HomeMy WebLinkAboutMEADOW BROOK BLK 2 LT 22AMeadow
r'ook
lock 2
Lot ZZA
050-191
-81
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 Page / of z/'
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSPll 1131 PID Number: 050-191-81
Name:
Jeffreyor Debie Blair Wastewater System: [] New [] Upgrade
Address:
18037 Sanctuary Ddve, Eagle River, AK 99577, ABSORPTION FIELD
Phone: 694-7207/H 857-9007/C Number of Bedrooms: 3 ~ Deep Trench [] Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION soil Rating: Total Depth from odginal grade:
0.8 GPD/Ft~ Varies from 9.2 to 9.5 Ft.
Block: 2 Lot: 22A Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe:
Meadow Brook Varies from 2.5 to 2.8 Ft. 6 Ft.
Township: 14N Range: lW Section: 12 Fill added above odginal grade: Gravel Length:
Varies from 0.3 to 0.6 Ft. 50 Ft.
Well: [] New [] Upgrade Gravelwidth: Numberoflines: I Distance between lines:
.. 3 Ft. 1I N/A Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Ft. Ft. 600 FF 3034 ASTM
Ddller: Date Ddlled: Static Water Level: Instaltar: Date Installed:
Ft. Dean Construction 7/12/2011
Yield: GPM PumpSetat: Ft. CasingHeightAboveGround:
Ft. TANK
SEPARATION DISTANCES 'El Septic [] Holding [] S.T.E.P. [] Other:
· T~ Septic Absorption Lift Holding 3ublic/Private Manufacturer: Capacity:
Tank Field Station Tank Sewer Line Gal.
Material: Number of Compartments:
wel~ N/A N/A N/A N/A 10+ ft.
surface water 100+ft. 100+ft. N/A N/A ~ / LIFT STATION
Size: Manufacturer:
Lot Line 10+ ff. 8 ft. N/A N/A Gal.
"Pump on" level at: "Pump off' level at: I High water alarm at:
Foundation 8 ft. 23+ ft. N/A N/A in. in.I in.
Curtain Drain None known N/A N/A N/A Pump Make & Model Electrical Inspections pedormed by:
Remarks:
The existing Sunset septic tank is one compartment, 1000 gallon. BENCH MARK
Location and Description:
The existing Peach field that failed is still in place with a Garage cement slab
diversion valve. Assumed Elevation:
100.0 Ft.
The subdivision is served by public water.
Inspections performed by: Fred Kenle, Dates: 1st 7,11,2011
Development Services Department Approval
Conditional Approval Date:
Lot 1
Swinq Ties
Description A B
FCO 9.5' 19.0'
Tank 12.0' 26.8'
DBL-CO 15.0' 30.5'
Diversion Valve 16.0' 32.0'
New C0-1 28.0' 41.8'
New MT 27.6' 54.9'
New C0-2 40.0' 69.0'
Exist. C0-1 57.5' 65.5'
Exist. MT 52.0' 64.0'
Exist. C0-2 57.7' 75.0'
Lot 24
/ /'SEPTIC
- AREA/
Lot 23A
3 B.R.
SINGLE
RESIDEI~CE
Lot 22A
/
10' Util. Esmt.
\
\
\
Lot 2
Lot 20
1 ¥00 GALLON
SUNSET T~qK
Util. Esmt. ~
\ x
Lot 19
50' ~NG TRENCH~
~ ~ N~ _ EPTIC Lot 21
Lot 1~ ~ ~KEY BOX W/ PU_~ATER LINE
Lot 1 3
Lot 12
DOUGLAS T. KENLEY, P.E. c,v, Engi .... PLOT PLAN
~,.,.,.,c,.~...,-,.~,,~..,~,,.,,, ASBUILT
~: Blair, Jeffrey
L~ Meadow Brook S/D, Block 2, Lot 22A
~DR~S~:18057 Sanctuary Drive, Eagle River, AK J ~,D .u.sE~: 050-191-81
~"~7/1.3/11I ........ I.....FKI 1"= 50' J ......... 11112
J~ ,u,.,8~ OSP111131
JSHEET 2 of 4
DISCRIPTION OF SYMBOLS
ON SITE PLAN & SWING TIES
DESCRIPTION A B
(~)Existing FCO 9.5' 19,0'
(~ Existing Tank 12.0' 26.8'
~ New DBL-CO 15.0' 30.5'
(~)New Zobel Diversion Valve16.0' 32,0'
(~ New 00-1 28.0' 41.8'
~ New MT 27.6' 54.9'
(~)New C0-2 z~O.O'69,0'
~ Existing 00-1 57.5' 65.5'
~ Existing MT 52.0' 64.0'
~ Existing C0-2 57.7' 75.0'
1. Distance between A & B -- 28'
DOUGLAS T. KENLEY, P.E.
