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Home My WebLink AboutCRESTWOOD LT 13 Municipality of Anchorage Department of aea~th and Human Services Division of Environmental Services On-Site Sep~ices Section 825"L" Street Room 502 P.O. l~ox 196650 Anchorage, AK 99519-6650 Page of wvcw.cLanchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ Permit Number: SW0001.~4 PID Number: 01.5-361-05 Ms. Ma ieBixton ~ [] New [] Upgrade 6000 Bart Slreet ABSORPTION FIELD LEGAL DESCRIPTION aD, R~u.,: *o~, D.~ f,om o.~.~, ~: ~o,: su~,~o,: 0.45 ~a~ 11.5 ~. ~3 Crestwood 5.3 Ft. 6.5 ~ 0 ~,. 80 Well: ~ New ~ Upgrade ~.~.m~i.~: Numberoflines: ~'~ ., 1040 Ft' f810/3034 ~, TANK SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.p. ~ Other: T~ Septic Absorption LJ~ HoldJRg Public/Privet< Manufacturer: Capaci~: Tank Field Station Tank Sewer Line Existing [000~.~. w~m~ 103 110 n/a 90 Material: Number o, Compad~ents: .... steel 2 s..~.~w~ 100+ 100+ ~ ~ LIFT STATION ~ Founda.on 20 12 *.~, o.",.v.,~,: -- "PU~. off' level at: ~ralarmab CudainO~ai, 100+ 100+ / NPumpMake&M~em ia P ' spe~ormaby: in. BENCH MARK Front Door Threshold 100.0 Engineer's Stamp ~nspections pe~ormed by: Pannone En . Svc Dates: 1~t6/8/2000 ~ ~/ 4;~, ~ 2n~ ~,,,,,r ....................... ;~,,.,,p ~ D 06/08/2000 ~ epa~ment of Health and Human Se~ices approval . ..... ~., ,.~ *~.~Steven R. Po,,nor~e~.~ Reviewed and approved by: ~ ~, ~ Date: ~ / ~- O' ~ ~, ,,,o. C~8149 PERMIT ND, ~;~V000134 S- BUILT ;DETAILS WASTEWATER aJ~SE1RPTZFIN LOT 13 CRESTWDO]) P,I,D, NDI 015-361-05 L~ C'\~/ork\DRA~/ING\13cr es:cwood,])WG PREPARED Ms, Moggle ~lx~on GO00 ~rry Anchor~ge~ AK 99516 (907) 346-2810 PANNDNE ENG, SVC,, LLC P, 0, 3DX 10~954 ANCHORAGE, ALASKA 99510 272-8218 PHDNE & FAX DESIGN PERMIT NO, S;~/000134 AS-~BUILT P.~.~. ND, 015-3~,~-05 ~/A~TE~/ATER AB~DRPTI~N ~Y~TEM LOT 13 CRE~T~OOD / EXI~T'G / ~ELL~ / E~ / ~ST~G ~ ~ ~ ~EL ~ / ~T~R X,VAL V~/ ~ ...... GRITY ........ ~ ~ FIELD~ IN FAILUR ~. EXI~T'G FLD~ ~PLITTE ~ ~ELL REPLACEMENT SY~TEW TRENCHES~ 40LFx3'x6,5' ............. '~ X'I~T.' C ~ork~DRAWIN 13Cres~woo~,OWG c3 c~ ~.~ ~,~ A~-~UILT~ ~ --~ ~ '~ DEEP TRENCH, 6.5' EFF, ..~ .... TDTAL DEPTH = 18' 80' LONG,TOTAL AREA=IO4Q ~F ~~~ ....~ Ms. M~OOl~ a~x~o~ P, O. BOX 10895~ 6000 ~arry ~e~-~6~O.....'~ ANCHORAGE, ALASKA 99510 .~ .. ...............%. ~ Amchoroge, AK 99516 -S~~e~ (907) 34S-se10 878-8818 Phone g F~x ]ATEI 6-10-00 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99549-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 30, 2000 Expiration Date: May 30, 2001 Permit Number: SW000134 Legal Description: CRESTWOOD LT 13 Design Engineer: 0062 Pannone Engineering Services Owner Name: Maggie Bixton Owner Address: 6000 Berry St. Anchorage, AK 99516-6444 Parcel ID: 015-361-05 Site Address: 006000 BARRY AVE 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 ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Total depth of absorption field must not be more than 12' Date: Date: Pannone Engineering Sew&es, LLC Consulting Engineers (907) 227-3522 May 29, 2000 EO. Bo~ 102954 Anchorage, Alaska, 99510 (907)272-8218 Fax Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 13, 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 89 inches of liquid in an 84 inch deep system. A single test hole was excavated on May 22, 2000 for a potentall 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 13 slopes to the west at a rate of approximately 1 to 2 percent. The proposed installation will be located in the 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 service 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 272-8218 or 227-3522 if you have any ,,~;~ v:....%402 Sincerely, ~ ~..-' /t ".~ '~ ne, P.E. nnone~ ~ ~.~.. No. CE 8149 Attachments: **i ¢~-....~ ~.....'~ C:~WORK~L~ERS~ 13 CRESTWEOOD.O01.DOC PERMIT DESIGN NB, om-36 -o5 WASTEWATER ABSORPTIE]N SYSTEM LOT 13 CRESTWE]OD EXI~T'G / ~ i ,. / '..