HomeMy WebLinkAboutCALKINS LT 5Calkins
Lot 5
#050-211-16
. GREA.cR ANCHORAGE AREA BOR GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME %ZP � ��a L� /"MAILING ADDRESS 2 r 5 � f ` Lf % PHONE
LOCATION LEGAL DESCRIPTION `t COL -LA L1 -:)S
SEPTIC TANK:
DISTANCE��TJ— NUMBER OF
FROM WELL ' -4� MANUFACTURER � e� MATERIAL COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY Zo-�GALLONS.
TILE DRAIN FIELD:
� TOTAL LENGTH l/p�
DISTANCE FROM WELL :EFOUNDATION NEAREST LOT LINE L OF LINES
NUMBER OF LINES 1�DISTANCE BETWEEN LINES TRENCH WIDTH 3 IN. TOTAL EFFECTIVE
mob:
ABSORPTION AREA � SQ. FT. LENGTH OF EACH LINE r�C•
I , DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE 2e' MATERIAL BENEATH TILE IN. ABOVE TILE IN.
WELL:
TYPECONSTRUCTION
DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM_
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES!
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:����I
REMARKS
DIAGRAM OF SYSTEM
. lcf Akttl� 44,4V r-,-44 ' ! I'Gy DATE C '� APPROVED _ F 0. �' v
,1,Jw Q rYrt-' cdi'�% / G.A.A.B.
Form EQ -032
U apo
I
- ti
C��e t trd "Drittinby
�r
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694.2588
OWNER OF LAND W4f#vc" or2ous .vEA-4 DEPTH OF WELL /�� ee
ADDRESS ISTATIC LEVEL OF WATER FT. �`✓�
LEGAL DESCRIPTION—i <� (�14oi_K IPJJ Sudo DRAW DOWN FT. 1c),
DATE - Started10 Z_'*Ended _� _� GALS. PER HR 300
PERMIT NUMBER 7L�G KIND OF CASING 6 -T ori
KIND OF FORMATION:
From 0 Ft. to-2—Ft.
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From /35' Ft. to _L9 -Eft Ft.
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MISCL. INFORMATION:
to 4F" 7'o i3c✓r►7PrlO J�JT r�/$TE or` 5ft'rn
f�rrP To 4 SFi 30 76/0 ar= C,Qsiw<
DRILLERS NAME 2-9?
f
t'1 L.1t-J I C,I t= FAL I T•,r• 07F At.�CHt_tR1�GE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 E. TUDOR, RD.., ANCHORAGE, AK. 99507 /
276-2221 Z'o
t%IEL_L_ AttilC i0M—S I TE SEL4e:FZ F=EFSt-y I 'T -
PERMIT
PERMIT NO. { • 76285 ) `�o �� G^ ✓ 1 \
APPLICANT M.K.E. CORP. 4263 MINNESOTA DRIVE /� 277-1443 V
LOCATION CRESTVIEW LANE
LEGAL L5 CALKINS SUBD LOT SIZE 20663 SQUARE FEET
TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C�EPTH= 11 LEhtGTH= 4-c=. C3FZRkfEL_ E>EF=l'TH= 5,5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRE14CH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
FZE=lD_U I FZE:E> SEPT I C3 -rnNF: S I ZE:E_ :3 -C -i093- C3nL-lL0"_gl_
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
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT I-IITHI14 30 DAYS
OF THE WELL COMPLETION. ---
SPECIFICATIONS AND CONSTRUCTION -DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
P'EFZM I T Vf=lL_ I C? FOFZ QNE: VF_= IFZ FFZIDM I SSUFEE
1 CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR Ott -SITE SEWERS AND WELLS.AS.SET
FORTH SY,THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT"IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE -THAN 3 BEDROOMS.
SIGNED: --I -------------------- .
APPL I CANT M. K. E. CORP. -
JISSUED B4'_
)RTE------ �-
r, haobS L.�Guutcf'�nC� GREATER ANCHORAGL• ARL'A BOROUGH
Department of Environmental Quality
k�' 3330 "C" Street
Anchorage, Alaska 99903
MI• hMM• •
Performed for h/a_1ne.
Legal Description: Le
This form reports:
SOILS I,O(j - PERMATION THST
Date Perfonied�
S -log ro-- - Percolation tes
Depth
Feet
- 5,ity 60.+d 66-6cvntlr/
4?e61YUu/ moi/ ,Ceddjsh %6APOWn
2 - 54. d ep"d 6.%!y dO�C/ [dP-6M)
3 - COn+r1v' '10y'a. gaavels
Low Mu%afuQe_ ton
4-
5rity
5-
6-
7 [6w) .
2u�,dn,ti., Gvb6/e5 ,.,
9 Lahb/e cLn/1 lf2tcv�/ �Rlat�F�c�n
10 - �uhtmqu/u2o'6c/b2ou�Jec(
11 -
12 -
13 -
14 - GOT OtA a t= ZFrxcavar-JorJ 1
e4E6TV/EW /JorvE
Was ground water encountered?, If yes, at what depth?-
; --
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate minute.
-Proposed installat of n: Seepage Pit Drain Field
Depth of Inlet Depth to bottom 5Y pit or trench
COMMENTS: /1='=4
of- B5 114Z. a Lo1."b,4ad ail, rlafe oe- Howe✓e2 dve v'O Mine2 6;H- cfQGGftUr) r�
afh� /owe,;: 64i'/6_ un'�cf• Q/Iaie /SD /� �['o m�nr./P.� Lh„p /ZoGi%/t��•/ �-y.�i/� . .�t�� d�f�Jurr���l.
Performed BY: -( r _Certified 4y: ! a_,n ri, !Date:1��1.
F
Municipality
of
Anchorage
August 25, 1986
•
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Robert A. Shafer, P.E.
S & S Engineering
SRB 196X
Eagle River, Alaska 99577
Subject: Lot 5 Calkins Subdivision
Waiver Request, WR86-123
Dear Mr. Shafer:
Your request for a waiver of the 100 foot separation required between
the septic system on the subject lot and the well on the adjacent lot
(Lot 6) has been granted.
This waiver is valid for the existing septic system only. Any
enlargements of the existing three bedroom single family septic system
will void this waiver.
Sincerely,
Q.
S tap lenS. Morris
Civil Engineer
On-site Services
SSM/ljw
T` �XtS�1ri, Waiver is
Se e' cW veS l �at�
OtOL/ J_vctib l 3 / 2 0 12
Douglas T. Kenley, P.E. 9806 E. Northstar Circle, Palmer, Alaska 99645
(907) 746-1073
June 13;2012.
Municipality of Anchorage
On -Site Services
4700 South Brame
Anchorage, AiasKa-
Re- James Whitecavage, Owner
Calkins SID, Lot 5
10535 Crest View Lane
Eag(e River, Alaska 99577
REQUEST FOR AMENDED WAIVER
A waiver dated August 1986 is on file at the M.0-A.negarding Lot 5. The waiver was requested by
S & S Engineering for Lot 5's septic tank and leach field to be within 85' & 96' on neighboring Lot
6. At that time, S & S stated the distance from the well to the tank on Lot 5 to be 100'; however; it
is shown as 94' on the asbuit survey & field measurements.
SGS water sample report dated 5/18/12 shows the following:
Arsenic (ND)
Total Nitrate/Nitrite-N (ND)
E. Coli (Negative)
Total Coliform (Negative)
1 am requesting an Amended Waiver to the existing Waiver mentioned above. It could easily have
been done in the existing Waiver. S & S's drawing showed that the tank was 100' from the well.
This was done during an adequacy test, but at that time the M.O.A. was not requiring surveyor
asbuilts, which contributed to the signing off and approval.
In conversation with staff at the M.O.A., it was stated that they will not charge for this Amended
Waiver.
If you have any questions, please call me at (907) 746-1073 or 243-5372.
Sinncce�reellyy,,
U �
Douglas T, Kenley, E.
PE #8176
EPu}uS
MUNICIPALITY OF ANCHORAGE
Development Services Department , Phone: 907-343-7904
On -Site Water &Wastewater Section
- Fax: 907-343-7997
Parcel I.D. 050-211-16
Certificate of On -Site Systems Approval
Expiration Date:
1. GENERAL INFORMATION
Complete legal description CALKINS LT 5
Location (site address) 10535 Crestview Ln Eagle River 99577
Current property owner(s) LEVOY LAURA L
Mailing address
Real estate agent
same as site address
Pete Carpenter
2. TYPE OF DWELLING:
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
Day phone
Day phone 907.854.8404
TYPE OF WASTEWATER DISPOSAL:
0
Private Septic
0
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer %
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ J`J� Waiver Fee $
Date of Payment Date of Payment
Receipt Number 03(1-316 Receipt Number
COSA # ®5 C Z 100 Waiver #
I
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Eklutna Engineering, LLC Phone 907.355.9820
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend, PE/2020
L� Curhs L send .... '/
6. DSD SIGNATURE !A �'., Date ? 9 7o?rt•Q
No. CE fl
System #1 Approved for bedrooms Fy
�tI��PROFESSIONP� d
System #2 Approved for bedroomsa�;.,�,,��"�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By:
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 X
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other
Legal Description: CALKINS
LT 5
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1976
Total depth 315.5 ft
Cased to 315.5 ft
FOR Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 16 in.