Blair, Jeffrey
Civil Engineer
ASBUILT
NOTES
Meadow Brook S/D, Block 2, Lot 22A
~oR~s:18057 Sanctuary Drive, Eagle River, AK IP'O"U~SER:050--191--81
ISHEET 3 OF 4
/ G/L 99.8'
/ /- -- G/L DIVERSION
~FROM' T~NK~ '-
97.5'--~
DBL-CO '~--DIVERSION C0-1
VALVE 97.1' C0-2 95.25'
-- MONITOR TUBE PIPE IS
PERFORATED IN SEWER ROCK,
SOLID ABOVE.
-- C0-1 & C0-2
C0-1 G/L 98.6'
C0-2 G/L 98.4'
GRADE
GRADE
FILTER FABRIC
- 2-1/2" DIA.
SEWER ROCK
BOTTOM OF-
TRENCH 88.9'
NOTES:
1. LENGTH OF TRENCH IS 50 FEET.
2. AREA AROUND NEW TRENCH G/L CO'S & MT
VARIES 0.4.
5. LOT LINE WAIVER WILL HAVE NO ADVERSE
EFFECT ON ADJACENT PROPERTIES.
NO IMPERMEABLE LAYER FOUND /
4. THE ORIGINAL GROUND LEVEL AT THE MONITORING TUBE
AT THE NEW LEACH FIELD IS APPROX. 2' HIGHER THAN THE
ORIGINAL GROUND LEVEL OF THE TEST HOLE.
BOTTOM OF TEST HOLE
79.6' FROM ORIGINAL
GRADE 95.8'= 16.2'
LEACH FIELD PROFILE ASBUILT
NTS
ASBUILT
DOUGLAS T. KENLEY, P.E. c,v,, ~.¢.~.
-.,.~,~. ,,.,A.~.,. I.~,~,0~ DRAWINGS
cumin': Blair, Jeffrey
Meadow Brook S/D, Block 2, Lot 22A
~D.~ss, 18057 Sanctuary Drive, Eagle River, AK IP'~ "uM"~": 050-191-81 I"c""'"u"~ 0SPl11151
7/13/11 I ........ DTK I .... ~ I'~:NTs I .......... 1111~ Is,~ ~o~
Permit Number:
Tax Code Number:
Work Type:
Permit Effective Dates:
Design Engineer:
Subdivision:
Site Legal Address:
Owner/Address:
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
OSPl11131
05019181000
Septic Upgrade
July 08, 2011 to
DOUGLAS T KENLEY
MEADOW BROOK
July 07, 2012
MEADOW BROOK BLK 2 LT 22A G:0153
BLAIR JEFFREY A & DEBRA L
18037 SANCTUARY DRIVE EAGLE RIVER AK 995778223
Lot Size in Sq Ft: 17963
Site Mailing Address: 18037 SANCTUARY DR, Eagle River
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field N 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.
ecelved By: /~ /~,,: /
Issued By: '].( '[(:;? /~'/~.
Date:
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Mayor Dan Sullivan
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Propertyowner(s) ~"~,¢'¢¢-¢,,~{ 8[/1~i~2,. aayphone ~"
Mailing address [~20~"[ ~R~1'(,1,1~¢--~ ~[6,. ~l~t/~/ 17..I, tj¢,¢. ~'~-
Site address [~0'~ ~lJ.C..d/~Of¢-'~ 1)¢-'~
Legal description (Sub'd., Block & Lot) ¢¢~¢ e~¢~ e/~,
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
(l~ all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade ~
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(S~gnature of property ownec~tSr authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. (-~ ~ ~/\
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 )
SEPTIC SYSTEM SPECIFICATIONS:
1. ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH M.O.A.
WASTEWATER CODE CHAPTER 15.65.060.
2. EXISTING TANK TO BE LEFT IN PLACE & EXISTING LEACH FIELD TO BE CONNECTED
WITH A ZOBEL OR EQUIVILENT DIVERSION VALVE.
5. SERVICE LINE TO DRAIN FIELD SHALL BE 4" DIA. ABS PIPE.
4. DRAIN FIELD LINE SHALL BE 4" DIA. 505z~ ASTM PIPE WITH HOLES LAID DOWN
5. PROVIDE 12' SEPERATION BETWEEN NEW & EXISTING LEACH FEILDS.
6. PROVIDE 10' MINIMUM SEPARATION BETWEEN EDGE OF TRENCH AND FOUNDATION.
7. PROVIDE 10' MINIMUM SEPARATION BETWEEN SEPTIC SYSTEM AND PROPERTY
LINE.
8. PROVIDE 100' MINIMUM SEPARATION BETWEEN SEPTIC SYSTEM, WELLS &
SURFACE WATER.
