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Home My WebLink AboutCRESTWOOD LT 15 PermitNo.' ~'~/G~O00{~ Page ~' _of ,r~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ~tichc~! ~. [t,n;~erson 43'81 - E Permit. No. ~ [''j c/5'000 ~ Page ,~ of -~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report __ Legal..Descript!on: ~o7" /~', C-/Z~'$~'u./O0~ ~'~J ~" PID No.: O/~'O&/17 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE P.O. BOX 196650, 825 "L" STREET, ROOM 502 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950006 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:ZELAYA MARTHA OWNER ADDRESS:9600 BRIEN ST ANCHORAGE, ALASKA 99516 DATE ISSUED: 1/25/95 EXPIRATION DATE: 1/25/96 PARCEL ID:01506117 LEGAL DESCRIPTION: CRESTWOOD LT 15 LOT SIZE: 49500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 January 20, 1995 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 15, Crestwood Subdivision Septic System Upgrade Design Impacts to Adjacent Properties Dear On Site Services Engineer: The absorption trench on the subject lot has failed and must be replaced. We hereby request a permit be issued to upgrade the system in conformance with the attached drawings and details. The existing septic tank has been inspected and will require some modifications, but it can be reused. Insulation will be placed atop the tank to provide the proper amount of cover. The new absorption trench will be placed a minimum 10' away from the existing trench. The existing trench will be abandoned in place. If the system is constructed as shown on the attached drawings the following statements can be made. The system, if constructed as designed, will have no adverse impact on the wells currently in use on adjacent lots. The minimum 100' separation distance will be maintained. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainag~e~-5~t~l~ill be maintained ~.:.:/~: ,_ ................ .~ Sincerely, Michael E. Anderson, P.E. SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE ~ O ' Lot 15, Crestwood Subdivision DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Perc. Rate: 41 Min./Inch Application Rate: .45 GPD/SF Deep Trench System 1,250 Gal. Septic Tank 8' Drainfield Rock Existing 4 Bdrms. X 150 GPD / .45 GPD/SF = 1,334 SF of Absorption Area 1,334 SF / 16 LF Sidewall per Foot of Trench = 84 LF Length Therefore: Construct a Deep Trench System at the Location Shown on the Site Plan. Place 8' of Drainfield Rock Beneath Distribution Lateral. Utilize Existing Septic Tank. t -j NOTE: TYPICAL DEEP TRENCH SYSTEM (NO SCALE) Install M.O.A. Approved Manway Lid with Riser on the Second ~Compartment of the Septic Tank. The Existing Septic Tank Has Approximately 2' of Cover. Therefore 2" of High Density Insulation Must Be Place Atop the Tank. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESO.,PT,ON: b' I ¢ 1 3 4 § 9 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: SLOPE WAS GROUND WATER r'-11[ J~;;~ ENCOUNTER ED? s IF YES, AT WHAT ~ ~) DEPTH? p, E SITE PLAN Depth to Water Alter Monitoring? Dat~ Gross Net Depth to Net Reading Date Time Time Water Drop Ii- ' I/~.'vo/'t,~.~ z.¢,~ ~'.~/7.~' . ~K ;1:~,~'/~ ~,/.. ~ ~./~ /7, ¢~ , ~') /,,~/ / ~i.~ ¢.¢,¢' ~.~g/~ .~ PERCOLATION RATE 42/~ tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ¢ ~ FT AND '7 ~ FT PERFORMED BY:/.~' ~L , ~ ~~'~ERTIFY THAI; THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage. Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST .~~O~. ~l/l~;~?.'rownship, Range, Section: )PE II WAS GROUND WATER ENCOUNTER ED? IF YES, AT WHAT DEPTH? Depth to Water Monitoring? SITE PLAN Gross Net Depth to Net ReadingDate Time Time Water Drop ~h'~ I~;,~;.~,. ~ ~, ~-~-. ~ I:~~ ~.~ ~.~1~.,~ .~ nl' 1~71;~ ~. ~ ~.7~/~ .~ ~ PERCOLATION RATE ~" (m,nutes~inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~.7 FT AND ~. 7 FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) GRE R ANCHORAGE AREA BOR, GH Department of Environmental Qualitv 3330 C Street Anchorage, Alaska gA§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM' SEPTIC TANK: DISTANCE I~F~ FROM WELL INSIDE LENGTH. LEGAL DESCRIPTION MANUFACTURER '~_~E~<~.~.- MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY~?''~(~ GALLONS. T!LE DP .... N . _. n... ~1"' DISTANCE FROM WEll //~)0 ~-'/FOUNDATION ~'~,~"7 NUMBER OF LINES / DISTANCE BeTWeeN LINES ABSORPTION AREA ~'~)~::~ <~ DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH NEAREST LOT LINE ,~g~ "'~ Of LINES -- TRENCH WIDTH"~IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF .EAQH LIN~' q~;> DEIdTH OF FILTER t~_"~_/::TMATERIAL BENEATH TILE t_"~-"7'-IN. ABOVE TILE ,~---~ IN. WELL: BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE_ SEWER LINE__ OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: MATE RIAL PIPE LOT SLOPE: Form EQ-O32 DIAGRAM OF SYSTEM i Ho PERMIT NO. APPLICANT LOCATION LEGAL MUN I C I PAL I TY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 99507 276-222i ON--S I TE SEWER PERM I T ( 76i95 > pICK RNTHON¥ 252~ BROOK DR B~RRY & BRIAN STS L15 CRESTWOOD SUBD LOT SIZE 278-2644 49500 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 10 LENGTH= 41 GRi::iVEL DEPTH= 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELDo THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCRVRTION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. REQU I RED SEPT I C TANK S I ZE= i250 GRLLOf-IS BACKFILLING OF 8NY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN 8 WELL 8ND 8N¥ ON-SITE SEWAGE DISPOSAL SMSTEM IS i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T VAL I D FOR ONE YEAR FROM ISSUE I CERTIFY THRT l: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAW REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. RPPLICANT DI~I< RNTHONY GRLATER ANCtlOkAGL ARLA UOR()UGI~ Department of L~vironmental Q[ ity 3330 "C" Street ~ /\nchorage, /\1 aska 99503 Performed for Legal Description This form reports: Soils log ....... Depth Feet 1 - 2 3- 4- 5- T~ p6~L-, 6- 7- 8- g- 10- 11 - 12- ]4 .- _4. bias ground water encountered? _.~_~ If yes, at what depth7 ..... _--_.1_.~._ .... Reading Date Gross Time Net Time _?epth to W~ter Net Drop tr~Fcol a t i'o-n- Fat--e ......... m~ nute. ' :JctJ[h of 'Il;let .................. . UepLJF"Li~' bi,-r.'tbin-b-f-'pi t or Lrc,lci~ ..................... r~IUN I C I PSL I T~,~ OF F~NCHORAGE DEPRRTMENT OF HESLTH 8ND ENVIRONMENTRL PROTECTION 25i0 E. TUDOR RD. · 8NCHORSGE~ PK. 99507 276-2221 HELL PERt1 I T PERMIT NO. ( 76~6 > FOREMOST SERVICES. BRIEN STREET LiS CRESTWOOD SUBD 8PPLICRNT LOCSTION LEGRL 2525 BROOK DRIVE 278-2644 LOT SIZE 49000 SOUSRE FEET MINIMUM DISTSNCE BETWEEN 8 WELL 8ND 8NY ON-SITE SEWSGE DISPOSSL SYSTEM IS 100 FEET FOR 8 PRIVSTE WELL OR 200 FEET FOR 8 PUBLIC WELL. WELL LOGS 8RE REQUIRED 8ND MUST