HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 4 LT 7North Woods
#i
Block 4
Lot 7
#051-821-04
�� \I Municipality of Anchorage
Development Services Department
Building Safety Division
On Site Water and Wastewater Program, 4700 S. Bmgaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page Of
www.d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO40391 PID Number: 051-821-04
Rama:
R & E Godden
Wastewater System: [Z] New ❑ Upgrade
Add.sa:
660 Marley Dr. Wasilla, AK 99654
ABSORPTION FIELD
242-0755 Nta W 01 Becla . 3
Dow Tr 13 stwbe T,a [38•d ❑mould ❑oe
LEGAL DESCRIPTION
soa Ramp:
0.8
Tam a al Depongi" Pada:
GPoXr
3.67 Ft.
ek 4k L01: su0a
Lot 7 Bk 4 Northwoods IImrm:
Dedddm e0rn "na 9r
aps b ppe
Gmelap
ds eanaam pp:
1.34 F,
2.0 Ft
Tpwunq: Rarpa: SMdexL
FM adoadarov. arVnY preOe:
Grant Largtn:
2.0 F,,
80 Ft.
Well: ❑New [I Upgrade
° avNx °0' S
"wn0a I `"'
P.Mrge eer, aenrar
Ft.
NIA Ft.
Cteaaifitauar, (Pminw, A B. CC
T" D.pm:
Geed m:
tom abempaon "a:
Pqa 14. M :
AWWLI
Ft,
F,
GT 563 Ft'
I PVC
Dr+Mr.
(Ma Dnaad:
Slaw Watw La.M
a
Mwr:
A 8 F Contracting
Dau MaoW.
10/1/04
Ft
Ye�d.
Pw sat OL
C." H.01 apwa Groom:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
[I Septic ❑Holding E lS.T.E.P. ❑Other:
To
Septic
Absorption
Lift
Holding
lublituPrivate
wnWwm..
h -
From
Tank
Field
Station
Tank
Se"f Line
Anchorage Tank
1,250 cai.
Wal
N/A
N/A
N/A
N/A
N/A
MelenM:
steel
WunWMel con ~ts:
2
sudacewelM
+100
+100
+100
N/A
LIFT STATION
Lel Lar
+10
+10
+10
N/A
u.
250 Ga,.
u uaurr.:
Orenco
FouM.tm
9.2
+10
+10
N/A
Pun.N:
g9
93.9955 TBM N
•Fong ort'urw
9 97.60 a TSM N
Ryh walM Mwm.1:
94.24fl TBM ti,
c�MMna..
N/A
N/A
N/a
N/A
Purq Mak. B Model
STD
ERtlrcel Mwpac 5 pedmM py
Alcan Elec
R• *:
BENCH MARK
Lauwn Mq Deempm.
TBM: Sill of patio door
Permit Submittal Modified. See attached
Naunwd ievsum:
Ft
100.00
Addendum
_= mp
� of
..
„gyp,. a8..f1b.
R. Godden
Inspections performed by: Dates: 1al 10/1/04
2nd 10/2/04
.. /
Development Se ices Departure pproval
••
Reviewed and approved by: Dale:
IRw. 12401
CE pppyyyG���ODDEN�
'•, 1�• i
Theta Environmental & Engineering
660 Maney Drive
Wasilla, Alaska 99654
(907) 242-0755
September 7, 2004
On -Site Services Program
Dept of Health & Human Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 7, Block 4, Northwoods II Subdivision, On -Site Wastewater Disposal System
Inspection and As Built, Permit # SW040391 Addendum.
In accordance with AMC 15.65.030, the following information is an addendum to the
MOA On-site Wastewater Inspection Report for the subject property:
Installation began 10/01/04. During the first inspection, the septic tank and lift
station installation and verification of soils, the monitor tube in Test Hole # 3 was
checked. It was found that the ground water had risen drastically. It was apparent
that the system as designed and permitted, could not be installed. Jeff Poet of your
office was contacted and the problem discussed. Dan Roth and Joe Goodall were
not available. Jeff was concerned that the high water was considered to occur on or
about Oct 15 of each year. He wanted to wait until that date, if possible to
determine the highest seasonal ground water table. Since the installation was
underway, it was not possible to wait. He asked that if it was installed, that it be as
high as possible above the apparent high ground eater table.
2. It was decided that instead of a deep trench, the system would be changed to a
wide drainfield. This would make the system much shallower, but longer. Additional
percolation tests would be required to meet the MOA requirements. These
percolation tests were accomplished 10/3/04. The results of the percolation are
provided elsewhere in this addendum. After the percolation tests, the design was
modified. It appeared that 24 to 30 inches of gravel could be placed under the
drainpipe. The monitor tube was checked, and it was found that the ground water
table had dropped almost 0.8 feet since checked 10/1/04. It was assumed that the
ground water table had peaked, but that 24 inches of gravel would be used under
the drainpipe.
3. A discussion occurred 10/4/04 with Joe Goodall concerning the ground water table.
Joe advised that Dan Roth had determined that the highest seasonal ground water
had occurred and that there was no need to wait until 10/15.
11/15/05
Northwoodsl I-U84rMuniUr2.doc
The following is the percolation test results for an additional percolation test in the
vicinity of Test Hole # 3. The test was performed between 1.5 and 2.0 feet below
grade. The test hole was pre-soaked for 4 hours. The test was performed in
accordance with all state and municipal guidelines in effect on the date of the test. The
locations of the percolation tests were in the drainfield and are shown on the plan view
drawing provided with the Inspection Report.
Addendum, Percolation test data:
Date: 10/3/04
Percolation Test # 3
Reading Date
Gross Time
Net Time Depth to water
Net
1 10/3/04
0
4:00 pm
0
0.55 ft
0
2
10
4:10 pm
10
0.43/0.55 ft
0.12 ft
3
20
4:20 pm
10
0.43/0.55 ft
0.12 ft
4
30
4:30 pm
10
0.43/0.55 ft
0.12 ft
5
40
4:40 pm
10
0.43/0.55 ft
0.12 ft
6
50
4:50 pm
10
0.43/0.55 ft
0.12 ft
7
60
5:00 pm
10
0.43/0.55 ft
0.12 ft
Percolation Rate 6.94 min/in
min/in
Perc Hole Diameter:
6.0 in
Test performed between 1.5 ft and 2.0 ft below grade.
Pre -Soak: 4 hrs.
Percolation Test # 4
Reading Date
Gross Time
Net Time Depth to water
Net
1 10/3/04
0
4:05 pm
0
0.65 ft
0
2
10
4:15 pm
10
0.57/0.65 ft
0.08 ft
3
20
4:25 pm
10
0.57/0.65 ft
0.08 ft
4
30
4:35 pm
10
0.57/0.65 ft
0.08 ft
5
40
4:45 pm
10
0.57/0. 65 ft
0.08 ft
6
50
4:55 pm
10
0.57/0. 65 ft
0.08 ft
7
60
5:05 pm
10
0.57/0.65 ft
0.08 ft
Percolation Rate 10.41
min/in
Perc Hole Diameter:
6.0 in
Test performed between 1.5 ft and 2.0 ft below grade.
Pre -Soak: 4 hrs.
2
11/15/05
Northwoodsl I-L704rMuniLt2.doc
Based upon the data and drawings attached, I recommend the installation of this
wastewater system be granted. If there are any questions, please feel free to contact
me at (907) 242-0755.
Since y,
OF
Ronald E.odden, P.E. ....... .
.:IOXILD E GODDEN
3
11/15105
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'�•. RONALD E. GOODEN ;'Jr
G¢ f • N04E §589 ,•'
THETA Lot 7, Block 4, Northwoods Subdivision, Phase II Drawn by:
Environmental & Engineering New Septic System RTK
Contract No: Overall Plan View Checked by:
REG
Figure 1
Project No:
XXXXX
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW040391
Legal Descriptiom;NORTH WOODS PHASE 2 BLK -A LT.,7'
Design Engineer: 0072 Theta Environmental Engineering
Owner Name: RON & ELLEN GODDEN
Owner Address: 23254 NORTHWOODS DRIVE
CHUGIAK . AK 99567-5464
/o- I-bl;i ® 6:<0<
/0 -2- *I/@ Y:3o
Date Issued: Sep 20, 2004
Expiration Date: Sep 20, 2005
Parcel ID: 051-821-04
Site Address: 023254 NORTHWOODS DR
Lot Size: 43401 SO. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
❑/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSO at least 2 hours prior to each Inspection. Provide notification by catling
(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 dosed on the same day.
B. Covered, sealed, and heated to prevent freezing.
�/' 741 1-(- !, /L ¢a r; ; _T, s �b
7.7""1 ol° iced sys-jZ: 14f ' of
/p -y _ort R°^' # 2 7-0keD. T ¢4VE r2u�J 0•1c) 154,17 ocr Y1i / (Tao4.I
vJovlot B[ 0.1%. IFOA, 4:11P {Tauv.ID W47 -C4 OvC Tu WE
N/EATf(ER roti LAST tovr/t WrE/�g
Received By:
Issued
Date:
q 2t d
Date:9/'?C-/C'te
Municipality of Anchorage
--1 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. e)51-9:�I'04 Permit Number SW
1 _
Property owner(s) JPoA f-) l � Day phone
Mailing address (1) &&6
b g address (2) A3L%
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size As.: 9
Number of Bedrooms
THIS APPLICATION IS FOR:
Q6SL1
Sewer Only ❑ 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 th bov/en
/alio is correct. I further certify that this application is being made for a
Single Family �ellid is ' accordance with applicable.Municioal-Codes.
(Signature of prinerty owne r orized agent)
Permit Fees: 41&0 OD Waiver Fees:
Date of Payment: Iq113`Or{ Date of Payment:
Receipt Number: 59D / Receipt Number:
(Rev. 12/00)
Theta Environmental & Engineering
660111aney Drive
Wasilla, Alaska 99654
(907) 242-0755
September 7, 2004
On -Site Services Program
Dept of Health & Human Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 7, Block 4, Northwoods II Subdivision, On -Site Wastewater Disposal System
Permit Application
In accordance with AMC 15.65.030, the following information is provided in support of
an On-site Wastewater Disposal System Permit Application for the subject property:
The subject property currently has a 3 bedroom single family dwelling with
public water (AWWU) and a documented on-site wastewater disposal
system. The existing septic tank is a 1,250 -gallon double compartment tank.
The soils absorption system is a bed. The soils absorption field appears to
be marginally acceptable for a 3 -bed room dwelling and may be installed too
close to the existing ground water table, during the wet part of the year.
Since the engineer has financial interest in this property and In the spirit
of full disclosure, the system must be replaced. This application is for a 3
bedroom single-family dwelling.
2. The property lies is on Northwoods Avenue in Chugiak, Alaska. The lot is in
the shape of a rectangle and is bounded by the Lot 6, Block 4 Northwoods II
Subdivision to the east, Lot 1 Block 3, Northwoods 11 Subdivision to the north,
Lot 1 and 2, Glenn View North to the west, and a green belt to the south. All
adjoining lots have public water and onsite wastewater systems.
3. The property is generally flat with a 2 to 5% slope to the south and southeast.
At the south end of the lot, a slope of over 25 - 30% extends to the end of
the lot and into a greenbelt. The southeast corner of the lot appears wet and
the ground water appears to be much more shallow in that portion of the lot.
It appears the lot was landscaped and at least 3 to 4 feet of material was
removed from the natural terrain over most of the east side of the lot. The
west side of the lot appears to be the original natural terrain.
4. The area, where the replacement soils absorption system will exist is located
along the west side of the lot. There appears to be sufficient area for at least
two replacement systems between the parking area along the side of the
dwelling and the 25 - 30% slope to the rear of the lot.
sn VO4
Northwoods 11• V 84rMuniUrl .doc
5. A new 1,250 -gallon septic tank with an Orenco lift station will be installed and
the existing septic tank removed. The bed will be abandoned in-place.
6. The soils found during the soils test were silty sand and silty sandy gravel.
Ground water was observed in the test holes, and in subsequent monitoring
indicate the maximum height of the ground water table is 10.5 feet below
grade. Other test holes on the lot had groundwater at a much higher level.
However, the elevations were determined and the groundwater monitoring is
provided graphically. It appears the ground water table is in the sandy gravel
encountered in all test holes. The elevation of the sandy gravel varies over
the lot. During periods of the year when the groundwater table is higher it
appears to have more head pressure and rises up in the monitor tubes.
However, the highest elevation monitored, is still at least 10.5 feet below the
elevation of test hole # 3. This is why the location was selected for the new
soils absorption field.
7. Percolation tests were performed in the silty sandy silt and silty sandy gravel.
The silty sand percolated at 6.4 minutes per inch and the silty sandy gravel
percolated at 16 minutes per inch. Per MOA guidance, the silty sand will be
loaded at 1.2 gal/ftZ/day and the silty sandy gravel will be loaded at 0.8
gal/ft2/day. The silty sand layer is 2 ft thick and the silty sandy gravel layer is
8.5 ft thick. Using 2 feet of silty sand and 3.5 feet of silty sandy gravel for a
trench, the average between the two is 0.945 gal/ft Z/day.
8. The system will be a trench. The bottom of the trench will be 5.5 feet below
the distribution pipe. Using 450 gal/day, 450/0/0.945 = 476.19/5.5 = 86.58/2
= 43.29 ft of trench.
9. There will be a single trench and will be at least 44 feet long. This will provide
for a total of at least 484 sq ft of absorption area. This will allow the bottom of
the trench to be at least 6 feet above an impermeable layer or bedrock and at
least 4 feet above seasonally high ground water. Since the elevation of the
top of the silty sand is above the outlet of the septic tank, a lift station is
required.
10.There are no wells on the adjacent lots. There are on-site absorption
systems on all adjacent lots. There are no wells, or surface waters within 100
feet of the proposed system. Since all lots adjacent to this property are
developed, it does not appear the system on this property will prevent
development of the adjacent lots or the installation of replacement systems
on the adjacent lots.
The following is the percolation test results for an additional percolation test in the
vicinity of Test Hole # 3. The test was performed between 1.0 and 1.5 feet below
grade. The test hole was pre-soaked for 4 hours. The test was performed in
accordance with all state and municipal guidelines in effect on the date of the test.
9/11104 2
N orthwoodsl l•L7B4rMuniLtr1.doc
Test Hole # 3 Addendum,
Percolation test data:
Date: 07/17/04
Reading Date
Gross Time
Net Time
Depth to water
Net
1 7/17/05
0
5:10 pm
0
0.59 ft
0
2
10
5:20 pm
10
0.46/0.59 ft
0.13 ft
3
10
5:30 pm
10
0.46/0.59 ft
0.13 ft
4
10
5:40 pm
10
0.46/0.59 ft
0.13 ft
5
10
5:50 pm
10
0.46/0.59 ft
0.13 ft
6
10
6:00 pm
10
0.46/0.59 ft
0.13 ft
7
10
6:10 pm
10
0.46/0.59 ft
0.13 ft
Percolation Rate—6 4 min/in-
Pero Hole Diameter: Akin
Test performed between 1.011 and 1.511 below grade.
Based upon the data and drawings attached, I recommend a permit for this wastewater
system be granted. If there are any questions, please feel free to contact me at (907)
242-0755.
Sincerely,
Ronald E. Godden, P.E.
Enclosures: Soils Log, Test hole # 2
Soils Log, Test hole # 3
Soils Log, Test hole #3
Plan View Drawing
Details Drawing.
Ground Water Monitoring Data
9/11/04 3
Northwoodsll-U64 rMuniUrt.doc
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THETA Lot 7, Block 4, Northwoods Subdivision, Phase II Drawn by: Figure 1
Environmental & Engineering New Septic System RTK
Overall Plan View Checked by: Project No:
Contract No: REG XXX"
Municlpallty of Anchorage
Development Services Department
Bidding Safely Division
On -Site Water and Wastewater Program
4700 South Bragow St.
P.O. Box 196650 Anchorage, AK 99519-6650
rnvrr. mure. orgrom i le
(907) 3437904
Soils Log - Percolation Test
Performed For Ron Codden TH11 Dale Performed
Legal Description: LT7, BLK 4, NOR
DEPTH
0—(FEET)
OL — SM
1— CM — COBBLES
2—
3— ML — MOTTLED ORANGE
4—
S— CM/CP
6—
,_ ORANGE
SUBD., PHASE II
WAS GROUND WATER
ENCOUNTERED?
IF YES,AT WHAT DEPTH?
Depth to Water After
Monitoring?
Z! 46%_*. *}
tom ....
C(E. 000DO N f�
Township, Range, Section. SECTION 3, 715N, R1W, SEWARD MERIDIAN
Site Plan
s
6.0, L
0
6.0 P
E
Date 6/2/04
PERCOLATION RATE N/A (minMedhch) PE RC H CLE DIAM ETER N/A
TEST RUN BEMTEN N/A FT AND N/A FT
COMMENTS NOT PERCED — CWT TOO HIGH
PERFORMED BY, R. CODDEN I RONALD E. CODDEN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 6/2/04
P.. `3% It,
Municipality of Anchorage CANLLf•SJL
�+ ,.A. j
Development Services Department r'0�+v: Z !j
Building Satery Division i ..i� `''4 •+; i1
.a.+ On -Ste Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www muni orgronsile %f
(907) 343-7904 % V• 6b i
if
Soils Log - Percolation Test
Performed For: _ Ron Codden THI2 Date Penormed._ 5/26/2004
Legal DescriptionLT7. BILK 4, NORTHWOODS SUED.. PHASE II Township, Range. Section: SECTION 3. T15N. R1W. SEWARD MERIDIAN
SIODe Site Plan
I OL�A MOTTLED ORANCE
•4��COBBLES
CM — TAN/BROWN
FEW COBBLES
OCCL BOULDERS
SAND SEAM
11
L 1-M
14-
15-
16-
17-
1 -1 -M
4-
15-
16 -
17—
COMMENTS PRESOAKED 4 HRS
WAS GROUND WATER
Date
Gross Time
ENCOUNTERED?
YES
Net Drop
0
5/26/04
8
IFYES.ATWHATOEPTH?
10.0•
L
D•pth b Wrter AfM
5/26/04
C
P
writN1ng?
11.3•
E
Dates
6/2/04
20
FLAT
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
0
5/26/04
0
0
0.6
0
1
5/26/04
10
10
0.585 / 0.6
0.015
2
5/26/04
20
10
0.585 / 0.6
0.015
3
5/26/04
30
10
0.585 / 0.6
0.015
4
5/26/04
40
10
0.585 / 0.6
0.015
5
5/26/04
50
10
0.585 / 0.6
0.015
6
5/26/04
60
10
0.585 / 0.6
0.015
PERCOLATION RATE 56 MIN rrnwWn•hl PERCHCLE DIAMETER 6.
TEST RUN BETWEEN 3.5 FT AND 4.0 FT
PERFORh1E0 BY: R. GODDEN I RONALD E. CODDEN CERTIFY THAT THISTEST WAS
PERFOPMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/2/04
Municipality of Anchorage CiINEE .S P
Development Services Department �;• /
Building Safety Division • {Z /�
�
On-SteWater and Wastewater Program
4700 South Bragaw St. . • ,
!••/
P.O. Boz 196650Anchorag5156650 p Jilo
w
wwWlu
.nn aglonsite, rsde / /
(907) 343-7904 t '•; 168G •: V
(0
Soils Log - Percolation Test
Performed For: Ron Codden TH13 Doti)PGrfOrmed 7/05/2004
Legal Description: LT7, BLK 4. NORT14WOODS SUED., PHASE II Township, Range. Setaon: SECTION 3. T15N, R1W. SEWARD MERIDIAN
DEPTH
0—(rEET)
ORGANICS
1—
2— SM — ORANGE
COBBLES. GRAVEL
4:i:1
MIN
4`;GI
10-
..41•'
GRAY
SANBBLks k SILT
12- BOH
COMMENTS
Im
WASOROUND WATER
Date
Gross Time
ENCOUNTERED?
YES
Not Drop
0
7/27/04
8
P YES.ATWHAT DEPTH?
10.5
L
D4pthto W*w Albr
7/27/04
0
P
Nbrdtomg7
10.5'
E
Date
7/27/04
20
2%
K-1
Reading
Date
Gross Time
Net Time
Depth to Water
Not Drop
0
7/27/04
0
0
TEXT
TEXT
1
7/27/04
10
10
0.70/0.65
0.05
2
7/27/04
20
10
0.70/0.70
0.05
3
7/27/04
30
10
0.70/0.70
0.05
4
7/27/04
40
10
0.70/0.70
0.05
5
7/27/04
50
10
0.70/0.70
0.05
8
7/27/04
60
10
0.70/0.70
6.05
PERCOLATION RATE 16.6 (m @doth) PERC HOLE DIAMETER 0.5'
TEST RUN BETWEEN 4.0 FT AND 4.8 FT
r
PERFORMEDBY. R. GOODEN I RONALD E. CODDEN CERTIFY THAT THIS TEST WAS
PERFORMEDIN ACCORDANCE WTH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/28/04
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Wij it*.ti 041.1--- FYJOAIT- I Mrs :.
MUNICIPALITY OF ANCHORAGE
fJ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street •Anchorage, Alaska 99501 Telephone 264720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
b ��[
❑UPGRADE
MAILINq DDR �-, sled7
3t
LEG DESCRIPTION
' /
1-17 6 Y•
LOCATION
NO. OF BEDROOMS
1,J ! (,.js (?/I
DISTANCE TO:
Well
ZC� t 8L( G
Absorption area
ZG7 /
Dwelling
S
PER TNO.
9
O
V
.Y
i Q
Manufacturer
M�soipr_Q
No. of comparygents
»
Liq. anaci1y in_gallons
Z �r CJ
IF HOMEMADE:
Inside leng`h
Width
Liquid depth
d Y
DISTANCE TO:
Well
Dwellin
PERMIT NO.
J t72
_
ManufacturerMaterial
Liquid capacity in gallons
W =
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
.W.1 W Z
No. of lines
Length of each li
Total length of lines
Trench width
Distance between lines
F• ? W
Inches
H
Top tile to finish
Materiel beneath
of grade
tile
Total effective absorption area
inches
Length /
0
Width
4 o
Dept / r
PERM N
I ,Q
Type of crib
Crib diameter
Crib depth
Tot effective ab{osptjo,ypr@a
LOU
W
rn
DISTANCE TO:
will -- L(6L G
Buil 'pforndation
ff'.�p
Nearest lot line /O
J
Class
epth/'
Driller
Distance to lot line
PERMIT NO.
J
L C -
i
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption steals)
OTHER
T.
Z
114
PIPE MATERIALS
Dil G
cr
SOIL EST RATING 77 [
f
r
'r
p
✓0 � / /L
/
_ _
m ^ .
v
INSTT LER >�
REMARKS
O
1
.. OF A1'
..
P(E .«.r;..4`%,.
—�:%
re . Mbers A. 31se/wr t
j s'.r No. 131E Jap`
!'yfp ~••.wew•e'•�rf. r
� PROF IONa+
APPROVED - -'• '• DATE LEGAL -
end 138:.
Yr7= RIVER, ALAS, A T^=
n - 6 lJ
Pts. a'1 -2s70 Ip
72-013 (Rev. 3178) - - r f ,/ —
' J MIJN I C I 1='AL I TY OF ANCHOF�AGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
ON—SITE SEWER F�EF;ZM I T
840815 •
09/25/84
DON % S&S ENGINEERIN WALKER
SRD 196X
EAGLE RIVER, At; 99577
694-2979
SUBDIVISION: NORTHWOOD 82
SECTION: 4 TOWNSHIP: 15
45000 (SQ.FT. OR ACRES)
3
LOT: 7
RANGE: 1W
BLOCK: 4
Listed below are the options
available to you
in designing
your septic
system. Choose the option that
best fits your
site.,
TRENCH
LIED
W _ I}FzA I N
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
4.0*
GRAVEL DEPTH (FT.)
6.0
0.5
3.5
TOTAL DEPTH (FT.)
10.0
4.5
7.5
GRAVEL WIDTH (FT.)
2.5
27.0
5.0
GRAVEL LENGTH (FT.)
100.0**
52.0
129.0
GRAVEL VOLUME (CU.YDS.)
60.2
52.0
95.6
TANK SIZE (GALS)
1,000.0 **
1,000.0 *
1,000.0 **
SOIL RATING (SQ.FT./BR)
397
307/
397
** GRAVEL LENGTH > 75 FT.
REQUIRES MULTIPLE
RUNS (NOT EXCEEDING 75 FT. EACH)
** TANK MUST -HAVE AT LEAST
- - - - - - - - - - - - - -
TWO COMPARTMENTS
- - - - - - - - -
- - - - - -
- - - - - - - - - - -
I certify that:
1. I 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.
2. I'will install the system in accordance with all MDA codes and regulations,
and in compliance with the design criteria of this permit.
I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system an this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3'bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION S INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELE RI L PERMIT AND INSPECTION MUST DE OBTAINED; (2) AS-DUILTS
WILL NOT BE AP FOV W T T AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL W tK M TAMOAY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT:`1)0N/% S146 ENGINEERIN WALKER
ISSUED BY
DATE:
DATE:
r
or- 1=1t-1r"H
DEPARTMENT OF HEALTH ANID ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE,. AK 99501
264-4700 : ANCHORAGE 694-2131 : EAGLE RIVER
�Jt}:-=� I TE '�CWErt f=•Cf�t�1 I T
PERMIT NO. E•31052
APPLICONT: STEVE SKAGGS PHONE:
ADDRE'TZ : PO DOM D
CHUGIAK, AK 99567
LEGnL DESCRIPTION - SUDDIVI51ON: NORTHWOODS #2 CLOCK: 4 LOT:
LOT SIZE 0 SQ.FT. TOWNSHIP: 15N RANGE: 1W SECTION: 4
MAXIMUM NUMCER Or BEDROOMS 3 SOIL RATING = 397 307 397 (SG:FT./BR)
LISTED CELOW ARE THE OPTIONS AVnILnCLE TO YOU IN DESIGNING YOUR, SEPTIC
SYSTEM. CHOOSE THE OPTION THnT BEST FITS YOUR SITE.
Tr:Pyrar_mi CC I C3r4
WIDTH 2.5 FT.
LENGTH 149.0 FT. ! NOTE ! - >75 FT. REQUIRES TWO TRENCHES
TOTAL DEPTH G. 0 FT.
GRAVEL DEPTH- 4.0 FT.
GRAVEL VOLUME E2. O CU. YDS.
TANK SIZE = 1,000.0 GALLONS (TWO COMPARTMENT TAME)
_:CC- E> 1-- I C-3t-49
WIDTH 27.0 FT.
LE:GTI1 54.0 FT.
TOTAL DEPTH 5.0 FT.
GRAVEL DEPTH Cl. 5 FT.
GRA'vEL VOLUME 54. 0 CU. YDS.
TANK SIZE = 1,000.0 GALLONS (TWO COMPARTMENT TANK)
W I LSE E.vm : I r. r I aL_E> C•Cf-, i (3r4
WIDTH 5. 0 FT.
LENGTH 139.0 FT. ! NOTE ! - >75 FT.' REQUIRES TWO TRENCHES
TOTAL DEPTH 7.0 FT.
GRAVEL DEPTH 3.0 FT.
GRAVEL VOLUll.' _ 90. 0 CU. YDS.
TANK SIZE = 1, 000. 0 GALLONS (TWO COMPARTMENT TANS:)
7
r
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I CERTIFY THAT:
1. I nM rnmILlnr, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH DY THE PUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED
A COPY OF THE CODE SUMMnRY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS
PERMIT.
_. I.UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
PERMIT nPPLICnNT HAS THE RESPONSIBILIT'i TO INFORM PERS=ONNEL DUPING
THE INSTALLATION INSPECTIONS OF ANY WELLS nDJACENT TO THIS PROPERTY AND
THE NUNDER OF RESIDENCES THAT THE WELL WILL SERVE.
IF A LIFT STATION IS INSTALLED, AN ELECTRICAL PERMIT AND INSPECTION MUST
DE OCTAINED. n5-CUILTS CANNOT CE APPROVED WITHOUT AN ELECTRICAL INSPECTION
REPORT. T14C ELECTRICAL WORK MS=T CE DONE CY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT: STEVE SKAGGS
ISSUED Dy:
DATE: 12/12/03
MUNICIPALITY OF ANCHORAGE
Departmentr� Health and Environmenta)-%Protection
3 1 06) y 825' Street, Anchorage, AK.' _ 9501
264-4720
Permit 4 * * * HANDWRITTEN PERMIT
N -SITE SEWER PERMIT
Applicant: Mailing Address:
Location: �� Ph ne Number:
Legal Description: /t5 :t RIkk /I(ln Lot
Type of Soil Absorption System Is:
TrencDrainfield: _; Seepage Bed:
Size:
Holding Tank:
Maximum NiN er of Bedrooms:_ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System
Is: `397"
DEPTH _�� LENGTH 1�.h .GRAVEL DEPTH WIDTH �J
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(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).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = 1v GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of'any wells adjacent to this property and the number
of residences that the well will serve.
* *.* TWO M INSPECTIONS ARE REQUIRED
Backfilling of any system without final inspection.and approval by this departmer
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
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) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that bedrooms
Signed: j' �. Issued by:
Applicant
Date: '7 --; I —e-
SWP/024(1/81)
Cow. r7.. LJ AMO= n
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
I. 825 L. Street Anchorage, Alask! 99501 264.4720
-- SOILS LOG —PERCOLATION TEST
PERFORMED FOR: �7'c�LI E't� Z. ILAa'W L—f'i^�'T DATE PE
❑ SOILS LOG
PERCOLATION
TEST
3-/z-`63
LEGAL DESCRIPTION: 4-Z'r- /� /mac a C/ J2LAZrT1sw_ aL
DEPTH
(FEET)
ML
1 �
Sr[T /aC(alt�
2-
3-
5
35 �M S/eT-t
' COJEfitt</ S.O JQ
6-
7-
9-
SLOPE
7 9
SLOPE
11 WAS GROUND WATER s
ENCOUNTERED?
12 W1+rE?_
IF YES, AT WHAT
DEPTH?
13-
14-
15-
3
1415
,Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Ll
17
Ir
OF
s siEe,. *.:�(.9�y���1
C3
16
o*?49IN % it
1
�I ms`s Russoli L O W
0
'1`
mac rcnw
_t—^r
Reading
,Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Ir
C3
01
It I
c
C . Ysfer
20v"1 sf :•• No. 4286E ��?W10 Llg
a c,9E y<••N.H< <✓��= PERCOLATION RATE (minutes/inch)
0FESS+��� TEST RUN BETWEEN 3_17 FT AND �' FT
COMMENTS �aoOF �Awa-rZ�}:� �Ir �i e- 1r. na,J/•�/I ✓/O� gkEyle~ I✓ !f_.A<=Nt <--
PERFORMEDBY: CERTIFIEDBY: I` (/I/ DATE:
D.f w!(.I nlart'Iwllj
72-008 (6/79)
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
Parcell.D. 051-021-04
1. GENERAL INFORMATION'
Complete legal description Lot 7 Block 4 Nort hwoods # 2
Location (site address) • 23254 North o s Drive
Current Property owner(s) Pita Corwin
Mailing address 23254 40rthW00d51lff-chugmkAlm-99sU—'S4ar 2r 140 C TN r �*112g;
cosA#A n36({
Expiration Date: 10-13-10
Day phone 632-7775
Lending agency Credit union 1
Mailing address
11940 Abbott Road Anchorage Alaska 99501
Real Estate Agent Brian Sherburne
Mailing Address
Day phone 339-9455
99507
Day phone 561-3733 1
7731 E. Northern Lights Blvd, Suite 250 Andhorage Alaska 99504
Unless otherwise requested, COSH will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class Well ❑
Public Water System ID
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ❑
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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, 1 verify that my investigation,
based on procedures outlined in the Certificate of Onsite 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 Alaska Pim Engineering. Inc.
Phone 745-0222
Address P.O. Box 2749 Palmer, Alaska 99645
Engineer's Printed Name Chanes A- Leet, P.E.
Date toro9/09
AL:;Sffl
gyp.• /
49
!D V i � w'
4=
S. DSD SIGNATURE/Icy
�, ,•
. ° ce1oieo"�
•. ••r��
Approved for bedrooms. l%��i11„";; ;��
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By; Original Certificate Date: O— %-OGj
(R. 1105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & 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 CHECKLIST
Legal Description: Lot 7, Block 4 Northwoods #2 Parcel ID, 051-821-04
A. WELL DATA
Well type NIA
Date completed _
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # _
Sanitary seal (YIN)_
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: _ ugA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel/Ancwrage Tank
_ ft.
9 P. m.
Nitrate mg/L
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
n
9 -p.m
Other bacteria colonies/100 ml
Date of sample: _ Collected by:
Tank size 1.250 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date installed 10/1/04
Cleanouts (Y/N) Y
Depression over tank (Y/N) l High water alar (Y/N) Y
Date bf pumping 8ffim Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 10/1/04 Soil rating (g p.d.e or felbdr).a System type 5 -wide
Length e0 ft. ' Width 5 ft. Gravel below pipe 2 ft
Total depthx�ft. Eff. absorption area a 563 fl? Monitoring tube Y Depression over field N
Date of adequacy test 10-0s-09 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 9-9 in. Water added483 gal. New depth 16.15 in.
