` 4-304 VJ a s ground water encountered? /U0 S/'O 100 If yes, at what depth? Rea di ny Date Gross Time Net Time —.Depth to Water Net Drop ----------- L on rateminute. PrOosed 1); k J (A L: L ura i n f i e l d I :jcpt'J1 of Inlet pit or, Lrul)(11, FT, 0 Pf:rfonilcd I;y. -["Y,:-, T -- ---------- o L t? 5fi 7/76 _.. - J. i Al� ..... EQ 0,10 (6/74) rjUN I K-- I F=NF=IL- I -r%-' C7 F= F:i " (_- " ID F;Z F=l Cj E: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 99507 276-2221 WELL F=F= FZ P1 I _T PERMIT NO. ( 76335 ) APPLICANT LOCATION LEGAL FORF0051 qFRVTQES 2523 BROOK DRIVE 278-3644 BRIEN STREET L16 CRESTWOOD SUBD LOT SIZE 49000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='I-= FZ M I _r IvP f=1 L_ X E> F= C:) FZ 01"E krx FE Fzl FZ F= FZ ID r-1 11 E3!E5 LJ E= - I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I R: I WILL INSTALL THE 5Y M IN ACCORDANCE WITH THE CODES. SIGNED: -- -------------------- APPLICANT FMOST SERVICES ISSUED BY --'L -------- DATE -IL- • -� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPRO Parcel I.D. 015-061-18 Expiration Date: 1. GENERAL INFORMATION Complete legal description CRESTWOOD LOT 16 Location (site address) 9650 BRIEN STREET ANCHORAGE, AK 99516 Current Property owner(s) PETER & CRYSTAL OMEL Day phone Mailing address Real Estate Agent 9650 BRIEN STREET ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class —Well L1Community ElPublic Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless requested by the engineer. COSA Fee $ 5za '6s-1 Date of Payment Receipt Number 7i a/0l00 COSA# �f)0-4I L Date: 3/Z 3/, Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER `Testing performed by Anderson Engineering 05/1212015, site inspection only on 03115/2017 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 03/21/2017 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rales may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF AL� \ 1 encroachments, deficiencies or discrepancies exist. y i* � s�911 4cm ■ 6. DSD SIGNATURE X System #1 Approved for System #2 Approved for Disapproved. Conditional approval for _ bedrooms. P� I�hNEfH ir. D bedrooms. �; 7/ Es I ppb bedrooms, with the following stipulations: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the Slate of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: CRESTWOOD, LOT 16 Parcel ID: 015-061.18 A. WELL DATA ipw F~ C"VS. Well type PRVr If A, B, or C provide PWSID # _ Well Log (Y/N)A* Date completed 06114/1977 Sanitary seal (Y/N) Y Total depth 80 ft. f Cased to >40 ft. TO FROM WELL LOG Date of test 0611411977 'W Static water level 60 ft. Well production 15 g.p.m WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 3.52 mq/L, Arsenic: ND ug/L Date of sample: 0311512017 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 09/19/2016 Pumper A+ Home Services C. ABSORPTION FIELD DATA *Testing by Anderson Engineering Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION ' Anderson Engineering 0611212015' 55.4• ft. ti' Collected by: ARCTERRA Date installed 0812812013 Cleanouts (Y/N) High water alarm (Y/N) N Date installed 812812013 Soil rating (g.p.d./fl? or ft'/bdrm) 1.2 GPDISF System type T WIDE Length 55 ft. Width 5 ft. Gravel below pipe 2.5 ft. Total depth 7.8' ft. Eff. absorption area 430' fe Monitoring tube Y• Depression over field W Date of adequacy test 0511212015' Results (Pass/Fail) PASS" For 3 bedrooms Fluid depth in absorption field before test 0' in. Water added 4W gal. New depth 0' in. Elapsed Time: 0' min. Final fluid depth M in. Absorption rate >= 450+' ' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N' If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons _— "Pump off"level at in. Cycles tested Septic