BE RETURNED TO THE DEPSRTMENT WITHIN 3:0 DSYS OF THE WELL COMPLETION. SPECIFICSTIONS 8ND CONSTRUCTION DISGRSMS ARE AVAILABLE TO INSURE PROPER I NSTSLLST I ON. PERM I T %-'~=~L I D FOR ONE VE~=~R FROM I SSI_IE I CERTIFY THAT l' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS'AND WELLS AS SET FORTH BY THE MUNICIPSLIT¥ OF ANCHORAGE. ~: I WILL~N~T~~~~S~jN ACCORDSNCE WITH THE CODES. ~SPPLICSNT ~OREMOST SERVICES WATEI~'WELL DRi~.LED AND CASED OUT TO THE DEPTH OF AT THE'RATE OF /~,~N~ . PER FOOT. __ - ~ .... ~ i'i, ,'I"HAI~,¥OU N,'"]tRN~ llUC:I~L, ALL L~,B'OR AND M~TERIAL FOR COMPLETION OF SAID DRILLING, ;NECK PAYABLE .T~,~A~ART. ~RILLING WORKS FOR THE SUM O~ ' ' ~ :1512.,bb DEPARTMENT OF.HEALTH & HUMAN . ~ Division of Environmental Se~ices .................... On-S~te Seduces Section -,.,, ~ ,-. ,. ,. P.O. Box 1~50 [ Anchorage; Alaska - ~ 'Unless otherwise requested, HAA will be held for pickup. --~--,.-NOTE: ...... lf ~ommuni~ ~ell system, provide wri~en confirmation from State ADEC~st- ingtothe legality and status ofsystem. . .................... ~ .... , ...... ~ ., 4. ~PE OF'WASTEWATER DISPOSAL: Individual on-site ~ ',; : :~ ~'~-'~ 'NOTE' :~ If commUni~'wasteWater system; provide wriffen cont/rmat~on from ~tate 72.025 (Rev. 1/91) Frof~t MOAt21 5. STATEMENT OF INSPECTION BY ENGINEER As ce~ified by my seal affixed hereto ~nd as of the validation date shown ~low, I veri~ that my investigation of this H~lth Authori~ Approval appli~tion shows that the on-site water supply and/or w~ew~ter dispo~l sy~em is ~fe, functional and ad~uate for the numar of ~rooms and ~pe of stratum indi~t~ herein. I fu~her veri~ that be~d on the info~ation obtain~ from the Municipal~ of An~ho[age' fi~'and from my investigati6q'and ins~ion, the on~ite water ~ supply an~or wa~ewatef'dispo~l system is in compliance with all Municipal and S~te codes, .... ~ - ordinanc~and r~ulations in eff~t on the date of this ms~on::~ ~;~?x~:, Name of F~ ~ 0~0~ ~ ~/J~t~6 ..... Phone ...... Conditional approval for bedrooms, with the fol!owjng stipulations: Note: The well for this property meets existing State and ~unicipal Codes. 'Th~r~ c~r~ ~iL~.ctL~ t~'m-"~z~L. IL i~ suggested that a periodic testing be performed to insure the wells continued suitability. Nitrate concentration ~s D.u~ mg/£. maximum concentration is 10.0. mg/1. . additionalComments ~ -/~-/~ ~/~~ .,,~.,¢t,"/$~3,"d/w' TI~' MUnicipality of Anchorage Department of Health and Human Services. (DHHS)issues Health Authority Approval Certificates based only upon the representations given in parag,,m_p.h 5 ~ab.ove by an independent professional engineer registered in the State of AlaSka, The DHHS does this es a cou.rtesy: 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 Municipally. of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-~5(1~v. 1/91) Back MOAe21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well .type Log present (Y/N) y Total depth ~' 3 i Samtary seal (Y/N) Health Authority Approval Checklist C,~l~'$,"'tOOO0 ~tJ~'. Parcel I.D.: Ot~'- obi--. 17 If A, B, or C, attach ADEC letter. ADEC water system number Date completed 6,/t/*,/7/a Cased to ~> Z. i Casing height (above ground) Y Wires properly protected (Y/N) Y Date of test Static water level Well production FROM WELL LOG AT INSPECTION 7. '7 WATER SAMPLE RESULTS: Coliform O Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping Tank size [,/.-t~--t~ Number of Compamnents ~ Cleanouts (Y/N) . Y Depression (Y/N) d High water alarm (Y/N) y Pumper /~Jotla't4 l~.~l b Y ABSORPTION FIELD DATA Date installed --~/~k~" Soil rating (g.p.d./fi2 or ft2/bdrm) · ~ System type ~&"l~ Length ~,%t. ~'t ~ Width .~ Gravel thickness below pipe Total depth [~, Effective absorption area ~$~. FE. g'Monitoring Tube present(Y/N) Y Depression over field (Y/N) Date of adequacy test A~-~,O C.~,J ~7" Results (Pass/Fall) Ft~'$5 For ]'~dd_. bedrooms Fluid depth in absorption field before test (in.); /~d/~ Immediately after,n//~ gal. water added (in.): Fluid depth /~J/,4 Minutes later: ,n//~ (in.) Absorption rate= ,nd//~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date go Size in gallons Manhole/Access (Y/N) High water alarm level at* Cycles tested SEPARATION DISTANCES "Pump off" level at* *Datum ~ SEPARATION DISTANCES FROM WELL ON LOT Septic/holding tank on lot ] 0 I Absorption field on lot ~ ] ! s4' t Public sewer main /~ i t.~'<~ Sewer/septic service line TO: · On adjacent lots ; On adjacent lots Public sewer manhole/cleanout ! > Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Z] ' Property line ) ~0 t Absorption field t t Water main/service line ~'t9 Surface water/drainage. ~'lOt~ Wells on adjacent lots /4' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ,~.t :.- ~ Water main/service line Surface water 7/00 t Driveway, parking/vehicle storage area Curtain drain /~0 ~/~' Wells on adjacent lots 7t00 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review ofMumctpal recos~atthe dbov~stems in conformance with MOA HAA guidelines in effect on this date. s: .:~.. : i ~:~ Signature Date Date Of Payment /~ '~/~,~ 7~ ReceiptSumber / _~. *~ ~7~) Rev. 8/95 OSS: haa. wk.doc Waiver Fee $ Date of Payment Receipt Number are CT&E Ref.# Matrix Client Sample ID CT&E Environmental Services Inc. Laboratory Division ~~'~'~'~'~'~'~'~'~'~'~'~'~'~'~'~'~'~'~ ,5.,4,9-1 Laboratory Analysis Report WATER L15 CRESTWOOD S/D Client Name ANDERSON E~GINEERING WORK Order 18777 Ordered By ALAN Printed Date 10/13/95 ~ 09:18 hrs. Project Name Collected Date 10/09/95 ~ 18:05 hrs. Project# Received Date 10/10/95 ~ 11:40 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: SAMPLE C0LLECT~D BY; A.H. QC Allowable Ext. Anal Parameter Results Qua1 Units Method Limits Date Date Init Nitrate-N 5.83 mg/L EPA 353.2 10. 10/11/95 CMR * See Special Instructions Above UA - Unavailable ** See SauMple Remarks Above ~FA = Not Analyzed ~. = Undetected, Reported value is the practical quantification limit. LT = Lees Than ~ = Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 --Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 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) Location (address or directions) (b) Property owner I~( iffor/~nj Plo/I), Mailing Address 9~'~ (c) Lending Institution N,/~. Telephone · (home) 3 ¥'~'-(~& 7' Business Telephone Mailing Address (d) Real Estate Company and Agent Address ..~ 2 3d~ '~" Telephone ~ 73 - ~ ~ 37 (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 ~ 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 th 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. 72-025 {Rev. 7/88) Page 1 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 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 Address / Date '~..