DEEP TRENCH CALCULATION:
SOIL TYPE:
PERCOLATION RATE:
APPLICATION RATE (AR):
DESIGN (,3) BEDROOMS:
..~k'be4;~_Y GRADED SANDS (SW)
9.6 MIN. PER INCH. (6" PERC HOLE DIA.)
0.8 GAL./DAY/SF
@ 150 GAL. PER BEDROOM = 450 GALLONS
ABSORPTION AREA =
450 GAL/DAY
0.8 GPD/SF
= 56,3
EFFECTIVE DEPTH
6 FT PROPOSED
TRENCH LENGTH = 563 - 46.9 (USE 50')
2X6'
ASSUMES DOMESTIC WATER USAGE FOR RESIDENTIAL HOME COMSUMPTION.
CALCULATION METHOD OBTAINED FROM MUNICIPALITY OF ANCHORAGE "WASTEWATER
DISPOSAL CODE REGULATION" FEBRUARY 14, 200`3; AMC 15.65, TYPICAL DEEP TRENCH
FIELD REQUIREMENTS AND SPECIFICATIONS.
NOTE: FOR APPLICABLE EXCAVATION, TRENCHING, AND SHORING SAFETY
STANDARDS, CONTACT THE STATE OF ALASKA, DEPARTMENT OF LABOR, OCCUPA-
TIONAL SAFETY AND HEALTH COMLIANCE CONSULTATION, AND TRAINING DIVISION OF
LABOR STANDARDS AND SAFETY AT 269-4955.
DESIGN
DOUGLAS T. KENLEY, P.E. o,v, EnCneer
9806E. NolthafmrCllcle o Palmm',Alaslm99~45 o (907) 74~-1013 CALCULATIONS
cu~.'r: Blair, Jeffrey
Meadow Brook S/D, Block 2, Lot 22A
^OD"Ess:18057 Sanctuary Drive, Eagle River, AK I"'D"u"D~":050--671--17 I"E""""""B~
6/15/11I........ DTK I .... FK I*~ N/AI .......... ,,1,~ ISB~ET
1 OF6
Lot I
':%
Lot 3
Lot 1 I I Lot 2
Lot 31 i
CE-8176
Me~dow Brook S/D, Block 2, Lot 22A
Lot 1
Lot
EPTIC
J AREA/
N~ Lot 23A
I i I
I I Lot 2
10' UUI. Esmt. - -- -
/
5 B.R. ~
SINGLE F~AMILY
RESIDENCE
DOUGLAS T. KENLEY, P.E. c,v,, Engineer
Blair, Jeffrey
~ Meadow Brook S/D, Block 2, Lot 22A
40'
Lot 20
3'W X 6'E.D. X
LONG TRENCH
AREA~/
/
5'w x 6~E.97 x
.NC T~j~EN C H
Lot 19
-- XISTINC 1000 ,~L~LON SUNSET TANK
/
Util. Esmt.
,
*aD~ss:18057 Sanctuary Drive, Eagle River, AK I 050-191-81
DESIGN
IPERM~ NUMBER:
Lot 12
DISCRIPTION OF SYMBOLS ON SITE PLAN
(~) FCO
Q DBL-CO
O 4" LINE TO ZOBEL DIVERSION VALVE
® C0-#1 & 2 (NEW TRENCH)
G MONITOR PIPE (NEW TRENCH)
® C0-#1 & 2 (OLD TRENCH)
(~) MONITOR PIPE (OLD TRENCH)
Notes:
1: Maintain at least 12' between old & new trenches.
2: Bottom of new trench is to be 10' from ground level of test hole.
DOUGLAS T. KENLEY, P.E.
cu~: Blair, Jeffrey
Civil Engineer
DESIGN
NOTES
~: Meadow Brook S/D, Block 2, Lot 22A
¢~DRESS:18037 Sanctuary Drive, Eagle River, AK IP~D"U""ER:050--191--81 I"ER"~"u~"~:
MONITOR TUBE PIPE IS
PERFORATED IN SEWER ROCK,
SOLID ABOVE.
BACKFILL--
C0-1 & C0-2
ORIGINAL GRADE
TRENCH WALL SLOPES WILL
WITH SOIL TYPE AND MUST CONFORM
TO SAFETY STANDARDS, SEE SHEET
1 OF5
2" DOW RIDGID INSULATION
REQUIRED IF LESS THAN 56" OF COVER
¥' DIA. 50,34 ASTM LAID LEVEL WITH
HOLES DOWN.
SIDEWALL OF TRENCH
1/2" - 2-1/2" DIA. SEWER ROCI<
NOTES:
LENTH OF TRENCH IS 50 FEET.
-- FILTER FABRIC
2.5' MIN. ~
2-5/4" OF WATER FROM BOTTOM~'
\
NO IMPERMEABLE LAYER FOUND
BOTTOM OF TEST HOLE 16.2'
FROM ORIGINAL GRADE
LEACH FIELD PROFILE DESIGN
NTS
DESIGN
DOUGLAS T. KENLEY, P.E. o,v~, Encneer
.. ~.....c..~. ~,..,,~.~.~ . I.~,~,.. DRAWINGS
CUNT: Blair, Jeffrey
Meadow Brook S/D, Block 2, Lot 22A
18037 Sanctuary Drive, Eagle River, AK I~'~"u~"'050-191-81 I~'~"u"~'
50F6
DEPTH
F~ET)
1
2O
COMMENTS:
ORGANICS
SW
PERC TEST
SW
SM
-- B. of H.
SOILS LOG - PERCOLATION TEST
TEST HOLE #1
-.o:: .,,~.~.o.~'oO I IIIIIIIIII"L
~~w
~~sc SEE ATTACHED SHEETS
FOR SITE DRAWINGS
DEPTH TO
DATE
GROUNDWATER
NONE 6/15/11
16' 6/22/11
NET TIME WATER LEVEL NET DROP
DATE READING TIME
(MIN.) READING (IN.) (IN.)
6/15/11 1 2:32 8
3:02 30 4-4/16 3-12/16
2 5:06 8
5:56 50 4-6/16 5-10/16
3 3:59 8
4:09 30 4-13/16 3- 3/16
4 4:12 8
4:42 30 4-10/16 3-2/16
PERCOLATION RATE 9.6 (MIN./INCH)
TEST RUN BETWEEN 4.5 FT. AND 5 FT.
PRESOAKED FOR FOUR HOURS YES x/ NO
PERC. HOLE DIA. 6" (IN.)
PERFORMED BY: FRED W. KENLEY
DOUGLAS T. KENLEY, P.E. c,v,, E.¢ .... I
SOILS
Blair, Jeffrey
Meadow Brook S/D, Block 2, Lot 22A
18057 Sanctuary Drive, Eagle River, AK IP'D"u"~: 050-191-81
LOG
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
Parcel I.D.
GENERAL INFORMATION
Complete legal description Meadow Brook S/D, Block 2, Lot 22A
Location (site address) 18037 Santuary Drive, Eagle River, Alaska
Expiration Date: g - ~'- //,~
Current Property owner(s) Jeffrey or Debbie Blair
Mailing address 18037 Sanctuary Drive, Eagle River, AK 99577
Day phone 694-7207/H, 862-7207/C
Lending agency
Mailing address
Real ,Estate Agent Audrey Mason
Mailing Address 11525 Old Glenn Hwy., Eagle River, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
Day phone
Day phone 622-3344
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 vedfy 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 Douglas T. Kenley, P.E.
Address 9806 E. Northstar Circle, Palmer, AK 99645
Engineer's Printed Name
DSD SIGNATURE
~'"' Approved for --~
Disapproved.
Conditional approval for
Phone (907) 746-1073
Douglas T. Kenley
Date
bedrooms.
bedrooms, with the following
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
,~/~O~riOriginal Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Progmm
4700 Elmore Road
P.O. BoxY19'6650
Anchorage; Al(
www. muni.orglonsite
(907) 343-7904
' ~
CERTIFICATE OF ON-SITE SYSTI~/IS"~ROVAL CHECKLIST
Parcel ID: 050-191-81
WELL DATA
Well type
Date completed
Total depth
If A, B, or C provide PWSID # Well Log. (Y/N)
Well production
WATER SAMP~.: .
Coliform / colonieS/lO0 mL Nitrate
~ ug/L date of sample:
ft. Cased to fi. 'Oasing ~i~ai~ve ground) in.
. g.p.m . g.p.m.
mglL Collected by:
B. ~ ; -- - '~---- -- TANK DATA
Tank Type/Material Septic/Sunset,Fiberglass
]ran¥'size ~1000, gal. Number of Compartments ~'1 ) .v
Foun~. c~no~ ~). Y, Depr-~on ov~ ~nk C~/"~,-, ,.N,
rOamOf:ing i'~. "-~-6/-1~11.*' uml~..t,i,, ,,, JR~s Pumping
-" '~ i~ :/red¥~'~!~' ~ 'soil-'r~ting (g.p.d./lt2°rft2/bdm~) 0.8
.. .- ~..;':~ .:' ~,
-' ~fl1~ '. '" "~';. ft. ~ V~r~lth 3 fL
.... - ~.. ~.,..:.. -., ,:~ . ....................
T6ta~:~'~ .§.5 'ft Eft. absorption ama.. ,600 ft2 Monitoring. tube__
,Date installed 10/1976
.-,? . , ~
:.: Clean,outs (Y/N), . Y
High'~ater alarm (Y/N) N/A
System type Trench
Y Depression over field. N
Date of adequacy test
Results [Pass/Fail) For bedrooms
Fluid depth in absorption field before test . in. Weter 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) If yes, give date
LIFT STATION
Date installed Size in gallons Manhole/Accass (Y/N)
"Pump on" level at,, in. "Pump o~ level at ,, in. High water alarm level at m.
Datum
· Cycles tested: .. . :. ~ Meets ala~ents?
SEPARATION DISTANCES - ~
SEPARATION DISTANCES FROM VItF. LL.O~4 LO_-r~ , . , .
Septic tanldiift station on lot / On adjacent lots
Absorption field on lot ~
Se~septic service Iine
"Animal cOntainment areas 50+ ft.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANKON LOT TO: -
On adjacent lois
Public sewer menhole/cleanout
Holding tank
Manure/animal excrete storage areas 100+ ff.
Building foundation8 lt. Property line 10+ ft,
Watermaln 101' fi, Wa ser ce 10+*ff.
Wells on adjacent lots 200 + fL
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Prope~ej line 8 fL
VVater Serviceline' 10+ fL
Building foundation 23+ ft. VVater main
Curtain drain None known
Surface water 100+,ff.
Wells on adjacent lots 200+
16ff.
10o+ fL
8+' ft.
F. COMMBNTS
E~s Pfiq~ ~ ~ T. Kenley P.E.
.......... , ' ,
D~ ~ P~nt ,~e ~ Payment.
(Rev. ~10)
FRONT BUILDING S~'IBAC~
REAR BUILDING SETBAC~
23A
UNDER NO CIRCUMSTANCES SHOU~ AN AS-BUILT BE USED FOR CONS~UC~ON OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SUR~YOR TAKES RESPONSIBILI~ FOR ~E INI~AL ~ANSAC~ON ONLY AND ASSUMES FINANCIAL LIABIM~ ONLY FOR ~E COST OF ~E SURLY.
LIS~D DISTANCES PREVAIL O~R SCALING. REPRODUC~ON MAY CAUSE ERRORS IN SCALE.
~ LOT SURLY SURVEY TYPE SYMBOLS
~ F~NDA~ AS-BUILT
~ RN~ S~UC~ AS-BUILT o SET REBAR ~ ~ DRAINAGE ~ ASPHALT
~ PLOT PL~ ... AS-BUILT... LOT ~R~Y... T~APHY O FOUND REBAR ~ ~ ~ WOOD FENCE ~ CONCRE~
~ AS-BUILT . . . NO ~NERS SET ~ RE~RCA~ AS-BUILT . . . NO C~N~S ~T ~ ASSUMED ELEV. X X X METAL FENCE ~ WOOD DECK
PLOT PLANS A LOT SURVEYS NOTE:
IT IS ~E RESPONSIBILITY OF ~E BUILDER OR O~ER, PRIOR TO ONLY ~OSE IMPRO~MENTS ABO~ GROUND AND VISIBLE ~LL BE
CONSTRUC~ON, TO ~RIFY PROPOSED BUILDING GRADE RELATI~ SHOWN. FENCES, ~LLS, SEPTIC CLEANOU~, SIDEWAYS, DRI~WAYS,
TO FINISHED GRADE AND U~LITY CONNEC~ONS AND TO DETERMINE ETC., ARE SHO~ IN ~EIR APPROXIMATE LOCATION, ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, CO~NANTS OR RES~IC~ONS MAY PREVENT SOME IMPRO~MENTS FROM BEING SEEN AND LOCA~D.
WHICH DO NOT APPEAR ON ~E RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CER~FICA~ON ,~~, Prepared by
~ g u~ 4~' Robert E Johns, Jr. ~ Assoc.
~/~... ......... ~,,~ Professional Land Surveyors
;' ~ m *e ~m md to ~. ~ of my :C+ ~ ~ 1700 Brink Drive.
ANCHORAGE, ALASKA 99504
~o,.~.~o," ~' '",~-.u.,~="' sco,.: 1" = 50' ,.c. Lot s.F. ,~. ,,~t ~,. ~o.
he. ~ ~ ~at ~ of ~e Date Surve~d: Drawn b~ Checked
,~.~ - ~ ,~,-. -.,-, ~ ........ " 07/15/11 REJ L
'- ~""' ; ~. 07/15/11 NWl 53 11-209
FINAL SmUC~RE AS-BUILT **,.,,, // ,,**" ' A ~
~-.---~ ,0,-,-0, ,,-. Lot 22A Block 2
.o.o.~.. ",.~' MEADOW BROOK
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES ~_.,~r'-O I ~ / ~/1
Environmental Health Division
825 "L" Street, Anchorage, Alaska 995021 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES ,_
~, ~, ~, ~., ~ SEPTIC ABSORPTION WELL
TANK FIELD
Phone(s) ~ Permit NO. No of Bedrooms
LEGAL DESCRIPTION
S b ,s, n /
T~wnship, Range, Section kS-BUILT DIAGRAM (Show Iocahon of well, septic system, properly hnes, ~oundabon,
'~~ __ dr,veway, water bodies, etc.)
TANKS U
~EPTIC ~ HOLDING
c~.c,,~,.~.,,o~ ~ ~ ~ .~ I
: Manulacture~
TYPE OF SYSTEM _ _ ~.
Depth tO pipe bottom lrom To~al depth ~om odgmal grade
ongi,al grade '~ ,~FT ~ ET
Gravel length Grave~ width
Total absorption area Distance between lines I~ ~
~0 FT FT
SOd
f
~ PRIVATE ~THER fldentifvl /
,nstalle~ Date Installed: ~N
Scale: ~
inspect,o~by: ~~"
Health Depa~ment Approval: '
SCALE
Municipality el Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- i~. RCOLATION 'rEST
LEGAL DESCRIPTION: L,,~-~.~A
2
3
'4
5
6
7
8
'9
10
11
12
13
14
15
16
17
18-
19-
20-
DATE PERFORME
Township, Range, Section:..-~'~.~,
SLOPE SiTE~PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
Depth to Water Af.~J.[[[~ .', ....
Monitoring? ~ ,/'~-'~ Dale:
Reading Date Gross Net Del)th to Net
Time Time Water Drop
PERCOLATION RATE ~ ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN -~.-.~-.-----'""~:T AND FT
COMMENTS ./'"/ /
Eagle
PERF. ORMED : - ~ ~ CERTIFY ~HAT ~HIS TEST WAS PERFORMED IN
/
ACCORDANCE WITH ALL STATE AND MUNICIPALGUID ECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
GRE ,.ER ANCHORAGE AREA BOP, JGH
',~,'i~' .] Department of Environmental Quality
~;' 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK: Y~S~ T
DISTANCE NUMBER OF
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/~ALLON5,
TIt~~:'- '
TOTAL LENGTH
NUMBER OF LINES ~ __ DISTANCE BETWEEN LINES TRENCH WIDTH ~IN. TOTAL EFFECTIVE
ABSORPTION AREA ~ C$ SQ. FT. LENGTH OF EACH LINE
_~/ DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISII GRADE . MATERIAL BENEATH TILE '~ IN. ABOVE TILE ~ ' IN.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOl
APPROVED
_.CONSTRUCTION
NEAREST
LOT LINE __
, OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
.... REMARKS
DEPTH
SEPTIC SEEPAGE
TANK , SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE iV1ATE RIAL:
DIAGRAM OF SYSTEM
Form LQ-032
I'"IF:I',:.:;]iI"ILII"'I I'.,[I.Jl"ll~iiHiii:R O1:::' E:[i:l)f;?.En3l'"l'.F5 ::::: :i}i:
"l"l"lliii: I...1~:1"4 [::!i '1"1-'1 I:::, :1:["lEt",l:i5:1: Ol",l :1: '.~i; -I"HEi: I...l!!if.lll:3"l"H ,:: :I: I',l F:'Ilii:IE'T' ::, [:::iF::' 'f'l-lE: "FJ:;i:l!ii]l"ll[::::l'"l CJI;;;: I:::,F:?.I:::1:1: )",lJ:::' :il Iii:L.[::,.
"I'HIE I::,IEF:"I'H O1::: I:::1-f'l;;:li!:i'.,ICll OI;i' I:::']:'T :1::~!; THE: I:::, :I: :i!i;'FFII'.,IE:E E',E:"f'I.,.tEliiN'.,I 'l'l..flE ~;I..II:;~:I:::'I::IC:J~: (:)J::' 'TMIE
GI:~:CH...It'.,II:) I::11'.,1[)'T'HE IE:O'I"'T'OI'"I (]11::' "f'HIE IE::.::C:I:::I'v'I:q'T'I:C~hl ,:: ]:1'.,I FlEE]T).
'['HIEI:;;:IE ]; :~; I",10 '.E;E"f' I.,.I :[ I:)'T'H F'OI:;?.
"rlqlE I:~il:~'.l:::l',r,'E[... I]:,EFr"TI-I ]:'J5 "f'HE I'"l]:l'.~]:klL.II"l [)IEF:"T'H (31::' Gr;;'.l:::l'vqE:l.... 131E'T'I.,.IIEE:I'.,t 'T'HE O]..J'T'I:::I::II..[.. I:::' ]: I:::'E
I:::11'.,1[) 'T'HE E:O'T'T'OI"'I OF: TI.'.IIE E:::.::C:l:::l',,,q:::l'f':[131'.,I (]:t",l
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch ~650, Anchorage, Alaska 99502 276-222~,
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
·
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
DATE PERFORMED:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
-
'
IF YES, AT WHATE
DEPTH? ~ ]__~ ~.~_ I _ J -~ J -.J~
Lo ~o ee- Lim',t
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERFORMED BY: ,~ /'3'.00 C',/[ ~,:' ~' J,
PERCOLATION RATE (minutes/inch)
_ FT AND ~ FT
TEST RUN BETWEEN -
CERTIFIED
DATE:
72-008 (7/76)
MUNICIPALITY OF ANCHORAGE ,~--~
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES -
343-4744
Parcel I.D. #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2~Ai Bloc~ 21 Meadow Broo~ Subdivision~
Location (address or directions)
18037 Sanctuar~ Drive
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Telephone:(home)
Anchorage, AR. 99503
Telephone
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
A.H.F.C.#66171
520 East 34th Avenue
Business
(d) Real Estate Company and Agent _ JACK WHITE COMPANY ATTN; Lori Crowder
Address I09~8 Eagle River Road_ ~g£,e River, AR. 99577
Telephone 694-5500 _
(e) Mail the HAA to the following address: (or check here [;g~f hold for pick up.)
List contact person and day phone number below:
S & S FNGINEERING
17034 Eagle R ,ve~' Loop I~a~,.I NO. 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single. Family)4~] Number of bedrooms 3
3. WATER SUPPLY
Individual Well [] Community [] Public ~
Note: If community wel,l system, must have written confirmation from the State Department of Environmental
Conser~/atiOn attesting tOth legality and status.
4, SEWAGE DISPOSAL
On-site ~ 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 1 of 2
5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by mysealaffixed hereto and as of the validation date shown below, Iverifythatmyinvestigation 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.
Telephone
17034 ~egie River Loop R~a~ No, 204
~.agie t¢iver, Ala~k~ 995;/2
Name of Firm
Address
Date
6. DHHS APPROVAL
Approved for...~ bedrooms by
Approved ~'~x. Disapproved
Terms of ConditiOnal Approval
.Conditional
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 inordertosatisfycertain federal and state requirements. Employees of DHHSdonotconductinspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (NAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: ~ ~'~_,~, ~L.~. ~--
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total Dep2h~_~sed to
Static Water Level _ ~-
Date Completed
Depth of Grouting
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
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments ~d~ ( ~-~ / r/.-~%¢ ,/>'1_-
If A, B, C, D.E.C. Approved (Y/N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
~~round Wellhead (Y/N)
· On A~.~.ing Lots
; On A~ Lots
To Nearest Public Sewer Cleanoub~nhole
; Date ~
B. SEPTIC/HOLDING TANK DATA
Date Installed I~-'/¢-¢'/'~~ Size
Standpipes (~/N) ~ Air-tight Caps
Depression over Tank (Y/~')
Pumping/Maintenance Contact on File (Y/N~
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
No, of Compartments
~' Foundation Cleanout ¢¢ZN)
ate Last Pumped '~/¢~
/'~ ; for '------
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Page 1 of 2
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed L~- { '~--
Width of Field '~-,~
Square Feet of Absortion Area
Depression over Field
Results of Last Adequacy Test
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
~'-'~ ~:¢ Statndpipes Present ~N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments 1:~'~-~:~-"F,--f ~ ~
/
To Property Line /
To Existing or Abandoned System on
· On Adjoining Lots
To Cutback (if present)
D. LIFT STA, TION
Date I n stalle-'~:t-~~
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 guidelines in effect on the date of this
inspection.
Signed
Company
Date ,~ .¢ %¢~r// ?:,. : E~gin ' r's Seal
MOA No.
~ "Z¢ -q ( Waiver Fee: $
Dato of Payment
Receipt No.
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
Page 2 of 2
DA'i~ECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
INSPECTOR INSPECTOR ~NSPECTOR
MUNICIPAI:I'P/ C7 ...........
MUNICIPALITY OF ANCHORAGE~DEPT' OF ~: ~ALTH &
DEPARTMENT OF HEAL'rH & ENVIRONMENTAL PROTE~NMENI'''L
825 L Street - Anchorage, Alaska 99501 .,
JAN
ENVIRONMENTAL SANITATION DIVISION
~EQUEST FOH APPBOVAL OF INDIVIDUAL ~ATEB AND 8EWEH FACILITIES
DIReCTIOnS: Complete all parts on page ~, Incomplete requests ~ill not be processed. Please allow ten (~0) days far processJnfl,
1. pROPERTY OWNER PHONE
MAILING A~DRESS
PROPERTY RESIDENT'(If different fr~m a~)~Ge) ' ' ~ ' PHONE
2. BUYER PHONE
MAILING ADDRES~
MAILING ADDRESS
MAI LING AD~R E~S ...... t ' ' '
5, LI=GAL DESCRIPTION
STREET LOCATI~ ' ~ '
6. TYP~ OF RESIDENCE NUMBER OF~BEDROO~S
~ One ~ Four ~ Other
~~ SINGLE FAMILY ~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
7, WATER SUPPLY
[] INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
~ COMMUNI-['Y since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL, SYSTEM
~ INDIVIDUAL/ON-SITE** _ lfl'~7 YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE', THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified
INSTALLER
[~]Septic Tank or [] Holding Tank
Size: 1~0¢~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line [ Nearest Lot Line
1
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~'~ APPROVED FOR ~_~) BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
72-010 (Rev. 6/79)
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-456'1
Date Received February 4, 1977
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Cony.