tank/lift station on lot 100'+* Absorption field on lot 100'+* Public sewer main 75'+* Sewer /septic service line 25'+' Animal containment areas 50'+' Manhole/Access (Y/N) __ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+* On adjacent lots 100'+' Public sewer manhole/cleanout 100'+* Holdingtank _100'+__— Manure/animal excrete storage areas 100'+* SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+* Property line 5'+* Absorption field 5'+ Water main 10'+* Water service line 10'+* Surface water 100'+' Wells on adjacent lots 100'+ * ABSORPTION FIELD ON LOT TO: Property line 10'* -_-- Building foundation 10'_+' Water Service line 10'+* Surface water 100'+* Curtain drain _50'+INONE NOTEDl Wells On adjacent lots 100'+* F. COMMENTS Watermain 10'+* Driveway, parkinghvehicle storage 5'+* in. Well flow and tic adequacy_testi� preformed by Anderson Engineering on 05/12/2015. Septic fluid levels checked and confirmed on 03/1512017 by ArcTera Consulting. 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 COSA guidelines in effect on this date. OF, Aj \ Engineer's Printed Name KENNETH M. DUFFUS ��~� Date 03/2112017 — A" 4 9 H v* -- — — — — COSA canary sheet_2-6-15.doc P KEunerr M. uU100' i ELECTRIC EASEMENT RECORDED / AT BOOK 277, PAGE 647 S 89 59' E 300.00 OF AC•gs��--�0 10:- 49 THw y� � o SHANE A. HOLT .' m Q LS -6914 ,•'• y�oO 4�Q. ••........• ' oa d 0��!essionai o� S 239 59' E 3U0.UU THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. I— W w AS -BUILT SURVEY 11" = 301 NO CORNERS SET THIS DATE 7I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 16, CRESTWOOD SUB.( PLAT P 525) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _22ND DAY OF _MARCH , 2017. 13522, FB 181-70 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 35' w L7 a o 0 Z t9jy � o FRgdi�cy z$ ��Y s DEO( O Q G/G DECK Z S O o o04p0 y ¢ O uDECK ¢ OR P o � w Z n ? Q W w > r - y w U " DWELL G W 0 OR74F�� r GARAGE 1 PARKING AREA OF AC•gs��--�0 10:- 49 THw y� � o SHANE A. HOLT .' m Q LS -6914 ,•'• y�oO 4�Q. ••........• ' oa d 0��!essionai o� S 239 59' E 3U0.UU THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. I— W w AS -BUILT SURVEY 11" = 301 NO CORNERS SET THIS DATE 7I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 16, CRESTWOOD SUB.( PLAT P 525) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _22ND DAY OF _MARCH , 2017. 13522, FB 181-70 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 I r P11SH! Parcel I.D. 0 1' 1. GENERAL Complete le Location (sl Current Pro Mailing address '., • — - - _ _ . _ Real Estate Agent Rhonda Richie Day phone 250-9098 2. TYPE OF DWELLING: [K] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual (] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received b �— Date: ——y COSA to be releas to the neer, unless otherwise requested by the engineer. COSA Fee $'JZ/{' J� .�/S� -� Waiver Fee $ Date of Payment l`D� (1�A_ Date of Payment Receipt Number 0, A Receipt Number COSA # 01-1�) « Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER d by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, Vita Sedprocedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. I 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved 522-7773 Conditional approval for bedrooms, with the following stipulations: B�4J�Wv C .� Original Certificate Date: / 7pe,Municlpalily, of Anchorage Development Services Division (DSD) Issues Certificates of onsite Systems Approval (COSA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the Stale of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheelr'- :, c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Crestwood, Lot 16 parcel ID, 015-061-18 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 6114/77 Sanitary seal (Y/N) Y Total depth 80 ft. Cased to >40 ft. Date of test Static water level Well production FROM WELL LOG 6/14177 WATER SAMPLE RESULTS 60 ft 15 Nlaw Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 6/12/2015 55.4 ft 5.4 g.p.m. Coliform 0 colonies/100 mL Nitrate 9.01 mg/L Arsenic ND ug/L Dateofsample: 5/11/15 Collected by: Anderson Engrg. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 11000 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 514115 Pumper A Plus Home Services Date installed 8/28/13 Y C. ABSORPTION FIELD DATA Date installed 8/28/13 Soil rating (g.p.d./fe or felbdrm) 1.2 GPD/SF System type 5' Wide Length 55 ft. Width 5 ft. av� tre�ow yip 2.5 Total depth 7-8 ft. Eff. absorption area 430 ft2 M ng tube Y_ Depression over fie] f. 5/12/15 Date of adequacy test Results (Pa Fail) � _ r/1?, J. For bedrr Fluid depth in absorption field before test 0 in. W er added 450 gal. New de Elapsed Time: 0 min. Final fluid depth 0 1n. bs r t >= 0 c Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ft. N in. D. LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench. Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: >100' On adjacent lots >100' Septic tank/liftstation on lot 1 >100' On adjacent lots >100' Absorption field on lot J Public sewer main >76 Public sewer manhole/cleanout >100' Sewer /septic service line >25 Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTICIHOLDING TANK ON LOT TO: Building foundation >51Property line >51 Absorption field >51 Water main >10, Water service line >10, Surface water >100, Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10 Water main > 10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >10 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 6/5/2015 COSA brown sheet_10.10-12.doc ri , -. MICHAEL E. ANDERSON 4 t j,:� CE -4381 Municipality of Anchorage Community Development Department ° Development Services Division `� s On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC151266 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 16 of Crestwood subdivision. This inspection revealed a nitrate concentration of 9.01 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. e , • Municipality of Anchorage On -Site Water and Wastewater Program r [�/ (907) 343-7904 w � I ] 1 s , Certificate of On -Site Systems Approval Parcel I.D. 015-061-18 Expiration Date: 1. GENERAL INFORMATION Complete legal description CRESTWOOD LOT 16 Location (site address) 9650 BRIEN ST., ANCHORAGE, AK 99516 Current Property owner(s) STEPHEN MILLER Mailing address Real Estate Agent JAMIE HARVEY 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) �] ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 229-9552 Day phone 230-7123 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual n Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NONE Distance:_ Received by: i XMA Date: COSA to be released to the enbineer, unless otherwise requested by the engineer. COSA Fee $ 4 0(. 61) Date of Payment q�� Receipt Number COSA# Waiver Fee $ Date of Payment Receipt Number Waiver # 5. 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 Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation - Name of Firm SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE 7 _� System #1 Approved for J bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Phone 279-3916 Date 9/5/13 i9T ... s.. P i.....?