HomeMy WebLinkAboutCRESTWOOD LT 20Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191498 PID Number: 015-061-23
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade
Name
ANDREW GRUNZA
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ound
Site Address
9701 BRIEN STREET *ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth original grade
907-337-0377
4
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
CRESTWOOD; LOT 20
Fill added above original gr
Ft.
Gravel length
Ft.
Township Range Section
-
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total orption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
1 00'+TANK
❑ Septic ❑ S.T.E.P. ElHolding [:1Other
Manufacturer
GREER TANK
Capacity
1500 Gal.
Surface Water
100,+
Material
Number of compartments
Lot Line
51+
00,
NA
HDPE
2
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks OLD TANK DECOMMISSIONED PER UPC
PER CONTRACTOR
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034Tank to D3034
drainfield
Installer
A+ HOME SERVICES
Drainfield D3034/EXISTING CO/MTD3034
Inspector TIM ECKLUND AND DAVID GARNESS
BENCH MARK (Assumed elevation) 102.81 ft
Inspectiones: 15` 11/15/19 -
Location and description
2 ntl
TOP O F MH
3b _ 4'h _
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Sf,mp
oo600O��
oF ".
Conditional Approval: Date
oo ` .. . '950
T/ I .
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Septic System
y ..
� CL, ealzriod Date�Approved
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Note: this approval does not include well permit requirements.
4aecc8844�DO�000�a�
(Rev 05/02/18)
PERMIT NUMBER: PARCEL ID NUMBER:
OSP191498 RECORD DRAWING 015-061-23
/
CRESTWOOD: LO 221
EXISTING DRAINFIELD; CLEANOUTS WERE
MRED BY A+ HOME SERVICES DURING INSTALL
CRESTWOOD; LOT 19
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NEW 1500 GALLON
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GARNESS
ENGINEERING
— — —
HDPE GREER TANK
-___------= ENGINEERING o SALES o CONSULTING ��_
3701E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 PHONE vxiw.gamessengineenng.com
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LEGAL DESCRIPTION:
CRESTWOOD; LOT 20
DRAWN BY:
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I,._SEPTIC TANK RECORD DRAWINGS
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DRAWN BY:
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TYPE OF WORK:
DATE:
I,._SEPTIC TANK RECORD DRAWINGS
11/19/2019
LICENSE♦�
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r7PERMIT NUMBER: PARCEL ID NUMBER:
OSP191498 RECORD DRAWING 015-061-23
TOP OF MH = 102.81
FINAL GRADE = 102.55-102.73
MH ST2
TOP OF TANK AT INTLET = 95.06 TOP OF TANK AT OUTLET = 95.08
INVERT OF BUNG AT INLET = 94.42 NEW 1500 GALLON
H. D. P. E. SEPTIC TANK INVERT OF BUNG AT OUTLET 94.23
RATED FOR 10' BURIAL
Lk
..............
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GARNESS ENGINEERING GROUP, Ltd -
ENGINEERING o SALES o CONSULTING---
3701E.TUDOR ROAD, SUITE 101'ANCHORAGE, AK 99507'PHONE (907)337.6179'FAX (907) 3383246' WEBSITE: -gam sengineenng.com ea.. a eee e.e.ee.. eee.a ;
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �n •• y A. • @SS •' 4�i
ANDREW GRUNZA 907-337-0377 3 OF 3 �jGi E-79 3 _m
LEGAL DESCRIPTION: DRAWN BY:
CRESTWOOD; LOT 20 D.J.G. �#0 '•� .,.,... 4W
TYPE OF WORK: DATE: LICENSE♦1 . ESS\9 ' �•
SEPTIC TANK PROFILE 11/18/2019 #AECC884
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP191498
Work Type: SepticTank Upgrade
Tax Code Number: 01506123000
Site Legal Address: CRESTWOOD LT 20 G:2438
Site Mailing Address: 9701 BRIEN ST, Anchorage
Owner: GRUNZA ANDREW L & DEBRA A
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
11/6/2019
11/5/2020
49500
❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: �-
Issued By: C�a�
Date: //
Date:
LI
MUNICIPALITY OF .ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-061-23
Property owner(s) ANDREW GRUNZA
Mailing address 9701 BRIEN STREET *ANCHORAGE, AK 99507
Site address 9701 BRIEN STREET *ANCHORAGE, AK 99507
Legal description (Sub'd, Block & Lot ) CRESTWOOD; LOT 20
Legal description (Township, Section & Range)
Lot Size
APPLICATION IS FOR:
( ® all that apply)
Absorption Field
❑
Septic Tank
N
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Sq.Ft. Number of Bedrooms
APPLICATION IS AN:
Initial ❑
Upgrade
Renewal ❑
Day phone 907-337-0377
4
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
TYPE OF DEWELLING:
Single Family (SF) N
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
Distance: _-
I
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: Cha' Waiver Fees:
Date of Payment: 1114111 Date of Payment:
Receipt Number:: %COQ —a 2L�
Permit No. a,50q 102
Receipt Number:
Waiver No.