~'~ ~TH~OD02~ F. MOORE ~ 6. DHHS APPROVAL~ -/ ~pOrovod for odrOoms b ~ate ~p~roved ~isapprovod Conditional Terms of GondiUonal Approval Engineer's Seal 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 ~\C,?N~'!?~C~ MUNICIPALITY OF ANCHORAGE (MOA) ~, . ,~~a~ CHECKLIST - FEBRUARY 1984 ~~ 343-4744 .~C~~ Legal Description: A. WELL DATA Well Classification ~R~VATE If A, B, C, D.E.C. Approved (Y/N) Iq.~, Date Completed {~//{a/'7~ Yield IflERS, T. qS¥~P~t Depth of Grouting Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) NO Well Log Present (Y/N) ¥6¢ Total Depth ~2. ' Cased to Static Water Level S2 ' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ;On Adjoining Lots '7'/00 ' ; On Adjoining Lots ',7/oo ' ~ ZOO ' To Nearest Public Sewer Cleanout/Manhole ~C5 ;Date (~ /t~/?o SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Io2' F:eo~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line '7/00' To Nearest Sewer Service Line on Lot Water Sample Collected by ~'L/~TTOP Water Sample Test Results Comments D ~¢' ~'~,,~' c¢,, ~ (( 3C(o co 993 12So Air-tight Caps (Y/N) No No. of Compartments ~. YE ~ Foundation Cleanout (Y/N) "{¢- <; Date Last Pumped fi[E,C/('?o &y /~c,,~ /i%,~F¢~' N, J~. ; for ~J ,/~ ' Temporary Holding Tank Permit (Y/N) t~,,,~. B. SEPTIC/HOLDING TANK DATA Date Installed ~/1~/~ Size Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~.l,~ - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation 22 Feom C.c. To Disposal Field FRoM ~.T, ¢.0, TO Su~P · ~ too To Water-Supply Well lO2. ' Fl~o~ C.O, To Property Line ~ to ~ To Water Main/Service Line ~ ,50 To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (,,/TG Width of Field ~(~ ~ Joo Square Feet of Absortion Area Depression over Field (Y/N) No Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 1~3. ' To Building Foundation ~5' Lot To Water Main/Service Line ~ I10 To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /E~ol~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test ; On Adjoining Lots '>' '/~' To Cutback (if present) To Property Line ;~' I0~ To Existing or Abandoned System on ! ~ Iio Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at// Tested for / Meets MOA Electric~eY~odes (Y/N) Comme.~./ Lmensions _../l[4anhole/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~[I~s, in effect on the date of this inspection. ....... Signed _ _ Company Date ~ [ ~ 7 / ~ ....................... :'"i Engineer's Seal MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back ~i:k.'. CE- 3589 vi~;~ ·. · ~ = tm, ~SSt~:~ Receipt No ~~ Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D, #92-0040440 ANALYSTS REFORT BY SABLE for Work O~der # 22463 Date ReCent F~inted: JUN t5 90 @ 13:26 Client Jampi~ ID:LIS CRESTWOOD LAUNDRY ~00~ PWSI5 UA ~]]e~ea JUN 13 90 kecelved JUN 13 96 Ciient Name : FLAT!O? Client Acer : MLATTOI P.O.~ NONE RECEIVED ~eq ~ Ordered ~y , IED ~00~ Laboxatomy Supervisor :STEPHEN C. £DF ljFLATTOP CECHNiCAL SgV Special instruct: Chemleb Re£ #: 901~49 Lab Smpl iD: ! Mat~ix~ WATE~ atlcwabl. Pazame~e~ Tested Result U~u%a ~ethod £~mits NITRATE-N 4.5 ~/t EPA 353.2 Sample ~A~LE COLLECTED BY CHRIS. 50UTINE SABLE. See Spec~ai Inst~uc%icns Above - APPLI( NT FILLS OUT UPPER HAl ONLY Proper~Y-Owne4 '/.,~:~t/"~/,) /~/~-~'/~"~'~y j'.~')~,~//~2,.'/d.~y ---"~i'~,i~,~.,C,~:~._,~~ Phone Mailing Address ,~-,~,,~..~ ~ ~,~:~'/~,,~ Zip Code .... Buyer ~~ ~ ~ ~~ -- ~7~. ~ ~ ~ Zip Code Address ~O ~) J~ ~[~. ~ ~ Lending Institution Phone RealtyCo.&A~nt ~/~ ~~~.~ ~ ~ ~/~~ Phone Address ~ 7~ ~~ ~ ~ Zip Code Legal Oescript~n ~O ~ ~ ~-- ~~ ~~ ~ ~ Type of ~esi~nce Single F~mily Multiple F~mily No. of Bedroo~ ~ .... - ~ Olher W~ter Supply lndividl , ~ A~ACH ~LL LO~. A w~l log is required for ~11 well~ drilled since 3une lg75. Community ~o~ For wells drilled prior ~o lh~ d~e, give well deplh (~l~ch log if ~v~il~ble]. ~ Public Sewer Disposal ~ Individual Year Indiv~u~l Ins~lled: ~ ~ ~ Public ~ilily When Connecled ~o Public Ulility: ~ Holding Tsnk NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH ~E~EST BEFORE ~OCESGIN~ CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ~, N~LINIciPALI~ Y O1' Field Notes: ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ~DISAP~OVED ( ) CONDITIONA~APPRO~* DATE BY: Soils Rating Date ~wer Installed Well To ~sorption Area 72-023 (3/82) June !7, 1983 Bryan Rickey Moberly 9600 Brien Anchorage, AK 995 Subject: Lot 15, Crest~ood Subdivision Approval for the individual sewer and water ~:aciiities cannot be granted until the following items have been completed: sce.-water facilities %;ere not turned on at the time og the heduled, inspection. Please call this office for another appointment. he water analysis report ~eeds t~ be submitte¢i to th f~ice from the Che?,~ Lab, D633 i5 .~treet, for our revi~¥s/.'~-~ %~ ~'xpose tile %,~ell for our inspection to determine proper ~construction, also to insure ~ninimum (/istance requirements ~are met between the tqell and sewer system. The septic tank t~umped with a receipt subnlitted to this department. ~)~.A_~ -,-. four (4) inch cieanout needs to be installed to the sep- ~ t~i~c tank. o An adequacy test needs to be per~:ormed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this o~fice for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. I~ there are any f_urther questions, please call this office at 264-4720. bincerely, ~,~7/ej/E2 Cory ~illis ' , ...... ~.,r~Lli ~ g~ A~CI~ORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF I!~.ALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTiF~IRONMENTAL 825 LStreet-Anchora~.AI.ka99501 JAN 1 8 1979 ENVIRONMENTAL ENGINEERING DIVISION Telephone 2.-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRE¢TIONS: Comple:e all parts o~ page 1. Incomplele requ~B will not be proceed. Please 811ow ~en (10) days for processing. 1. PRO~TYOWNER .J PHONE ~AILING PROPERTY ~ESIDENT {If different from above) PHONE 2. BUYER PHONE MAILING ADD~ESS 3. LENDINg INSTITUTION J PHONE I 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION Z. o-ir- STREET LOCATION 6. TYPE OF RESIDENCE I~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five .J~ 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 INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY "If individualJon-site, give installation date ~_' ;]'~ (~ If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM I~ I NDIVI DUAL/ON -SITE r---I PUBLIC UTILITY Connection Verified [~'eptic Tank or [] Holding Tank Size: ./.~"l~ If Tank is homemade give dimensions: TOTAL ABSORPTION A~A -- WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] ONE ~' THREE [] FIVE [] TWO [] FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED C PERMIT NUMBER · 7 lq >- DATE INSTALLED SOILS RATING MANUFACT~ MATERIAL ~a~ Septic/Holding Tank 0 ISewer Line OTHER Nearest Lot Line r~ [] [Z~DISAPPROVED APPROVED FOR BEDROOMS CON DITIONAL APPROVAL (letter must accompany certificate) DATE IBY (Titl~e) / LEGAL DESCRIPTION 72-O10 (Rev. 3/78) 23, 1979 Gordon TurnE~ Post Of£Xee Box 4-1SS1 Anchor&ge, AXBika 99509 Sub3oc~m Lot X5 Crest~ood SubdXvXsicm Approval for your individual sewer and water facilities will not.be granted until ~he following items have been c~mpl~r~d t () ¢) The depression oF pit arour~ ~.he well oasinq should be filled with ~iou8 type 8oil so that it elopes away from the ~ell O&sing. The ~ell onsinq is extended twelve(X2) inches above ground level. (x) Expose the well for our inspection to detex~ne proper o0astruction, also, to insure the minims distance s~oqui~tm are not between Four well and 8eeer system. (x) Tho septic tank is pumped with a receipt submitted to this office. ( ) A four(4) inch ~st iron cleanout be installed to the septic t&nk or leachin~ area. () A por~oXetion toot be performed on the existing lea~hing area. This will determine if the system is adequate according to National Standexds. A list of p~ivate firms ~ho ix~r£orm the test ia enclosed. -Oordon Turne~ ~anu&L~ 23, 1979 () Your a~pllc&k~on 8ho~s tho number o£ bedroo~ exceeds the number the ~e~er ~otem ~as originally approved t~tere£ore, an ~&de will be requir~d. () Connect to ~he public oewer which io available you. 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: O0 p.m. Date of Inspection 2-24-77 JK REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR % Caroyln Bararra Phone: 279-5641 Phone: 278-3644 Cony. ]. Approval requested by: Alaska Bank of Commerce Mailing Address: 712 West 4th Avenue 2. Property 0wner: Howard Smith Mailing Address: 2523 Brooke Drive 3. Legal Description: Lot 15 Crestwood Subdivision 4. Location: Off of Birch Road, left on Barry, right on Brian 5. Type of facility to be inspected Single Family No. of bedrooms 2 6. Permit #76336 Individual 82 ' Well Data: A. Type C. Construction B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: E. Disposal Field: , Sewer Lines We Be On-site system, Permit #76195 1976 B. Installer ]. Size 2. Manufacturer ]. Absorption Area 2. Material Total length of lines , Absorption area , Other contamination , Absorption area Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages 1. Type of Inspection: MUNICIPALITY O F ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA FHA MUNICIPALITY OF ANCHOP. AGE DEPT. OF HEALTH &, ENVIRONMENTAL PROTECTION' FEB P. $1077, Property Owner: HOWARD SMITH 2525 Brooke Dr. Mailing Address: Day Phone: 278-~6~4 3. Name of Buyer: Howell Reed ATT; Carolyn Barrera Day Phone: Location' COMMERCE Phone: 279-5641 4. Name of Lending Institution: ALASKA BANK OF Mailing Address:712 West ~th Ave. TOTEM REALTY 5. Name of Realtor or Agent: , Mailing Address: d ,5 ~ Gambel ,. Phone'%:i~i~:~'cA~272-057''1 Lot 15-Crestwood subdivision (Fifteen) 6. Legal Description: Off Birch-Left on Barry-Right on Brian o Type of Facility to be Inspected:Single Family Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation One 82) Eighty-Two Feet No. Bdrm~) Two rlndividual Individual (on-sil:ei Public Utility 6-'1 ~-76 Page 2 of two pages - Re~.~Jst for Approval of Individual ~..~er & Water Facilities ~'egal"Description Lot 15 Crestwood Subdivision Comments Approved-~~ ~.~d/~ 0 _(~z/ Disapproved Date ~/, - ~ C) 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)