^�.. . ..... SPURKLAND; �� 115 0 .4V 4 0 V +> l `Fppt?OFsskNP�� with the following stipulations: By: vv. / Original Certificate Date: The nici Ity Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r - c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: CRESTWOOD LOT 16 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed 6/14/77 Sanitary seal (Y/N) Y Total depth 80 ft. Cased to >40 ft. Date of test FROM WELL LOG 6/14/1977 Static water level 60 Well production 15 WATER SAMPLE RESULTS: ft. Coliform NEG colonies/100 mL Nitrate 8'13 mg/L Arsenic ND ug/L Date of sample: 8/29/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping NEW C. ABSORPTION FIELD DATA Depression over tank (YIN) N Pumper NEW Parcel ID: 015-061-18 Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 7/12/13 56 6+ ft. g.p.m. Collected by: ANSON MOXNESS Date installed 8/28/13 Cleanouts (Y/N) Y High water alarm (YIN) N Date installed 8/29/13 Soil rating (g.p.d./W or ftzlbdrm) 1.2 System type 5 -WIDE Length 55 ft. Width 5 ft. Gravel below pipe 2'5 ft. Total depth 6'7 ft. Eff. absorption area 430 ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at _ Datum Size in gallons in. "Pump off" level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Water main NA Water service line 10'+ Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10'+ Water Service line 10_+ Curtain drain 50'+ (N.O.) F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water 1004 Wells on adjacent lots 100'+ I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 9/11/13 COSA brown sheet_10-10.12.doc Absorption field 5—+ Surface water 100'+ Water main 1 NA Driveway, parking/vehicle storage 10' Municipality of Anchorage Community Development Department t f" _ Development Services Division E. On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval 4 131474 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 16 of Crestwood subdivision. This inspection revealed a nitrate concentration of 8.13 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. w a N 0 c c PLAT NO. P-525 CRESTWOOD SUBDIVISION LOT 16 49,500 S.F. D ow -Do vv"C >VV.Vv- GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 1000 E. DOWLING RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 I GRID SW2438 19/10/2013 F.B. 9JOB N0, 3-10 CWS16 I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. R IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE. .*slk*\04• 4W �\ OF �* 1�Q.' �i1..49.............. •: il... ..................40 m : Jeffery A. 0astoldi : o t LS -6091 : AIV sl"s •••;��o�2oh� 5�`a¢40 t••� �S\1��♦•♦ 30' 111=30' BUILDING DETAIL SCALE: 1"=20' MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # 01 — 12, HAA # iA WSDS "- ,q 1. GENERAL INFORMATION Complete legal description LoT 1 CREST Woo SU 13. Location (site address or directions) 9(,So B121Ew ST. A9cu. A k q9s/6 Property owner :5 -FE VE M I L LER Day phone 3 q6 - 30 I z Mailing address 9Ks0 O ries Sf. Aei ch cralcre, A kr 99�t'!r Lending agency (f4y M0 r;A�e Day phone -563 ^0700 Mailing address 12 1 Cv r=# re u., Lunetlr►ce. A`� �9-1- 67-? Agent N A ( Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well ✓ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 5. 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 of 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 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. Name of Firm FG,4TTDP 16CN SVCS, Phone 3q 135s Address HS3o FCNo ST 4A(CFl, 'Ak 9 tS/6 Engineer's signature / Date 7"^e Zg 174 4 9TH �rw.rrrrr..r.r.rrrrrrrr:!►.