(Rev. 01/11)
GARNESS ENGINEERING GROUP, Ltd
-- ENGINEERING SALES CONSULTING
October 22, 2019
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Crestwood; Lot 20 — Septic Tank Design Upgrade
To whom it may concern:
The existing 4 -bedroom house is served by a private well and septic system. The
existing tank is 35 years old and needs to be upgraded. We are proposing to
decommission the existing 1,000 -gallon steel septic tank and install a Greer 1,500 -
gallon HDPE septic tank.
We are unaware of any adverse impacts this installation will have on adjacent wells or
septic systems. Ify;Qu have any questions, please contact us at 337-6179. Thank you
for your assistance
ince�ely,
,�effreytnes`s�_2) M.S.
Presid
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER /
THAT PERTAINS TO THIS DESIGN. BY PROCEEDING /
FORWARD WITH THIS INSTALLATION, THE /
ENGINEER, WELL DRILLER, CONTRACTOR AND /
PROPERTY OWNER AGREE THAT THEY HAVE %
READ THESE SPECIFICATIONS AND AGREE TO
ACCEPT THE TERMS AND CONDITIONS OUTLINED.
i
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CRESTWOOD; LOT 2
----INSTALL DBL CO'S -
PROPOSED GREER 1500
GALLON HDPE SEPTIC TANK —
i
i
INSTALL DBL CO'S -
i
100' WELL RADIUS
CRESTWOOD; LOT 19
WELL ON LOT IS NO CONCERN (100'+ FROM
�\ PROPOSED SEPTIC TANK LOCATION)
NOTE: CONTRACTOR SHALL HAVE THE NORTH LOT
LINE AND THE WELL RADIUSAGGED BY A
PROFESSIONAL LAND SURVEYOR PRIOR TO LAYOUT
AND EXCAVATION. THE DRAINFIELD MUST BE
EXPOSED TO CONFIRM 5' SETBACK FROM THE
PROPOSED TANK.
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GARNESS ENGINEERING GROUP, Ltd
_ — — - - ENGINEERING SALES - CONSULTING =— —
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 338-3246 - WEBSITE: v .gamessenginee6ng.com
PREPARED FOR:
ANDREW GRUNZA
PROJECT/LEGAL DESCRIPTION:
CRESTWOOD; LOT 20
TYPE OF WORK:
SEPTIC TANK UPGRADE DESIGN
PHONE NUMBER: PAGE NUMBER:
907-337-0377 2 of 2
DRAWN BY:
PNB
DATE:
10/22/19
NEW LOCATION
CONNECTING TO l
EXISTING ,-
DRAFILD OLD LOCATION FOR
CONNECTING TO TRENCH
TO BE CAPPED
EXISTING 1300 GALLON
HDPE SEPTIC TANK TO
BE DECOMMISSIONED
PER UPC
EXISTING 4
)ROOM HOUSE
/
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(~~ '-" MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME JPHONE I F-INEW
MAILING ADDRESS
LEGAL DESCRIPTION
DISTANCE TO: JWell I J Absorption area Dwelling PERMIT NO.
~ Z Manufacturer , , Material No. of compartments
Liq. c~bacity in gallons Inside length -- wiath Liquid depth
90~O IF HOME~DE:
~ ~ ~ ~anufacturer -- ~ateria~ Liquid c~pacity in gallons
0 Well I Foundation Neares~o~i~e PE~I~.
~Z DISTANCE TO: J i3 ~ 7~ 7'
~ No. of linesj Length ofje~ line Total length o~ linesj~. Trench wi~ ~ Distan~en lines
;~ Top of tile to finish grade / Material beneath tile I T°tal "ffe~b~r~i,narea
Length Width Depth PERMIT
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~m DISTANCE TO: Well ~ Buildin~undation Nearest lot ~line
~ Classp~ ~V~T~ Depth ~ Driller ~ D~stance~ot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO: ~ ~
OTHER
PIPE MATERIALS ~' Z
iMST~LL~
REMARKS ~ ~ T;~G ~ I
~/ /O~ ~
APPROVED DATE LEGAL
~ ~ 9/,'~/~ LoT ~o ~K~
~ 72-013 (Rev. 3/78)
~PPLZCANT:
LEGAL
L 0 T S ! Z E:
PLOCK: NA
I C~T'FY 'THAT'
FORTH ~;Y TH,? ~UNTCTP~Li'TY Oc ANCH~P.~5 (N~) ~N~ TM~ ST.~T~ ~ ~LASK~.
ALL ~OA CODL~3 ~,~O RE"ULATION~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Stree% Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
v,~~'*i{'1 c,~ ~
SLOPE
DATE PERFORMED: ~'(~p3~- ~ [ ~ ~ ~"~
SITE PLAN
WAS GROUND WATER
ENCOUNTERED7
IF YES, AT WHAT
DEPTH?
S
L
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
v--%-/ ,
l ~ (minutes/inch)
FT AND ~ FT
CERTIFIED BY:
DATE:
PER~
TEST RUN BETWEEN
t~ ,'~
72-008 (6/79)
GRE, : R ANCHORAGE AREA BOI dGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska gg§03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS ~ ~'"~'~ ~ PHONE
SEPTIC TANK:
DISTANCE N0~'
FROM WELL
INSIDE LENGTH
MANUFACTURER ~
INSIDE WIDTH
NUMBER OF
__ MATERIAL COMPARTMENTS
LIQUID DEPTH
LIQUID CAPACITY /~('~GALLONS.
TILE DRAIN FIELD:
NUMBER OF LINES / DISTANCE BETWEEN LINES
DEPTH: TOP OF TILE TO FINISH GRADE
NEAREST LOT LINE /~ ('~'OF TOT LINES AL LENGTH~ /,
/~V///~1~ TRENCH WIDTH~'~::~.~ IN. TOTAL EFFECTIVE
SQ. FT.
LENGTH OF EACH LINE
DEPTH OF FILTER
MATERIAL BENEATH TILE
IN.
WELL:
BUILDING
FOUNDATION __
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST NEAREST
LOT LINE__, SEWER LINE__
OTHER SOURCES
DISAPPROVED
DEPTH
SEPT lC SEEPAGE
TANK__, SYSTEM
REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY: ~ I
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
Form LQ-032
!'-1 Id r-.! ]E C: .]. . Fl L_ :[ '1- %r~ Cn F' FI I'-.I C: t J [-;-: Ft t-:_~ EZ
E:,EF'FIF..'THENT ~ HEFIL. TH FIND EN'v'IF.:ONH[NTFIL"~'ROTEC:T ION
825 '"L'" ':-STREET., RNOHOF.:FIGE, f~K.., 9~SCtt.
&--~ E.'. L. L_ Fl i'-.i r_::. t.%~ !--.i -- .-.~.1 -[ '1- E: :E: E &.-I[E E: F' EZ F-." l'.1 ][ ]F
,' 77"2!:.7:7 :.',
RF'F'L. I C:FIN-r'
L. Or':RT I ON
t_E:GFiL.
F Q_F.: E H 3 ~ T H O H ~S
E:RIEN ST
L2F1 CF.:ESTI.,.IOO[> SUE:D
LnT SIZE
::.....' 7 :.:_:- 3:6 4 4
4~'.::'~'~:~ SQUFtF.:E FEET
]""r'F'E OF SO I L. · FI E: S O F.: E: 'I" I ON ::, .r z, TEI'I I S ' TF..:ENCH
t"'IFt::.,: T HI_IH NIjHE',EF..: OF E:EE:,F.:F,3FIL:.; ~ SU I L F.:FI'F I NG ,:; SQ FT..-"BR', =
THE F.:Eg!UIF.:Et.3, SIZE L3F THE SOIL FIBSOF.:F'TION .z, 'r z:,TEfl IS'
THE I...EI"4GTH [."IHENS]:ON IS THE LENGTH '::IN FEET::' OF THE TRENCH OR [:'RFIINFIELD.