Date of flow test for COSA 2i10/2020
Static water level at beginning of test 288 ft.
Comments
B. TANK DATA
Age of tank(s) 44 years
Tank type/material septic p18StIC
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping Feb 3, 2020
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1976
❑ ALL standpipes present per record drawing
Total measured depth from grade 14 ft (max)
Measured depth to pipe invert from grade 9 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2000 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-211-16-000
Structure served by this system _
Well production at time of test 3 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑ Coliform bacteria is Negative
Nitrate 0.255 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Curtis Townsend, PE
Date of Sample 2/1012020
C. LIFT STATION
❑ Required maintenance co
Age of lift station yea
Lift station mat lal
Adequacy test date 2'2r"2'
Results 0 Pass For 3 bedrooms
Fluid depth prior to test 11 in
Water added 450 gal
New depth 23 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 4au gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
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'
94
ft
Community Sewer Manhole/Cleanout > 100'
F-1Yesif
No
ft
❑✓ Yes
if No ft
Neighboring Tank > 100' R� Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' El Yes
if No ft
Neighboring Absorption Fields > 100'
❑ Yes
if No 85 ft
Animal Containment > 50' ❑✓ Yes
if No ft
❑✓ Yes
if No
ft
Community Wells > 200'
❑✓ Yes
if No ft
Water Service Line > 10'
Manure/Animal Excreta Storage > 100'
if No
Community Sewer Main > 75' 0Yes
if No
ft
M 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'
❑Q Yes
if No ft
Property Line > 5'✓❑
if No
Yes
if No
ft
Wells on Adjacent Lots:
Yes
if No
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100'
❑ Yes
if No 85 ft
Water Main > 10'
❑✓
Yes
if No
ft
Community Wells > 200'
❑✓ Yes
if No ft
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'
121
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓❑
Yes
if No
ft
Private Wells > 100' ❑ Yes if No 96 ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
i❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
foundation cleanout in downstairs bathroom
waiver WR86-123 was amended by MOA on-site June 19, 2012
septic tank material was confirmed by camera inspection Feb 2020 by JRs Septic
G. ENGINEER'S CERTIFICATION
l certify that I 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
49 TH
Curfis L ovm �en0
il
Oate 2 0 2
I��`��'iJ;. No. E11
.or
��®��pROFESS1D�tp�'-a
ENGINES R'S
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEms APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-211-16
1. GENERAL INFORMATION
Complete legal description Calkins S/D, Lot 5
COSA # 0509 11 I
Expiration Date: Cl — / q l
Location (site address) 10535 Crestview Lane, Eagle River, Alaska 99577
Current Property owner(S) James wnitecavage
Mailing address
Lending agency
Mailing address
Real Estate Agent
Advantage Mortgage
100 W. 38th Ave., Ste. 100, Anchorage, AK
Mark Soquet, Soquet Realty
Day phone 694-93351H. 360-3302/C
Day phone 257-0145 (Lisa)
Day phone
727-1616
Mailing. Address 4155 Tudor Center Dr., Ste. 208, Anchorage, AK 99508✓ (�
Unless otherwise requested, COSA will be held by DSD for pickup. 0 K -R t_ � PtCX (iP
0641q�Y
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well✓❑
Individual On-site
❑✓
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I 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
Douglas T. Kenley, P.E.
Address 9806 E. Northstar Circle, Palmer, AK 99645
Engineer's Printed Name Douglas T. Kenley
5. DSD SIGNATURE
Approved for _3 bedrooms.
Disapproved.
Phone (907) 746-1073
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Byr Original Certificate Date-
(aev nrosl
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program `
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Calkins SM, Lot 5 Parcel ID: 050-211-16
A. WELL DATA
Well type amare
Date completed X17
Total depth 315.5 It.
Date of test
Static water level
Well production
if A, B, or C provide PWSID # _
Sanitary seal (Y/N) Y
Cased to 315.5 ft
FROM WELL LOG
9/10/76
292 ft
5 g.p.m.
WATER SAMPLE RESULTS:
Coliform Negatn'e colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L date of sample: 5/16112
B. SEPTI:/HOLDING TANK DATA
Tank Type/Material Septic/Plastic
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 16 in.
AT INSPECTION
9/28/10
288.3 ft.
3.5 g.p.m.
Collected by. F. Kenley
Date installed
6/14176
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y" Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping 617/12 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Date installed 6/14/76 Soil rating (g.p.d./W or fe/bdnn) 150 System type Trench
Length 48 ft. Width 3 ft Gravel below pipe 5 ft.
Total depth74 ft. Eff. absorption area 480 ftz Monitoring tube Y Depression over field N
Date of adequacy test 9/28/2010 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 6-1/2 in. Water added 467 gal. New depth 6-1/6 in.
Elapsed Time: 115 min. Final fluid depth sin in. Absorption rate >= 450 g,p.d_
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date W
D. LIFT STATION
installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at — in. u in. High water alarm level of in.
Datum Cycles tested Meets alarm & circuit regw
E. :SEPARATION DISTANCES
SEPARATION DISTANCES FRQM)NELL ON LOT TO:
Septic tank/lift station on lot 160* ft- On adjacent lots 100+ fl;.
Absorption field on lot 100+ ft. On adjacent lots 100+ ft.
Public sewer main NIP` Public sewer manhole/cleanout N/A
Sewer /septic service line 25+ ft. Holding tank N/A
Animal containment areas 50+ ft. Manure/animal excrete storage areas 100+ ft.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ ft. Property line t0+ ft. Absorption field 5+ ft.
Water main NSA Water service line 10+ ft. Surface water 100+ ft.
Wells on adjacent lots See commerds
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ ft. Building foundation 10+ ft. Water main N/A
Water Service line 10+ ft. Surface water 100+ ft. Driveway, parkingtvehide storage 5+k
Curtain drain None Known Wells on adjacent lots $` c "
F. COMMENTS ix«isrra„e4•vdvoso�+�✓rc
vlq
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name Douglas T. Kenley P.E.
Date % ! I,%/ I -L"
COSA Fee $
Date of Payment
Receipt Number
(Rev, 4/10)
Waiver Fee $ _
Date of Payment
Receipt Number_
Y
• 4 k�5
_ ►ZS,ZQ
l
1,
{
{
e N
rtt-cs
o
�. O � •._. � v�NTS 8 1 7
to Q
�'. / �r s. C'tar�s•�` �
v
s,s� ttauk i �
'0
AS-BViLT _
I hereby certify that. I. have surveyed the following
AtUCtKS. _
described proPertS
Stamm :7�
„a sx tea T
14 N R 5 hA
+^ onrt Anchorage Recording Precut Alaska5 and thst hhe:'
+ ��. " "' "�'^ timpron
ovements situated there' ar'i` within the property
' ` •" , "" hnes and do Mot overlap�r encroach on the' propierty
thh
y lying- adjacent thereto, at nb....uunnppr�ovements 'o�ti;P
td l • it �� £ ertyt lying adjacent thereto enctoach on the preinrsed'
question and that there axe no roadv3Ys, tranarncept'
v
lines or other vjsible easements on SAI Property except
as indicated hereon.
repeataF Dated at Eagle River, Alaska r °. ;•�Fi `NC. ULc7:-i /�ul
_,�
��� SY'fr •�4t•b Me a�.xx yip/ this—_:.'iay Of
APS. 19_-""---
r ROBERT C_SOIINSOM
SCALE:Registered Land Surveyor
1'a - 36' Boz 455, Eagle River, Alaska
Phone 694-3543
r'_50
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # HAA # UQ01 I CY'1t�;!Zk
1. GENERAL INFORMATION
Complete legal description Lot 5; Ca2Funa Su6diviaion '''
Location (site address or directions) 10535 Cne.atv.iew Lane
Eag.2e Rim. AK
Property owner Jin Wh tecavage Day phone 694-9335
Mailing address 10535 Cne4tv.i,ew Lane Eagte Rim. AK 99577
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well XXX
Community well '
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest -
Ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev.1/91) Front MOA 421
k7m
6.
By
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 17034 Eagle
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
No.204
3 bedrooms.
Conditional approval for
Additional Comments
Phone
Date
Aoaon
'7-2 ' " 7
`n2
bedrooms, with the following stipulations:
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-C25 (Rev. 1/91) Back MOA $21
Municipality of Anchorage Alk
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "-rs- Lra�t,�S s`o Parcel I.D.
A. Well Data
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present N) Date completed OA La Driller L— D, -,L. k i b
Total depth 3\7 I (, Cased to Sts L.Casing height tZ1tl-
Sanitary seal O/N) Wires properly protected (*/N)
FROM WELL LOG AT INSPECTION
Date of test
°1 11 110
I Z - 3 a _ 9
3
a
MUNICIPALITY OF ANCHORAGE
Static water level
?f1 2
�/ 6 1
FnntIRONMENTAL SERVICES DIVISION
Well flow
g.p.m. S, /
gTA —4 1994
Pump levell
3 0 `
U 14-
LSEPARATION
RECEIVED
SEPARATIONDISTANCES FROM WELL TO:
Septic/holding tank on lot
1 L> of
; On adjacent lots
Absorption field on lot
1117 I
; On adjacent lots
vo
I
Public sewer main
`a
Public sewer manhole/cleanout
'� A
Sewer service line
ZS 1�
Petroleum tank
WATER SAMPLE RESULTS:
Coliformy Nitratey A 0 Other bacteria O
Date of sample: 17, - t V - 93 Collected by: 5 �, S E,,5 c,, ,� 5,6Rl ALu
B. SEPTIC/HOLDING TANK DATA
Date installed _ L+ - ► `1 ��1 !, Tank size I two o Compartments Z
Cleanouts (Y -)N) T/ Foundation cleanout (YIQ ,, -Depression (Y/19) tl
High water alarm (Y& Alarm tested (YM) A&
Date of pumping I - 3 j7 3 Pumper ��•' !:Ess'/� a
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot / o On adjacent lots %� 8 S Foundation 3 3
7
To property line / `' r Absorption field / Water main/service line / D
S
Surface water/drainage
konJ S - 7-5--
72-028 (3193)' Front ° CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTAWCE FROM LIFT STATION TO:
lot
D. ABSORPTION FIELD DATA
Manufacturer
Manhole/Access (Y/N)
at
tested
On adjacent lots Surface water
Date installed Soil rating (GPD/Ft2)1 So`�lbL System type �i:fu1
i
Length mgr Width 3� Gravel thickness *s� Total depth
Total absorption area BD; Cleanout present6/N) Depression over field (Y4 "J
Date of adequacy test---! ' 3 0— ry 9 Resultsas ail) 6 s for 3 Bedrooms
..
Water level in absorption field before test (� 3 After test
Peroxide treatment (past 12 months) (Y& ���� ILS° r.f�( If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
i
Well on lot '! / S"' On adjacent lots -k 9 G r Property line /
To building foundation S t ( To exi;ting or abandoned system on lot "Ilii
On adjacent lots 3 o r J-Cutbank �` .� Water main/service line
I,L e0 r+
Surface water 100 Driveway, parking/vehicle storage area
\I' Curtain drain
E. ENGINEER'S
4
-ZS -13(.
CERTIFICATION
I certify that I have checked, verified, or conformed t OA and HAA guidelines in effect on the.date is inspection.
�.Y.i '••.n� n y
OW J
Signature S & S ENGINEERI
17034 Eagle Riv
P Ro No. 204
Engineer's Namff
Date r,�'% •.....>....� .
HAA Fee $ ',� Q O e�
Date of Payment
Receipt Number o?SS�/ C/7 Ski
72.026 (3193)' Back
Waiver Fee $
Date of Payment
Receipt Number
COMMERCIAL TESTING & ENGINEERING CO.
Ak' ENVIRONMENTAL LABORATORY SERVICES
SINCE 1908
REPORT of
ANALYSIS
5633 B STREET
Chemlab Ref.#
:93.6765-3
ANCHORAGE, AK 99518
Client Sample
ID :LOT 5r CALKINS S/D
FAX: (90 561 5301
Matrix
:WATER
Client Name
:S & S ENGINEERING
WORK Order
:74262
Ordered By
:RJS
Report Completed
:12/21/93
Project Name
Collected
:12/16/93 @ 13:30 hrs.
Project#
Received
:12/17/93 @ 14:15 hrs.
PWSID
:UA
EDE
Technical cByr:
Released
2 N
Sample Remarks: SAMPLE COLLECTED BY: RAY.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date Init
---------------------------------------------------------------------------------------------
Nitrate-N 0.10 -U mg/L EPA 353.2/300.0 10 12/20 CMR
* See Special Instructions Above UA = Unavailable.
** See Sample Remarks Above NA = Not Analyzed
U = Undetected, Reported value is the practical quantification limit. IT = Less Than
D = Secondary dilution. �± GT = Greater Than
18010%SG
� S Member of the SGS Group (SociAt6 G6ndrale cle Surveillance)
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 1-270'd6(0
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
1-vt S of tLtN_-�s
Location (address or directions)
(b) Applicant Namel�&r"\,�Ad2LG � Telephone: Home Business ssz—
Applicant Address 12 Z; 3S 4*6'r* V I C -w L.A. - r3WA V4 ymytok'T�L. �G577
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builderO-. Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution SAOX!!L 49f 'O'F lt—keTelephone
Address a.,6.41
(e) Real Estate Company and Agent f�nJ -
Address
Telephone
(f) Mail the HAA r jhE inl b jnaarl U6
55 55 EEIIVVSS��1IINYEEEERRIIIIVV
SR B I 96X
�•
CF. ACTt r AK 99577
2. TYPE OF RESIDENCE
Single-Familo* Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual WeII� Community ❑ Public ❑ .
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ 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 72-025111184)
S. ENGINEERING FIRM PROVIDIhu INSPECTIONS, TESTS, FILE SEARCH, Dr. @ A 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 & S ENGINEERING Telephone 95��?17,�
Address SR B 196X
Date EAGLE RIVER, AK 99577 8 ZL �6
6. DHEP APPROVAL
Approved for �ti''« bedrooms by �'�'"�� Date
Approved Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an Independent professional
engineer registered In the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
r? ' CHECKLIST - FEBRUARY 1984
264-4720
rn _,
9 p o 4! 1 IVJ4
Legal Description:
A. WELL DATA y; r
r
Well Classification S •�• If A, 8, C, D.E.C. Approved (Y/N) /b
Well Log PresentCYN) Date Completed +1 Yield Q•S &F -f-44
Total Depth �sK 10 Cased to 315 6 Depth of Grouting
Static Water Level 2'1'I� r Pump Set At V VG
Casing Height Above Ground 110" Sanitary Seal on Casing (VN)
Electrical Wiring in Conduit &N)
Separation Distances from Well:
Depression Around Wellhead (Y/10
To Septic/fJolding Tank on Lot I od r ; On Adjoining Lots t oo I�
To Nearest Edge of Absorption Field on Lo( So' ; On Adjoining Lots L mo t
To Nearest Public Sewer Line a /S To Nearest Public Sewer t
Cleanout/Manhole a P To Nearest Sewer Service Line on Lot
Water Sample Collected by S s_*�4 ; Date 6-1-66
Water Sample Test Results =5. f!
Comments %436u- S(1 &.4> ::1%6T Jr-11e4W=Q Ar=2'? D.S G-,!'a/�.
B. SEPTIC/HCti7I1aG TANK DATA
Date Installed A.P_-J4_-_7 6 Size 1 dspo No. of Compartments Z
Standpipes (7/N) Air -tight Caps ®/N) Foundation Cleanout (Y(1P
Depression over Tank (YAW a Date Last Pumped 5(e
Pumping/Maintenance Contract on File (Y/N) ; for
Holding Tank High -Water Alarm (Y/N) P Temporary Holding Tank Permit (Y/N) a
Separation Distances from Septic/Heidi, g Tank:
To Water -Supply Well d d r To Building Foundation
To Property Line 1't'• To Disposal Field fin
To Water Main/Service Line %0, A- To Stream, Pond, Lake, or Major Drainage
Course
Comments
Page 1 of 2
72-026111/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Sd 62- Type of System Design 'relµ
Date Installed V ' ( +'"7 Length of Field L4
Width of Field 3 • Depth of Field
i
Gravel Bed Thickness s
Square Feet of Absorption Area L4 130 Standpipes Present®N)
Depression over Field (Y(fj�ij Date of Last Adequacy Test
Results of Last Adequacy Test t5e=m S rjo,- &.&I r 3 F --
Separation Distance from Absorption Field:
To Water -Supply Well k \ S , To Property Line
To Building Foundation S To Existing or Abandoned System on
Lot ala ; On Adjoining Lots 3�
0
a b
To Water Main/Service Line To Cut�JA
ank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ep .-t
Comments ��y3p" V -Z — 'R�rJ E -'7•f Ta
t�V., vJ amu_ e,J L -C ' to .
D. LIFT STATION
Date Installed
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at "Pump Off' Level at
High Water Alarm Leve) at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
•' Check Permitted Bedroom Rating Against HAA Request ••
1 certify that I have checked verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
BI
S & S ENGINEtNG
Signed DateUln 96X
�
Compan MOA No.
LE RIVER, AK 99S77
At
Receipt No. OO.0 .+P���.... .C4 %1
s
.o
77
Date of Payment o a b ,r = 00%17
Amount: $ �5o •� . 9 .. ...Set
Page 2 of 2
72-026 (11i84)
bb.rt 3tyf.r i i
ROFES w�
Municipality
of
Anchorage
August 25, 1986
n
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907)264-4111
TONY KNOWLES.
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Robert A. Shafer, P.E.
S & S Engineering
SRB 196X
Eagle River, Alaska 99577
Subject: Lot 5 Calkins Subdivision
Waiver Request, WR86-123
Dear Mr. Shafer:
Your request for a waiver of the 100 foot separation required between
the septic system on the subject lot and the well on the adjacent lot
(Lot 6) has been granted.
This waiver is valid for the existing septic system only. Any
enlargements of the existing three bedroom single family septic system
will void this waiver.
Sincerely,
Stelpen S. Morris
Civil Engineer
On—site Services
SSM/ljw
• �'+�;,tli�ilj�,
r
A A .S
E,ClF RIVFR.PS�P
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
ANDREPORTS
WELLINSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSALSYSTEM
DESIGN
August 22, 1986
Mun.icipat.ity of Anchonage
Depattment ob Hea.Pth and Human Setv.tces
825 L Stkeet
Anchonage, Ataska 99501
ATTENTION: Steve Mott.ia
REFERENCE: Lot 5; Catkins Subdivision
Dean Steve,
ROBERTA.SHAFER
CIVIL ENGINEER
694.2979
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
'AUG 2 2 06
RECEIVED
Request you approve the attached Heatth Authokity Apptovat appt.ication
'and .Lbdue a a>Iai.vet 'to' -the hontiontat bepanatLon dietancea between the!
on -6,i to wa.6tewatet d.ispozat system and the ne.ighboni.ng weft Located
on Lot 6; Catkins Subdivision.
Attached bon yours %ev.iew .in addition to the tegmitement6 Joh an HAA
ate the 6ottowing documents:
A. Wa,ivet review work sheet
B. Letter of acceptance o6 the wai.ven conditions by the owner of
Lot 6.
C. A copy o6 the wet tog, coti6otm bactet.fa anatysts, and n,i tAate
anaty6.i,6 Jon the weft on Lot 6.
D. Site pian showing the ketation6h.ip ob the on-site wastew tet
dispo6at system to the netghbot.ing weft.
In accordance with the t.iak anaty6.i6 nun by this o6b.ice it .is out opinion
that the hokizontat 6epatation distances ptactibed by 18AAC72.021 ate
not tequited .in this case.
be o6 Jutthet 6etvice, ptease contact us.
, P. E.
SRB 196X EAGLE RIVER, ALASKA 99577
('I
MUNICIP&LITY GF A.NC60k.10E
DEPARTMENT OF HEALTH. AND NU:!AN SERVICES
WAIVER RE'," E ^'ORKSHELT
DATE RECEIVED: LEGAL:
ENCINEER: e e ei ,E 11N5 -
SR B 196X
EAGLE R1V@R, AK .717
APPLICANT. T/>an -
WAIVER REQUESTED: 1::) ►3�--(W<��L,E� s.�- b —rU
5v—�1L �t'a-•� 1c.� o� Ler S � SSS _ —ra I—�—.tet-1 X11=s--�
CRITERIA:
1) Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
0,c) _
s.S
Z.o
TOTAL: l7,3
2) Special Conditions:V6-f::p_ kepiIrf& -. N.i�
44w ifp„�avtjs 0 -
3) Other: �_�_VWL-
--
WAIVER IS: granted, with condtticns listed beluw:
not granted :or reasons iisr.ed beluw:
w
DATE: PY:
Lau
¢ a
a� •� «
1
4t
1p9
-r...... ..........1^'Yv+..w..�.a............ ........w
I '
Eagi. River Area
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
n�-°ani v
_ �✓ QQQ111
Date Received .February 17, 1977
Time of Inspection 11:00 4111
Date of Inspection--J77�p�.
REQUEST FOR APPROVAL OF tII�tUU
INDIVIDUAL SEWER & WATER FACILITIES
FOR u�
Conv. qo 0111.
1. Approval requested by: Alaska National Bank
E. Disposal Field: Total length of lines
B. Distances:
A. Well to: Septic tank , Absorption area , Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Mailing Address:
Pouch 7-010, Calais II
Phone: 278-4581
2.
Property Owner:
Wayne Cousineau
Phone: 694-2140
Mailing Address:
NHN Crestview Street
3.
Legal Description:
Lot 5 Calkins Subdivision
4.
Location:
NHN Crestview Drive
5.
Type of facility
to be inspected _Single Family
No. of bedrooms 4
6.
Well Data:
A. Type
Individual B. Depth
330'
C. Construction
D. Bacterial Analysis
7.
Sewage Disposal
System: On-site system
A. Installed
B. Installer
C. Septic Tank:
1. Size 2. Manufacturer
D. Seepage Pit:
1. Absorption Area _ 2.
Material
E. Disposal Field: Total length of lines
B. Distances:
A. Well to: Septic tank , Absorption area , Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
GREATER ANCHORAGE ARL-!, BOROUGH ENyj oE''T•
Department of Environmental Quality NA1FNrAtpROrc�„vtV
3330 "C” St., Anchorage, Alaska 99503 - 274-45UA
R
REQUEST
SEWER &PWATTERLRECEIVED
FACILITIES
1. Type of Inspection:• CMRO VA FHA CONV xx
2. Property Owner: Wayne Cousineau ;
Mailing Address • NHN Crestview Street Day Phone 694-2140
3. Name of Buyer: MADDOX, Ronald E. & Gail K.
Mailing Address: 2151 Chandalar Drive Day Phone Work:279-9441 .
4. Name of Lending Institution: Alaska National Bank
Mailing Address • 3301 C Street Phone 278-4581 Ext. 274
5. Name of - Realtor or Agent: Gary Deardorff Smiley's Realty
Mailing Address: PO Box 1086 Eagle River phone 694-2114
6. Legal Description:
Lot 5, Calkins Subdivision
Location: NHN Crestview Street Eagle River, Alaska
7. Type of Facility to be inspected: Single Family No. Bdrms. 3
8. Water Supply
Type of Supply: Public Utility Individual X
If Individual, number of dwellings presently served 1
If Individual, depth of well 330'
9. Sewage Disposal -System
Type -of System: Public Utility Individual (on-site) x
If Individual, date of installation unknown
MUNICIP
GREATER ANCHORAGE ARLI, BOROUGH ofa tlryop
Department of Environmental Quality EM'IRpN . Of yfANCyO
Lu 3330 60
3330 "C" St., Anchorage, Alaska 99503 - 274-4561 MfNrgt�cF
9 DoTECTio
FEa 1 � N
REQUEST FOR APPROVAL OF 19?1
INDIVIDUAL SEWER & WATER. FACILITIES RE�F/VE
D
1. Type of Inspection:' CMRO VA FHA CONY XX
2. Property Owner: Wayne Cousineau
Home Phone 694-2140 7
Mailing Address: NHN Crestview Street Day Phone '
-Lagle - , " asit
3. Name of Buyer: MADDOX, Ronald E. & Gail K.
Mailing Address: 2151 Chandalar Drive DaJ pis hnehO g9-9441
4. Name of Lending Institution: Alaska National Bank
Mailing Address: Pouch 7-010 Calais II Phone 278-4581
5. Name of -Realtor or Agent: Listing Agent: Gary Deardorff of Smiley's Realty
Mailing Address: PO Box 1086 Phone 694-2114
Eagle Mer, Alaska
6. Legal Description. Lot 5, Calkins Subdivision
Location: NHN Crestview Drive Eagle River, Alaska
7. Type of Facility to be inspected: Single Family Res. No. Bdrms. 2 & 2 Unfir
8. Water Supply
Type of Supply:
Public
Utility
Individual XX
If Individual,
number of
dwellings
presently served
If Individual,
depth of
well 330'
9. Sewage Disposal -System
4
Type -of System:
Public
Utility
Individual (on-site) X
`
If Individual,
date of installation1RfallYOFANCHORAGE
EWJRONMENTAL PROTECTION
FEB 1?1977
RECENO
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Page 2 of two pages - Rec ^t for Approval of Individual S'r"1- & Water Facilities
Legal bescription Lot 5 Calkins Subdivision
Comments VD l-5.1
D.i
Dat' 717
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
EQ -034 (1/74)
Date