�, stn �' s r g THEODORE F. MOORE ; Af CE - 3589 +` 4� � p 6. DHHS SIGNATURE�'�� Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: BY: -R C -Z v ;r Date q- 6-- �% 3 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025(Rev.1/91) Back MOAR21 Municipality of Anchorage AEFM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT Ilo CREST VOOD Parcel I.D. O / A. Well Data Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 6/30/76 Driller 6RCTIC DRILLJNG i Total depth Cased to So Casing height Sanitary seal (Y/N) Y Wires properly protected (Y/N) y L'3 C: FROM WELL LOG AT INSPECTION n Date of test 613076 G /22 93 rT'1 r r C-1 Static water level �0 S8 R7 cg o 0 Well flowIS g.p.m. > 8.3 g.p. D N �►' Pump levell —' 7 loO Q N rn SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot 1044 To C-0. ; On adjacent lots >/00 Absorption field on lot 10(oI 7o Co. ; On adjacent lots > /oo ' Public sewer main nl.A• Public sewer manhole/cleanout N. A Sewer service line > SO' Petroleum tank NONE OB SERyE D WATER SAMPLE RESULTS: Coliform O of /100 m Nitrate 3.93 rhQ /.!? Other bacterianoi)c �rcnorl-epi Date of sample: (,,/.2.2 /93 Collected by: FLATToP TECH . .S(/CS B. SEPTIC/HOLDING TANK DATA Date installed 717(o Tank size / 000 Gy L Compartments 2 Cleanouts (Y/N) Y Foundation cleanout JY/N) Y Depression Y/N ... N C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water 12.5 a Arwv, Date installed 7/7(c Soil rating (GPD/Ft2) 1.2 System type TREP4CH Length 42 Width 3 1 Gravel thickness S Total depth 81 Total absorption area 1420 FT?_ Cleanout present (Y/N) y Depression over field (Y/N) N Date of adequacy test (6/27_/93 Results (pass/fail) ?ASS for 3 Bedrooms Water level in absorption field before test (6 3 5.6 L . After test 58" B. G. t . Peroxide treatment (past 12 months) (Y/N) NO N E K Ni Q wrr( If yes, give date N, A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 10(4r FROM C-0, On adjacent lots > to Property line -7 /01 To building foundation 5HED ON 70F of iut4cH To existing or abandoned system on lot N,A On adjacent lots > 5br Cutbank WA Water main/service line > 50 Surface water > (0o Driveway, parking/vehicle storage area S� Curtain drain NONE OSSEP YED E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature I!r w� Engineer's Name %A cow. -e_ F /`tc o -e- Date Tun e- HAA Fee $ /70 0 e U " Waiver Fee $ Date of Payment 6 Receipt Number a c?) 72-026 (3/93)' BaCk Date of Payment Receipt Number THEODORE F. MOORE 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) 1-67— /6 C�f'� 5�"�Jc�a� Svc%. Location (address or,directions) (b) Applicants Name XMAI Telephone - Home Business 7,7Z--d!�7/ Applicants Address 9(S ��'IfN :5r (c) Applicant is (check one) Lending Institution Owner/builderC�; Buyer = ; Other E::1 (explain); (d) Lending Institution 1' I P_S T EW Q L I NC_ Telephone Address (e) Real Estate Co. & Agent 'TO e Address ori a IE QJ 'A--" Telephone 05 -71 (f) Mail the HAA to the following address: R I f A Ac -n o', 0tit TO c C� U C� 2. Type of Residence Single -Family r4 Multi -Family Number of Bedrooms -3 - 3. Water.Supply Other (describe) Individual Well Community Public 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 Community Holding Tank 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] Gel- 1(o ... CS/b �, 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 regula- tions in effect o/n� the date of this inspection. Name of Firm /f � ��C " Telephone - Address %oTd Address % � �- 53 r /tFg" �G�1'�fr *jew: Date / - ' y, (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms B0 Approved Disapproved Terms of Conditional Approval CAUTION Conditional` -- OF A �-,""% Reid, Jr. 2251rE THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH. AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE— MENTS. 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 T.1 THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH,.AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /a ,s (a) Legal Description (include lot, block, subdivision, section, township, range) Ael- /(o MV -5-7-00677> Location (address or directions) '1105D ARI" Applicants Name Z7x (b) App AV. �plalr1 Telephone - 4tMTe'--' Business Applicants Address 9l05�� /C.v STET Cjr?�/(o (c) Applicant is (check one) Lending Institution , Owner/builder ; Buyer r_1 ; Other [� (explain); - (d) Lending Institution 'ab * 114 C Address (e) Real Estate Co.,& Agent Address ! a Telephone c>7a - 0 J / (f) Mail the HAA to the following address: W 2. Type of Residence Single-FamilyD7!� Multi -Family Number of Bedrooms 3 3. Water SuDDl Other (describe) Individual Well Community Public. 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 Community Holding Tank 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] �l� 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date (ENGINEER SEAL) Alit" 6. DHEP Approval Approved for _ bedrooms By� Approved Disapproved Conditional Telephone _1-50Y Lacy 4 Reid, Jr. rld CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPA',�iY C. ' .L ,� ErVV1 ✓ .`ice. ,. ._ _ ... MUNICIPALITY OF ANCHORAGE (MOA) DEC 1 1984 HEALTH AUTHORITY APPROVAL (HAA) ®C [ ®� CHECKLIST - FEBRUARY 1984 C i_ � V� R L LL) A. WELL DATA Legal Description: /OT 16 Well Classification ) /r UQk If A, B, cr C, D.E.C. Approved(YM) Well Log Present Y Date Completed % Yield.O *iU7 Total Depth gyp/ Cased to $p Depth of Grouting 0 � Static Water Level x/34" Pump Set At Casing Height Above Ground Sanitary Seal on Casing62) Electrical Wiring in Conduit &) Depression Around Wellhead ( ) Separation Distances from Well: To Septic/Holding Tank on Lot / 05- ` On Adjoining Lots -t /00" To Nearest Edge of Absorption Field on Lot /jj5 �'�` ; On Adjoining Lots fi-/Do" To Nearest Public Sewer Line ,J`q To Nearest Public Sewer [J� Cleanout/Manhole AV- To Nearest Sewer Service Line on Lot /✓ Water . Sample Collected ByC� , �V rte✓ ; Date i 2-1 - Water Sample Test Results F4(f-TOS Comments �� / 3ki/ 3.1,E . /1�cti !dm'" ;Zia 4YSDsial a B. SEPTIC/HOLDING TANK DATA Date Installed _ Size /000 No. of Compartments Z.— Standpipes Y ) Air -tight Caps 6Y ) Foundation Cleanout /N) Depression over Tank (Y Date Last Pumped 3L-611 �� Pumping/Maintenance Contract on File �(Y/N) A)&T ; for Holding Tank High -Water Alarm (Y/N) /V/,y Temporary Holding Tank Permit (Y/N),rr1,-t- Separation Distances from Septic/Holding—Tank: To Water -Supply Well �/> S / �` To Building Foundation 5 To Property Line 3D �` To Disposal Field /D To Water Main/Service Line f J0 To Stream, Pond, Lake, cr Major Drainage Course .j- / 00 Comments -I` CJ [Page 1 of 21 Z_/ Receipt # 5 Date Paid: a Amount: C 2-15-84 �, ize 64Jlwe�caC C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata j,,?,s 11:!T Type of System Design 7Wf VC'ff Date Installed �� In, Length of Field "121 Width of Field 3 / Depth of Field 8' Gravel Bed Thickness 51 Square Feet of Absorption Area L/ bJ Standpipes Present ((Y,->4) DDate of Last Adequacy Test Depression over Field (Y ) Results of Last Adequacy lbst Separation Distance from Absorption Field: To Water -Supply Wbll /0 S I To Property Line y- /-0 To Building Foundation To Existing or Abandoned System cn Lot A> I �A- ; On Adjoining Lots Ji -36 / 7L-' To Water Main/Service Line 4_95 To Cutbank(if present) N LA To Stream/Pond/Lake/or Major, Drainage Course po r To Driveway, Parking Area, or Vehicle Storage Area :It Z0 / Com4me nts *r- t/n4ag Got oa t c 57d c�/'� 11"7Lo1 07 14 D. LIFT STATION Date Installed kao s Size in Gallons ccess (YM) "Pump On" Level at " Level at High Water Alarm Leve Vent (YM) Tested for ing Cycles during Adequacy Test. Rieets MDA Electrical Code ) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Gu on the date of this inspection. -1 Signed Date Company CS MOA No. KBl /d5/s [Page 2 of 21 WMY ines in effect RS '•�h� Cc� . Reid, Jr. 2251•i: 2-15-84 ALASKA MINERAL COnTROL R O HS, InC. Enqineerinq & Enuironmental Studies December 10, 1984 Q 3 A M A Department of Health & Environmental Protection -01 J i 30 825 L. Street Anchorage, Alaska 99503 NOIM31oad 1y1.N3WN031AN3 V H11d3H 40 UO3 ,10"OK Md do unYdIDINM Attn: Crestwood Subdivision, Lot 16 Well Flow Test On December 3, 1984, AECS performed on the subject properties' well. The flow rate was 6gpm for 90 minutes during which the well produced a total of 540 gallons.' The static water level was at 56.4', there was a drawdown of 3.6' and the recovery time was 10 minutes. In our opinion this well is adequate for this three bedroom house. Sincerely, 6 �il L n Turner vironmental Scientist Approved by: 1200 West 33rd Auenue, Suite B • Anchoraqe, Alaska 99503 • (907) 561-5040 E� • �••MR•• • 1.7••O • y C eid, Jr. 4aM A'1) Fv 1200 West 33rd Auenue, Suite B • Anchoraqe, Alaska 99503 • (907) 561-5040 nm, mnnnrvtmr AD 7Dfll1TTTR UVTTT Tr ATT'PVnV 1 Time APPLIi IVT FILLS OUT UPPER HAI ONLY Proparty Owner Time Phone Date ROBERT & MADALEINE DOLAN Mailing Address SRA Box 85D Anchorage, AK 99507 Zip Code 344 4456 Inspector Buyer Bone Yet Address Zip Code Lending Institution Phone None Yet Address Zip Code ( ) DISAPPROVED Realty Co. & Agent Totem Realty, Konni Snyder Phone BY. 724 E. 15th Avenue, Anchorage, AK 99501 Zip Code 272 0571 Address Well Log Received Septic Tank Size /4.00 Legal Description LOT 14 (Sixteen) , Cresttod Subdivision Street Location Q-650 Brien Street Type of Residence DIcSingle Family 3 MAP` ATTACHED FOR DIRECTIONS. ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑Xlndividual Well 120feet deep ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility permit # 76335 Sewer Disposal ❑glndivldual Year Individual Installed: _z9!7'7 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank r— NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Ji Inspector Inspector Inspector Inspector Field Notes: G O Sp -we (_3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE l� F > BY. Soils Rating Date Sewer Installed 14 D - -7 --12C� Well To Absorption Area / 3 I Well to Tank I Well Log Received Septic Tank Size /4.00 72023 (3182) ALASKA MIn0nEnTAL C0nTn0L SCRUICES, InC. Engineering & Enuironmental Studies OCTOBER 16 1983 ROBERT DOLAN 9650 BRIEN ROAD ANCHORAGE AK 99507 SELLER — ROBERT DOLAN BUYER — SUBDIVISION — CRESTWOOD BLOCK — 0 LOT — 16 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 420 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 10/17/83 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. �►_ ter w�`�� 1200 lest 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (901) 216-1361 October 11, 1983 Robert & madaleine Dolan SRA Box 85D Anchorage, Alaska 99507 Suoject: Lot 16 (Sixteen), Crestwood Subdivision Approval for the individual sewer and water tacilities cannot .be granted until the following iteiiis have ween cowipleted; The septic tank pumped with a receipt submitted to tail department. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. 6 Locate and expose the cleanout to the seepage pit and/or °/CLocate area -Lor our inspection. 'his is to insure the minimum distance requirements are met between the well and sewer systeiri. 0 The top of tile well casing should be sealed so that it is 6-2/,e"" water tijht. '0Exposed electrical wires to thQ well head are in violation e-'Z(f�of the Municipality of Anchorage codes and must be encased in conduit. please notify this Department Li -or a reinspection when tile noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. sincerely, Jiia Roberts Associate Environmental Specialist JR51/E2/S CC: Totem Realty, Konni Snyder Enclosure MUNICIPALITY OF ANCHORAC- . DEPARTM _;r OF HEALTH AND ENVIRONMEN__,L PROTECTION 825 L Street, AnchoracrP. Alaska 99501 264-4720 Date Received: February 9, 1978 #1: Time nryt #2: Time #3: Time Date 111L) Date Date Insp 0"_4 Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES ASSUMPTION 1. Lending Institution Request: Alaska Bank of Commerce Mailing Address: Pouch 7-012 99510 Phone: 279-5641 2. Property Owner: Noah Taylor Phone: Mailing Address: o Konni Snyder, 272-0571 3. Legal Description: Lot 16 Crestwood Subdivision 0 Brien Street 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit # 76335 Construction Depth of Well 120' Well Log on File (xX Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Permit # 76196 Installed 1977 Septic Tank Size Absorption Area Public Utility ( ) Installer Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area I"JMAA�r Absorption Area 7j - MUNICIPALITY OF ANCHORAGE ((0 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 2. Property Owner: Mailing Address: 3. Name of Buyer: CMRO VA FHA Day Phone: Mailing Address: , )6, Day Phonl 4. Name of Lending Institution:O!-" [_C Mailing Address: �r!�� Phone: 5. Name of Realtor or Agent: Mailing Addr 'Y'l // r- /!h-�`A ✓ / n 1YI 4 — 6. Legal Description: Location: - 7 91 pssuM�ro,✓ CONVZ,----" Type of Facility to be Inspected: No. Bdrms. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 19 Z 7 ?94e,ew i � Q 72-003(3/76) j V II><-C� Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 16 Crestwood Subdivision Comments: Affadavit Attached: Approved: k--', C. Disapproved: Department Worksheet: Letter Attached: ( ) Date:' --,;L Date: MUNICIPALITY OF ANCHORAGE �EPART OF HEALTH AND ENVIRONMEN- PROTECTION --L Street, Anchorage, Alas -a 99501 279-2511, ext. 224 or 225 9:30 a.m. Date 5-16-77 Monday Insp Dixson #2: Time Date Insp Date Received: May 13, 1977 #3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Bank of Commerce % Carolyn Barrera Mailing Address: 712 West 4th Avenue Phone: 279-0571 2. Property Owner: Howard Smith Mailing Address: 2523 Brooke Drive Phone: 278-3644 3. Legal Description: Lot 16 Crestwood Subdivision 4: Single Family Residence: (x) Number of Bedrooms: (-"2D— Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (YJ Community/Public System ( ) Permit # 76335 Depth of Well 80' Well Log on File (x) w.o. Construction Bacterial Analysis (V '1111� 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1976 — Installer Septic Tank Size Q Manufacturer _ Absorption Area 0 Soils Rate Material 7. Distances: Well to Septic Tank /.22 Q to Absorption Area LSO to Sewer Line 0,k, Nearest Lot line /Q Absorption Area to Nearest Lot Line 61 yc ( .'AUNICIPAUT( ,-; MUNICIPALITY OF ANCHORAGE �?`PT' 0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 . w �z 1,1l7 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONY 2. Property Owner: Howard Smith Mailing Address: 2523 /Brooke Dr. Day Phone'. B-364-+ TAYLOR 3. Name of Buyer: 38MiAdldmix Att T Carol m 1Barrera Day Phone: 4. Name of Lending Institution:Alaska Bank of Commerce Mailing Address:712 West 4th Ave Phone: 279-56.1 5. Name of Realtor or AgentTotem Realty Mailing Address:15 & Gambel Phone: 272-0571 6. Legal Description:Lot 16—Crestwood Subdivision (Sixteen) Location:Off Birch—left on Barry—right on Brian 7. Type of Facility to be Inspected: Single Family No. Bdrms.2 Two 8. Water Supply Type of Supply: Public Utility Individu If Individual, number of dwellings presently served ONE If Individual, depth of well 80) Eighty Feet 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72-003( 3/76) 6-15—?6 Individual (on-site)��1L1``�1`l` page `1Vb Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 16 Crestwood Subdivision Comments: Affadavit Attached: (') Approved: Disapproved: Department Worksheet: Letter Attached: