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HomeMy WebLinkAboutCRESTWOOD LT 18Crestwood Lot 18 #015-061-20 ' ' Municipality of Anchorage Page 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO00005 PrD Number: 015-061-20 Name: PETER & ANDRIA THORNI WastewaterSystem: [] New · Upgrade Address: 9750 BREIN ST. ABSORPTION FIELD Phone: (907) .346-2607 No. of Bedrooms: ~. [3Deep Trench ·Shallow Trench DBed [:]Mound DOther LEGAL DESCRIPTION ~,, ,o,.0= To,°, eep~ ,,m o.,,.o, 1.2 oPD/e,.~ 10.9 - 12.6 18 - CRESTWOOD 6.9 8.6 F~4.0 n. 0 0.25 ~ 60' (2 © 30') WELL; [] New [] Upgrad~ 5 ~ 2 15+ --~ ~. ~ 600 S~.Ft ASTM D-3054/F-810 ~. EAGLE MOUNTAIN D°t*l~,~700 -- 1/26/00 cp. ~ ~ TANK SEPARATION DISTANCES · Se~o [] ,ord,., [] S.T.~.P. --rom Tank Reid Station Tank S,w,r U,,, ANCHORAGE TANK 1250 Weft 100'+ 100'+ - 25'+ ,~,,a~: STEEL Number of comporfl~ent~: 2 Sudace Water 100'+ 100'+ - - - LIFT STATION Lot S~ze in aarton.:I Line 5'+ 1 O'+ -- -- - -- _ ~°b IHigh wa[er alarm et: Foundation 5'+ 10'+ _ ·Pump on" level ob · ' , CurEaln I I ~emarks: COULD NOT GET GRAVI'P( FLOW TO OLD TRENCH. BENCH MARK THERE WAS REVERSE GRADE FROM OLD TANK TO TRENCH. NORTHWEST CORNER OF DECK (AT POINT "C") FUTURE CONNECTION WILL REQUIRE A LIFT ST,~TION. FLOW SPLITi'ER WAS NOT EXTENDED ABOVE GRADE. IAsBumed E]evob'on: 100.00 n. Inspections performed by: AWWC, ,NC. Dates: 1st 1/24/oo ~ .~. :.~.., ~L,/~.~ ~f ~ ~ ~ '"~-~ Ord 1/51/oo 1~ ../JJq trey IA. 'C:~ n e s s...' Department of Health and Human Services approval ~0~..~../...~7~ ......;~/ PER~JT NUMBER: s ooooo AS-BUILT DRAWING 015-061-20 A B C \ T ST1 12.7 28.5 - ST2 20.4 33.0 - DBL1 22.5 33.1 - DB~ 23.1 33.4 - C05 25.2 35.7 - C01 81.1 - 64.6 MT1 92.9 - 80.5 ~ L C02 99.6 - 90,5 C03 101.1 - 82.0 MT2 112.1 - 95.0 C04 121.3 107.3 ~2 ~INST~ED ~OW SP~ER~ NT m"~' ~ BEDROOM EXISTING D~INFIELDS ABANDONED AS SUCH THAT J ~ it MAY BE USED iN THE / FUTURE (WrLL REQUIRE ~HE ~ USE OF A LI~ STATION). . .... / SEPTIC TANK ~AS~ WATER ~ WAS~WATER CONS~T~S, ~C. CRESTWOOD SUBDIVISION, LOT 18 AS-BUILT OF SEPTIC SYSTEM UPGRADE PETER ~ ANDEIA THORNI (907) 546-2607 /O~ff,~ ;~-7953 DWN BY: SC~: PAGE; >A~:2/16/2000 J.W,M./J.L,M. I = 40' 2 OF 3 q~ PrOfess~Oo~ PERMIT NUMBER: swooooo5 AS-BUILT DRAWING PAROEL,O NU.6. 015-061-20 SOUTH Mf TRENCH - Ok~INAL. figt~ _ 94 J37~5:,~ NORTH Mf TRENCH /~INA!. ~ [30frOM OF I~NO't - 82,q~ [~fOM Off I'RCN(Td - 8P,44 A'r Ik~f . 9~,72 ALASKA WATER & WASTE, WATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: CRESTWOOD SUBDIVISION, LOT 18 WPE OF WORK: PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ~REPARED FOR: PHONE NUMBER: PETER & ANDRIA TNORNI (907) ,.7,46-2607 DATE:z/16/2000 J.W.M./J.L.M. N.T.S. 5, OF 3 ~, WATER & WASTEWATER CONSULTANTS, INC. ,~ ~- ' ; ,c::, L,2F '.~, [SOIL LO(; - PERCOLATION TEST] ~,~.~.,. i,~/~4.j_~!~,~ ..,?~, PERFORMED FOR: PE'I'ER AND ANDRIA THEONI ~,~...~.o.~. ........... D^TE PERFORMED: 1 /28/99 ~1~',,,,_"'.... ....... · '%%,,,.,o f e ~EPTH~ I TEST HOLE #1 I '~ ORGAN'OS SO~L C~SS,F,OAT,ONS ~ GW ~ ORG iS~TE PLAN1 [ I" = I00' J -~. ......... ~ GP IIIIIIII ML '"" -- GM CL GC OL ~. SW ~SC I i / DEPTH TO 3ROUNDWATER DATE DRY 12/28/99 I ~RY 1/~/00 \ / lo 11 4~'~:~:~ DATE READING CLOCK NET TIME WAIER LEVEL NET DROP W TIME (MINUTES), READING (INCHES) 12---.~,~;~I 12/29/99 PERC. HOLE WAS PRESOAKED ~+ HOURS PRIOR TO TESTING 13 1~- 15 SOIL ABSORBED WATER AS FAST AS IT WAS ADDED P, VERY CLEAN 16 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 11 FT. AND 11.5 .FT. COHHENTS: PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: DEPTH TO 3ROUNDWATER DATE DRY 12/28/99 DRY 1/5/00 ALASKA WATER & WASTBWATER CONSULTANTS, INC. 8901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK. 99504 .~,,~.? r. ~.7..~...~,~j~/, PHONI~ (907) 337-6179 * FAX (907) 338-324-6 ' '"' ' [SOIL LOG - PERCOLATION TEST1 .ETA. OESOR,PT,ON: C.ES.WOOD B. O,V,S,ON= ............ DATE PERFORMED: 1/22/00 ·;' ~'-'~"'~ ~PTH~ ~ TEST HOLE ~2I SIL LOAM SOIL C~SSIFICATIONS FSlTE PLAN~  ~GW ~ ~ ~ORO / r'=100'/ 3 ~ GP ML GH CL GC,,, , OL ............................................ SIL~ SM SW ~HH ........................................... ~ / /4 BEDROOM oo~ ~~ HOUSE 7 q~ DEPTH TO 0o~o~ SROUNDWATER DATE 8 10 ~ ~ 0% %o%' SES OF SP 11 ~¢o%' DATE READING CLOCK NET TIME WATER LEVEL NET DROP % o°o' TIHE (MINUTES) READING (INCHES) 19 ~ * ~ ~ PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 ~ TEST RUN BETWEEN 7.5 FT. AND 8.0 FT. B.O.E. COMMENTS: THE INSlTU SANDY SOILS SHOULD ACT AS A SAND FILTER. PERFORMEB BY A~SKA WATER ~ WASTEWATER. I, JEFFR~ A, 6ARNESS, CERTI~ THAT THfS WAS PERFORMED IN ACCORBANCE WITH ALL STATE ANB MUNICIPAL GUIBEUNES IN EFFECT ON DATE; ~/~ DEPTH TO 2ROUNDWATER DATE DRY 1/22/00 MUNICIPALITY OF ANCHORAGE Department of Hea/th and Human Serv/ces On-Site Serv/ces Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 ¢O7) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date issued: Jan 14, 2000 Expiration Date: Jan 13, 2001 Permit Number: SW000005 Legal Description: CRESTWOOD LT 18 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Peter & Andria Theoni Owner Address: 9750 Bden St. Anchorage, AK 99516-6448 Parcel ID: 015-061-20 Site Address: 009750 BRIEN ST Lot Size: 49554 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field ~ Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. ALASI A WATER WASTEWATER CONSULTANTS, INC. January 6, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Crestwood Subdivision, Lot 18 To whom it may concern: The existing 4 bedroom house is served by a private septic system and well. The existing septic system is in a state of failure and must be upgraded. One test hole was performed on the property. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is the soils log which shows soils classification, groundwater monitoring, and percolation test data. No groundwater was encom~tered in the test hole. The soils below the organics is a SM/ML material to a depth of 9 feet and then transitions to a SW material to a depth of 14 feet. At 14 feet, the soils transitions to a SP material to a depth of 17 feet (bottom of test hole). A percolation test was performed at a depth of 11.0 to 11.5 feet and found the rate to be <1 minute/inch. It is our opinion that the insitu soils will act as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 ft2 f. Maximum total depth: 11 feet g. Effective Depth: 2 feet h. Reduction Factor = 0.70 i. Width: 5 feet j. Length: 80 feet (2 ~ 40 feet) k. Effective absorption area = 571 ft2 6901 Debarr Road,, Suite 2B N Ancl~orage, AK- 99504 ~ (907)337-6179 ~ Fax (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The area where the proposed trenches are to go has a relatively flat slope. The trenches are to be installed parallel to the slope contours. 5. RESERVE DRAINFIELD SITE: The existing (failed) drainfield is sized for a four (4) bedrooms. Once it recovers, it can be used as a reserve site. If deemed necessary by D.H.H.S., we can have a test hole excavated for another drainfield site. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. assistance. Thank you for your Jeffi'~,~/ Presi~/c If yoi~ve any questions, please contact me at 337-6179. Note: Attached is a site plan, a design drawing, a soil log, a topography site plan, and a 4 page Consi~'uction Specification letter for the septic system, which are all part of this design package. 6901 Debarr Road,, Suite 2B ~ Anchorage, AK ~ 99504 ~ (907) 337-6179 ~ Fax (907) 338-3246 LOT 5 LODGEPOLE SJD s~/2, NW~/4, SW~/4, NW~/4 SECTION 14, T12N, RSW NO ENCROACHMENT CONCERNS LOT 17 CRESTWOOD S/D LOT 16 CRES~OOD ~D / PROPOSED SEPTIC SYSTEM EXISTING DRAINFIELDS-~ PROPOSED 1250 GALLONj SEPTIC TANK EXISTING FOURj BEDROOM HOUSE EXISTING SEPTIC LOT 21 CRESIWOOD LOT 20 CRES~OOD Sl/2, SWl/4, SWl/4, NWl/4 SEC~ON 14, T12N, R3W NO ENCROACHMENT CONCERNS ALASKA WATER AND WASTEWA'fER CONSULTANTS, 1NC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-617g/FAX: (907) 538-5246 LEGAL DESCRIPTION: CEESTWOOD SUBDIVISION; LOT 18 ~FPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: PETER AND ANDRIA THOENI (907) ,:346-2607 DATE:1 __ __ JDRAWN BY: ISCALE: ! PAGE: /6/2000 K.D.W. 1 = 100' 1 OF 2 10' UTILI3Y EASEMENT I PROPOSED DP. AINIqELD UPGRADE,~~.~ EXCAVATE IWO TRENCHES ll~T ARE 11 FEET DEEP BY 5 FEET WIDE BY 40 FEET LONO EACH. AOD 2 FEET OF CLEAN, WASHED DRNNROCK. INSTALL PARALLEL TO THE CONTOURS, NSTALL FLOW SPLrFrER I / TO REMAIN IN PLACE I A RESERVE SITE INSTALL FLOW~ ALASKA WA'I'~R AND WASTI4.WA'i'ER CONSULTANTS, INC. 6901 OEBARR ROM), SUITE 20. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: CRESTWOOD SUBIDVJSION; LOT 18 IYPEOF WORK: ANDRIA THOENI (907) 346-2607 ." I I I "" "' .... '"" DATE:l/6/2000 DRAWN ~y: SCALE: PAGE: ~;."e., ' ..... . G~; ~=' J.W.M. 1 = 40' 2 OF 2 ALASKA WATER & WAST~WATER CONSULTANTS, INC. 6.°, ~HON~ (907) 557-6~79 * FAX (907) LEGAL DESCRIPTION: CRESTWOOD SUBDIVISION, LOT 18 ,""; ..... I"~ '"~'..:...J PERFORMED FOR: PETER AND ANDRIA THEONI DATE PERFORMED: 12/28/99 DEPTH ~ (f~~ TEST HOLEI #1 SOI_I.L C LASSI FI CATI 0 N S Il !;'~,:~:~i.C,~ GW ~ ...... ORG SI~PLAN00 GM CL L GC OL If~H IIII S~/ML SW NH SM OH SC DE~TH TO I GROUNDWATER DATE DRY 12/28/9~9 I DRY 1/5/00 11 DATE READING CLOCK NET TIME WATER LEVEL [ NET DROP W TIME (MINUTES)[ READING[ ONCHES) 12~o~1 12/29/99 PERC. HOLE WAS_ PRESOAKED 4+ HOURS PRIOR TO TESTING 15~S 14 15 SOIL ABSORBED WATER AS FAST AS IT WAS ADDED P, VERY CLEAN -- 16 1 ?~ __ 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 .(INCHES) 20 TEST RUN BETWEEN 11 FT. AND 11.5 FT. COMMENTS: PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: DEPTH TO GROUNDWATER DATE DRY 12/28/99 DRY 1/5/00 STING 4 ~. MUNICIPALITY OF ANCHORAGE Dr- ,-1TMENT OF HEALTH AND HUMAN SER¥._~ES ... Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2~-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N~ ~/ DISTANCES Address ' ~ TANK FIELD WELL Ph°ne's'~7~__~~ / LEGALJ~~I Permd N°'DESCRiPTiON ~ iN° °f Bedr°°ms~ LoTWELLuNE /~/~ '~ ~ C~~O ~ ~/~ FOUNDATION ~ '~ Township, Range, Section /~ ~* /¢ driveway,AS-BUILT DIAGRAM {Show locahon of well, sept,c system, property hnes, Ioundat,On,water bodies, etc.} TANKS ~/~'~/~ N ~ SEPTIC ~ HO~ Manuiacturer ~ ~ gallons M~ NO. of Compa,ments *'' Iii ~ J-Jill TYPE OF SYSTE~¢~¢~ ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe botJom from Total depth from original grade or,ginal grade ~ ( FTJ /~ ' FIIJ ad~e~ agove original graae ,~ ~ ~ ~, ~ FT FT D~stance between hnes/ ~ ~ L¢~i~;- ,T 2¢ ,T". . WELLS ~/~/~ /L ¢0 ¢~~/Z X~mVATE ~ OTHE~~ ~'--/~7 -' 33 ff'i~'~' ~~~ "TI FT ~-~b~'~ - ~' ~ -,C~'~,~- ~' Installel Date Installed: REMARKS: ~ ~gt- I 17034 E~le R~ L~ R~d No, 2~ ce~ify that this inspe~ion was pedormed according to all Municipal and ~tate guidelines in effect on this date: . Health Depadment Approval: Date: ~--2 ¢ --~ 72-013 (3/85) S & S ENGINEERING :1. 7034 E. R. LO01'"' ~2()4 I!EAGI_E R i VER ~ (..~K 995'7'7 PHONE ,~694.-2979 1 / 4 / 88 ALASKA H[)L.tSllqG/ TIM AI"-.IC H. AI-::i 995C) 1 t EGAi_ Dt-i::SCR i F."i I ON: I....CIT lB [iRES f WOC]O SUBD. SEC J. 4 ,]"].2N,R3W I..0t' '..:J.':.;]:ZI:_":_,~ 1. 1:]:(3 (S(.:! F'l' (::iR ACRES) MAX. NUF'IBER OF BEDRO[)Iq,S SC:iii ....RATING: ,SC) Il... '11!:!:S'I DEF"IH: 14. F'I' NJ::) t, gA'i'EI:~ I::'I::~,ESEI'~'I'' IN ]'ESI' t'-tCH._E. -[HIS i,S AN L..IPGRAOE OF 2 BE:DROC~M '10 "I'HE EX1S"IING ,SEPiIi.] SYS"I'EM 'TRENC:H BE!iL) W. DI--:A i NF 1 [::.L..D ti:!:l::'l:: t:ii:C;f' :t: VE OEP'I'H 5 ~ 0 0 C::OVER DE~P f t"'l 5 C) (.) 'l'[J f Al .... ,O I:.:.: F:' TH ]. () () () I. li:i.l'"-.il:!'.; I' H 4 ~'! () 0 I,'4 Z D ]'1--I 2 ,, 5 0 J ~:i:;[:..! I:::'l, ..':1.9C) '/ (.) SI-::'E!.C :t: F:fl C[]I"'.t)D t '1' i ONS Ut:,: I NSTI:TUC: t" 10NS: PERFORMED FOR: DEPARTMENT OF HEALTH & HUMAN SERVICE,~, 825 "L" Street, Anchorage, Alaska 99502-0650 ( SOILS LOG -- PERCOLATION DATE LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ~_.~_.~.57-~,,.,~:~,~Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ] / ~-~ ~ R~ 2_-: ~, ~ ~ '~}~" - - PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~ ~r TEST RUN BETWEEN ~ AND ~'P FT COMMENTS // / , & s ENGINEERING ~// /,.~ : .......... CERTIFY THAT. THI~TEST,WAS PERFORMED IN ACCORDANCE WITHALLSTATEANDMUNICIPALGUIDEU~~CTONTHISDATE. DATE: ':/Z/~/' GRE^- R ANCHORAGE AREA BOR , GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION / SEPTIC TANK~ DISTANCE FROM W~LL /~ MANUFACTURER MAILING ADDRESS '~"-~',,'~:' INSIDE LENGTH LEGAL DESCRIPTION L NUMBER OF MATERIAL ,,.~ ~'~?,_. L, COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/<~0 GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ~FOUNDATION .,,2~- ! NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA DEPTH: TOP OF TILE TO fiNiSh GRADE NEAREST LOT LINE 20 "'"--- TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE "~ ~ t DEPTH OF FILTER ;~' MATERIAL BENEATH TILE TOTAL LENGTH OF LINES '~'~ ! ~ TOTAL EFFECTIVE · 1'~'. ABOVE TI LI~I~ ~ IN. WELL: TYPE_ BUILDING FOUNDATION CESSPOOL------ APPROVED NEAREST LOT LIN~ NEAREST SEPTIC SEWER LINE /~ , TANK OTHER SOURCES DISAPPROVED DEPTH DISTANCE FROM: SEEPAGE / SYSTEM /3 ~ DISTANCES: SEWER LINE DEPTH: PIPE MATERIAL: L/~E ~ LOT SLOPE: REMARKS: "~-~(~ (~'~'~' /~t. DIAGRAM OF SYSTEM DATE ~!~/'71~ APPROVED _ ~~ ~'.~~ G.A.A.B. Form LQ-032 PERMIT NO. MUNICI -'~LIT'T' OF ANCF -'RAGE DEPARTMENT ~ HERLTH RND ENVIRONMENTAL ~.~OTECTION 2510 E. TUDOR RD... ANCHORAGE, AK. 9950? 276-222i ON--S I Ti SEWER Pier'1 I T 76257 > APPLICANT LOCATION LEGAL FOREMOST ~ERVICE CORNER OF BYEN 8ND BARRY L i$ CRESTWOOD S/D 2523 BROOK DRIVE LOT SIZE 279-3:644 49000 SQUARE FEET TYPE OF SOIL AB~ORBTION SYSTEM IS' TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <SQ FT/BR>= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C, EF"TH= 14 LENGTH= 2::1_ GRAVEL E¢EPTH= 9 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR'PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E~CAVATION <IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ~:EQUIRED SEPTIC: TANK SIZE= i000 GALLE~[-~S BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 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 '-.-'AL I D fOR ONE YEAR FROrq I SSLIE I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 MAY REQUIRE ENLARGEMENT IF THE RESIDENC~~~%~~~E MORE THAN 3 BEDROOMS. Performed For Leaal Qescrintion: Lot Z8 Block . This rorm Renorts Soils Loq yes 2204 Cleveland Anchorage, Alaska 99503 Foremost Services 0ate Performed 5/19/76 Subdi¥isi0n Crestwood Subdiv~inn Percolation Test ~enth Feet Soil Characteristics 4 6 10-- 12--~ $ 14 --~ 16-- 18-- Topsoil Clean Gravelly Sand (SP-SW) [125] 20-- Bottom of Test Hole Was Ground Water Encountered? No I¢ Yes, At what Denth? ii Readinq Date Percolation Rate Gross Time ~li nute Net Time Depth to H20 Net Dron Prnposed Installlation: Seenaae Pit Drain Field Deoth of Inlet Denth To Bottom Of Pit Or Trench C~ENTS: 125 Sq Ft drainaqe area requ~r~ No ground 'water or bedrock encounter_9~ Test Performed By Jim Mack Data Certified BY:CONsTRUCTION TEST Date:_ 5/19/76 LAB PERMIT NO. MUN I C I PAL I TY EmF 8r~,3HORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 25i0 E. TUDOR RD., ANCHORAGE.. AK. 99507 27~-2221 ~ELL ~E~I Z T APPLICANT LOCATION LEGAL FOREMOST SERVICE~ B~IEN ST LiS CRESTWOOD SUBD 252~ BROOK DRIVE LOT SIZE 49000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN _~0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER I NSTALLAT I ON. F'ERI'4 I T Vi:~L I D FOR ONE '~-"EAR FROM I SSIJE I CERTIFY THAT i' I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WIL~~TAL L~~N ACCORDANCE WITH THE CODES. ..... 'APPLICANT FOREMOST SERVICES Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Sita Services Section P.O. Box 196650 Anchorage, AJaska 99519-6650 (907) ~4~.4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-061-20 I. GENERAL INFORMATION Complete legal description CRESTWOOD SUBDIVISION: LOT 18. Location (site address or directions) 9750 BRIEN STREET Property owner PETER AND ANDRIA THEQNI Dayphone (907~ ,346-2607 Mailing address 9~50 BRIEN STREET ANCHORAGE. ALASKA 99516 Lending agency Day phone Mailing address Agent SALLIE NICKERSON w/ PRUDENTIAL J.W. Day phone (907) 229-114~ Address .7,201 c STREET. SUITE 200 ANCHORAGE. ALASKA 99505 Unless otherwise requested, HAA will be held fo pickup. 2, NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xx Community well Public water NOTE: If community well system, provide written confirmation from State AD~C attest~ lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 Computer Version 5. STATEMENT OF INSPECTION BY ENGINEER As Certified by my seal affixed hereto and as of the validation investigation of this Health Authority Approval application she wastewater disposal system is safe, functional and adequate structure indicated herein. I further vedf7 that based on the in' Anchorage files and from my investigation and inspection, the date shown below, I verify that my ~/s that the on-site water supply and/or ior the number of bedrooms and type of ermation obtained from the Municipality of on-site water supply and/or wastewater disposal system is in camplianca with all Municipa!~nd State [codes, ordinances, and regulations in effect Name of Firm A~S~ W~ & ~ST~ATER CONSULTANTS, INC. Phone (907) 337-6179 Address 6901 DEBARR~AD~ ~ ~C~O~GE,~S~ 99504 / Engineers Signature ~ ~~ Date ~7/~0 ALASKA WATER &: WASTEWATER CONSULTANTS, INC. SHALL BE PAID $5,420.00 ;AT, OR PRIOR TO, CLOSING FOR THE ENGINEERING SERVICES PROVIDED. 6. DHHS SIGNATURE ~ Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-925 (Rev. 1/91) Back MOA#21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Legal Description , A. WELL DATA Health Authority Approval Checklist CRESTWOOD SUBDIVISION; LOT 18 Parcel I.D.: 015-061-20 Well Type PRIVATE Log present (Y/N) Total depth. 85' Sanitary seal (Y/N) YES Date completed Cased to 85' If A, B, or C, attach ADEC tstter. ADEC water system number N/A 6/8/76 ¢ Casing height {above ground) 12'~ + YES Wires properly protected (Y/NI YES Date of test Static water level Well production FROM WELL LOG 6/8/76 50' ATINSPECTION 12/9/99 56' 5-10 g.p.m. 4.7 AVG. Nitrate ~ ~ c) ~ mg/L Other bacteria ~ Collected by: A.W.W.C., INC. g.p.m. Fluid depth in absorption field before test (in.); Fluid depth - (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* Computer Version - Immediately after - gal. water added (in.): __ - Absorption rate = - NONE KNOWN If yes, give date System type TRENCHES 4' Totaldepth 11' - 12.5'~'' 600 SQ.FT. Monitoring Tuba present (Y/N) YES Depression over field (Y/N) NO NEW Results (Pass/Fail) For. ,~ Bedrooms WATER SAMPLE RESULTS: Coliform ¢ Date of sample: 2/14/2000 B, SEPTIC/HOLDING TANK DATA Date installed_ 1/24-26/00 Tanksize Foundation cleanout (Y/N) Date of Pumping NEW C. ABSORPTION FIELD DATA Date installed 1/24-26/00 Length 60' (2 © 30') Width Effective absorption area Date of adequacy test _ Pumper. -- Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 5' Gravel thickness below pipe 1250 Number of Compartments 2 Cleanouts (Y/N). YES YES Depression (Y/N) NO High water alarm (Y/N) N/A D. LIFT STATION Date installed Manhole/Access (Y/N) ~ High wata~ ..~gles't~sted ~at* _"Pump off' level at*_ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic/holding tank on lot 100'+ Absorption field on lot Public sewer main N/A 25'+ Sewer/septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: 10'+ . Building foundation _ 10'+ Property line Surface water Curtain drain F. ENGINEER'S CERTIFI I certify that I hi. et of Municipal ~_cord. ~. ti with MOA ~AA gui~' SignatUre ' ~// Engineers Name ' Date 2.//'7 ,! 100'+ NOF ~,, ti~e ~/bov ~in~ffec KNOWN ield inspections and review ystams are in conformance this date. A. GARNESS On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout- N/A Lift station N/A · Absorption field 5!+ · Wells on adjadent lots L 100'+ .Water main/service line_ 10'+ 10'+ . Driveway, parking/vehicle storage area ,+ ,Wells on adjacent lots ~ v~ ~/~ J~fr~y ~A. Garness.; .~ ...... Waiver Fee $ Date of Payment Receipt Number ALASI WATER & WASTEWATER January 28, 2000 Prudential Jack White Real Estate 3201 C Street, Suite 200 Anchorage, Alaska 99503 Attn: Sallie Nickerson Subject: Crestwood, Lot 18. 9750 Brien Street, Anchorage, Alaska Dear Ms. Nickerson: During the installation of the subject septic system it was discovered that the elevation difference between the sewer line at the house and the old drainfield was only 3/4 of an inch. Given that the sewer line must slope at at least 1/8 inch per foot to the septic tank, and that there is a 2 inch drop through the septic tank, it is impossible to get gravity flow t}om the new septic tank to the old drainfield. This prevented us t~om connecting to the old drainfield. All of the pipes to the old draiafield were leR in place, however, in order to connect to it in the future a lh°t station will be required. The cost to install the lift station (year 2000 dollars) is approximately $5000.00. The lift station can be installed in the vicinity of the new septic tank and should not encroach upon the potential garage sites. If you have any quesl ~e ~ly~/~f ~es~ Pre~tde~nt ~J ans, please contact me at 337-6179 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D,VlS, O. OF E.V, RO.ME.TAL SERV, CES CERT,F,CATE OF,.SPECT, O. FOR HEALTH AUTHOR,TV APPROVA. OF O.-S,TE SEWER A.D WATER FAC,L,T¥ 264-4744 Application Date Mc-_u' 15:1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18... Cr~twood Subdivision Location (address or directions) (b) PropertY/OWner AHFC Telephone: Home Mailing Address (c) Lending InstituticJn Telephone Mailing Address Business (d) Real Est~,te Compan~;'and Agent 2001 REALTV/Rick_u Do,an A~'dres~ ~45 W~s~'gth; Suit~ 201~. Anchorages. Alaska 99501 Telephone . '276- 2001 (e) Mail the HAA to the followina address: or: Check here ~, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING~694-2979 17054 Eagl~ River Loop Road, Su~t~ 204 Eag~ Riv~, Alaska 99577 0rder~d b~ Rick~ Doran TYPE OF RESIDENCE Single-Family [] Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public [] Note: If'community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 tRey B/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & $ ENGINEERING ! 17034 F,.agie R[v=r L~,p ~c,~d t;c,. =",4 Address ,.__,_ u],,,r. Alaska 99577 Date Telephone Approved for "~ bedrooms by . . ,,~r'"'_ 2 ~ -- ~:~ Approved ~. Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 trey 8/86) Back A. WELL DATA ~)-~"~' % Casing Height Above Ground Electrical Wiring in Conduit (Y~) Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST o FEBRUARY 1984 264-4744 Legal Description: ~-' / ~resenll~N)..,~..~./"~ ___ Date Co~npleted V~-~j ~ //~2(~ Yield '~'~ ~VVe. II LO/o~al Depth ;[~ Cased to ~-~'~ Depth of Grouting ~ ~ Static Water Level ,~ / / Pump Set At ~ ('~ Sanitary Seal on Casing ) Depression Around Wellhead (Y~) To SepticA~aetdh=~j-Tank on Lot /0~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot .J~'~ /''~ · On Adjoining Lots To Nearest Public Sewer Line ~ //~r- To Nearest Public Sewer Cleanout/Manhole ~ ~' ~ To Nearest Sewer Service Line on_Lot Water Sample Collected by ~'.~, ! -~' ~.~'/P/~'(--~*'//~ ~' 'Date Water Sample Test Results ,_~/~:~' ..~,?,._~,...,,~-.t'~...~.~,,~ / ../~,.~ ~ ~,~'-x~ ~ Comments .~*~" B. SEPTIC~'I~I~FTANK DATA Date installed ?/~//7~' Standpipe~N)/ Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~nk: TO Water-Supply Well ~0~-~ TO Property Line /~ To Water Main/Service Line Course Size'//z~)4:~ ~3 NO. of Compartments Date Last . m.eU ~ /~ ;for Temporary Holding Tank Permit TO Building Foundation To Disposal Field .. TO Stream, Pond, Lake, or Major Drainage Comments Pag~ 1 o.! 2 . ,. 72-026 tRbv '8/8t~1 Front ABSORPTION FIELD DATA Soils Rating in Absor[)tion Strata D atelnstalled ,~'//~//7,.~z:y. ~ / ~'2/'~/(~1 ~-~ Width of Field /~, ,~IP Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /"'~) To Building Foundation" Lot 2 ~:~ / TO water Main/Service Line To Stream/Pond/Lake/o? Major Drainage Course To Driveway, Parking Area, or Vehicle Storage ~rea/, Comments ~"~',~'/~/.l.~ Type of System Design ~'~/'~ Length of Field ~'~ --~ t ~ ~ ~ / Depth of Field Standpipes Present'N) Date of Last Adeq uac~¢Tes/t ~_///~/~:~/~ fl ! ' To Property Line ~'~ To Existing or Abandoned System on · On Adjoining Lots /(..'3 To Cutbank (if present) D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N.)._._ "Pump On" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M/OA and/HAA guidelines in effect on the date of this inspection. ~ n $ & S ENGINEERING - S'g ed 17034- le~lverLoep RoadNo ~:~ '--~//~/~::~ Compan,, · L,E~--/ Receil~t NO. ~'~3 7 Date of Payment Amount: $ Page 2 of 2 72-026 (Rev 8/86~ Back APPLIC ~IT FILLS OUT UPPER HAl. ONLY Property Owner ~,O~I~ ~'/~//,~/~/,,~ F ~~ Phone .... ~ ' ' ' fZ ~ Phone Len~n.,ns~u.o. ~ ~ ~ ~' /~ ~ / ~ .... Address ~ ~ ~ Address / ~ ~~ ~ ~ ~/~ ~/ .~/~/V ~ Zip Code Legal Descript~n ~O~ /~ ~ ~--~~ Street Locati~ ~b~ ~/~ ~ ~X)~, ~ ~.~~ Type of Resi~nce ~ingle Family ~ -Multiple Family No. of Bedroo~ ~ ~ Other'% Water Supply ~lndividual ~ ~ A~ACH ~LL LOG. A I log is required for all wells drilled since June 1975. ~Community ~ ~ For wells ~illed prior to(th~ date, give well depth (attach log if available). ~ Public Utility ~ .¢: ' i Sewer Disposal Year Indiv~ual Installed: ~ ~ ~,nU,~.~, Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Time (:::::::::~L_ J~-~'l~ '~ Date Date Date Date Inspector Inspector Inspector Inspector .! Field Notes: ~ · ,'~ 0/'~ e~ ' RECEIV[D (~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CO~ITION~L APPROVAL* DATE ~/ ~" Soils Rating Date ~wer Installed Well To ~sorption Area ~ ~ Well Log Received '~--~ Well to Tank ~/~ Septic T~k Size 72-023 (3182) ALASKA--cflUIROnmEnTAL COI1TROL S UICES, Inc. ~nqineerinq ~ ~nuironmental Studies M AY 17 1983 RON WENT P.O. BOX 10-4482 ANCHORAGE AK 99510-4482 SELLER - RON WENT BUYER- SU BDIVISION-C REST W 0 OD BLOCK- LOT-18 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 414 SQFT. THE SYSTEM IS CAPABLE C~F ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 804 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 GALLONS IS INADEQUATE BY 250 GALLONS FOR THIS HOUSE OF 4 BEDROOMS. 1200 LUcst 33rd J~uenue, Suite [~ · Anchoraq¢. J~laska 99503 · {9071 276-1361 May 9, 1983 Rom & ~4aria F. %{ent P. O. Box 104482 Anchorage, AK 99510-4482 Subject: Lot 18, Crestwood SU~iV~$~OO Approval for the individual sewer and water facilities cannot be ~3ranted until the following items have De. un completed: Exposed electrical wires to the well head are in violation of the ~iunicipa, lity of Anchorage codes and n%ust be encaseG in conduit. The water analysis report needs to be suOmitted to this office from the Chem Lab, 5633 B Street, for our review. The septic tank pumped with a receipt submitted to this department. An adequacy test needs to be perfor~ned on the existing leaching area. This test ¥;ill determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report ne~~ ~b?,it~e~~is office for our review. Please'~no~i'~-this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, Enclosure Robert C. Pratt Associate Environmental Specialist RP38/ej/E1 Time MUNICIPALITY OF ANCHORAGE ~'~ ' '' '~F. Street, Anchorage, Alaska 99501 2M, 5~ E~ OF HEALTH'AND ENVIRONMEN' PROTECTION Date Received: May 13, 1977 9:30 a.m. #2: Time #3: Time Date 5-16-77 MONDAY Date Date Insp Dixson Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Bank of Commerce Mailing Address: 714 West 4th Avenue Phone: 279-5641 Property Owner: Mailing Address: Howard M. Smith 2523 Brooke Drive Phone: 278-3644 3. Legal Description: Lot 18 Crestwood Subdivision 4: Single Family Residence: ( Multiple Family Residence: Number of Bedrooms: Number of Bedrooms: e Individual well Well System: Permit # 363_3--3 Depth of We/~ (7 Construction Community/Public System ( ) 85' Well Log on File Bacterial Analysis _~,.fi.. Sewage Disposal System: On-site System (x) Permit # ?& ~ g7 Installed 1976 Septic Tank Size Absorption Area 7. Distances: Well to Septic Tank to Sewer Line Public Utility ( ) Installer /~ ~ j Manufacturer ~ ~//~/~- Soil s Rate /~-- Material Nearest Lot line to Absorption Area / ~ 3- ' Absorption Area to Nearest Lot Line 0~, Type of Inspection:. N~'ONICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIO~/i,O~.~ ~10 Ea~ Tudor R~, A~h~a~, Al~ka ~ 276-2221 'REQUEST FOR APPROVAL OF INDIVIDUAL ~SEWER and WATER FACILITIES CMRO VA FHA CONM Property Owner: Howard M S_mith. Mailing Address: 2523 Brooke Dr, 3. Name of Buyer: MIKE OBRIEN ~ Att; Carolyn Barrera 4. Name of Lending Institution: Alaska, B,~nk of Mailing Address:.7'1'2 West L~th Ave. Totem Realty,. 5. Name of Realtor or Agent: Mailing Address: '15 & Gambel o Day Phone:.278-36L1~ Day Phone:... Commerce 279-56~ Phone: .Phone:, 272-057~, Legal Description' LOt ~8LCRESTWOOD SUBDIVISION (~ighteen) Location: Off Birch-Left on Barry-Right on Brian 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: Single Family Public Utility. TWO No. Bdrms rlndividua .~''X~Xxxx If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation ONE 85ft Eighty-five Feet Public Utility 6-4 5-? 6 Individual (on-site) 72-003(3/76) Page'~o L~ · ~ _ Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 18 Crestwood Subdivision Comments: Affadavit Attached: (') Approved: ~ Disapproved: Letter Attached Date: ~epartment Worksheet: