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Home My WebLink AboutCRESTWOOD LT 23Crestwood Lot 23 015-361 -07 GREA R ANCHORAGE AREA BOR ..dGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~l~'~'~"~/I-O ~-~ LOCATION &/~I~.. SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER _ ATERIAL COMPARTMENTS .- INSIDE WIDTH LIQUID DEPTH ..--/ LIQUID CAPACIT~LLONS. TILE DRAIN FIELD: ~..~/, DISTANCE FROM WELL FOUNDATION ~"~ /NEAREST LOT LINE ~_~O¢,~L_ TOTAL LENGTH~oF LINES NUMBER OF LINES [ DISTANCE BETWEEN LINES /~/// TRENCH WIDTH~---~. TOTAL EFFECTIVE ABSORPTION AREA ~ ~ SQ. FT. LENGTH OF EACH LINE /~- ~ ~ F DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE~, SEWER LINE__, TANK__, SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: f INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: ~ REMARKS: "?(~' ~ /a~ ..~ DIAGRAM,,_.../_ C~F,, S, YSTEM 0 , Form EQ-032 PERMIT NO. RF'PL I CRNT LOE:RT I ON LEGRL f-liJ[-~ I C: Iv'RE I T'"T" C"F R f'~C:F...~.:" Y-. R"3 E / ~ I '~¢ D,EF'RF.:TMENT OF HERE'TH RND EN',,,'IRONf'IENTRL F'ROTEC:TION '~,~''~~ ,:,~._'~ '"L'" STREET., 279-251j.ANCHC'RRGE' AK. 99501 /~.O~ ' ' / '.~'~,;,~ FOREMOST HOMES 2522: ERCICIK DR ~::64~~ ST [_23: CRESTNOOD SUBD LOT S ZZE 40E~E~O SQURRE FEET 'T'gF'E OF SCIIL RBSORBTION SYSTEM IS: TRENCH MRXIMUH NUMBER OF BEDROOMS = 4 SO I L. RRT I NG ,:: SL.] FT,?BR ::, = ±25 ]'HE REQUIRED, SIZE OF' THE SOIL RBSORPTION S'¢S'TEM IS: [:, E F' T H = :5: L. E [-~ ~'S -l'- H = ~; _:J: ~S F-: R '-.." E L [:, E: F' T H = 4 THE LENGTH DIMENSION IS THE LENGTH ,:: IN FEET) OF THE TRENCH OF.'. DF.'.RINFIELD,. THE DEPTH OF R TRENCH OR PIT IS THE DIS'TRNCE BETWEEN THE SURF8CE OF THE GROUN[:, RND THE BOTTOM OF THE EXCRVRTION ,:: IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GF.'.RVEL DEPTH IS THE MINIMUM [:,EPTH OF GRR',,,'EL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (:IN FEET::,. F: E ~_c:.~ L.I :[ F-: E [:, S E F' '1- I C: -f R ~-~ ~=:: :S I Z E =-.-=- ±. ;: 5 ¢£'~ ~3 R L l.... C~ ~-~ :_::-; -1- L-~ E], ,:: 2 ::, I ~-~ ':-~ F' E C: -'l" ICI I'-,~ S R F-: E; F-: E ~;~- I_l ][ F-' E L::, BRCKFILLING OF RN'9 S'¢STEM WITHOUT FINRL. INSPECTION RND RPPRO',,,'RL. B'¢ THIS [:,EF'RRTMENT [,JILL BE SUBJECT TO PROSECUTION. I'"IINII'dLIH DISTRNC:E BETWEEN R WELL RND RN'9 ON-SITE SEWRGE DISPOSRL S'gSTEM IS i. O0 FEE]" FOR R PRIVRTE WELL OR 200 FEET FOR R PUBLIC: WELL SPEC:IF ICRT IONS AND CONSTRUCTION DIRGRRr,IS ARE RVRI[_RBL. E TO INSLIRE PROPER I NSTALLRT I ON. F' E ~-': ~",1 I 'T '-,-" R L I [:, F' i'-i ~.." IZI [-~ E %-" E R F-.' F F-: C~ [,'1 I :S S L! E I CERTIF'¢ THRT ±: I RM FRMIL. IF~R WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLIT¥ OF FtNCHORRGE ;-2: I I.,.IILL INSTFIL. L THE S'¢STEM IN RCCORD8NCE WITH THE CODES. 3.: I LINDERSTRND THRT THE ON-SITE SEWER S'¢STEM f'lFI'¢ REQUIRE ENLRRGEMENT IF THE F.'.ESI[:,ENCE IS REMODELED TO INCLUDE MORE THRN 4. BE[:,ROOMS. S I GNE[:': .......................................................... RF'PLIC:RNT FOREMOST HOMES I SSLIE:[:, BY DRTE ............................. GREATER ANChORAgE AREA BOROUGH DEPARTMENT OF' ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT pE.M,TN27 5 SEEPAGE PIT TO BE INSTALLED BY DRAIN FIELD . OTHER .