~ / \ WELL-1 ? \ i , / ~ , E~ST G '\L EXIST' ........ ! ;;:~;:~ ~':~ '; ~ 7,.-~' ~ ........ .... ............................ / / ~ ~ FER "..VA L VD~ x / EXIS BARR ST FIELD, IN FAILURE--~ FLOW SPLITTE PROPOSED REPLACEMENT P TRENCHES, 36LFx35 : ~.~;_~]: .y : :~:,'~':.; PREPARED FOR~ ~O~OPl~ggle BIx~on 9~rry S%ree% Anchorage, AK 99516 (907) 346-2210 EXIST'G ',yELL] / / ] 3B~ HE]USE DESIGNI 3 BEDROOM HOUSE PERC RATE 45 MIN/IN ~OIL RATING[ 333 1000 ~F RQD DEEP TRENCH, 7' EFF, TOTAL DEPTH = 78' LONG,TOTAL AREA=lO08 IPANNONE ENG, SVC,LLC P, 0, BOX 108954 ANCHORAGE, ALASKA 99510 878-8818 Phone 8, F6x ~ DESIGN PERMIT ND, DESIGN ]DETAILS WASTE~/ATER A]~SDRPTIDN SYSTEM LOT 13 CRESTWOOD S,D P,I,D, ND, 015-361-05 C'\Womk\DRA~/ING\13crestwoooLDWG PREPARED FOR~ Ms. Maggie Bix~on 6000 B~ppy S~pee~ Anchorage, AK 99516 (907) 346-2210 PANNONE ENG, SVC,, LLC P, O, BOX 108954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX DATE: 5-25-00 NOT TD SCALE DESIGN SOILS LOG - PERCOLATION TF.,S'P PANNONE ENGINEERING SERVICES, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 (907} 272-8218 PERFORMED FOR: Ms Mag~e B/xton LEGAL DESCRIPTION: Lot 13 Crestwood S/D SLOPE Organic- OR Topsoil ML Brown Silts Brown Silty Gravels GM-GP to Poorly Graded Silty Sired and Gravels GP BOH 'rF, ST HOLE DATE PERFORMED: 5-22-00 Sandy Gravel W/Cobble~ srrp~ PL~ !~ELL- 3BR HOUSE WELL1 WAS GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTH? .... DEPTH TO WATER AFTER MONITORING? D.ry DATE: 5-2g-00 TEST HOLE X DEPI'H OF NET WATER DROP 5 5/16' 11/16' 6 1/4' .... S 9/16' 11/16' 5 5/15' 11/16' PEROLATION RATE 45 (mln,/inch) PERC HOLE DIAMETER 5 inches TEST RUN BEWTEEN 7 FT and 8 FT COMMENTS: Test hole excavated by Carl's Excavating. Test Hole was presoaked before perc test. PERFORMED BY: Steven R. Pannon% 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. GRE~__R ANCHORAGE AREA BOR~ SH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL/~ INSIDE LENGTH MANUFACTURER ~/~ ~'1 INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF LIQUID CAPACITY/~'~g'~ GALLONS. T,! LE DR.~,!.~! DISTANCE FROM WELL4 '.~ FOUNDATION LINES t DISTANCE BETWEEN LINES NUMBER OF ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LE N G T H,.~,~ NEAREST LOT LINE ~:~X'~/'T-~ OF LINES - F'~' TRENCH WIDTH~.~_- IN. TOTAL EFFECTIVE SQ. FT, LENGTH OF EACH LINE DEPTH OF FILTER '///~/ MATERIAL BENEATH TILE ,..~ -~ FY- "7F/ IN. ABOVE TILE IN. WELL: CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST FOUNDATION___ LOT LINE_ NEAREST SEWER LINE__ SEPTIC-- ~ f SEEPAGE TANK /~' , SYSTEM CESSPOOL APPROVED -- OTHER SOURCES DISAPPROVED DISTANCES: 4/~_ ~"'.-/~-"/.,C~-~--~ INSTALLED BY: SEWER LINE DEPTH: PIPE MATE RIAL:/"~£/'/ LOT SLOPE: ~--~ Form LQ-032 PERMIT NO. APPLICANT LOCATION LEGAL l.'li_lN I C I I'-~-AL I 'T'"r' CIF ANISHfz. i~RAm..~E . .. _ ~,~l~ L_~ DEPARTMENT 0F HEALTH AND EN,, ]RONMENTRL PROTECT]ON ~,~ E. TUDOR RD.., RNC:HORRGE., PK. -.~.-,~,' ~,~ _ C~N-c_. [ Ti SIPPER F-ERr-1 [ T FOREMOST S~RV ICES 252~. BROOK DR~ VE ~ ~ ,=,-~.b4.4 CORNER BYEN AND BARRY L~ CRESTN00D S/D LOT SIZE 4~000 SQUARE FEET' TYPE OF SOIL ABSORBTION SYSTEM IS' TRENCH MRXIMLIM NUMBER OF BEDROOMS SOIL RATING '.':SQ FT?BR)= i45 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C, E F'TH= -14 L Ef-~GTH= _--~-2 GRRVEL D, E F'TH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF 7'HE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE: AND THE BOTTOM OF THE EXCAVATION <IN FEET). ~:E~LIIRED SEPTIC T~=Ir-4K SIZE= ieee BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR 8 PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS PRE AVAILABLE TO INSURE PROPER INSTALLATION. F'ER~'I IT %~RLI D, F C~R CINE '-r'ERR FRCI£~ I SSLIE I C:ERT !FY THAT i' I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2' I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I I_INDERSTRND THAT THE ON-SIT, SEWER SYSTEM MAY REQUIRE ENLARGEMENT ~:ESID~~,~~;I~ THAN ~ BEDROOMS. S I GNEB: _-~--/-%/-~-~---~--- ~[ FOREMOST SERVICES I SSLIED ~ ...... [)RTE_ IF THE '"One ~st t~ worth a ~ho~sand opinio~" 2204 Cleveland Anchar~ge, ~laska 9950~ Performed For Foremost Services Date Performed Leaal Qescrintion: Lot 13 Block Subdivision This Form Renorts Soils Loa yes 5/19/76 Crestwoo~ Subdiv~inn Perc0]ati0n Test ~enth Feet Soil Characteristics 2 Topsoil 4 8-- 10 12m 14--. 