James Davis
Phone:
Phone: 276-7777
1670 Crescent Drive
Legal Description: Lot 22 Block 2 Meadow Brook
Location:
Sanctuary Drive
5. Type of facility to be inspected Single Family
6. Well Data:
A. Type Public
C. Construction
7. Sewage Disposal System:
A. Installed 1976 B. Installer
C. Septic l'ank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
A.Well to: Septic tank
Nearest lot line
B.Foundation to septic tank
C.Absorption area to nearest lot line __
No. of bedrooms
B. Depth
D. Bacterial Analysis
2. Manufacturer
2. Material
, Absorption area
Other contamination
, Absorption area
, Sewer Lines
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re( st for Approval of Individual F ~r & Water Facilities
Legal Description Lot 22 Block 2 Meadow Brook
Comments
App~'~iid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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 facilit~.gs
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
Cai]_ Jo Davis o ~1o Childs 276-7777 Whe' ~.eady
MUNICIPALITY OF ANCHORAGE MUNICiPALiTY OI; ANCHORAGI~
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DEPT. OJ: HFAI.'fll &
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 ENVIRONMF-N'[AL PRO[ItC~ION
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
VA FHA
1. Type of Inspection: CMRO
2. Property Owner:
Mailing Address:_ ] 670 Crescent Dr.
F "_B 4 1!)77
CONV X X
James, E. Davis -- Enterprise Const. Co.
Day Phone:276-7777
3. Name of Buyer:
Mailing Address:
4. Name of Lending Institution:
Mailing Address:_
5. Name of Realtor or Agent:
Mailing Address:_ 2810
6. Legal Description:
Day Phone:.
Phone:
Jim Davis - Executive REalty
C Street Phone:.
Lot 22 Block 2 Meadowbrook Sub
276-7777
Eagle River
Location: Santuary Drive
7. Type of Facility to be Inspected: sFR
8. Water Supply
Type of Supply: Public Utility XX~X
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility.
If Individual, date of installation NM 1 976
No. Bdrms. 2
Individual
Individual (on-site) ¥ × ×
72 003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department Of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Date Received September 28, 1976
Time of Inspection 10:30 a.m.
Date of Inspection 9-29-?6 Wednesday
Neaie
Conv.
Arctic First Federal Savings
Phone: 278-9541
Phone:
Lot 23 Block 2 Meadowbrook Subdivision
1. Approval requested by:
Mailing Address: 701 West 4th Avenue
2. Property Owner: James E. Davis/Robert Cousineau
Mailing Address: ~ , J__x~
Legal Description:
Location: Eagle River
Type of facility to be inspected
Wel 1 Data:
A. Type Public
C. Construction
Sewage Disposal System:
1.976
Single FAmily No. of bedrooms
B. Depth
D. Bacterial Analysis
On-site system
B. Installer
A. Installed
C. Septic Tank:
D. Seepage Pit:
Sewer Lines ,
4.
5.
6.
1. Size 2. Manufacturer
1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank , Absorption area
Nearest lot line , Other contamination
B. Foundation to septic tank , Absorption area
C. Absorption area to nearest lot line
EQ--O34 (1/74) Page 1 of two pages
Page 2 of two pages - Req ~t for Approval of Individual S ~r & Water Facilities
Legal Description Lot 23 Block 2 Meadowbrook Subdivision
Comments
Approved
Disapproved Date /~-
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)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRQ
2. Property Owner:
Mailing Ad rd~/ess:.~
Mailing Address:.
4. Name of Lending Institution:
FHA_
Day Phone:
CONY ~
Day Phone:
Mailing Address:. ~/~ ~-~--- Phone:
Name of Realtor or Agent: ~';~--C--<--~----~.(.~,( ~ ~ ...~~~, Mailing Address:. ~----~-~/~ ~ ~ Pho~
Legal Description: .....~~ ~ ..... /~~ ~
Location: ~~ f~~
7, Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
No. Bdrms...
If Individual, number of dwellings presently served
If Individual, depth ot: well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation ~
Individual (on-site)
72-003(3/76)