~ ~~ NOTE:: THIS PERMIT IS NOT VALIO WITHOUT ~OIL TEST INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS / ~ ~'~ COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE / 25''"~ TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS I FOUNDATION TO SEPTIC TANK _~ FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO ~~/~ALL SEPTIC TANK , SEEPAGE PIT ., DRAIN FIELD TO NEAREST LOT LINE. DRAIN FIELD · ALSO CONSIDER AREA WELLS. I WATER MAIN TO SEPTIC TANK / ~'~ . SEEPAGE PiT DRAIN FIELD SEPTIC TANK, / O0 . SEEPAGE Pit ~(~ , DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRiB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF (~REATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. FORM NO. EQ-01 6 Performed For leaal Qescrintion: Lot 23 Block This rorm Renorts Soils Loq "One ~s~ (s w~ a ~h~sand op~nlons" 2204 C~v~and ~nchor~, ~askn 99503 Foremost Homes Date Performed Subdivision Crestwood yes 5/23/77 Percolation Test nenth Feet Soil Characteristics b" ~at & b~ Reddish ~iit Silty Sand 6 8 Sandy Gravel 10-- ~2~~round water level 14--. 16 18, Bottom of Test Hole 2O I 1 I I Was Ground Water Encountered? yes I~ Yes, At what Denth? - 12 feet fReadinq Date Gross Time Net Time Depth to H20 Net Dron I ' ' I-- ' Percolation Rate )linute Proposed Installation: Seenaae Pit Drain Field Deoth of Inlet Depth To Bottom Of Pit Or Trench Cm~ENTS' i25 Square Feet drainaqe a~ea required per bedroom ~ro~ 3.5 tO 12 ~e~ ~ Test Performed 8y Davi~ Paul ~ -- Date: 5/23/77 LAB' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 23; Crestwood Subdivision Expiration Date: Location (site address) 9551 Brien St. Current Property owner(s) Citibank Mailing address Day phone Lending agency Mailing address Day phone Real Estate Agent Mailing Address Katherine Donahue / Prudential Day phone 244-6939 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems 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. (Certificates may be reissued for a period of up to one year with valid water samples.) 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. 4, 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 s & s Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. Phone 694-2979 Date bedrooms, with the following stipulations: WATER AND PROGRAM · · ..... ' By: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ?('~'J Date completed Total depth II q ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to { [~"[ ft. Parcel ID:(~ / .¢'- ~ (~/- o 7 Well Log (Y/N)... y Wires properly protected (Y/N) Casing height (above ground) /9 in.'~ FROM WELL LOG / Date of test Static water level '~'~ ft. Well production ~/O g.p.m. AT INSPECTION WATER SAMPLE RESULTS: Coliform tJ~-.~ colonies/100 mL Arsenic: ~ mg/I Nitrate L/,~ mg/L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~['} ~t~3 [q$5/~ p lrl'~ Tank size I"z.5--o gal. Number of Compartments "L Foundation cleanout (Y/N) ~ Date of pumping (~/'z,'S// I C. ABSORPTION FIELD DATA Date installed [/~/'~'~ Length Jo '~ ft. Total depth ~ ft. Depression over tank (Y/N) Pumper //t~ Soil rating (g.p.d./ft2 Width ft. Date of adequacy test Fluid depth in absorption field before test Other bacteria ~ colonies/100 m L Collected by: '"~ j,e./ "~,/~ Elapsed Time: ['7,~D min. Date installed Cleanouts (Y/N) High water alarm (Y/N) I System type ~'-¢~ c. ~ Gravel below pipe /"/ Eft. absorption area ~"0~ ft2 Monitoring tube ~.~ Depression over field ~/~-~/lo Results(Pass/Fail)~tS<) For /'/ bedrooms Final fluid depth ~ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) in. Water added~l~ gal. New depth l ~ in. Absorption rate >= ~ (30 g.p.d. If yes, give date .... Date installed / Size in gallons __ "Pump on" level at ~ level at~ in. .~_~~~ Cycles tested E. SEPARATION DISTANCES ~...-k4s~h,:,;~iA¢ces s (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot /'~0 Public sewer main / Sewer/septic service line Animal containment areas On adjacent lots /00 ~¥' On adjacent lots / 0 0 ' + Public sewer manhole/cleanout Holding tank ,,4,///cF Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~,--I.( Property line ~ ~ Water main (O ~ Water service line tO l.~ Wells on adjacent lots /~)d LI Absorption field ,~' 3" c/ Surface water /o~ ~' Property line Water Service line ( 0.(f Curtain drain (4o'~,e.. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~'O Surface water I~3o Wells on adjacent lots Water main / 0 (+ Driveway, parkingNehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION review of Municipal records that )~he above syst.~nl~ are/in conform~nce with MOA CQS g~/lines/h~ct fn ~is da~. Engineers Printed.Namf~ Date -- COSA Fee $ J"~~~'"// Waiver Fee $ Date of Payment ~'~ Date of Payment Receipt Number /~ q ~'~) Receipt Number (Rev. 11/05) SGS Ref.# 1102847001 Client Name S & S Engineering Printed Date/Time 06/29/2010 17:24 ProjeetName/# Lot2$ Crestwood S/D Collected Date/Time 06/21/2010 15:00 Client Sample ID Lot 23 Crestwood S/D Received Date/Time 06/21/2010 15:$0 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 170 5.00 mg/L SM20 2340B C 06/23/10 06/29/10 KDC Waters Department Total Nitrate/Nitrite-N 4.00 0.100 mg/L SM20 4500NO3-F B 06/24/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 06/21/10 DLC Ne~zative I 100mL SM20 9223B A 06/21/10 DLC Total Coliform Private Individual Analysis Alkalinity 118 10.0 mg/L SM20 2320B D 06/21/10 LP Aluminum ND 20.0 ug/L EP200.8 C 06/23/10 06/29/10 KDC Antimony ND 1.00 ug/L EP200.8 C (<6) 06/23/10 06/29/10 KDC Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/23/10 06/29/10 KDC Barium 10.8 3.00 ug/L EP200.8 C (<2000) 06/23/10 06/29/10 KDC Cadmium ND 0.500 ug/L EP200.8 C (<5) 06/23/10 06/29/10 KDC Calcium 51300 500 ug/L EP200.8 C 06/23/10 06/29/10 KDC Chloride 25.0 0.100 mg/L EPA 300.0 D (<250) 06/24/10 06/24/10 SDP Chromium ND 2.00 ug/L EP200.8 C (<100) 06/23/10 06/29/10 KDC CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 06/21/10 LP Conductivity 384 1.00 umhos/cm SM20 2510B D 06/22/10 LP Copper 97.6 1.00 ug/L EP200.8 C (<1300) 06/23/10 06/29/10 KDC Fluoride ND 0.100 mg/L EPA 300.0 D (<2) 06/24/10 06/24/10 SDP HCO3 Alkalinity 118 10.0 mg/L SM20 2320B D 06/21/10 LP Iron 652 * 250 ug/L EP200.8 C (<300) 06/23/10 06/29/10 KDC SGS Ref.# 1102847001 Client Name S & S Engineering Printed Date/Time 06/29/2010 17:24 Project Name/# Lot 23 Crestwood S/D Collected Date/Time 06/21/2010 15:00 Client Sample ID Lot 23 Crestwood S/D Received Date/Time 06/21/2010 15:50 Matrix Drinking Water Technical Director Stei}hen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Private Individual Analysis Lead 0.330 0.200 ug/L EP200.8 C (<15) 06/23/10 06/29/10 KDC Magnesium 10000 50.0 ug/L EP200.8 C 06/23/10 06/29/10 KDC Manganese 1260 * 1.00 ug/L EP200.8 C (<50) 06/23/10 06/29/10 KDC Nickel 5.45 2.00 ug/L EP200.8 C (<100) 06/23/10 06/29/10 KDC OH Alkalinity ND 10.0 mg/L SM20 2320B D 06/21/10 LP pH 7.80 0.100 pH units SM204500-H B D (6.5-8.5) 06/21/10 LP Selenium ND 5.00 ug/L EP200.8 C (<50) 06/23/10 06/29/10 KDC Silver ND 1.00 ug/L EP200.8 C (<100) 06/23/10 06/29/10 KDC Sodium 3400 500 ug/L EP200.8 C (<250000) 06/23/10 06/29/10 KDC Sulfate 18.2 0.100 mg/L EPA 300.0 D (<250) 06/24/10 06/24/10 SDP Thallium ND 1.00 ug/L EP200.8 C (<2) 06/23/10 06/29/10 KDC Total Dissolved Solids 235 10.0 mg/L SM20 2540C D (<500) 06/23/10 JJR Zinc 656 5.00 ug/L EP200.8 C (<5000) 06/23/10 06/29/10 KDC JUL-O 1 -2010 04 : 58 PM I)ONOHUE 909 ~46 4610 ...... ..... ~ ....L;,: ........ LI.;, ,,,~i,;,.,,, ................. : .... P. 0 1 F ~ls ~s-lmllt s#ell not any purpose other than financing requl~emen~s. Under no elrcupstanoal Should any data hereon be used for oons~ruotioe or for EASEMENTS OF REOORD, OTHER THAN "' :' :" Il'IdS; SHOWN ON THE RECORDED .L~T ARE ,OT SHOW, HE.~O.. ~£';'Z'/ ? ZO AS. BUILT NO OOFINE, RS SET THiS DATE X bez'et~ e.e~t,~ that ! have st~e~flon o! the ~oXtow"~ng des~t4b~t ~I;~-~Y: - ' .... MUNICIPALITY OF ANCHORAGE ~i~ 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 I.D. HAA# ~~ GENERAL INFORMATION Complete legal description Lot 23; Cr~(~o'd:$~zb'.~d~qi4io~ Location (site address or directions) 9551 8¢i~ St, Anchoc~zq~t A~z~laz Property owner L.ou. ~, N~,,~ F£ctch~.~, Day phone $46-2775 Mailing address 9551 Lending agency Ncca~on~t. 8oink o{ A~z~/~ Day phone Mailing address St, f~: D;.5/~ E~nd Agent St~v~ Sct~/~'~ / S~t/..~.~ R~.z~ E~.~ Day phone 278-1000~k 278-3367hm Unless othe~ise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ×XX Holding tank Community on-site Public sewer 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 Address $ & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional Phone Date ~-~_~,~ 5 bedrooms. approval for bedrooms, with the following stipulations: Additional Comments Date 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 MOA #21 ' ~--~..~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~:3'T ~,..~/ ~-7'PP'd4/~) ~ Parcel I.D. A. WELL DATA Well type Log present Total depth Sanitary seal ~N) If A, B, or C, attach ADEC letter. ~/~$ Date completed I I~,c~' Cased to ~/,~---~ Wires properly protected {~N) ADEC water system number ~_c~/,~. /~/' Driller .~/~O..7/d. Casing height Date of test Static water level Well flow Pump level FROM WELL LOG ¢ lO SEPARATION DISTANCES FROM WELL TO: Septic/hotdh~ tank on lot f Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION~ ~ ; On adjacent lots /00 ~ ; On adjacent lots /0~ '~ Public sewer manhole/cleanout /~J/~ Petroleum tank ~J(Y~ /~/A.)~COp, J WATER SAMPLE RESULTS: Coliform (~) Nitrate / Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~3 - ~-~'~' Tank size ja~0 Compartments ~' Cleanouts (~N) ~> High water, alarm (Y/I~ Date Of pu~ping Foundation cleanout (Y/~j~ ~) Depression (Y/~ /~J0 ~-J//~ Alarm tested (Y/~) ' /~J/~ F"~-A'~- --~ ~-- Pumper SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot ,/~ ~ ~'f On adjacent lots To property line ~i~ ~'/' Absorption field __ Surface water/drainage /~)/~' Foundation .Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIF? STATION /~/~ ~ Date~ Manufacturer ~ Size in gallons ""---. _ Manhole/Accees~~/N) ~ Vent(Y/N) "P~ ~'~ "'Pu~;off" level at High water alarm level ~.--'/ ~ Cycles tested ~ ~_ ~f~t : On adjacent lots Surface water "---.~. D. ABSORPTION FIELD DATA Date installed ~- ~- ~:~ Soil rating ~ ~c.~ S F//,~dl System type J-~P Length · . ~'z'~/ Width Gravel thickness f"/ Total depth · Totai:abso~pfion area COOH ~ Cleanouts present (~N) ~,.~ Depressior~ ~/er field (Y/~ j~u Date of adequacy test I~-~- Resui{~ (pa~/fail) ~,z}5'~ for ~ bedrooms Peroxide treatment (past 12 months)(Y/~D ~J03' ,~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot !,~//c On adjacent lots /~) ~ Property line · /~) To existing or abandoned system on lot To building foundation On adjacent lots ~O' Surface water Curtain drain / Cutbank /~,//~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on S & S ENGINEERING 17034 Eagle River Leep Read No. 204 Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number ,n Lha ~laZe of this inspection. CHEMICAL & GEOLOGICAL LABORATORY A OIViSION OF COMMERCIAL TESTING & IENGI~JEERING CO. -.---,_-~_--_~%- -_..-_.-._~-----_2.'~2_..--2~'.-::T,.'7,:*-;~' ...... :-:~,-,:--T-, 'T'7 ....... .-L:'V.,:. .5633 B STREET ANCHOIqAGE. AL/~SKA 99518 TELEPHONE (G07) 56.2-2343 FAX: (907} 6G1-5301 : " See ~a~ple · D · Secondary d~lutto~. ~"~SQ~ M~mber o' ,he GO~ Group (~c,6,, fl,n,ra,e d~ Su~el~lance) #1: Time Date Insp MUNICIPALITY OF ANCHOR~ DEPARTMEL..~OF HEALTH AND ENVIRONMEN~._~ 825 L Street, Anchorage. Alaska 264-4720 Date Received: 1:30 p.m. #2: Time 9-2~k-77 ~a~ Date ~,~/~ Insp PROTECTION 99501 September 20, 1977 #3: Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Pacific Bank Mailing Address: 601 West 5th Avenue 99501 Phone: 276-3110 Property Owner: Mai~ing Address: Howard Smith/Foremost Services 2523 Brooke Drive Phone: 278-3644 3. Legal Description: Lot 23 Crestwood Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System: Permit # Individual Well (x) Community/Public System ( ) Depth of Well 114'6%" Well Log on File Construction Bacterial Analysis Sewage Disposal System: Permit # 77331 Septic Tank Size Absorption Area On-site System ( ) Public Utility ( ) Installed 1977 Installer Manufacturer Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area tO Nearest Lot Line Page TWo Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 23 Crestwood Subdivision Comments: Affadavit Attached: Approved: ~_~ C - Disapproved: Letter Attached: ( ) Date: Department Worksheet: ,,.,~UNICIPALIT,Y OF ANCHORAGE DEPAR, TMENT OF HEALTH AI~D EN~/~RONMENTAL PROTECTI~'I~ 2~0~East Tudor Road, Anchorage, Alaska 99504 276-2221 ,/~'-I~"U£ST FOR APPROVAL OF Type of Inspection: CMRO_ VA_ .FHA_ Property Owner: Howard Smith DBA; ~o~emost Se~ices Mailing Address: ~-,~ B~ooke D~. Day Phone: Name gf Buyer: Mailing Address:~ Day Phone: Name of Lending Institution: ~~.~ MaiJ~ng Address:~ ~O~ Name of Realtor or Agent: Mailing Address :_ o_?_2_Lk_ ', 6.. Legal Description:~~..,' LOcation: Phone: 7, Type of Facility to be Inspected: ., Water Supply xzcx:x:x~ ~/.,' ' If Individual, depth of well_ · Sewage Disposal System Type of Supply: Public Utility. If Individual, number of dwellings presently served Type of System: Public Utility If Individual, date of installation 6-flQ-?9 No. Bdrms. _-~ Individual r? Individual (on-site) xxx3cx::x~_ ,, Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2B -., Anchorage ~ Alaska 99504 Phone (907) 337-6179 .-. Fax (907) 338.3246 January 2, 1999 Wood & Sons Contracting Atto: Jason Wood 1623 Early View Drive Anchorage, AK 99504 tCmv$o JAN 16199 De t ttCtpal~t ~. REFERENCE: Lot 24; Clearview Sulxh'vision. Recirculating Upflow Filter Dear Mr. Wood, During recent samples of the subject RUF system, it was noted that the upflow filter was not full. In each case, after activation of the discharge pump, it took 2-5 minutes before effluent was discharged into the sample port. This is an indication that the upflow tank is leaking. It is assumed that the leak is at one of the inlet bungs, probably the one that was supposed to he fitted with a threaded plug. It is probable that the majority of the trickling filter effluent does not make it through the upflow and to the drainfield. This Problem needs to he corrected as soon as poss~le. Based on our recent conve~ sation, it is my understanding that you plan to do the repair in the spring of 1999. Plea~ t°tify us when the work is completed. cc Bob McManus MOA, DHHS