THE DEPTH CIF Ft 'TRENCH CIR PI::.' IS THE [::,ISTFtNC:E BE"FNEEN THE SUF.:FFtC:E. OF 'THE
GF:'.OUND FIN[:' THE BOTTOP1 OF :''HE E::',:CR'v'FITION ':.'IN FEET;.".
THER..E tS NO SET WIDTH FOR TF..'ENC;:HES.
THE GF..'FI',,,'EL DEF'TH IS THE; htINIPtljH DEF"TH I)F GF.:FI'v'EL. BETWEE'."N THE OI...I'I-FR[_L PIPE
FIND I'HE BF~TTF'IH OF ].'HE: E::':;CR'v'RTIEIN < IN FEET::'.
E:RI'_':~:::F' [ t_L [ Nl_-~ L-IF RN"r' .z, 'r .:,] Er1 [,J ]: THOIJ-F F' Z NFIL Z Nz, F EI....T ]. I_ N RNE:' HF F ~. _ HL TH ! ~.;
E:,EF'RF.'.THENT W I EL. BE SUEkJ'EE:T TO F'F.' L"~ECLIT :1;
HINIf'IlJH DI S]"RNC:E BETWEEN R WE:L.L FINE:, Rr.4'~-' ON-SITE SEI.qFIGE E:,ISF'OSRL S'-r'STEI"t IS
:l. 6~E~ FEET FOR R F'F.'.I',,,'RTE 1.4EL. L. OF.'. 2E'"-3 FEET FOR R PUBLIC WELL._
WEL. L L. OGS FIRE REQUIRED RNI]:, P'IUST BE F.:ETUF.:NEE:' TO THE [:,EF'RF.:TP1E:NT H ITHIN ]i:E.~ [:,FPr'S
OF THE WELL C'OHF'L. ET ION.
SPEC: I F I CFI"r' I ON'_z, FINE.:, C:ONS'TRLICT I FiN [.', I FIGRFIHS FIRE FI',,,'FI I LFIBLE '1"L3 I NSIJF.:E F'F.:OF'EF.':
! t'.,ISTFIL. LRT 10[4.
I CERTIF"r' THFIT
±: I FIt'1 F'FIP'IILIFIF.: WITH THE F. tEQIJIREP1ENTS FOF.: ON-SITE SENEF.':S FINE:, WELL_S FtS SET
FORTH B"r' THE I"ILINIC:IF'FILI T"r' OF FINCHOF.:RGE.
2: ]: 1.4IL. L INSTFILL. THE S"r'STEhl IN FtCCEIRDFINE:E 14ITH THE CODES.
Z.':: i UN[:'EF.:STFIND THFIT THE ON-SITE SEWER :F.,"r'STEI"I HR"[' REQUIRE ENL. RRGEHENT IF THE
F.:ESIDENE:E IS; RE:HO[:,EL. ED ].'O INCLLI[:'E HORE THFtN 3: BE[:'ROCff'IS.
S I G N E [::, '
FIF'F'L I CFIN-I' F 3F.'.EHOST HOHE'E
1:5'"::;LJE[:, E"r'_ ..................................................... [::,RTE ..............................
GREATER ANCHORAGE AREA BOROUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT
INSTALLATION LOCATION
FINANCED THROUGH
SOiL TEST RESULTS
COMPLET,ON PATe ANT, C,PATED
TO BE INSTALLED B.
NOT~; THIS PERMIT IS NOT VALID WITHOUT
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPT,C TANK S,Ze
TYPE
SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PiT
, DRAIN FIELD
SEPTIC TANK ., SEEPAGE PIT , DRAIN FIELD .
TO NEAREST LOT LINE.
WeLL tO SEPTIC TANK /~0 / SEEPAGe Pit
DRAIN FIELD I _/~/~) / ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK /.~// . SEEPAGE Pit
DRAIN FIELD
SEPTIC TANK, ~/. ~ ~ I /.
, SEEPAGE PIT -- , DRAIN FIELD
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
F, ED W,T. A,RT,G.T.EMOVASLE CAPS.
( t
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
FORM NO. LQ-016
Performed For
Leaal Qescrintion:
This Form Renort$ Soils Loq
2204 Cleveland Anchorage, Alaska 99503
Forremost Homes gate Performed
Lot ~ B10ck Subdivision Crest~ood
yes
5./23./77
Percolation Test
nenth
Feet Soil Characteristics
6"Peat & Reddish Silt
Sandy Silt
10
Sandy Gravel
16m
20~
·
Was Ground Water Encountered? No
I~ Yes, At what Denth?
JReadinq Date Grnss Time Net Time Denth to H2O Net Dron
Percolation Rate Hinute
Prnposed Installation: Seenaoe Pit Drain Field
Den. th of Inlet Denth To Bottom Of Pit Or Trench
cn~!~ENTS' 1Aa2,qq,~m?~ Fe~t d:~._=-,{_~ge mrmm r~?~r~ per h~rnnm
Fro~7' to 15'
Test Performed By 't~~~~ Data Certified BY:_~
Parcel I.D. 015-061-23
Municipality of Anchor
On -Site Water and Wastewater Program
GE B`
�e NOV 8 2019
(907) 343-7904 A E T
e h
O[ 6 g �g5
Certificate of On -Site Systems Approva
Expiration Date: loo d I , Q C) ) 0
1. GENERAL INFORMATION:
Complete legal description Crestwood: Lot 20
Location (site address) 9701 Brien Street *Anchorage, AK 99507
Current Property owner(s) Andrew Grunza Day phone 337-0377
Mailing address 9701 Brien Street *Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING: t r.
® Single Family (w/wo ADU) c� flu
F1Duplex f I!
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well..
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 22 () Waiver Fee $
Date of Payment ! 96It A Date of Payment
Receipt Number Receipt Number
COSA # t36c1 15&S Waiver #
FN
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness
Date:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system Ur
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the Oo
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells • A I H
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ..... • • - • -
groundwater levels (that may fluctuate during the year)
, quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ! of : y
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of Ur,n�
CE—
the well or septic system. GEG makes no representation whether an alternative well or septic system Vl9
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to ap
roi�
perform the evaluation. Reliance upon the information provided in this report by any other perspp p�j[�( ���4Oe
party (including subsequent property purchasers) is not authorized, nor will it confer any 1p%.gN 1 t; (t (t 1(f///
whatsoever. `\� �'( l F A�/C,y�/��
6. DSD/SIGNATURE ON-SITE
./ System #1 Approved for bedrooms AND
Z
System #2 Approved for bedrooms D WASTEWATER Q
ssDisapproved` pROC'RAtVI Q
iO 5 �
Conditional approval for bedrooms, with /FM, 1, *46,ns:
Cxr, Ie
#AECC884
eI U)ccAA6L Vv horn A t +1 adder +Aie L-) t , d + VV Al'Pi A-41
owad_c be gee 4' e �6 k o&d14 f dreurLGtL0' GC_e.an o t of blveAl
By: ` LV k ca_7U'Z Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet_10.10.12.doc
1� Nitrate Advisory.:.; 5
Arsenic Advisory
Other J
W c t7t0,j-Xt
Legal Description: Crestwood; Lot 20
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
-
FOR Well log is filed with Onsite (or attached)
Date drilled 8122/77
Total depth 67 ft
Cased to unk ft
❑ Sanitary seal is functioning correctly
ON Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 10'28/19
Static water level at beginning of test 54.5 ft
Comments
B. TANK DATA
Age of tank(s) New years
Tank type/material-0,JH0PE
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New
D. ABSORPTION FIELD DATA
Which system tested (date installed) 19"81980
❑ ALL standpipes present per record drawing
Total measured depth from grade 11.58 ft (max)
Measured depth to pipe invert from grade 7.5 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective 4.3+
Parcel ID: 015-061-23
Structure served by this system
Well production at time of test 6+ gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 8.01 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ND ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG, Ltd.
Date of Sample 10/16/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Co
Adequacy test date 10/28/19
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 11 in
Water added 620 gal
New depth 33 in
Elapsed time 120 min
F0 Code -required soil cover over field Final fluid depth 21 in
❑ System presoaked Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No
date of test) _
If yes, enter date
Gallons introduced N/A gallons
Comments/Deficiencies: 1977 &1984 TRENCHES COMBINED =-4-BEDROOMS
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0✓ Yes
if No
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
ED Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' E✓ Yes
if No ft
Absorption Field on Lot > 100' 0✓ Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Q✓ Yes
if No ft
❑✓ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0✓ Yes
if No
ft
FZ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft
Property Line > 5'
0✓ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q✓ Yes
if No
ft
Private Wells > 100'✓Q Yes if No _
Water Main > 10'✓❑
Yes
if No
ft
Community Wells > 200'✓Q Yes if No _
Water Service Line > 10'
❑✓ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 2✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
0✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
0
O
41 . .. ...........
J Ga ess.-
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ft
ft
ft
s
DEVELOPMENT SERVICES DEPARTMENT
On -Site water and wastewater Section
www.muni.org/onsite
907-343-7904
�AT Fax: 343-7997
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC191563
Subdivision: Crestwood, Lot: 20
A water sample revealed a nitrate concentration of 8.01 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include. avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Ma[> [ngAddress P O Sox 196650 Anchorage, Alaska 99519 66bQ >www mur[ org 4
November 20, 2019
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Reverse Grade from Tank outlet to Drainfield — Crestwood; Lot 20
To whom it may concern:
A new septic tank was installed at the referenced lot. During the installation inspection by the engineer
(David Garness, P.E.) the cleanout repairs (as stated on the design) had not been completed by the
contractor. In short, the contractor did not have "altitude awareness" when he installed the tank. After the
septic tank installation and cleanout repairs, elevations were taken by the engineer and it was noted that
the northeast cleanout (where the line from the septic tank connects to the drainfield) is slightly higher
than the invert of the outlet line on the septic tank (approximately 0.09 feet). Although reverse grade is not
an ideal scenario, we feel there is minimal risk that this condition will be problematic. The justifications are
as follows:
® The invert of the cleanout at the connection is approximately 7.5 feet below grade. It is unlikely
that the line will freeze due to the significant soil cover. In addition, it is in the yard and will likely
have snow cover during the winter months.
® The invert of the tank inlet is approximately 0.1' above the invert of the trench cleanout. In short, it
appears that effluent will flow to the drainfield without surcharging the inlet invert of the tank.
It should also be noted that the trench cleanout to the west was lower than the outlet of the tank and the
trench cleanout to the south was higher than the tank inlet, outlet and the other two trench cleanouts.
Given that the elevation of the distribution line has not changed, it is likely that this deficiency has existed
since its original installation. It is reasonable to assume that effluent will travel throughout the drainrock
subsurface as it likely has done throughout the life of the drainfield.
Garness Engineering does not guarantee the functionality of the drainfield, as we were not involved with
the design and/or inspections of the drainfield. If you have any questions, please contact us at 337-6179.
Thank you for yoWr assistance.
rely,
M.S. i�,k•"'�- (`}e-1 S
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
A HOME'SERVICES,
7501 Irl 14Ofl),,f%VCnijt�,
Al-rWJloMUTe,_ 'Ska
Engineer:
Legal Description
Parcel ID:
Permit:
Report Type:
Municipality of Anchorage
On -Site Water and Wastewater Program
P.O. Box 196550 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
Review Comments
GARNESS ENGINEERING GROUP LTD
CRESTWOOD LT 20
01506123000
OSP191498 SepticTank
On -Site Review
�I114_n t 'S,
n
�• l
L)epai•tn ent
_11/5/2019
Completed By: R.Carroll
The application has been reviewed and the following comments have been generated. These are to be satisfactorily
addressed prior to MOA approval:
� � :moo '9:%i� +-'�s✓` �
'f`> IJ�sF�J flui��
1. Please add the scale to the Septic Tank Upgrade Design drawing. �
2. The submitted as -built survey is not printed to scale. Please address.
3. FYI: MOA records indicate the drainfield is only approved for 3 bedrooms. For future COSAs, justification will need to
be provided for a 4 -bedroom approval or the drainfield will need to be upgraded. This does not have to be addressed at
this time.
SGS Ref.#
1196236001
Client Name
Garness Engineering Group, Ltd (GEG)
Printed Date/Time
11/07/2019 17:00
Project Name/#
Crestwood Lot 20
Collected Date/Time
10/16/2019 14:30
Client Sample ID
Crestwood Lot 20
Received Date/Time
10/16/2019 14:58
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 B (<10) 10/22/19 11/06/19 BMZ
Waters Department
Total Nitrate/Nitrite-N 8.01 0.200 mg/L SM21 450ONO3-F C (<10) 10/24/19 EWW
Microbiology Laboratory
E. Coli Negative 1 100mL SM21 9223B A 10/16/19 A.L
Total Coliform Negative 1 100mL SM21 9223B A 10/16/19 A.L
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address ora directions)
(b) Applicants Name ,_~ ._~?_ ~~ Telephone- fo~m~e'~/~ Business
Applicants Address
(c) Applicant is (check one) Lending Institution ~-~~_2._.~_. _ ~=~.~~uilder~;
; Other (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single-Family~
Number of Bedrooms
3. Water Supply
Multi-Family ~--~
Other (describe)
Individual Well~ Community~ Public~-~
Note: If community well system, must have written confirmatioa from the State
Department of Environmental Conservation attesting to the !egaiity and status.
4. Sewage Disposal
Onslte ~ Public.~-~. Community F'-I 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]
5. En~ineerin~ 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 M~nicipality of Anchorage files and from my
investigation an~ inspection, the om-site water supply and/or wastewater disposal
system is in compliance with all M~nicipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Firm~ Telephone _~/-
Name
of
Addres
Date
DHEP Ap
Approved ~ D:[ sapproved Conditional
Terms of Con~it%onal Approval ~ ~ ~.~ .~$!~.~, ~ ~
CAUTION
THE I~JNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGIneER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. %~{E MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
Well Classification
Well Log Present (Y,
Total Depth . ~_~ -~ Cased to
Static Water Level .--~l / ~
Casing He ight Above Ground
Electrical Wiring in Conduit ~)
Separation Distances from Well:
To Septic/Holding Tank on Lot /~
To Nearest Edge of Absorption Field on Lot
Date Ccmpleted
If A, B, cr C, D.E.C. Approved(Y/N)
Yield ~, ~
m,~/~ Depth of Grouting FP//~
Pump Set At
Depression Around Wellhead
; On Adjoining Lots ~-/~
/~"~; On Adjoining Lots
To Nearest Public Sewer Line ~//~ To Nearest Public Sewer
Cleancut/Manhole ~//~ To Nearest Sewer service Line on LOt
Water Sample Collected By ~ ; Date ~
Water Sample Test Results ~ ~k ~~ ' '
CQt~ents ~
B. SEPTIC/HOLDING TANK DATA
Date Installed {~/~_~ Size 'I~D NO. of Compartments
Standpipes ~N) i Air-tight Caps _~N) Foundation Cleanout (Y~.
Depression over Tank (Y~ . Date Last Pumped _~/~/~
Pumping/MainteDmnce Contract on File (Y/N) ~]/~; for
Holding Tank High-Wate~ Alarm (Y/N) ~//~ Temporary Holdin~ Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~/~
To Property Line ../--c'~)!
TO Water Main/service Line ~/~/~ ~
co. se /
To Disposal Field ~, ~- / ~
To Stream, Pond, Lake, or Major Drainage
Receipt #
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~
Results of Last Adequacy Test
Standpipes Present
Date of Last Adequacy Test
/~) ~'~Type of System Design
Length of Field ~ /
Depth of Field ///
Gravel Bed Thickness ~/
Separation Distance fram Absorption Field:
To Water-Supply Well /05' ~- To Property Line
Foundation ~ To Existing or Abandoned System cn
To
Building
Lot ~) J,4- ~.,..; On .Ad~gining Lots
To Water Main/Service Line ~ To Cutbank(if present) 4%///$-
To Stream/Pond/Lake/ar Major Drainage Course ~-
To Driveway, Parking AreaI or Vehicle Starage Area
/ ,,
D. LI~ STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level
Tested for
Electrical Codes{
Dime ns ions
Manhole
Level at
Vent (Y/N)
Cycles duming Adequacy Test.
Meets MOA
Corm~nts
** Check Permitted Bedrocm Rating Against HA_~ Request **
I certify that I have checked, verified, or confarn~d to all MOA HAA Guidelines in effect
on the date~f this~7,cti~,o~.
si ed
KB1/dL/s
Date
[Page 2 of 2]
ALASKA IUIROFImI rlTAL COFITIgOL S UICI S, IFIC.
(~ngincerinq 6 (~nuironmenlal Studies
SEPTENBER 5 1984
JOE DEMARCO
9701 BRIEN
ANCHORAGE AK
SELLER - JOE DEI~RCO BUYER -
SUBDIVISION - CRESTWOOD BLOCK - LOT - 20
ADE~I. JACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM I5 A TRENCH WITH /iN AREA OF 308 5~CT.
THE SYSTEM I5 CAPABLE OF ACCEPTING 90 GALLON5 OF,WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 133 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM I5 NOT ACCEPTABLE FOR A
HOt~E OF 1 BEDROOM5.
THE SEPTIC TANK WA5 PUIVPED ON ,lINE 8 1984 .
FLOW TEST ON WELL
THE WELL FLOW RATE WA5 7.7 GPM FOR 2 HOURS.
SEPTIC TANK ADEq. JACY
THE EXISTING SEPTIC TANK VOLUNE OF I000 I5 ADE~I. IATE FOR
THIS 1 BEDROOM HOUSE.
1200 U, Jest 33rd Auenue. Suite B oAnchoraq¢. Alaska 99503.[907) 561-50z10
MUNICIPALITY OF ANCHORAGE
~3F HEALTH AND ENVIRONMENT.__ PROTECTION
Street, Anchoraa~, Alaska 99501 f ~
Date Received: November 2, 1977
#1: Time ti ./~)~}/~t'lq #2: Time .~.'Z~) ~t #3: Time
Date /~-,~-~ J~ Date ~- L/-7~ /~ ~;,~ Date
Insp i~~- ~' ~ Insp ~/ /'.~ Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Pacific Bank
Mailing Address: 601 West 5th Avenue 99501 Phone: 276-3110
2. Property Owner: Howard Smith Phone: 349-4631
Mailing Address:
Star Route A Box 85-K 99507
4:
Legal Description: Lot 20 Crestwood Subdivision
Single Family Residence: (x) Number of Bedrooms:~ ~~---
Multiple Family Residence: ( ) Number of Bedrooms:
Se
e
Well System:
Individual well (x)
Permit # ?~'~ Depth of Well
Construction ~
Community/Public System ~)
Well Log on File
Bacterial Analysis ~
Sewage Disposal System: On-site System (x) Public Utility ( )
Permit ~ ~%~ Installed 1977 Installer .~~ ·
Septic Tank Size / ~0 Manufacturer .~ ~
Absorption Area '.'.~9__~ Soils Rate /~ Material
Distances: Well to Septic Tank \~,~
tO Sewer Line ~\O Nearest Lot line
to Nearest Lot Line -{-- ~
to Absorption Area \\~)
Absorption Area
~age ' Two'
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 20 Crestwood Subdivision
Comments:
Affadavit Attached: (')
Approved :~~
D isappro
Letter Attached
Date: /-- // --
Date:
Department Worksheet:
: 7.
,~_.41C~iPA{.ITY OF ANCHORAGE
DEPARTMENT OF ~~,ND ENVIRONMENTAL PROTECTION
2510 East Tud~.~Chorage, Alaska 99504 276-2221
REQU'E~I~4~OR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
Type of Inspection: CM RO
Property Owner: Howard Smith
.CONY x:o~:oD~x:~
VA FHA
DBA; Foremost Services
Mailing Address: ~--__,._!_c D['.
Name of Buyer'RIC~RD ~T~:D!;NA
Mailing Address:.
Name of Lending Institution:
Mailing Address:. --~)~-W 5th
~'~'~ Day Phone:
Name of Realtor or Agent: '_~ot~m P~.alt~ __
Mailing Address:__~_~_~ 5~.~
Bank
Day Phone:
Phone:.P__j76-51 "10
Legal Description:__
Location: LO~
Phone: 272-057q
20 grestwood ~ub.
Type of Facility to be Inspected:
Water Supply ::~L-'z~::x~
Type of Supply:
~qngle Family
No. Bdrms. ~~'
Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well_ ~ 2 "/7~//
Individual
Sewage Disposal System
one
Type of System:
Public Utility__
f Individual, date of installation 6-qQ-77
Individual (on-site) xxxxxx~xxx il
,,~