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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 13North Woods Block 3 Lot 13 #051-731-27 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221123 PID Number: 051-731-27 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name JON & HELEN SAAM ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench 0 Bed ❑ Mound Site Address 22674 MCMANUS DRIVE, CHUGIAK, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-269-9103 4 0.4 GPD/SF SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot NORTHWOODS 3 13 Fill added above original grade SEE DWG. Ft. Gravel length 101+/- Ft. Township Range Section - Gravel width 16+ Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1616+ Ft z - - Ft. Well N/A N/A - - 25'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER TANK 1500 Gal. Surface Water 100+ 100+ _ _ Material Number of compartments Lot Line 5+ 5+ - - NA PLASTIC 2 Foundation 10+ 10+ _ _ L TION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER THE CONTRACTOR Alarm location Electric ed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield NORTHERN EXCAVATION Drainfield D3034 Co/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspdection 1st 5/26/22 2nd 5/27/22 Location and description 3rd 5/27/22 41h 5/31/22 TOP OF CONCRETE PAD AT BASE OF DECK STAIRS ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's S amp ods o OD 0 Conditional Approval: Date .............. D Septic System 1 fey Gorn ss.: QO // Approve �.. Date (e2-7'ZZ_ CE-7 53 �p� 0 // JIj n/ 4 'VI •r�i\DO Note: this approval does not include well permit requirements. 4er LJ'�"•Z #AECc8840poo�a\ kmuv uwuz/ 10) PERMIT NUMBER: PARCEL ID NUMBER:OSP221123 RECORD DRAWING G 051-731-27 TOP OF MANHOLE FINAL GRADE _ (MH1)=100.70 100.49-100.52 BTI MHi TOP OF TANK @ INLET = 95.69 TOP OF TANK @ OUTLET = 95.69 INVERT OF BUNG @ INLET = 95.02 INVERT OF BUNG @ OUTLET = 94.84 NEW 1500-GALLON GREER PLASTIC SEPTIC TANK DOUGLAS T KENLEY, P.E. 2003 TEST HOLE AL GRADE = 98.56.99.17 NOTE: BENCHMARK FOR PROJECT IS TOP Mrs GO'S Co's Cos Mrs OF CONCRETE PAD AT BOTTOM OF STAIRS FOR BACK DECK = 100.00 FILTER FABRIC �0.5 FEET OF EFFECTIVE `:t:':-'].;-'A,-�:'�::is1�iE`-,:yc';':Y{,�^•:::�ry`I�arC:'\`;��>�.,•.Y,*,>i<. :�:•iC•�?a� ��'va :. �i.^._�: _ .;' .Zh;s:f.•-i � :y�..,:.�`�'-::.aar-. h:. -]•>i;��.1^i: :;,tts.: iC;•� �.:tz-.l:, : LAy. .�:'e ' i'::,.-.i;C•; r-.i- :.\cY••,'�T!�.7r'7h'0�.�..';°>`�'F'{sM-4+. "i��.,..... _ --�' 11i•. .. i• r. �:.^.:. -:ham: :i ••?��'�•,•'.'.ti �;,_ LIMITS OF EXCAVATION - REMOVAL OF DIST. LINES INVERTS = 93.90 CONTAMINATED MATERIAL = 91.92-92.12 16 FEET WIDE BOTTOM NEW DRAINROCK= 93.40 EXISTING DRAINFIELD BED BOTTOM ELEVATION G.W. AT 87.31 ON 2/20/2003 PER DOUGLAS T KENLEY, P.E. 2003 RECORD DRAWING PER 2003 RECORD DRAWING = 92.34-92.36 G.W. AT 86.42 ON 4/28/2003 PER DOUGLAS T KENLEY, P.E. 2003 RECORD DRAWING BOTTOM OF TEST HOLE = 82.96 PER DOUGLAS T KENLEY, P.E. 2003 RECORD DRAWING ®�ea`as'Noion GARN,-'P--,'JSS JENGI EERIING GROUP, Lid`* ' ...49 ' i --- - r - -,_; ENGINEERING = SALES CONSULTING:,'-: -:-,• •• w:` 3701 EAST TUDOR ROAD SUITE 101 -ANCHORAGE, ALASKA- PHONE (907) 337.6179 • WEBSITE: www.gamessengfneedng.00m 01— ... ......................... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Ga ess 4�i s JON AND HELEN SAMM 907-269-9103 3 OF 3 �O��J,�CE 79 3 .,'�_�'' PROJECT/LEGAL DESCRIPTION: DRAWN BY: e®♦T�tT,'•. �j jlp�Z�r.•' � 0 NORTHWOODS S/D; BLOCK 3, LOT 13 DATE: J.L.M. ®Y0o•R�FESS1oNPi•®® TYPE OF WORK: ® pROFES®� RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 6/6/2022 # ICEN aT4 TAa I PERMIT NUMBER: PARCEL ID NUMBER: OSP221123 RECORD DRAWING 051-731-27 A B C FCO 16.4 1 26.1 MH 17.4 35.2 `/'co ST1 19.9 38.7 DBL1 21.6 40.1 DBL2 22.7 40.1 �� / MTI - 23.30 27.7 C01 25.0 28.6 CO2 29.1 33.0 CO3 33.4 38.1 MT2 33.1 39.9 MT3 83.3 80.1 - 004 85.7 1 81.4 C05 90.2 L83.9 C06 94.7 86.6 MT4 95.6 87.5 WATER KEY BOX LOCATION PER 2003 RECORD DRAWING / A / -APPROX. WATER SERVICE LINE \ LOCATION PER PROFESSIONALLY \ LOCATES PERFORMED BY \ CONTRACTOR. / EXISTING 4 -BEDROOM DECK / HOUSE / / / / / / N / \ SCALE: \ 1"=40' .•. FCO NEW 1500 GREER 'PTIC TANK NEW DBL CO'S (DBL1 & DBL2) NORTHWOODS S/D; BLOCK 3, LOT 12 NORTHWOODS SID; BLOCK 3, LOT 14 OLD 100' BY 15' DRAINFIELD. NEW 16' WIDE BY 101'+/- DRAINFIELD REBUILT IN THE SAME LOCATION. APPROX. LOCATION OF \\ \ O DOUGLAS T. KENLEY P.E. 2003 TEST HOLES / SHED g / NORTHWOODS S/D;\ \ BLOCK 3, LOT 29 NORTHWOODS S/D; BLOCK 3, LOT 28 -ot . `El1eO� rsW 7 7®0 AF ,....:� d •• ♦� 1 L 1. Irl � I � I 'V �- J Ltd •• ttt .._._ K. ENGINEERING _ SALES .,CONSULTING «_ . 3 ._..;w..,< r• 3701 EAST TUDOR ROAD SUITE 101 'ANCHORAGE, ALASKA, -PHONE (907) 337-6179'WEBSITE:v .gamessengineering.com •••• + • • •••••••••••.•• .......... .0 PREPARED FOR: PHONE NUMBER; PAGE NUMBER: t Cn f@y 5S cu JON AND HELEN SAMM 907-269-9103 2 OP 3 ��� E-7953 ,.�•��17d PROJECT/LEGAL DESCRIPTION: DRAWN BY;®� •�1 2Z +•• ��� NORTHWOODS S/D; BLOCK 3, LOT 13 J.L.M. �4•'c'R •••....•.1P�. ,�<r TYPE OF WORK: gATF_. LICENSE ���1$q1v$iip*�®� RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 1 6/6/2022 #Ar QC5 `/'co NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE / R GENERATED INS UTOCAD. �� / / DRIVEWAY -APPROX. WATER SERVICE LINE \ LOCATION PER PROFESSIONALLY \ LOCATES PERFORMED BY \ CONTRACTOR. / EXISTING 4 -BEDROOM DECK / HOUSE / / / / / / N / \ SCALE: \ 1"=40' .•. FCO NEW 1500 GREER 'PTIC TANK NEW DBL CO'S (DBL1 & DBL2) NORTHWOODS S/D; BLOCK 3, LOT 12 NORTHWOODS SID; BLOCK 3, LOT 14 OLD 100' BY 15' DRAINFIELD. NEW 16' WIDE BY 101'+/- DRAINFIELD REBUILT IN THE SAME LOCATION. APPROX. LOCATION OF \\ \ O DOUGLAS T. KENLEY P.E. 2003 TEST HOLES / SHED g / NORTHWOODS S/D;\ \ BLOCK 3, LOT 29 NORTHWOODS S/D; BLOCK 3, LOT 28 -ot . `El1eO� rsW 7 7®0 AF ,....:� d •• ♦� 1 L 1. Irl � I � I 'V �- J Ltd •• ttt .._._ K. ENGINEERING _ SALES .,CONSULTING «_ . 3 ._..;w..,< r• 3701 EAST TUDOR ROAD SUITE 101 'ANCHORAGE, ALASKA, -PHONE (907) 337-6179'WEBSITE:v .gamessengineering.com •••• + • • •••••••••••.•• .......... .0 PREPARED FOR: PHONE NUMBER; PAGE NUMBER: t Cn f@y 5S cu JON AND HELEN SAMM 907-269-9103 2 OP 3 ��� E-7953 ,.�•��17d PROJECT/LEGAL DESCRIPTION: DRAWN BY;®� •�1 2Z +•• ��� NORTHWOODS S/D; BLOCK 3, LOT 13 J.L.M. �4•'c'R •••....•.1P�. ,�<r TYPE OF WORK: gATF_. LICENSE ���1$q1v$iip*�®� RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 1 6/6/2022 #Ar QC5 \ &e .\/ @(% \aw �() - (�\D a: - LL; 0� k°:% §�\ 7 U) / \k�/�o caw &e .\/ @(% \aw �() - (�\D . Qa9 caw \\ \ }\\)\ )®)yJ \ E}%§ \%°G3§ $ \ - ,Ja'"PA"T'�f' 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 4"'C If OR A6E On -Site Wastewater Disposal System Permit Permit Number: OSP221123 - Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 05173127000 Site Legal Address: NORTH WOODS BLK 3 LT 13 G:1459 Site Mailing Address: 22674 MC MANUS DR, Chugiak Owner: SAAM JONATHAN T & HELEN L nt n r S. 'r llepartntcnt 5/18/2022 5/18/2023 Lot Size in Sq Ft: 20046 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: This permit is for the construction of: Q Disposal Field Q 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 B, Issued By: Date: Date: 5 I ;2 d a 4 MUNMPAUTY OF ANC HIORZAGE Develo Development Services Department p� - - ,._..Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-731-27 Property owner(s) JON & HELEN SAAM Day phone 907-267-9103 Mailing address 22674 MCMANUS DRIVE *CHUGIAK, AK 99567 Site address 22674 MCMANUS DRIVE *CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTHWOODS; BLOCK 3, LOT 13 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) xQ Septic Tank ❑ Upgrade x P9 (w/wo ADU) Holding Tank ElRenewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: BED WIDTH Distance: 16' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or adWorized ageraf) r Permit/Rush Fees: Waiver Fees: Date of Payment: 22- Date of Payment: Receipt Number: © [O S Receipt Number: Permit No. OS P 2Z 11 Z—� Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewatefformsUient FormslPermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221123, Rebecca Carroll, 05/18/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221123, Rebecca Carroll, 05/18/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221123, Rebecca Carroll, 05/18/22 C `I O o\' 4 S O xv A .SFS � O ••, F-) � J , �' 2 y Q z?�o oz`cice w � ,'www o c`§wo'OE Q S0 w s wQW2 2 z w¢wo m w ozlot� �2� ~o z z � wQ-'w mag ~ a `gF"oz n. w<�o_o�oQ cz ' aoco pcnzZcnaQQ U-zooz>z� ww ocao'" r is z�o�E.. _ Swoc.>w„az zwww=wow o o U- ¢w�oow?� Lu z O V O W O j wzt WKO'�o> w¢zo�..a Municipality of Anchorage Development Services Department SuVi igSafetyDivision +•.•+• On -Site Water and Wastewater Program, 4700 S. Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 Page / of H w w.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SVJo Dozy PIDNumber. 051—'431-z4- Na""Wastewater System: ❑ New ® Upgrade ono d a T > egg ABSORPTION FIELD Pna:c ✓�✓ Nun�WdB•hxaa' 364- ✓ 0DespT+,1,h O Mod. L«rlt X Bed 13Ms4 OONar. SW Baba TOW Depth Aran aripiml grade: LEGAL DESCRIPTION O. P rpr to 3 FI ft& Lx /3 UkIw6mLL Depth1, pipe baararn m toor" grads: Cvar« depth bench ON: ALM iiO dS Y. .3 FI. FL Tay.nsnip: Range: sod $ / /✓ FA arced above MVV god, e t0 / Fr. Gravel Lard /DO FI. Well: lxvbta'nf ❑New ❑ Upgrade/,y G1h,wse= Fl. Number at bur 9 DrSa boh anee: 3 FL cla+YdKaacn (pm«e, A B. ci TOW Depart Ca+•d b: Total ab+arpum arae PV* Material: pl, FL .1-6-00 F? 301<i F8/D r Drwer Dee DnareG StakWalf Ur[ talmler D«atutaaM Ft Y'ast Pump S«,b Ca"H.OAt Gramd TANK GPM FI. R SEPARATION DISTANCES @Septiic ❑Holding ❑S.T.E.P. ❑Other. 7a Septic Absorption Lift Holding PubriUPlirat MaMamaen Capaay From Tank Field Station Tank Sewer Line 00 Gat A Mal" Nur2«dCanpartmeNr Wad 5,af,a,Wa„r , LIFT STATION / Sac anlacae•.. LN Line /y . A Gal. 'P11rp M�laval a[ �pury aK il: XKI1 Ma1H MYr11«: Fa hdalvn • t in K IL\ Pura 4ata d Vee al hspacaarn Wcrmed by Cadun Drain 0 C, Re."s: BENCH MARK Lmaon aria De+axoac rq k A.N:m.•d E:eraucn /CO wFL ' dAviroF S ease.. • • 1l r�P• 'as a,7. . 9TH :``ars'�I��I+I I 9 y} / insPtcliinPar jer n� y 11 Ktn/ey f Freta en ley, nspections performed by: Qday A -e n/t.�_ Dates: In ��Q/C3 •)•� .2rd ,�. ��y rvT10 Developmen Services Department Approval' I�L� .- CEEIl$ �0 Reviewed and approved by: Date: ii1:�4•i+r� v� ✓. Permit No, On—Site Page 2 of _ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 Wastewater Disposal System and/or Well Inspection 1 nT 11 DI nnV 2 AInDTU111nnnQ CI IonRACInAI 4 Report .. V t3do,s O � � I : ®o 8' : AVM3Naa l I Q .. ..l..�l..:.I. y . z Q✓ It 3da15 ... , .l .�. .Xl do15 . . . . . . . . . . .l \. v '3 dOlS. 3 O . 1. . I. . � . .LAj. 0 �MSS00'001r 197-W F— .. .....................I..� n z U C ' O� Yf iA m O m • • Y N� v m- wb o • Z W EJ Z� r -. Z 1 m tl O Z N N r � tom., ci 1O 1 �OC iRl ZQi '3 y O r � 1 Z� N 3 +• N� v r m n m g 0> R Y, n z Permit No. Paye 3 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DMSION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 On -Site Wastewater Disposal System and/or Wel Inspection Report I ennl nescrintinn_ LOT 13, BLOCK 3, NORTHWOODS SUBDIVISION PID No.: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . . . . . . . . : J m�..........� . a m m. .o Q O ................ b. y...... F :......I ......... ca . . . . . . . . . .�(� VJ • • • • • O • i Z P a m N F . J `V . . . . . . . . . . . . . . • W ,p . .......... ... . . . ��i.�.m 10 b : . . . . . . . . . . . . . . . Permit No. Page 4 of 4 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DMSION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report I ennl Nnnrintinn: LOT 13, BLOCK 3, NORTHWOODS SUBDIVISION PID No.: .............:...................................... g: .............:.....n.:.......:.......:.......:„....... t • `ll.i •Y ig . . . . . . . . . . . . . .V. I ��•� •fir ... ............... _ i b I• • • • • • • • • . . • • • • • . . . • • p S •fir x.39 . i b I• MUNICIPALIYOFANCHORAGE O 3 .2 Development Services Department ��' :00 On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Permit Number: SW030029 4=1-e4al Description: NORTH WOODS BLK 3 LT '13'_" (Design Engineer: 0069 Douglas T. Kenley, PE Owner Name: Donald Boyce Owner Address: 22674 MCMANUS DRIVE CHUGIAK , AK 99567-5446 Upgrade Date Issued: Feb 26, 2003 Expiration Date: Feb 26, 2004 Parcel ID: 051-731-27 Site Address: 022674 MCMANUS DR Lot Size: 20046 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [v Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy All construction must be In accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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. 5. The following special provisions. A FOUNDATION CLEANOUT SHALL BE CONSTRUCTED AS PART OF THIS PROJECT. Received Issued By' %C'd'! / Date: By: Date: 2 z 03 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 9)51- %31 - 07 Permit Number SW030029 Property owners) 47en41749 Pln y, G Day phone �'6/- 0 6 97 Mailing address (1) .ZRG y/ 4w"'e 4K,'4,tl Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) --YYe Legal description (Section, Township & Range) Lot Size -t n 200q&Acres�g.F�> THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only 011� Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or Permit Fees: �� O 0 Waiver Fees: Date of Payment: 2 - �- ��� Date of Payment: Receipt Number: 3 b L14' 2_ Receipt Number: (Rev. 12100) Douglas T. Kenley, P.E. 9960 E. Puffin Drive, Palmer. Alaska 99645 (907) 748.1073 February 21, 2003 Mr. Donald Boyle, Owner Lot 13, Block 3, Northwoods Subdivision Chugiak, Alaska PERCOLATION TEST RESULTS AND GENERAL SITE INVESTIGATION REPORT On December 13, 2002, an adequacy test was attempted on the septic system of the above -referenced property. The septic system was found to be in a failed condition. The 22,000 sq. R. site was inspected in support of this application for approval to upgrade the on-site wastewater disposal system. The inspection consisted of an overall survey of the conditions of the property. The site is located at 22674 McManus Drive. The subdivision is served with a community well. (PWSID #213001) The immediate area that has been selected for the replacement wastewater disposal system has an average slope of 1 to 2%. The site is sparsely treed with birch and spruce. On-site observation and physical survey show that there are no water wells within a 200' radius of the proposed system. On February 13, 2003, a test hole was dug to a depth of 16.62'. See attached soils log. Moist soils were encountered at 16' below grade. The perc hole was dug at 5' below grade. The perc result was 21.8 minutes per inch. After the 7 -day monitoring period, the water level was 53.75" from the bottom of the hole or approximately 12'4" from grade. It is proposed to use a 15' wide x 6" E.D. x 100' long bed. Both the 1000 and 500 gallon septic tanks were inspected for leakage and both tanks appeared to be free from leakage. With a reference taken from the cement pad at the bottom of the stairs as 100.0', the bottom of the replacement bed will be located at 92.46'. The proposed system will have no measurable impact on surface or sub -surface drainage, or on drainage from adjacent lots. It appears that there is no potential for contamination of adjacent water wells or streams from known sources. Also, the proposed 'development will not cause any neighboring lots from future development. Attached please find proposed design drawings for the replacement system. If there should be any questions concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073 or 243-5372. Sincerely, % Douglas T. Kenley, P. PE#8176 Douglas T Kenley P.E. 9960E. Puffin Drive, Palmer, Alaska 99645 (907) 746-1073 February 21, 2003 Municipality of Anchorage On-site Water and Wastewater 4700 S. Bragaw Street Anchorage, Alaska Re: Lot 13, Block 3, Northwoods Subdivision, Chugiak, Alaska Donald Boyle, Seller Gentlemen: This letter serves as a request for waiver on the separation requirement from a replacement system to an abandon leach field. Also, a request for a conditional Health Authority Approval. See attached site plan. The upgrade will not be installed until early May 2003. The seller would like to close on the sale of this property on February 27. Sincerely, par Douglas T. Kenley, P.E. CE 8176 cc Audrey Mason, Remax Dusty Finley, Owner Ea Z I /''� N Fn F zrn � _ v im �y ZO m I 1 F—F 1 I lo nr I I YI w 11 1 SLOPE 10% t I I DRIVEWAY 1 1 1 z V) m z v m Z5 z N O to OD V Oi N 4- (A N -� CC Z Z Z Q Q S! Q S! Q O u xo g r x 5 F x N rl o z o m 0Ei 4A �Cy (A X o a o $ ppo X '� • Z _ Q X ti x • • O Z O Z� S S S Arte SLOPE 1% i SLOPE 6X ` SLOPE 1% f SLOPE 6 f 1 18 09SLOPE 1X/ 1 — – – c OPE 6X 1 u Anel 0.00MUG. \-- i DONALD BOYLE DOUQLAS T. KELLEY, PE. 4g !? LOT 13. BLOCK 3, NORTHWOODB SUBOM PON q �• CIUGVX ALASKA vWarn " VNX*o r is e NOIBIAIOOM SOOOMKIUON'S HOOls u 101 ff j i Moe OT4N00 3d ATMA I SnonoU vnerr vvw"a , NOW AMM 8000MN1NOPt le Noole In 101 3d 'Jl3N3H '1 8V'IEM'104 31AOG alvNoa it KIM MOMMA 01 NIM .9 'NIM ,0-,f 1.9 1.9 1 MAXIM 011 MR,* ,Z ao t ._ En F- z 'a m 8 ' S�� m N4e,� .4 S ao t ._ En F- z 8 ' S�� m N4e,� S H F0. L7S , I i n ao t ._ En F- z v�wrn 'aowaaNv NOMMOM OM SOOOM HIUON It )K)Ole tt 101 I@ §S b A. -ON m 3 d 'Jl3?i3� '1 Sviof 0a 3lAOe OIVNOO i2 U F a_ w ,nz �• NG7NEER"3 S� )� Municipality of Anchorage "�• Ir Development Services Department rI Ea . + BuAdmg Safety ohisicn �. �• • y2 On -Site Water arid Wastewater Program ,:TI 'nyM • e• t. 47CO South BragaW S! P.O. Box IMM Anchmse, AK 99519-6650 .. ; .. ..... • .. .. www d anchomce.A US DUMILAS T (907) 3.3-70C4 8176 Soils Log -Percolation Test 7,1c�' ••••� T;��= Performed For. 004l.tc.IJ &-.0 yGE """•�"" Legal Desc ipticn: Le> A)0A9W44b°o s/o Township. Range, Section: —' Slope Tsr.�ouri Depth tr,¢G.44l1,e5 r• � 9 e 2- 3- 0 q. ° 5-;111' .oe2G 6. e j� 7�EJf 7. •� 8-I' • 18- 20- CO3M.MENTS W% -TR v::S CP..OUND MATER E\CCI:.i_ _07 IFYEs,ATVMATDEPTH7 �%� D Depth to Ylater After / P Monitoring? /1,:; 3 E Da:e: ZZo O Reading Net Time Depot to Water Net Drop 0,3r •3or/'.rJ, 6�"I ��i, F=RCCLAT:VIPAT- AAB FERC HCtE 01,%METER 6 T=:T F.L^: S_i.'e=N .4— Fr PIND F. PERFOR?dED BY: ,E/ A)4Ey I r l CERTIFY THAT THIS TEST WAS PERFORMED h1 ACCORDANCE WITH ALL STATE Pti7 6tU?:ICiPAL GUIDELINES IN EFrt T Oi I THIS DATE. DATE: Municipality of Anchorage Development Services Department p� Building Safety Division ' �.1 On -Site Water and wastewater Program ;tt. 47CO Bath eragaw SL P.O. eox 19E6=o Anchorage, AX 9951"650 • • t 9' www d anc�e.ak_°s 'c4' (907)34J-7904 C+• Soils Log - Percolation Test +�l PerlcnnedFcr. L7oa/A<O 'VYl_ DatePerfcnned: N06f7:�elOLW6 Township, RanSe, Sec9cn: _ Legal Description: [e s/ Site Plan Depth 67AEMa4A 1e t!r 1- C1 2- /�" (�4..S 3- /o 4- S.v.�vy G,eadEc. 5- O�Ke QST 6- '10- 11- 12- 13- 14- 15- 16- 17- 1-3- 19- COMMENTS 0- 11- 12- 13- 14- 15- 16- 17- 121°- COr. MEQ ITS uIA.S OSES 1ON ■■■■■■■■ ■M■■.■■IN OMME NIMEr ■. MENEZ ■■■■■■MEE ■■■■ MUMIN ,,,*JS OROUNO WATER ENCOU'rE?ED? S L IF YES, ATYMATDEPTH? D Dept" to Wafer After P hlontloring? E Date Rz=ding Da:e Gross Time I Net Time Death to Water NetDrcp /'3�0�• . P,�s'o�4,��0 /,/mss' I I rev 20 6 S sQ FERCCLAi:CPl P..1T_ .�J 1rx+�lesY.c11 TE=T RUN ETNE_`I S FT AND IDNiy I 4,// ' FERC HCtE LIA.'.I2TER 6 Z Fi !a l rJilG t wJ /GS.QNE �•.c�td I (%tj(-CERTIFY THAT THIS TEST WAS FERFOR?.IED EY: _ HH Z► •O PERFOR%IED IN ACCOROANICEVATHALL STATE PNOI.,U`,ICIPALGUIDcLINESRIEFr_CTOfITHISDATE. DATE: '1• W. A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES C, TO SEPTIC ABSORPTION WELL Address FflOM TANK FIELD U QoX /01020 WELL p f 2Gb ,no csl Vermis No No of bedrooms G 'Z �SOZ LOT LINE LEGAL DESCalellON O (� /O Lot block 5 n FOUNDATION f Townsh,p, Range. section AS -BUILT DIAGRAM Isnow,ocatioh of wed, septic system. Dropeny bne .,oundation. Onv¢way. wager ¢I<1 TANKS S , o ' x SEPTIC ❑ HOLDING T2 6'E 3' 8 Y ' kt.,n,y,LrO Sr �Q pO Wpacny m ganons 6 S 3NG//U EEK OOD s•OD /Say T 23 �• 2, o Manua. No of comp .mems Zp l t o' TYPE OF SYSTEM ' ' E I3 (TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER ! 2' p g 2 S!r r [x•pm to V�pe twuom Iwo, Total depth Irom ougma, grad¢ ongina, grad¢ �/ FT O FT y Fill added atwve mrginai grade Gravel o,pm beneath pipe } O S FT FT 4 4rave length r Gravel w.dth CIO 0/19. j%A'0D. 2 / FT 2,6- FT V l 1 oral at, krea Distance between mus 1 �30 So FT /O t FT C� CA k Numd.•r W tines Son rano pipe matena, O Z Zb So FT 3o3�f�,DVC ,n5laile, E r Daw Insane, �O y eJ R/C�2d, v/i . 6 e 2 —/0 2s 6 S WELLS ❑ PRIVATE OTHER (identilvl 4asvneenon to B.C., To .n U"in Cased to L FT FT y nistanei Date Installed nit e{ REMARKS: V s+ Scale: i — �Elhir {I ;AL Inspections, r e y '� w\ /.+. c OF L V"3 i�CP: ' . •�'�nAa Date Gi \' '.• ' •p J h S & S ENGINEERING .•rn•aa a �}t1y_! LMF7S=rf N. X61 eertily that INS inspection was pe ormed according to all !ate{ / M A- W,�,�� ��: ,f c...1. �t I. 99577i • heal. 14')F. a. r• Municipal and a ale-yvrt1nnhItLAa, tfi-dl- 12 4� ': u' . Yr ec un s as e. Health Deparlment Approval: Date..l,/ 72-01313.85) M U N I C I P A L I T Y O F A N C H O R A G E Department of Health u Human Services 025 L Street, Anchorage, Alaska 99501 343.4+2E+f7iVVtOt6eL) O N- S I T E S E W E R P E R M I T Pervii. Number: 880246 Enlargement Date Issued: 10/26/80 Engineer Designed Owner Name: A.H.F.C. / DANK OF AMERICA Day Phone: u.,nr.r Address: PO BOX 101020 694-2979 ANCHORAOE, AK 99510 P,rcel id: 051-731-27 (oL Legal: Subdivision: NORTH WOODS Lot: 13 Block: 3 Section: 4 Township: 15N Range: IW LoL Size 20046 (sq.(t. or acres) Max Bedrooms: This Permit: 1 Total Capacity: 4 SEpl IC IANk: Minimum total septic tank capacity: 1,250 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). INSTALL IT:R ENGINEERS ATTACHED DESIGN. NOTIFY DHHS PRIOR TO TACH INSPECTION. THIS PERMIT IS ISSUED FOR THE EXISTING 4 DDRM. ;,tHif_E FAMILY RESIDENCE ONLY AND EXPIRES ON 12/31/88. WDIV: I.XISTING SYSTEM WAS 50% FULL OF WATER WHEN HOUSE WAS OCCUP1LiU NOIIFY DHHS IF ANY FURTHER ENLARGEMENT OF THE SYSTEM 1S NELUED. 1 CLI:IIFY THAI: 1. l am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. Q. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. 1 will adhere to all MOA and State of Alaska requirements for the set back distances from any existing wall, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. 1 understand hat this permit. is valid for a maximum of 1 bedrooms. I also underst__d that the capacity of the total system is 4 bedrooms and any enlIfil, .t.'wwill require an additional permit. Signed: 17/ _�l. 1-m - (� r - --- ---------- DAT -: (Owner) A.H.F.C. / BANK OF AMERIC DATE: zs .;,r•d bye 1 g SCALE ;a dalF l G O U EAI Z N C k a ,tv 1 ITS Ohl $lie ;a dalF l G O U EAI e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: �/✓ L��'✓O! DEPTH `I O ✓l FF2 �f- �l 1 p� 2- 3- 4- 34 a c• 5- 6- o'v 7 - co 8 ` � 11 0 to- 12- 13 - 14 2 13 14 15 16 17 18 19 DATE r Township, Range. Section:/,j—/V SLOPE GM- 2,5Zi 18e C'I oo) ,e9j't doic%Dle IF YES, DEPTH? Depth to Wet Monitoring? ��arral�.a .` .... � .w..w.wr p.b..Wmiw ...r M .n A� : Ne. 1417.9 s FCS �~ AED: ■■■■■■■■■■ ==mmmM�'� PERCOLATION RATE_ (minutesnnch) PERC HOLE DIAMETER / r! 6 TEST RUN BETWEEN /1 FT AND FT 7r -A 20 -{ I 'l..—JI PERCOLATION RATE_ (minutesnnch) PERC HOLE DIAMETER / r! 6 TEST RUN BETWEEN /1 FT AND FT COMMENTS ,7034 Eagle River Loop Road No. 204 PERFORMED f`' CERTIFY THAT T IIS TEST WAS PERFORMED IN �s - Y ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI FFECT ON THIS DATE. DATE: a 72-M (Rev. 41951 J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ®rvtw 825 L Street - Anchorage, Alaska 99501 Telephone 264-0720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME NBOVI P ON NEw $$ -3TB UPGRADE MAILING ADDRESS QL)Y, n S l C ` K ej C� L LEGAL DESCRIPTION L 13 !3 3 N 02T WODb 51t) LOCATION NO. OF BEDROOMS DISTANCE TO: Well1 A N Absorption are, F 1 Dwelling S �� pg" 6 / U M i Pz P Manufacturer anuacturer Reds, Materials No. of compartments W f. fC 1 '✓�L Lid, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth d be DISTANCE T0: well Dwelling PERMIT NO. JV2 Z? h Manufacturer - Material Liquid capacity qin gallons DISTANCE TO: well . / Foundation Nearest lot lin;5"t N . 6' VO4 I s"* W No. of lines, Length of each linej� Total length of I �i Trench width/ Distance between lines f, T inches Top of the to finish grade Material beneath the Total effective absorpti �'urea 4 7z inches Length Width epth PERMIT NO. W l7 Q F- Type of crib Crib diameter b depth Total effective absorption area is, —y W in Well Building foundation Nearest lot line DISTANCE T0: J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Buil t etion li -Septic tank - Absorption area(s) OTHER L PIPE MATERIALS [� VG SOIL TEST RATING INSTALLER r,IBas excAi, ► L 5� REMARKS FO ? Rol,ert A..afMr t•V^ e. r D APP )VED DATE LEGAL &n ;.nr•;rcv-t•.� (V-;ZLE P1VaF.. ALI, 1 EC:TI 72d13/(Rev. 3/78) /• t•1 lJ r.a I i- I F• R L- 1 T'T C, F Fi r -a i_ H Q F: F=l l3 E DEPARTMENT HEALTH AND EtJVIROFJMEMTAL,^�.OTECTIOtJ 225 STREET, ANCHORAGE, AK. 9'c c31 ►v / 6 264-4720 r (J u � lDr•4—E I TE a: F;::, F1ERt7 I T F'ERF;IT NO. ( 820610 APPLICANT RAINBOW CONST PO BOX 251 E.P. 99577 644-3485 LOCATION LEGAL L13 63 NORTHNOODS LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS• = 3 SOIL RATING CSO FT/ER)= 226 THE REGUIR:ED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OC -F=^ -r"= 1 + L.Er-41Z5-r"1 Z57' GRn%-PE: — F�EF=•TH= r• THE LENGTH DIMENSION IS THE LENGTH (IFJ FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE EETNEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIM FEET). THERE IS NO SET NIDTH FOP. TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). F:EG!U I F:EC• =F=•T I C 1ID-CDC-:1 GRLLOta� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NU MPER OF RESIDENCES THAT THE I -JELL I -JILL SERVE. --- Tl4Q C 2 ? I rel'-F=•EIL- T 11.DrJa nF:E REE: C?U_t I RBC• - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPAP.TMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEMAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEFENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS APE AVAILABLE TO INSURE PROPER INSTALLATIIJN. F=•EF r'F I T E`r-:F� I F:E OECEMEEF: T1s 1 82 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE P.EQUIP.EMENTS FOP. ON-SITE SEWERS AND I•JELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I !•JILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE OFJ-SITE SEWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE ISF'EMODELED TO INCLUDE MORE THAN 3 BEDROOMS. _IGNED:jlS_1�G� `' •-` ;--------- APPLICANT /RKI6-fl-1 CONST ISSUED BY------- �;------------- ami DATE--- ?42 V4. 0 V n C '• 4 January 4, 1982 Dale Greiner Lugene Lane Eagle River, AK 99577 Permit # 811140 Subject: L 13 B 3 Northwood n tt7:, "L" S1 HEET ANCHORAGE, ALASKA 99501 161!1/I 261 4111 C1 OW;I V ':UR I IVAk 1.1.' VOR A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, 454 69 Les N. Buchholz R. . Program Manager Sewer and Water Program Enclosure: Copy of Permit MUr4I c-_ I T FnL I TY C,F= nr4CF-�lF_FIGE DEPARTMENT HEALTH AND ENVIRONMENTAL :OTECTION 825 'L' STREET, ANCHORAGE, AK.. 44501 264-4720 OM—no I TE F=WF=FR F=,,F=FRri I T PERMIT NO. C 811140 ) nv c.eAc�oa APPLICANT DALE GREINER LUGENE LANE 644-3485 LOCATION NOR..THWOOD LEGAL L13 83 NORTHWOOD LOT SIZE 22000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH ,-- MAXIMUM NUMBER. OF BEDROOMS = 3 SOIL RATING CSO FT/ER)= 226 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: &E=F•'fH= 1CA LEr4CiTH= Z5 r C3FQFA%A EnF_ E>E=F"IFV4= r. 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 EXCAVATION CIN 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 CIN FEET). FREC?U I FREL? S}EF•IF I co IFFlVAK S I noE= KEDC ED C3 F4 L_L_CDr4c PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT.TO THIS PROPERTY AND THE NUMBER, OF RESIDENCES THAT THE WELL WILL SERVE.l. t .. --- TF4Cti IC - ? I r}I'F�F=CT I OM'S RFZE ES:ECAU I F?F=E> — 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 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER, LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F}F=Ft M I -F F=><F} I FZES~ E>ECEME3EF4 = 1.s 1'9 C:1 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY 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 :_lAw"_`y!l-'j>q'_------------------------ APPLICANT DDALIE, GR/EINER ISSUED BY----- = ----- DATE --jQy V4. 0 n n O SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION %Q PERCOLATION 1* 825 L. Street, Anchorage, Alaska 89501 264-4720 TEST %%%�i SOILS LOG — PERCOLATION TEST �7 �/ PERFORMED FOR: 4 l `' nl��f�/�"' /� / DATE PERFORME02?s OC` rO / LEGAL DESCRIPTION: Z- A r �V q/ All `c/oy V 1 (Ft?F v 2- Depth to Water 3- 34 4- ggic A 5- 5 iy- 1 fA f. 2 6- 8 7- 7 �C °� '1 8- IV( 9- 91012 10- 18 12 D J� 13 S//Lr�S�rno�/o��rry� c cZ'pyFx 4efew 14 �If/�`'rlCG�r cY /JJ/L c WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE NO PLAN r Reading Date Gross Time Net Time Depth to Water M1 . soe ll ggic A — iy- 1 fA f. 2 17 °� '1 IV( Vi %y��''t• 18 to 'RcL3ri A. .far ce 20 c WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE NO PLAN r Reading Date Gross Time Net Time Depth to Water Net Drop soe ll ggic A — iy- 2 IV( Vi • :z� to ce % �� PERCOLATION RATE y Its (minutes/inch) It TEST RUN BETWEEN —4-1 FT AND s� FT 1 PERFORMED BY: -v -SL�N�/N�I�Q//✓L CERTIFIED 72-006 (6/79) / DATE:Z a7JCTzY Parcel I.D. 051-731-27 Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date: Complete legal description NORTHWOODS; BLOCK 3 LOT 13 Location (site address) 22674 MCMANUS DRIVE CHUGIAK AK 99567 Current Property owner(s) JON & HELEN SAAM Day phone 907-269-9103 Mailing address 22674 MCMANUS DRIVE CHUGIAK AK 99567 Real. Estate Agent DAR WALDEN TEAM D.ay phone. 865-6406 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ 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 ❑ Waiver/Variance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ a8_0 t `k 1 b R (P u S N Waiver Fee $ Date of Payment �j� �✓ 7 -2, Receipt Number_ _ d ZS �,� C COSA# 0SCaa Ia(o� Date of Payment Receipt Number Waiver # 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: Games s 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: 22. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system 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 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 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 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system 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 perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for �_( bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the followi 4IT f_t_�r ,... ., ...... ...... . Je r e A. orness.- -53 1� CF -7 53 ZG r ce `��`�Cp�ofesslon�\ #AECC884 B Original Certificate Date: b < 7C2 Z 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSAa Checklist Legal Description: NORTHWOODS; BLOCK 3, LOT 13 If more than 1 septic system on lot: COSA Checklist # 1 of 1 LL DATA ❑ Well log Date drilled with Onsite (or attached) Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for C PUBLIC WATER Static water) at beginning of test -ft. B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW M Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA BED Which system tested (date installed) 5/2022 W ALL standpipes present per record drawing Total measured depth from grade 5.77 ft (max) Measured depth to pipe invert from grade 4.66 ft (min) ❑ N/A — pressurized field n Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-731-27 Structure served by this system 1 Well production at time of test gpm Water storage tank v e gallons Well disinf for coliform test? E] Yes 9 No J��oliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) XP8�eis ug/L ❑ Arsenic less than MRL (ND) Collected Date of Sample STATION ❑ Requir aintenance Age of lift station Lift station material Adequacy test date NEW Results Q Pass For 4 bedrooms Fluid depth prior to test NEW in Water added NEW gal New depth NEW in Elapsed time NEW min 0 Code -required soil cover over field Final fluid depth NEW in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 'SEE RECORD DRAWINGS -" --"— -`--- —"`--- COSA Checklist yellow sheet E. SEPARATION DISTANCES JOUBUC.w R, rivate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift n Lot > 100' Community Sewer Manhole out > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if ft ewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Tank > 100' El Yes if No ft Neighboring Absorption Fiel Animal Containme ❑ Yes if No ft ❑ Yes if No _ ft Manure/Animal Excreta Storage > C pity Sewer Main > 75' ❑ Yes if No ft ❑ Yes if o ft •From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El 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' 0✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' P/ 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' ❑✓ 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' 0 Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' S Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS 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. COSA Checklist yellow sheet v ooh• .••• 9 ••• �0� �....... .... ..... J A....... .SS::... OQ4 9. E 71 3 40 aPro fessionoo� #AECC884 Municipality of Anchorage • -�1 Development Services Department j Building Safety Division On-Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051 HAA # L5LkL 1. GENERAL INFORMATION Expiration Date: --�7- Complete legal description Lof /3, 43/ock,3 �io���W000% 5��6l�idiSiOh Location (site address or directions) ;Ue 7y /37c �/]r ('� "s A' A,/ Current Property owner(s) X0.7,4 �`hs�n Arson Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Al 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class 4 _ Well ❑x Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority 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 on uest to homeowners. supply DSD also issues suoproperties private ertificates f slare vald orr 90 daysfrom the date of issue for served ba or Class Cwell end 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 Health Authority 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 /7ov9 ��s �en%`1 Phone (pate) q��-i073 Address IP�6 E Narih SfAr Cir., PA/mcg, ASE' 99Gy✓! Engineer's Printed Namel7ouq keN (e1 -I Date Il 12.aS 4r 5. DSD SIGNATURE tt: , _LZ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: t ��� Original Certificate Date: (Rev 01102) .� Municipality of Anchorage •, b Development Services Department Building Safely Division < On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �0 7" /5. 15161 c � j /Y0,17 I6 f/o0 g5 ,S10 Parcel lD:6S1 -•7.31 �a"] A. WELL DATA Well type , If A. B, or C provide PWSID # Vfeal Well Log (Y/N) Date completed _ Sanitary seal (Y/N)_ Wires properly protected (��Y/N) Total depth ft. Cased to ft. Casing height (above in. FROM WELL LOG AT INSP7=6TION Date of test Static water level ft ft Well productiong, p. m. g.p.m. :WATER SAMPLE RES liform colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml. epic: mg./I. Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Seo 7�'/c' 51.1 -el Date installed _1/_/-/4,' ; Tank size /sea gal. Number of Compartments Cleanouts (Y!N) _ V Foundation cleanout (Y/N) Y Depression over tank (Y/N) 11C_ High water alarm (Y/N)i L_ Date of pumping , Pumper -720 Pu.npii�9 C. ABSORPTION FIELD DATA Date installed 6 3 Soil rating(9.p-d or ft2/bdrm)O. 1� System type /'c o' Length /n a ft. Width /1' ft. Gravel below pipe 0 3 ft. Total depth Jr- f ft. Eff. absorption area Mo -oft' Monitoring tube _7)�__ Depression over field Al Date of adequacy test 111_91d5_ Results (Pass/Fail) - For '/ bedrooms Fluid depth in absorption field before test 4' in. Water addedG yfgal. New depth o in. Elapsed Time: =min. Final fluid depth O in. Absorption rate >= G OO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /Y If yes, give date D. LIFT STATION Date installed "Pump on' level at _in. Datum Size in gallons 'Pump off" levet at_ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT Septic tank/lift station on lot / Absorption field on lot / Public /septic service line Manhole/Access(Y/N) High water alarm level at Meets alar & On adjacent lots On adjacent lots Public sewer manholelcleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Pf Property line ZfZf Absorption field Water main „9s A 7 Water service line o S>` {f Surface water Wells on adjacent lots v -too •i Ft in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1' Building foundation IZ`A'� Water main Water Service line .,'Ir Surface water /041.14- Zt Driveway, parkinglvehicle storage SSt j't Bone /heron Curtain drain Tn e x ls7 Wells on adjacent lots X00 f 141 F. COMMENTS G. ENGINEER'S CERTIFICATION �` ••�) i TH �r I certify that I have determined through field inspections and I.. ... — review of Municipal records that the above systems are in ....... conformance with MOA HAA guidelines in effect on this date. 9, DOtT e CE81% Engineer's Printed Name t �"u`� +1�•, 'V Date HAA Fee $ H Date of Payment Nod I o Receipt Number Z (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number leeocwe rrfee RA°II ,BAr. I�°I Is•. fJM7 ssF PABYe �Ternr �3. O O. � T mss. ; •/ ; . ,. ... . ��5 �A Iy0Y ' EX/JTING �• - '' fiOUJtF . 0� S►�GD �, /2 ° SURVEY CERnFlCAflON r�T►TLlk%%% Prepared by -. PLOT PLAN .-,�. °•°° Robert E. Johns, Jr. & Assoc.. 1 e.+r a.wy Mel I Ae,e P�INeNY er+wd M•�......-.......NY., .••. ♦ •` r..................... �' e Professional Land Surveyors y w ..Nrrr w N e. le r w� IN N Nw N Y M MI N w/ _♦ 1700 BRINK DR. ANCHORAGE. ALASKA 99501 Soots: 1 11 =-- 1 Rea Lot S.F. Rea Plot Re No, . FOUNDATION AS -BUILT 1 ••` s•ys,,,w ".l r "°N ow 1 •,.e.u., e. M.0«w' iw.O1e / •••1 •••••• •••••• ••••••••••� 0°te Surve 11-14-0-9 Or°.n brRL•�J Checked by. �"..�..:.........,Y....,!.. E JR. �.PJ�; D°le Ura":11-14—OS G"QV[•7 1459 w.o. STRUCTURE AS -BUILT 12,*oa M +��•'>� •••'•.... 5364FINAL LsgPl oeempli°°: 13 BLK 3 L wsa c Aeq +.. 1,•wY entry M I IY•e Mti,ere w M -Mt wr N M • •••..u••• ....•'•• Zia 44LOT .w« .�..�erw•.°Y. L.a °°; °tssslond :���♦ NOY•t.1 woods Subdivision ❑ LOT SURVEY SURVEY TYPE ❑ FOUNDATION AS -BUILT .SYMBOLS ❑ FINAL STRUCTURE As -BUILT ........... • SET RESAR ASPHALT DRAINAGE ASPHALT ❑ PLOT PLAN ... AS -BUILT LOT WRVTY ... TOP ... aRAPNr o REBAR WOOD FENCE 0 CONCRETE p El A, - Pm, ' ^ vve = 12 WCQ�IICN A T ASSUMED 00 ASSUMED ELEV. �T. MFTAL FENCE 0 PLOT PLANS t LOT SURVEYS COTE IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO CONSTRUCTION,TO VERIFY PROPOSED BUILDING GRADE RELATIVE ONLY THOSE_ IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, SHOWN. FENCES. WIELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS. ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. PLAT. Al I DISTANCES ARF PP IN' 11C c NinTIE UNDER NO CRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE ONES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED OISTANCES PREVAIL OVER SCAUNC. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Municipality of Anchorage 0 -.f Development Services Department Building Safety Division on -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us b3 (907) 343-7904 CERTIFICATE OF IMEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051- 1-24 HAA# Expiration Date: _ 1. GENERAL INFORMATION Complete legal description Lori9 doe e3 ,Jo,¢�—ilulooOs �v zz67�/if /y -i ✓cJS�,eJ G',tiva�o,�jC.4,f_! 99 Location (site address or directions) s - Current Property owners) ,e:;" 4022/'�i/�vCa/8o��6SDay phone Mailing address �0 8`X�3o 92 i.�o�y`'Psl:��Fxf %k, 99683 Lending agency Day phone Mailing address v0-¢�1' f fAtoic./ Real Estate Agent �a o� E-OGL��"�Day phone Mailing Address -- Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site L� Individual Water Storage ❑/ Individual Holding tank ❑ Community Class A Well U Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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. - Nam_- of Firm - - Phone &Pe7> P%d —10,7g Address 996a Engineer's Printed Name Date — lb OF• Al %J1 S. DS�IGNATUREj� Tom, Approved for bedrooms. ��� CEI; Disapproved. ,e+• Conditional approval for bedrooms, with the following stipulations: Ittrtrfrrrr Additional Comments z�: • WATERAND r PROGRAM Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other Original Certificate Date: L S . Municipality of Anchorage .,.. 1\�nn Development Services Department !Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L �' i3� it%efi�c�loOQs Parcel ID: A. WELL DATA Well type Q If A, B, or C provide PWSID # Zi-rPe'/ Well Log (YIN) Date completed Sanitary seal (YIN) _ Wires properly protected (YIN _ Total depth ft. Cased to ft. Casing height (ab round) in. FROM WELL LOG AT IN TION Date of test Static water level ft. ft. Well production g.P•m. g.p.m. WATER SAMPLE RES Colifcrm colonies/100 ml. Nitrate mo.n. Other bacteria colonies/100 ml. A enic: mg.n. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA TankType/Material JrPvr/G ����� Date installed rte✓ Tank size /--F' 00 gal. Number of Compartments Z Cleanouts (YIN)---- Foundation YIN)_Foundation cleanout (YIN) y Depression over tank (YIN) 4/ High water alarm (YIN) Date of pumping S>'sr�-'/-" Pumper C. ABSORPTION FIELD /DATA Date installed �T -- Soil rating p.dJ or felbdrm) System type Length /OG ft. Width /�' ft. Gravel below pipe L S ft. Total depth��OO fe Monitoring tube Depression over field St ft. EN. absorption area Date of adequacy test`Results (Pass/Fail) For _ bedro Fluid depth in absorption field before lest _ in. Water added New depth_ in. Elapsed Time: _ min. p _Lin. Absorption rate >= g P d• enation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off" at 4ier alarm level at in. D Cycles tested Meets alarm ti circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main _� �Q Public sewer manhole/cleanout S is service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'Ff Water main x6* Wells on adjacent lots 200'�� Property line L4LXF6 Absorption field se !"'C;4 Water service line ���Ff Surface water i1!! SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation /�*�� Watermain Water Service line Surface water �OOFiL Driveway, parking/vehicle storage 6✓r=Ff .vs.a�r�,iJ Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in TM conformance with MOA NAA guidelines in effect on this date. Engineer's Printed Name- F v �Qy L e y Date 60 `{ (D -b �� CE 8176 HAA Fee S 3,3T, 10 Date of Payment z I Z ti 103 Receipt Number 31 to S o An (Rev. 12/Ot) Waiver Fee S Date of Payment Receipt Number l Municipality of Anchorage Development Services Department \�t t; .e Building Safety Division On-Site Water and Wastewater ProgramSA,r, 4700 South Bragaw St- P.O. Box 196650 Anchorage, AK 99519-E650 www.cLanchorage ak us . c . (907) 343-7904'. > CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING" Parcel I.D. HAAt ' AQ-2;nD&?Sy =. Expiration Date: 1. GENERAL INFORMATION Complete legal description Locafion (site address or directions) z %� �'y �`%'.�����r e c• Current Property owners) �O" �'"� �g'�c�c c9�a/�E Day phone Z'607 MaMng address �= Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site u Individual Water Storage ❑ Individual Holding tank ❑ Community Class 4 We!] Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are va!id 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 Health Authority Approval Guide!ines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) sate, functional and adequate. for the number of bedrooms and type of structure indicated herein. I further verify that based on ttie 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 comp!iancc �wlth all applicable Municipal and State codes, ordinances,` and regulations in effect at the time of ins:ta'lation. Name of Firm !mac ua[ 45 ��/r�C—iilGe"y . Phone Address Engineer's Printed Name /�.��.!!�/��. �v7(ali �.71?� �1i a�ln f•'��/.•vv�"�"� �Cr �7"/?Y� •Ti,/.S•C6 ii .ua h+�.�cYJ�9✓I.�oP..sIEJdc�rAyrN�1 T,v. 5. DSD SIGNATURE Approved for Disapproved. %x Conditional approval for b�_dreprs. 4 bedrooms, with the following stipulations: Money in the amount of 1.5 times the high bid of a minimum of three bids from approved contractors shall be put in escrow to construct in nevi wastewater disposal system pursuant to permit number SW030029 attached. Money in escrow shall not be re lease unti t Is 0 -ice has given linal approval. 6on5h t3chon shall be completed no luler than O:tj"c 15, 2003. Additional Comments - Attachments: HAA Checklist Septic System Advisory Well Flow Advisory 0 (Rev.0142) k Maintenance Agreements Supplemental Engineer's Report Othar Original Certificate Date: T Municipality of Anchorage Development Services Department !!. Building Safety Division On -Site Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Losi� ��o �t10 t�spOboos Parcel ID: A. WELL DATA Well type 4 Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Cofform If A, B, or C provide PWSID # -4/0"t Well Log (YIN) Sanitary seal (YIN) Cased to ft. FROM WELL LOG 1/r 00 ml. Nitrate mg./I mg.A. Date of sample: _ B. 4EPTI OLDING TANK DATA Tank TypelMaterial /000 Tank size i sfPO gal. Number of Compartments -41 Wires properly protected (Y/N Casing height (ab round) in. AT IN TION ft. g.p.m. Other bacteria colonies/100 ml. Collected by: 029/e". 01/98 Date installed 196O- 8' i96i5° Cieanouts(YIN) Foundation cleanout (YIN) N Depression over tank (YIN) A-1 High water alarm (YIN) _�yw Date of pumping 4r"s1,oA. Pumper —!moi fav v>6�S C. ABSORPTION FIELD DATA i 9022 sL Date installed i�BtT Soil rating (g.p.d./ft' o '/bdrm sTr System type 7;;;'drAAG-A1 Length F-1 F .� ft �B Width 2' f ft. Gravel below pipe 6 ft. { Total depth /A £ ft. Eff. absorption area 0-447 ft' Monitoring tube y Depression over field A�y Date of adequacy test Results (Pass/Fail) For Fluid depth in absorption field before test in. ,/Ate e —gal. New depth_ in. min. Final fluid depth _ in. Absorption rale >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A)V If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump otr level Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ManhoWAccess(Y/N) level at Meets alarm & circuit requirements? Septic tank/lift station on lot On adjacent lots Absorption field on lot /t Onadjacent Public sewer main �` 14 Public sewer manhoWcleanout p c service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line y3 VFf Absorption field Ble-74 Water main /D'F14 Water service line Zf"�A-/ Surface water Wells on adjacent lots in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� �Ff Building foundation �6rFf Water main Water Service line Z6i� Surface water 1'®o +`Ff Driveway, parking/vehicle storage If Curtain drain Ts Err i rr Wells on adjacent lots ZOO �'�� F. "'COMMENTS ` •" G. ENGINEER'S CERTIFICATION 07 Q.�y' I certify that 1 have determined through field inspections and *•A 9••••••• A review of Municipal records that the above systems are in •I . - *r .L s . conformance with MOA HAA guidelines in effect on this date. S �j FVs Engineer's Printed Name Dcv!j keN tc: jT.1�lYE . Date 2•tl.G3 (r :• HAA Fee $ Date of Payment d Receipt Number (6 S IR (Rev. 12101) Waiver Fee 5 Date . _ter,_,::_ :iii 0 Receipt Number YZI/ilY:��ts:•) MUNICIPALITY ANCHORAGE • �' DEPARTMENT OF HEALTH 8 HUMAN SERVICES 1 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 //jj Parcel I.D. # 451- � i )- Z } HAA p�/!J AM A GENERAL INFORMATION Complete legal description L%3e3 Noetxwo&is Location (site address or directions) MCmz's 5:1v Propertyowner Gzr�� ��` Day phone .�a... ti ..•1; `'. Mailing address. Lending agency Mailing Agent t-1vv3 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: g" 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X Day phone 6$8 OT e(' Day phone 699 91 L4;r 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 x 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-=(R...1191) F, nj MOA.21 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 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 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 Firi-r Address =V-1' Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. M Conditional approval for Additional Comments bedrooms. 544 Date 3 -II -93 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 thei r 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. 72W5(RW.1191) B.k MOI1121 Municipality of Anchorage Department of Health & Human Services • HEALTH AUTHORITY APPROVAL CHECKLIST 19 Legal Description: L-13 133 N&%41'\W01b1S parcel I.D. 051– A. 51– A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Total depth Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test Casing Wires properly protected e•A 1 1 JR Static water level Well flow. Pump level fJ s L D� . SEPARATION DISTANCES FROM WELI,TO: CI Septic/holding tank on lot _ Absorption field on lot — Public sewer main Sewer service line WATER SAMPLERE TS: Coliform Date of sam e: Nitrate Driller $ ;V On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria rn D B. SEPTIC/HOLDING TANK DATA Ise 1000 q /��ooq Z%z 4 J1 Date installed — Tank size �o I Compartments Cleanouts (Y/N) ' V Foundation cleanout (Y/N) Depression (Y/N) M High water alarm (Y/N) 1\1 A Alarm tested (Y/N) Date of pumping I- a-93 Pumper 'TRtS p%-�ptn4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well on lot N R On adjacent lots t Foundation 5 Topropertyline�10Absorption field 15' __Watermain/service line 't' 25' Surface water/drainage .4 tit 72-026 (Rev. 7191) Fwt 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 SEPARATION DISTANCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA 1 9813 Manufacturer "Pump off" level at Cycles tested M Surface water 'Muter( Date Install d t 7a G Soil rating System type') 57� Length -2 (1`�811onM1lidth 2'�� Gravel thickness �+Total depth I01 Total absorption area 30 Cleanouts present (Y/N) Depression over field (Y/N) N Date of adequacy test S-10-93 Results (pass/fail) PACs for 4' bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot NIA Onadjacentlots r2nb1 Property line To building foundation Fts, To existing or abandoned system on lot Kt R On adjacent lots "*' 2S1 Cutbank 4-4cyj Water main/service line + ho1 Surface water -r t�1 Driveway,t parking/vehicle storage area } 2S Curtain drain 50 E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signatur( Engineer Date HAA Fee $ 17 0 ' 622 Date of Payment 3—JZ 93 Receipt Number 72-026 (Ra. 3/91( 9&Ck MOA 21 Waiver Fee: $ — Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services O DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # Sl 7�1-'� 7 HAA # ' _) e2 - (-\. Lt f� 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) �. .-.7211111111 INN Location (address or directions) 41 • T/f/ rN RW / A (b) Property owner AMC Telephone: (home) BusinessZ76- SS 19 Mailing Address (c) Lending Institution Telephone Mailing Address Q (d) Real Estate Company and Agent Q =—MAX OF Address /� G oo l'en �aif Z O / EAS[ E 2y 44-e Telephone (e) Mail the HAA to the following address: (or check here If hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eag • tver LWP Road No. 204 Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of bedrooms d 3. WATER SUPPLY Individual Well ❑ CommunityX, Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025(n«.nasi Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 9 R S ENGINEERING Telephone 7f� 17034 Eagle River Loop Road No. 204 Address Gagle River Alaska 9957 Date }r Nw 1<d7JE f , 6. DHHS APPROVAL Approved for bedrooms by Date yaps l 1 Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections oranalyzedata before a certificate is issued.The Municipalityof Anchorage is not responsible forerrors oromissions In the professional engineer's work. 72m5 (Ft". rree) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • "' HORA�'E {health Authority Approval (HAA) M'0410?41 _fsoNks(o HECKLIST-FEBRUARY 1984 Ems, �hM�tn 343-4744 uc 31 t9sa Legal Description: re7N X0S J-4- Total -L Sec 7-isv .. A. WELL DATA RECE�xl Well Classification Well Log Present (Y/N) If A, B, C, D.E.C. Approved ON) 4Z - Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on'Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Date B. SEPTIC/#!* NK DATA Date Installed g2 $ Size S�No. of Compartments Z StandpipesY/ ) Air -tight Caps(Y ) Foundation Cleanout (Yo Depression over Tank (ye N Date Last Pumped—/01£38-T.S.s'z C Pumping/Maintenance Contact on File (Y/NA) L6 ;for Ni� Holding Tank High -Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N)_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ZGO f To Building Foundation 6 To Property Line /O i4- To Disposal Field r To Water•Main/Service Line rA- To Stream, Pond, Lake or Major Drainage Course Comments s6-00 GA G 5"z/ C 72-M (R«. tree( Fwt Page 1 of 2 E kJ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 226 Type of System Design Date Installed�,9 A�/1�Ab Length of Field Width of Field' 2 S Depth of Field 9 6 — /01 i Gravel Bed Thickness Square Feet of Absortion Area 930 Statndpipes Present Y/ ) Depression over Field (Y(RN ti Date of Last Adequacy Test / Results of Last Adequacy Testc !rtrJ=Ae-rs a 4.( 3 B eC. G✓o4 <d a ,.1sr0 YC SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ZOO � To Property Line To Building Foundation To Existing or Abandoned System on Lot N./K% ; On Adjoining Lots 3o to e To Water Main/Service Line f /0 To Cutback (if present) -*042 To Stream, Pond, Lake, or Major Drainage Course No AJE To Driveway, Parking Area, or Vehicle Storage Area /0 -,A- Comments-2Z `- Comments_2 . ice -T o f 7'ie6-Ne y & 4j, 0,jZ7,o F J A T -,rWl r ne t4F 7-6 RSP/NG TNF_ SNS7EH1 !�t7R Ta 4e e,2J 7 D. LI TATION Date Insta Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request',' I certify that I have checked, verified, or conformed to all MOA and Inspection. "Pump Off" Level at Vent(Y/N) _ Signed 5 g s ENGINEERING Company 17034 Eagle River Loop Road No. 204 Eagle Date �O Zt�r2!f MOA No. Receipt No. c�Q�t % 7 Z 7 Date of Payment ^� D Amount: $ l / n 72-M (Rev. 7/88) Beck Pumping Cycles during Adequacy Test. Receipt No. Waiver Fee: $ _ Date of Payment Page 2 of 2 • nj� USM STEVE COWPER, GOVERNOR �I� or U IJ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: 10-21-88 PWSID: 213001 To Whom It May Concern: According to the records on file in this office, the CHUGIAK UTI- LITIES/NORTHWOODS Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Michael P. Lewis, PE Environmental Engineer MPL:pkk - !\/ MUNICIPALITY OF ANCHORAGE O Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 05l -731-27 HAA# a -R%- 1—LM, 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner .BHnZZBan, "P ^wr; a Telephone: (home) Business 976-5599_ Mailing Address 101020 Anchoracre AK 99510 (c) Lending Institution n/a Telephone Mailing Address (d) Real Estate Company and Agent At Ranaszewski T7 llaY ^f Eagle River Address 1660 River AK 99577 Telephone - (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: p• k n ineer 694-5195 2. TYPE OF RESIDENCE Single -Family R Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community ® Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 6a Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72o5(Rw.7/88). Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm Eaglp River Fngineerina Svcs Telephone 694-5195 Address P.O. Box 773294 Eagle River AK 99577 Date �0�3�.f L CF ,4! LOY15 A. Utera CE•6726 6. DHHS APPROVAL, Approved forbedrooms by Date Approved 2C Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 72-025 (R". 7/88) Back Page 2 of 2 MUNICIPALITY OF AN ENVIRONMENTAL SE RV OCT - 31988 RECEIVED A. WELL DATA r �� Well Classification Well Log Present (Y/N) Total Depth Cased to - Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) Alik Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Date Completed Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Legal Description: L w'- V21 Bek 3 C4otyk�.,�aeaS INnM %\kZ Sec H Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by If A, B, C, D.E.C. Approved (Y/N) _,Tr " Ae&e) Yield Pump Set At Sanitary Seat on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Test Results Comments�w/s 2 /W )/ ad A215'49 B. SEPTIC/HOLDING TANK DATA ; Date Date Installed /9FLI Size /poo S No. of Compartments R i Foundation Cleanout Y/N N Standpipes (Y/N) _Air -tight Caps (Y/N) ( ) Depression over Tank (Y/N) to Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N/q ; for ''��► Holding Tank High -Water Alarm (Y/N) �*4 Temporary Holding Tank Permit (Y/N) t% SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Building Foundation S To Property Line *Z40 To Disposal Field To Water -Supply Well t .200 To Water Main/Service Line ''`/D To Stream, Pond, Lake or Major Drainage Course Comments 72-M (R". 7M)Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _-:2,26 �B/t' Type of System Design Date Installed Length of Field Width of Field - j 6 ' Depth of Field Gravel Bed Thickness Square Feet of Absortion Area �� Statndpipes Present (Y/N) i Depression over Field (Y/N) - V Date of Last Adequacy Test 7166 Results of Last Adequacy TestJtzar 6f 6sem. 6.0"e, vJ ,c?g Ae fir 3 Q,e u J SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well *a09 1P To Property Line t�O To Building Foundation -?o To Existing or Abandoned System on Lot N11A ; On Adjoining Lots ,-3-o ' To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course t Joo To Driveway, Parking Area, or Vehicle Storage Area •ve' Comments D. LIFT STATION nJ1 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA inspection. 4 Signed Company Eagle River Enpineerine Servlr., F. 0. Box 773294 Date /C�Eaglo River. AK 99577 MOA No. 594-5195 Receipt No. % ? i Date of Payment -_ /O -3- k Amount: $ r76-Qb 72-M (Rev. 7/ee) Back Receipt No. _ Waiver Fee: $ Date of Payment Page 2 of 2 Pumping Cycles during Adequacy Test. 3ulaen es.irLgqct on the date of this .v At y :ayPrae • S. c�P' f' F�•' ..:.y�..... .............Eineer's Seal R`t� Loui: A. Butero W �a CE -6 RUM DEPT. OF F.NVIRONMENTAIXONSERIkATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 DATE: September 30, 1988 PWSID: 213001 To Whom It May Concern: STEVE COWPER, 0 VERNOR 563-6775 According to the records on file in this office, the CHUGIAK UTILITIES/NORTHWOODS Water System is in compliance with the State - of Alaska Drinking Water Regulations. Sincerely, Michael P. Lewis. PE _ Environmental Engineer MPL:cV.1: I1. -.cam. Time . , Time IJme Date Date Date 5-C Inspector Inspector Inspector Comments Conditional Approval L 3 (3) Approved Bedrooms ( ) D:--app-Cvcd ( ) CCad Clonal Approval Data _S-1J�t t_ L�l S=am c _ p a` Dale Sewer Installed Permit No. Septic Tank Size oGo Z 7- )q�•L Holding Tank Size Solis R ing Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner t N E•5 Phone Mailing Address S)ZKi '8 97607 �/ �y7 Buyer Address Lending Institution Phone Address 95 57 p Z%y— Z5 Realty Co. 6 Agent / Phone Address Legal Description Street LocationK O / - ,72 4ya'✓o"`�e7 3/a�C'�wwyA`�,^' Type qLAbefidence Single Family Tj ❑ Multiple Family No. of Bedrooms ❑ Other Water Sugply ividual ATTACH WELL LOG. A well log Is required for all wells drilled since June LI Community 1975. For wells drilled prior to that date, give well depth (attach log If ❑ PublicUtllit available. Sewa sposal L1 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. APPL'"'ANT FILLS OUT UPPER H. ' 1 ONLY Property Owner Phone (APPROVED BEDROOMS ( j DISAPPROVED ( 1 CONDITIONAL DATE [/ BY: Soils RatingI Date 'CONDITIONS OF APPROVAL Well To Absorption Area Well Lop Received Well to Tank Septic Tank Siza Zip code7Phone Time Time / A �/3 (� �J Mailing AddressBuyer Date Date ZID CodeAddress Inspector Inspector Lending Institution Field Notes: < i ZID CodeAddress c4,0 Realty Co. 8 Agent Zip code Address Legal Description Street Location C ) Type of Residence mgle Family ❑ Multiple Family No. of Bedrooms_. ❑ Other Water Supply ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Individual For wells trilled Priorto that date, give well depth (attach log If available). U_A;enee{rnily ❑ Public Utility Sewer Disposal Year Individual Installed: ual When Connected to Public Utility: rJ Public Utility ❑ Holding Tank EACH RECJEST BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST ACCOMPANY (APPROVED BEDROOMS ( j DISAPPROVED ( 1 CONDITIONAL DATE [/ BY: Soils RatingI Date 'CONDITIONS OF APPROVAL Well To Absorption Area Well Lop Received Well to Tank Septic Tank Siza Time Time Time / A �/3 (� �J Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: < MUNICIPALITY OF AZ, G DEPT. OF HEALTH t. c4,0 ►►I��� r6l ENVIRON+tENTAL PROTECTION U MAY 3 110--% (� RECEIVED (APPROVED BEDROOMS ( j DISAPPROVED ( 1 CONDITIONAL DATE [/ BY: Soils RatingI Date 'CONDITIONS OF APPROVAL Well To Absorption Area Well Lop Received Well to Tank Septic Tank Siza