16 18, 20 Slightly Silty Sandy Gravel (GP-GM) [150] Sand (SP) [125] Slightly Silty Sandy Gravel (GP-GM) [150] Bottom of Test Hole Was Ground Water Encountered? No I~ Yes, At what Denth? IReadinq Date Gross Time Net Time Denth to H20 Net Dron Percolation Rate )linute Proposed Installation: Seenaae Pit Drain Field De~th of Inlet Depth To Bottom Of Pit Or Trench CnM!~ENTS: 145 Sq Ft drainage area required per bedroom. No ground Water or bedrock encountered. Test Performed By Jim Mack Data Certified By:CONSTRUCTION TEST Date: 5/19/76 LAB DEPARTMENT OF HEALTH AND ENVIRONHENTRL PROTECTION 25i0 E. TUDOR RD., ANCHORAGE, AK. 99507 276-222i L4ELL F'EF:P~IT F'ERMIT NO. ,:: 76~40 > RF'Pi_ ! C:FINT FOREMOST SERV_I_CE~ L. OCR'F I ON B~F.: I EN STREET i_EG~L L12-: CRESTWOI--ID SUB[:, _._,.--~ BROOK [:,R LOT SIZE 4~00~3 S(;!LtARE FEET MINIMUM DISTANCE BETWEEN A WELL 8ND ANY ON-SITE SEWAGE DISPOSAL_ icdO FEET FOR A PRIVATE WELL OR 200 FEET FOR R PUBLIC: WELL. NELL LOGS ARE REQUIRED, AN[:, MUST BE RETURNED TO THE DEPARTMENT N!~HIN 30 OF 'THE WELL COMPLETION. 5,PECIFICRTIONS ~ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROF'ER i NS, TALL_AT I ON. F:"EE:f-1 I T k-'AL I C, FOE~ Cmt-JE 'T'ERE: F~:Cmfd I i CERTIFY THAT l' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SE"I FORTH B'T' THE MUNICIPALITY OF ANCHORAGE. 2' I WIL, L IN~TRLL.~HE S~EM !N ACCORDANCE RPPL I CANT FOREMOST _ ER~ I CE_, NITH THE CODES. # (' >",-' - T wr ? Municipality of Anchorage Department of Health and Human Services Division of Environmental Services OmSite Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchora9e' AK 99519-6650 www. ci.anchorace, ak. us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-361-05 1. GENERAL INFORMATION Complete legal description Lot 13 Crestwood S/D Location (site address or directions) 6000 Barry Street Current Property owner(s) Ms/Maq,qie Brixton Mailing address Lending agency Mailing addres~ Expiration Date: Day phone 346-2210 6000 Barry Street, Anchorage, AK 99516 Day phone Real Estate Agent Mailing Address Day phone Un~ssothe~ise~ques~ HAA willbeheMbyDHHSgrp~k~,HAAp~ked ~ by: 2. NUMBER OF BEDROO~S: .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 [] E~ 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 uoon the represeetations given in ,~,=g,,=ph t~rr°ft~.,s; ~r~ca, lst~V'o?~tl~ ~ ~ ~',Stered in the State of,Alaska· Certificates of Heaith Authority Aporo,/a em meuimd disposal and/or water surely system DHHS also issues HAAs uoon reques~ to home owners Certificates o~ · , ,excac~ oe[weer!,s~ouses~ on properties served by a sinole family on-site ',:¢as~e',,'¢ater Health ,~,u~hor ty Approval are ' ' ·vaha for 90 days from the date ~'f i%ue for '*rope,-? well and may be reissued w~th new water sample results less than 30 days ~ _- ur ,~s C ' ' , o,,.. Certificates are '/slid ,er cna ',,ear 7or propertie~ sap/ed o',/ Class A or B wails or e oubfic wa[er system The Municiealitv or 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 Guidelines 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 on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En.q. Svc. Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. DHHS SIGNATURE ~ Approved for "~ Disapproved. Conditional approval for bedrooms. Phone 272-8218 Date 6/10/2000 bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow AdvisoW Expiration Date: X Maintenance Agreements Supplemental Engineer's Report Other Original Ce,,lificata Date: ~ - / ~ - O o :.,eJssue Date: 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 MUNIO~-,~, HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA WeU type PRIVATE. Date completed 12/1/1976 Total depth 103 ft- Date of test Static water level Well production 10+ WATER SAMPLE RESULTS: Coliform --C.~ colonies/100 mi Date of sample: 61912000 SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL LOT 13 CRESTVVOOD S/D IfA, B, or C provide PWSID # Sanitary seal _Y Cased to 103 ft FROM WELL LOG 1211/1976 45 ft g.p.m Parcel I.D.: 015-361-05 Nitrate ~' L~ mg/I Collected by: S.R~PANNONE Well Log Y Wires properly protected _Y Casing height (above ground) 15 in. AT INSPECTION 6/11/2000 ~ ~'~'~ ft 6+ g.p.m Date installed 6/15/1976 Tanksize Cleanouts _Y Foundation cleanout _Y Date of pumping 61812000 Pumper Northland ABSORPTION FIELD DATA Date installed 6~8~2000 Sail rating (g.p.d./ft2 or ft2/bdrm) 333 Length 80 ft Width 3 ff 1000 gal Depression over tank _N Other bacteria '--' ~ "~lonies/100 mi Total depth 11.5 fl Effective absorption area 1040 ft2 Date of adequacy test 6/8/2000 Results (Pass/Fail) PASS Fluid depth in absorption field before test NEW in Water added Elapsed Time: _ rain Final fluid depth __ in Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO (Rev. 11/99) Number of Compartments _2 Hig~ water alarm N/A System type DT Gravel belowpipe 6.5 ft Depression over field N Monitoring tube _.Y For 3 bedrooms gal. New depth.__ Absorption rate >=__ If yes, give date in. g.p.d. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) L 13 C_REST~'oob 5/~ S lUC TI2 N. R 3~,v' Location (address or directions) ( ooo , (b) Property owner JoL/tYNE /~L/~ C~u~$ T Mailing Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent ~'O~,Tu~E Address 3000 t~ ~ t~t'IcFI I~K Telephone ,5'~ 2 - 7(o ~3 Telephone' (home) 3z/'(o'3~)o¥ Business Telephone (e) Mail the HAA to the following address: (or check here ~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'J~, Number of bedrooms 3. WATER SUPPLY Individual Well'~ Community [] Public [] Note: If. community.well system., must have written .confirmation from the State Depa~ment of Environmental · COnservatiOn attesting to th legality and statUs. 4. SEWAGE DISPOSAL On-site'l~' 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. 72-o25 (Rev. 7/88) Page I of 2 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 investigatiun of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional.and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ]~/~ 'rTo ~' TE(::: H. 5u'c_ $, Telephone ~ zJ,5' -/,.~ .5.5' Date Seal 6. DHHS APPROVAL Approved for ~.~" .._bedrooms by Approve Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 A. ~:LL DATA Well Classification F'l~l v Well Log Present (Y/N) ¥ Total Depth I r~3' Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 105' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '71oo ' To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: L 13 C,.~-STV/oo b $ tD If A, B, C, D.E.C. Approved (Y/N) Date Completed 1:2./1 /7(~ Yield (~.°1 ~?1~ Ple4~ !o_g' Depth of Grouting N,/t, Pump Set At ~3 ,2, t" Sanitary Seal on Casing (Y/N) ~' Depression Around Wellhead (Y/N) 1~ ; On Adjoining Lots ~,/oo 12 8 ' -to ¢.O, ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~/15/7(,, Size Standpipes (Y/N) ~ Depression over Tank (Y/N) Iooo G No. of Compartments Air-tight Caps (Y/N) )/ Foundation Cleanout (Y/N) y Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ~ ./~, ; for Holding Tank High-Water Alarm (Y/N) ~t./~. Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building FOundation I~' fg~ C.o. To Disposal Field 2~/' C.o. To. C.o. t To Water-Supply Well J C) $ To Property Line 53 ~ F,eo~ C.o, To Water Main/Service Line "~ &O' To Stream, Pond, Lake or Major Drainage Course '~/0o ' Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field '~ ¢o" Square Feet of Absortion Area q$$ ~' Depression over Field (Y/N) Results of Last Adequacy Test [=/I-$$Eb FoR SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 12. 8' ~-~o ~ To Building Foundation 3'?' F~'o~ C.o . Lot t4 ,/~,. To Water Main/Service Line ~ I~o ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area //B~I~ t~ Type of System Design Length of Field ~- ' Depth of Field Gravel Bed Thickness m, sP.¢i~¢P. Statndpipes Present (Y/N) Date of Last Adequacy Test · On Adjoining Lots ;~ ! O o To Cutback (if present) 7/oo To Property Line To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons · "Pump On" Level at High Water Alarm Level at - Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA g~[e~e~ji~.effect on the date of this inspection. ,.-~'g 07. ~"-~1~ Company Fl~p Te~¢;~d ~¢~ -.~'. /' '"'"~ ,.., ' ~'-- ~v ................ 1...~ Enmneer's Seal MOA No. ~ -01~ ~ ..... %'~;i:3~o~.:~ r. ,u, oc,~a .. N Receipt No. ~ ~3~5/~/ ~ ~ ~ Receipt No. '~'''-- / Amount:$ /2 ~ ~ C 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEP^.TME.T OF .E^LT. .UMA. SE.V, CES D,V,S,O. OF E.V, RO.ME.TAL SERV,CES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner //~] ~'~_ Telephone: Home Mailing Address ~-~--~ ~ ~. ~ (c) Lending Institution C'~,~ F',Y' Mailing Address '//~5 ixJ, ..~/..~ (d) Real Estate Company and Agent Address ~,z/~ /-/,g,CT'Z'~'/_.~ ,~Z'=/ .-~"'~//'z~,~Z~//~'; Telephone __~/~/-43 ~O I (e) Mail the HAA to the followin~ address: or: Check here ~, if hold for pick up. List contact person and day phone number below. gA&l_ .]"oh~ l'~/[~F'/~,.l d~ ~/~'?' /')'/~,~7-~..~'~'~ .,~'Z:~.~ Business Telephone TYPE OF RESIDENCE Single-Family ~ Number of Bedroom~ WATER SUPPLY 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. SEWAGE DISPOSAL Onsite ,~ Public [] Community [] Holding Tank [] f- Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 fRev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~)6"~.$0,,J ~',~x~)~-E3~.,tG Telephone Address ~ ~' EO~ ~ ~0 ~7~ ~0 ~ ~,~ , Date Engineer's Seal DHHS APPROVAL Approved for ~bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date CAUTION The Municipality of Anchorage Department of Health and Human Services tDHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86/Back ,E^'TH AUT,OR'TY AP.ROVAL (.AA) CHECKLIST- FEBRUARY 1984 Legal Description: ~T Well Classification Well Log Present (Y/N) Total Depth /O~5 Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed /2-/- 7~ Yield /~3 Depth of Grouting ~o,~ Pump Set At ~/-~: Sanitary Seal on Casing (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line -=~ Cleanout/Manhole -~ Water Sample Collected by 6¢, /qqC~'A Water Sample Test Results ~ Comments !,~ E"/..L ]$ Depression Around Wellhead (Y/N) ~4 · On Adjoining Lots · On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot · Date ¢4~- _5/- ,~*,r¢ B. SEPTIC/HOLDING TANK DATA Date Installed ~. -1-5'- Standpipes (Y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~' To Property Line ~ Z' To Water Main/Service Line 5'~ ' Course Size /¢O,~ No. of Compartments y Foundation Cleanout (Y/N) Date Last Pumped · for ) Temporary Holding Tank Permit (Y/N) /,//'¢ __ To Building Foundation To Disposal Field Comments To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~-J.-~' 7/-~ Width of Field /9'5 Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /¢'¢,,,v'F_. ,¢/v To Water Main/Service Line //2 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Cam ments Type of System Design Length of Field Depth of Field /4/ Gravel Bed Thickness ? Standpipes Present (Y/N) Date of Last Adequacy Test Y 8 - ,51- To Property Line ..¢¢ ' To Existing or Abandoned System on ; On Adjoining Lots /~¢/ '/' To Cutbank (if present) z/~;,~'~' ..~'~'.~-.,~,, y' Date Installed ~ Dimensions _ Size in Gallons ~ Manhole/Access (Y/N) _ "Pum~ On" Level at ~ "Pump Off" Level at _ High Water Alarm Level at ~ Vent (Y/N) _ Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request ** ~ I certify that I have checked, verified, or conformed to all~4~ O~ and HAA guidelines 'm effect o n'fl"~C.~te of this inspection. Co m pan y/~ ~2~.!;0, Rece,pt .o. OZ5 Date of Payment Amount: $ Page 2 of 2 72-026 (11¢84) MOA No. Engineer's Seal CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SA~fPLE for Work 3~der ~ 893] Dste Report Printed~ SEP 2 88 @ 12:2i PW$1D :UA Collected AUG 31 88 @ 12:00 h~s + Recelve~ AUG 31 88 ~ 3.4:00 hfs P~e~e~ved with :4 DEG. C Client Nams ~CFADDZN. WAYNE Claent Acct : MCF&WC Req ~ Ordered By ~ Analy~ls Completed 'AUG 5end ~epo[ts to: !)~CFA£!DEN. WAYNE Spe,:iAi HOLD ~OR PICK UP AND PAYMENT. Cb,~mlab .%.f {: 2442 Lab Smpi ID: 1 M~trix: WATER Allowable ?az ~m~t ~z ~ste~ ~sult/Ur~ ~ s ~et hod L~mits NITRATE-N ~.~ n n~/1 EPA ~53,2 I0 Ssmple ROUTINE SA14PLE R~ks. SA~[PLE COLLECTED BY W. M ?~ts Performed ' S~e Special ]n~t:u,:tion~ Above UA-Unavai).able None Detected '~ $~s Sampi~ ~emarks Above CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 ? Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ~ PRIVATE WATER SYSTEM Name Phone No. Mailing Address /yA. ~ h~r~7_ ~. 5-¢/-Y'~Z? Zip Code City State Mo. Day Year ' SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. ¢' Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected [~: o6 I I I I Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: '/Satisfactory - [] UnsAtisfactory [] Sample ZOO long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: * No. oflrcolonies/100 mi. Lab Ref. No. Result* I I Membrane Filter Analyst ~_%,~.. BACTERIOLOGICAL WATER ANALYSIS RECORD iii READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB BGB Final Membrane ~es~ Reported ~// Time: TNTC = Too Numberous To Count OB = Other Bacteria PART 1 OF Z REMAINDER TO FOLLOW Coilformll0Oml Coilformll00ml ,/ ~ c>5-- a.m. MUNICIPALITY OF ANCHORAGE ~)/' ~ '~' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O GENERAL INFORMATION (a) Application Date Legal Description (include lot, block, subdivision, section, township, range) l-or /,¢ z:/~'$z'~,,'~oo .¢u,,~, $/q/ 7'fZ~.~ /~,,,/ Location (address or directions) (b) Applicant Name ~/4P-C.. Telephone: Home Business Applicant Address ~.~':E ~.. ~'/'~ ,,,~v_~. (c) Applicant is (check one): Lending Institution [] · Owner/builder [] · Buyer [] · Other [] (explain); (d) Lending Institution ALAS,~A Address ~0oo. ~',~E,O/~- ~/~ (e) Real Estate Company and Agent Address ~¢~ ~~ Telephone ~¢¢- ¢ (f) Mail the HAA to the following address: ATTN: ~]ALA~E TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ,~ Other WATER SUPPLY Individual Well I~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 72-025 (11/84) NOIJ. n¥9 leAoJdd¥ leUO)l!puoo 1o suJJa/ euo!l)puo0 , pe^oJddes!Cl X" pa^oJddv '9 leas s,Jaaut§u3 '9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4?20 GENERAL INFORMATION Application Date /-//'- ~'~ Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name /~ ~ ~'-('~ Telephone: Home Business ZTG- Applicant Address 7_-.¢~- ~', ~ ~ ,4V'~'. (c) Applicant is (check one): Lending Institution I-]'; Owner/builder J~ · Buyer [] ' Other'E] (explain); (d) Lending Institution A/..,4. sL",~, Address '~¢6~O ~,~_,E'Z)/r' (e) Real Estate Company and Agent Address ~ ~Z~C Telephone ~ ¢~' ~ ~ / (f) Mail the HAA to the following address: ALAS~ uSA - ~o~r6~ 4OA~ Telephone 7~'~- ~¢~ 2. TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Other Number of Bedrooms ~ 3. WATER SUPPLY 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 E] 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 I of 2 72-025 (11~84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~1./,4,~,~ ~-~ ~,, ,~ ~--"~-~/.4 ,~/~, Telephone Address //0~-~' 7 (.4,] · /~/~.-"' Date /./////_~ ~ Engineer's Seal Approved for ~,, (~2 bedrooms by _ _ _ . .. Date ~ -~ ' ' Conditional Terms of Conditional Approval ~-,~] ~ ~ ~ ~O~ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~) ~ A~[~..,,~_~).,~THORITY APPROVAL (HAA) ,. '-i:. [ ,:Q ~-~ Legal Description: /_~7' /~ Well Classification Well Log Present (Y/N) )/ Total Depth /~,,;,'T" Cased to Static Water Level .5'2"~ °' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line 5' Cleanout/Manhole .~ Water Sample Collected by If A, B, C, D.E.C. Approved (Y/N) Date Completed /Z'-/- 74 Yield /o$' Depth of Grouting _.4/owv'~' Pump Set At ~)-~" Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Water Sample Test Results Comments ; On Adjoining Lots /~ '~' //¢' ; On Adjoining Lots /0o' To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date /- B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~)0' To Property Line ~ ~''' '' To Water Main/Service Line Course ,4/~,~le: My /~,~-~IAI"E Comments =~'.,~,Tic TA~- 5,~'0¢~D ¢~" /~'~'o ~,,4't. ~,~/~'-7/.,, Size /0o~ No. of Compartments /Y Foundation Cleanout (Y/N) V Date Last Pumped t -~or Temporary Holding Tank Permit (Y/N) · To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of SyStem Design Length of Field Z~' Depth of Field Gravel Bed Thickness ? Standpipes Present (Y/N) /V Date of Last Adequacy Test /--~'-,¢~' Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //o ' To Building Foundation ~.~' Lot ~/o ~ ~ To Water Main/Service Line //Z ' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ~'o' To Existing or Abandoned System on ; On Adjoining Lots /~' ~' To Cutbank (if present) -',/~'~ ,~,~'~,~'-~"-'- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M(~ an.d HAA guidelines in effect on the date of this inspection. Signed ~~--~' legislate '/' ~/~ ~ Company ~U'~Z~ ~"',*//.,//,.¢-,, MOA No. ReceiptNo. /~ O /O~ Date of Payment ~/~/~ ~ Amount: $ / ~ Engineer's Seal Page 2 of 2 72-026 (11/84) ,~,,,,~.." A -"...'",'F I, /" ~:.-" ~ :Michael E. Anderson : .~'~ January 11, 1988 AHFC C/o Paul Wilson ERA Realty Center 8400 Hartzell Rd. Anchorage, AK 99507 RE: Lot 13 Crestwood Subdivision - 6000 Barry Ave. Dear Mr. Wilson: An adequacy test was performed at the subject property on January 3, 1988. Certain items are not in compliance with Municipality of Anchorage Regulations for on-site systems and must be corrected once weather permits. Apparently the septic system was designed and installed for a three bed- room structure before the four bedroom house was built. According to Dan Roth of the Municipality, a conditional approval will now be issued until the corrections are made. A list of the i~s requiring attention and approximate associated construction costs are provided for your use. Alaska Well and Pump Service and DanMar Construction were contacted for price quotes. Item Cost 1. Exposed wiring to the well must be $ 100.00 placed in conduit. 2. The septic tank size must be in- 1,400.00 creased from 1000 to a minimum of 1250 gallons. The absorption system must be ex- %ended from 32 to 42 feet. 3. 2,000.00 4. Engineering design and permits. 500.00 $4,000.00 If you have any questions please contact myself or Wayne McFadden at 561-5829. Yours truly, Michael E. Anderson, P.E. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION RECEIVED ¢ o ~-- ,,~t~! ~/' I l.~t~lPALiTY OF ANCHORAGE " · MUNICIPALITY OF ANOHORAGE DEPT. OF 1',TALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~'J~J~ONMENTAL P/:OrECTION; 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION ~J ~'~ 5 1980 Telephone 264-4720 DEr'E/%/E r% DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Wil 1 ~am ~ Dnnna Matthews 344 9519 MAILING ADDRESS SRA R~w ~SM. An~_hnrao~_. A}f 99507 PROPERTY RESIDENT'(If different fromm ~bove) PHONE South West Corner of Barry & Brien Streets 6000 Barry Street 2. BUYER PHONE Michael Lebmann & Diane Kara MAILING ADDRESS 3. LENDING INSTITUTION J PHONE Alaska 1st Mortgage - Please call Konni Snyder Totem Realty for pic~-up 272 0571 MAILING ADDRESS Anchorage 4. REALTOR/AGENT J PHONE Konni Snyder, Totem Realty - Will meet for inspection & will pick~ 272 0571 MAI LING ADDRESS 724 E. 15th Avenue, Anchorage 995-1 5. LEGAL DESCRIPTION ~TREET LOCAI'II'0~I ~' ............ 6000 D~rry Street 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY NcUMBER OF BEDROOMS One [] Four Two g Five Three ~ Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~ 8. SEWAGE DISPOSAL SYSTEM 'iC~'~(,..~ **If individual/on-site, give installation date~ below [] INDIVIDUAL/ON-SITE** If system is over tjj~)~years old an adequacy test is required [] PUBLIC UTILITY by this Department. This proD. was not occupied unti ~x~at~!~x~x~x~t~i~xA copy of the closing papers is attached - Do not have CO NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1977 72-O10(3/78) * ~ ~ ~.~ THIS SIDE FOR OFFICIAL USE ONL'~__ DATE RECEIVED I NSPECTI ON APPOI NTM ENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. ~)F RESIDENCE I~1 SINGLE FAMILY [] MULTIPLE FAMILY 2. ~ SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX 3. SEWAGE DISPOSA.~ SYSTEM [~Vl DUAL/ON -SITE []PUBLIC UTILITY C~]~ection Verified ~eptic Tank or [] Holding Tank Size: ~'/_,-~t~-~ If Tank is homemade PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLE~ SOl LS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line MATERIAL Septic/Holding Tank lAbsorption Area I [] OTHER ISewer Line I Nearest Lot Line 5. COMMENTS [~APPROVED FOR ~--~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED L~G~L DESCRiPTiON ' r' ,':, .:.,": ,~ ".~'~..: ~>,~. ~q ....:.~.,-.-'~ 72-010 (Rev, 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February 23, 1977 Time of Inspection 2-.00 p.m. Date of Inspection 2-24-77 JK REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. l. Approval 'requested by: Alaska Bank of Con~aerce Mailing Address: 712 West 4th Avenue 2. Property Owner: Howard Smith Mailing Address: 2523 Brooke Drive % Carolyn Barrara Phone: 279-5641 Phone: 278-3644 3. Legal Description: Lot 13 Crestwood Subdivision 4. Location: Off of Birch Road, left on BARRy, 5. Type of facility to be inspected 6. Well Data: Permit ~76340 A. Type IndividUal C. Construction A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: Single Family No. of bedrooms 2 103' B. Depth D. Bacterial Analysis Sewage Disposal System: On-site system, Permit #76192 1976 B. Installer l. Size 2. Manufacturer 1. Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Absorption area A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages NIUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 FEB 2 3 1977 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES RECEIME 1. Type of Inspection: CMRO 2. Property Owner: HOWARD SMITH VA FHA CONV~:C~'~ Mailing Addr~ BP. OOI~11~ - WILLIJLM MATTHEWS Name of Buyer: Day Phone: 4. Name of Lending Institution: ALASKA BANK 0F Mailing Address: 7q2 WEST ~th TOTEM REALTY 5. Name of Realtor or Agent: Addre'15thssr & GAMBEL Mailing A q~q~., P.~oT,yN ~AP_w_w._w~ Day Phone: COMMERCE Phone: 279-56~4 Phone.272-0574 Legal Description'~ot ~-Crestwood subdivi.~inn Location: Off Birch-Left O~ Barry 7. Type of Facility to be Inspecte(~±Agle Family 8. Water Supply Type of Supply: Public Utility. If Individual, number of dwellings presently Served If Individual, depth of well 'lO;~ft) One 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation No. Bdrms. Individual xxxxx'x-~x~ xx--x-~ ONE hundred three feet .Individual (on-site) xxx~ocxxxxxx 72-003{3/76) Page 2 of two pages - Req..Jst for Approval of Individual S..~er & Water Facilities L~g'al Description T,ot 13 Crestwoocl 8t~bct±xz±$±oz~ Comments 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 operating satisfactorily. SIGNED Date EQ-034 (1/74)