IWA� h -r: 1(oyzL. t" L*Tsn—
Elapsed Time min. Final fluid depth 13-t7 tn. Absorption rate >= 46-.n g.p.d.
Any rejuvenation treatment (past 12 mo ) (Y/N & type) N If yes, give date
vir�.l� is is�
D. LIFT STATION
Date installed 10/1/2004 Size in gallons 250 Manhole/Access (Y/N) Y
'Pump on' level at 93.95 in. 'Pump oft" level at 93.60 in. High water alarm level at 9424 in.
Datum SILL ON PATIO FLOOR Cycles tested 20*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NA
Absorption field on lot NA
Public sewer main NA
Sewer /septic service line ton
Animal containment areas NA
Meets alar ti Circuit requirements? YES
On adjacent lots Nn
On adjacent lots NA
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas NA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 9.2 Property line 68 Absorption field 72
Water main 1100
Wells on adjacent lots NA
Water service line 1100 Surface water 1800
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ,
Property line 12
Building foundation 36 Water main >1D0
Water Service line 1100 Surface water >IDo Driveway, parking/vehicle storage 30
Curtain drain NA Wells on adjacent lots NA
F. COMMENTS:
Date 10.9-09
COSA Fee $ Ll q U Waiver Fee $
Date of Payment_ 10 Of Le
ft/ Date of Payment
Receipt Number Receipt Number
(Rev. 11105)
A it
•
G. ENGINEER'S CERTIFICATION
�P.•'•••��•'•.¢
�
1 certify that 1 have determined through field inspections and
*•� 491M
•�� i
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.to
tt
Ot
Engineers Printed Name Charles A. Leet, P.E.
��j�*�.•e" eIts A. L"
Date 10.9-09
COSA Fee $ Ll q U Waiver Fee $
Date of Payment_ 10 Of Le
ft/ Date of Payment
Receipt Number Receipt Number
(Rev. 11105)
z3 zs+a
{ r,�
1 n 4
l E •� .
j l r t N
' vitiii"" ` _- ,,.. _ .. } • .s'` i'" f�R.�!VJ.t.:�:y
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r�` IGo
K.av r s,e_ d � vl_ o�a-`f.�•/ : 9= e � o q ✓ .. �; I wseutI.r
.�j air* th8t 1 have sFrveyW the following deembed
.' . St.e.i—i m n �S� T /SQA i P l W SIV
p �E pF q� %L2
Wasted A� , and thl the bwmv •
�P..•"wkhin
ovedap or ley >ines u,d do not
y !� N a'�vin 1 iey'y°� dn+e:et ene UW
• 49th In lys+ic aaprn,t
� visibbletefia,t,,,eeft on no �Ptr, •
y'7aFRtrt C�Jo rtsun fy°I Uprated At Bag1e River. Alaska
-,1 •: NO. CAG -S �•'Iy _ th�.i hof Oc`/•, ig 3'-,
�6 %i '�»••••• SCA
M R08IICf C JOHNSON
Oct Al 09 12:27p BRIAN SHERBURNE
Oct 01 08 01630p Betty J. van a
l�.
90751313747 p•2
auv p.1
SANUARY PUA ERS
20627 UPPER BOWERY LANE
CHUGIAK, AK 99567
90768&4602
cus7c ER6On0ERRQ
"C"
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R00fws6
w DaY
CA6R QQ6 C�MRGE OM 6CCT. DEER[T0.
MUOWT!
1-C 1,.c•6
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1
I
i
i
U x:Tf AM: r::r
I
i
I
TAX
RECEN DW
TOTAL
All claims and returned goods Thank You!
10 418 MUST be,acComparlied by this bill.
.ADD,CT =,
jl&dicirlT/%ZPi"ijigi V%%T/.
P.O. Box 2749
Palmer Ak.99645
Phone: 7460222 Fax: 746-0222
Adequacy Test
Legal Description: Lot 7 Block 4 Northwoods Phase II
No. of bedrooms: 3
Date: 10/8/09
Calc. Peak Load (gal).: 450 gal
Inspector: Claude Adams
Sludge (in): 0 Scum (in): 0
Tank size (gal).: 1250 gal.
Needs to be pumped: No
Ak. Rim Job #: 09-00533
S.A.S. eff. Depth (Il).: 2
Time:
Time:
Meter
reading:
Cum.
Vol.
(gal):
Flow
rate
(gpm):
Septic
tank
level
(in).:
A
Septic
tank
(in):
S.A.S. liquid level (in):
A S.A.S. (in):
1635
84142
0
0
52
9 9
1645
84224
82
8.2
48
(4)
9 9 -
1655
84304
162
8.0
1 46
(2)
10 10 - --
1705
84378
236
7.4
48
2
12 11 - -
2
1 _
1715
84460
318
8.2
46
(2)
13 12 -
1
1 - -
1725
84544
402
8.4
46
13 13 _
-
1
1735
84625
483
8.1
48
2
16 15 - _
3
2
(6:39'
1000
Recover
10/9/9
48
13 12
Test results:
Passed:X_ Failed:
Reviewed by:R) Date: 161 51��
Load= 150 gallons x number of bedrooms.
Test results are Indicative of condition of system at the time the test was performed,
Alaska Rim Engineering Inc. makes no representation of future life of septic system.
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.muni.org/onsite
(907) 343-7904
P��/tIJ� t
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Stip-o�k
Parcel I.D. 051 -PZ -DY HAA# o 0 to oL�
Expiration Date: 3�3�oT 5-
1.
1. GENERAL INFORMATION,
Complete legal description Lot 7 Block 4, Northwoods Subdivision II
Location (site address or directions) 23254 Northwoods Dr, Chugiak, AK 99567
Current Property owner(s) Ron, Godden
Mailing address 23254 Northwoods Dr, Chugiak, AK 99567
Lending agency Unknown
Mailing address
Rea! Estate Agent
Mailing Address
None
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
0
Day phone 688-0755
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
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. tSTATEMENT 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 Theta Environmental & Engineering Phone 242-0755
Address 660 Maney Dr. Wasilla Alaska 99654
Engineer's Printed Name Ronald E. Godden
5. DSD SIGNATURE
✓ Approved for _3 bedrooms.
Disapproved.
11/15/04
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date: IZ o f
(R«. o+02)
i� Municipality of Anchorage r.•,
(• ! Development Services Department 1
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lt 7, 84, Nonhwoods Subdivision 11 Parcel ID: 051-821.04
A. WELL DATA
Well type _
Date completed
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # A` wu
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
ft.
Coliform colonies/100 ml. Nitrate mg.A.
Arsenic: _ mg.A. Date of sample:
Well Log (Y/N)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Anchorage Tank. Steel
Tank size' 1.250 ' gal. ,. , , Number of Compartments 2
Foundation cleariout (Y/N) Y 'Depression over tank (Y/N) N
Date of pumping N/A Pumper N/A
C. ABSORPTION FIELD DATA } t
Date installed 10/1/04
Length 80 ft.
Soil rating (g.p.d./ftZ or f?lbdrm) 188
Width 5
ft.
ft.
Other bacteria colonies/100 ml.
Collected by:
Dale installed 10/1/04
Cleanouls (Y/N) Y
High water alarm (Y/N) Y
System type Wide Drainfield
Gravel below pipe 24" ft.
Total depth 3.67 ft. Eft. absorption area GT563 ftZ Monitoring tube Y Depression over field N
Date of adequacy test NIA Results (Pass/Fail) N/A For N/A bedrooms
Fluid depth in absorption field before test NIA in. Water added NIA gal. New depth N/A in.
Elapsed Time: NIA min. Final fluid depth N/A in. Absorption rate >= NIA g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) New System If yes, give date N/A
D. LIFT STATION
Date installed 10/1/04
'Pump on' level at 93_95• in.
Datum 100.00
E. SEPARATION DISTANCES
Size in gallons 1.250 Manhole/Access (YIN).y
'Pump off" level at as so• in.
Cycles tested 2
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot N/A
Absorption field on lot NIA
Public sewer main NIA
Sewer /septic service line N/A
High water alarm level at 94_24'
Meets alarm 8 circuit requirements? Y
On adjacent lots N/A
On adjacent lots NIA
Public sewer manhole/cleanout NIA
Holding tank
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 9.2 ft Property line OT 'Oft Absorption field GT 10 It
Water main GT25 It Water service line GT 25 ft Surface water GT 100 It
Wells on adjacent lots N/A
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line GT 10 ft Building foundation GT 10 Ft Water main CT 25 ft
Water Service line GT 25 Ft
Curtain drain N/A
F. COMMENTS
Engineer is co-owner of
G. ENGINEER'S CERTIFICATION
Surface water GT 100 It
Welts on adjacent lots NIA
Driveway, parking/vehicle storage GT 10 ft
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
/•
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Ronald E. Godden
Date 11/15/04
HAA Fee $ 51.570 Waiver Fee $
Date of Payment 1l lzzloq Date of Payment
Receipt Number 0 Receipt Number
(Rev. 12/01) UYU
OF
in.
)J-
7 -e /e,
r
f
V)
Fr, Ks
52,
% .
AS -BUILT
I hereby certify that I have' surveyed the following describk
p 1perty:
(A4-
13
Akhorige-Rkording Pficinct', Al&%ki,'ind that the inipruve
C•ments situated thereon are within the property lines and do no
,
overlap or encroach on the property lying adjacent thereto, tha
improvements 0 . n property roperty � adjacent thereto encroact
no lying
that there are no 'roadways
on
transmission tines or other vist'b
it easements on said propertl
except as Indicated hereon.-
Uateua.. age River, -Alaska
da' 0.
!M% PPL rt y
0 f ROBERT C. JOHNSON-';;,",,
.. I 'LS
i SCALE` Pegistered Lind Surveyoi No
Box 77-M
River,' Alaska 995T.
rhoniM PQSW'.'� i `
6
MUNICIPALITY OF ANCHORAGE ff
• DEPARTMENT OF HEALTH b 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 l.D.tl HAAN
2.
3.
4.
GENERAL INFORMATION
Complete legal description Ler 7 ;f';
Location (site address or directions) _� 32 s -v �✓�.n ,,�.,,, �� p,
Property owner -51-77' ' Day phone .245-4-4,/
Mailing address 3 Sy I✓orn c,v,=,�� D� G%, s�-•�> i�/r �7SL7
Lending agency
N JA
Day phone
Mailing address
Agent %r-oAP-5 / Day phone e:L V -24,y
Address j�f4•
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
y
X
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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(Rw.1/91) F,", MOAF71
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 forthe 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 Eagle River Engineerinji Cervices Phone —S -/9s"
P.O. Bo: 773244, Eagle Ricer, AIC 99577.3294
Address
Engineer's signature
6. DHHS SIGNATURE
� Approved for �' bedrooms.
Disapproved.
Conditional approval for
Additional Comments
M
Date 'i - 6— 9 2
6 C'•`°j2-U,
H.N»•�at.aw..p
re... I
J,�•, CFe730
I;lam •• '- - --' ��• �.� N
bedrooms, with the following stipulations:
Date a
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-M W.lm) arca u0Am
m��rnw , yr nrn.rRA,pAw
CWIRONWNT,NLSERVICESO MK)N
AUG 0 7 1997
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICE E C E I V C
Environmental Services Division
Q&
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: _ LYc 7 AV%i 6- /)-e- a Parcel I.D.: 10 S-)'- ?'Z 1 - D-41
A. WELL DATA
' / t
Well type l 1 * 13
1 If A, B, or C, attach ADEC letter. ADEC water system number (�(J t
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
I
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Date completed
Cased to
WELL LOG
Coliform Nitrate
Date of sample:
B. SEPTICIHOLDINO TANK DATA
Casing height (above ground)
Wires party protected (Y/N)
by:
AT INSPECTION
Other bacteria
g.p.m.
Date installed /o - g `r Tank size / -a so Number of Compartments 2 Cieanouts (Y/N)Y
Foundation cleanout (YM) Y Depression (YM) /V High water alarm (Y/N) x`'1.4
Date of Pumping 2-1742
C. ABSORPTION FIELD DATA
Pumper JA
Data installed AP Y'+ Soil rating (gg-p dAtg or tt*/bdrm) 30 7 System type /3rd
Length fio
----Width Ya Gravel thickness below pipe 6 Total depth `s
Effective absorption area 2 yg 4&% Monitoring Tube present (Y/N) Y Depression over field (Y/N) N
Date of adequacy test 8-5-9 Results (PasslFall) / 4X -f For ','—bedrooms
Fluid depth in absorption field before test (in.); 0 Immediately atter�bo✓_ gal. water added (in.): O. z S'
Fluid depth 0-10 (ins) Minutes later. 2 �- Absorption rate = .p.d.
Peroxide treatment (past 12 months) (YM) IV14 If yes, give date
72-026 (Rev. 3/98)'
D. UFT STATION
Date Installed
Manhole/Access(Y/N)
High water alarm level at' _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at'
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
'Pump off" level at'
Septic/holding tank on lot I'/ter On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main N/'r Public sewer manhole/cleanout
Sewer /septic service line wff Lift station IV14
SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOTTO:
Foundation %• O P line
Property e S / Absorption field OL.0i, "4 �..,.(
Water main/service line �o' Surface water/drainage t/oo ' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line .1 3 S Building foundation 3.c , Water main/service line
Surface water f /yo' Driveway, parking/vehicle storage area
Curtain drain N/A Wells on adjacent lots �` --)o,0'
F ENGINEER'S CERTIFICATION
I certtty that I have determined thru Held inspections and review of Municipal
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name 1-m*Ai , r t9w �' t'4
Data 5- - d, - 9 7
HAA Fee $ 3 t7D , /� G -7 Waiver Fee S _
Date of Payment ! �/ % / Date of Payment
Receipt Number -30,43 �i� � Receipt Number
72-028 (Rev. 3/98)'
1r
10 1& A. &~
CE67d0'
are
TO
Alaska Pacific Bank F MuaicV-2 ity of Anchorage
Depart. .nt of Health and Human Services
P. 0. Box 1C0420 R Environmental Health/4th Floor West
O Pouch 6-650
Anchorage, Alaska 99510 M Anchorage, Alaska 99502
SUBJECT Lot 7 Block 4 Northwood Subdivision Phase 02 DATE 6 /19 / 85
MESSAGE Attention: Ms. Kalpin;
This is to confirm the verbal information given to you during our telephone conversation
on June 18, 1985. The Department of Health and Human Services consider all Health Authority
Approval Certificates to be valid for two (2) years from the date of issue.
-- I
. SIGN D'�J
REPLY V
SIGNED DATE
RE --d RMjs 4S 471SEND PARTS i AND a INTACT - POLY PAK (50 SETS) AP472
PART 3 WILL RE RETURNED WITH REPLY.
DETACH AND FILE FOR FOLLOW-UP
KO::ICIYALI:'Y U' h:,IT:lJ:.
DIVISION OF ENVIRONMENTAL H1:ALTH
\a^C'\i C:
APPLICATION FOR HFaILTH AUTHORITY APPROVAL CERTIFICATE
1. General In_'orxation
Application Date
(a) Lraal r,^a:ri cir. .t/• .U. ••`i� w�1�t' r.'
,"cation (a'tztss c:
Ti -i- /\--/2 w
//
i (h) .\ppllcanta Namo,i2t'I-J/( :'i �f�_! Telophono - Home Business
Applicants Address II C. -still V?:x
(c) Applicant is (check oil Ing institution M; Owner/bullder •
Buyer = ; Other (explain);
t.11 :.•n.ilnp 1n�111„1 I,•H __.__. ( _'.-,.:�....3 t'.I.y`t��n.
(e) Real Estate Co. +6 Agent .cam C!/✓S
(f)
Address
Telephone
NQL. o
Vail -the HAA to the following address:
2. Type of Residence
Single -Family
Number of Bedrooms
multi -Family
Z/
Other (describe)
3. Water Supply /[f C0'e!✓L�1�f �L�nr
Individual Well Q Community E=1 Public JM
Note: If ccmmunity 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 Q Holding Tank Q
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 21
5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation data shovn below, I
verify that my investigation of this Health Authority Approval shows that the om-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 om-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm Telephone
Addr
Da
6. DHEP Approval
sr,
(ENGINEER SEAL)
Approved for
\'_�jXl bedrooms By
X
Approved Disapproved
Terms of Conditional Approval
CAUTION
�.bnrt•A. •Sh.hr NW �
_ :n�•. lio. 1137-E _.•.`'i
Conditional
THE MUNICIPALITY OF ANCHORAGE DEPARTME14T OF HEALTH AND ENVIROti^CENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSION%1 ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
B. SEPTIC/HOLDING TANK DATA
Date Insta d /�ci�//�i 7 size 2� No. of Cacpartmants z
Standpipes (`" Air -tight Ca (Y Foundation Cleanout(Y )
Depressicr. over Tank ( Date Last Pumped
Pumptng/Maintenance Contract on File (Y W ; for /✓
Holding Tank High -Water Alarm (YIN) 7bnporary Holding Tank Permit (Y/N) 772 -
Separation
19'Separation Distances frau Septic/Holding Tank:
To Water -Supply Fb11 2c70 744 f9tICTo Building Foundation 25'
To Property Line / n /- V To Disposal Field 2.0
To Water MxWService Line .moo -/- To Stream, Pond, Lake, or Major Drainage
Course
/-J
Comments -7t / 0 r�I T=
� c -d- 3t)-m(C l
(Page 1 of 21
2-15-84
MUNICIPALITY OF ANCHDRAGE
(MDA) a 3 n R A�
HEALTH AUTHORITY APPROVAL (HAA)
1100
CHECKLIST - FEBRUARY
1984
NOLL0310�d 1J1N2 N031AN3
A. WELL DATA
18 H11V3H d0 1d34
aoydOFDNV do'AU1Vd1ZXNnV4
Well Classification If A, B, or
C, D.E.C. Approved(YM)
Well Log Present (Y/N) Date CoWleted Yield
Total Depth Cased to
Depth of Grouting
Static Water Level Pump Set At
Casing Height Above Ground
Sanitary Seal on Casing (YIN)
Electrical Wiring in Conduit (Y/N) A
Depression Around Wellhead (YIN)
Separation Distances from Well:
To Septic Tank.on Lot Z
On Adjoining Lots
To Nearest Edge of Absorption Field on L4A 200
Cn Adjoining Lots
To Nearest Public Sewer Line
To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected By ;
Date
Water Saaple Test Results
Camlents
B. SEPTIC/HOLDING TANK DATA
Date Insta d /�ci�//�i 7 size 2� No. of Cacpartmants z
Standpipes (`" Air -tight Ca (Y Foundation Cleanout(Y )
Depressicr. over Tank ( Date Last Pumped
Pumptng/Maintenance Contract on File (Y W ; for /✓
Holding Tank High -Water Alarm (YIN) 7bnporary Holding Tank Permit (Y/N) 772 -
Separation
19'Separation Distances frau Septic/Holding Tank:
To Water -Supply Fb11 2c70 744 f9tICTo Building Foundation 25'
To Property Line / n /- V To Disposal Field 2.0
To Water MxWService Line .moo -/- To Stream, Pond, Lake, or Major Drainage
Course
/-J
Comments -7t / 0 r�I T=
� c -d- 3t)-m(C l
(Page 1 of 21
2-15-84
C. ABSORBTION FIELD DATA
Soils Rating in Absorption Strata 202A4 Type of System Design /X% A
Date Installed &ngth of Field 0
Width of Field SLO Depth of Field
Gravel Bed Thickness
Square Feet of Absorption rea 2Y U Standpipes Present/ '(06)
Depression over Field J) Date of Last Adequacy Test ^J(9 ✓
Results of Last Adequacy Teat --e_ CIL/
Separation Distance from A-bs/orption Field:
To Water -Supply WaVall r a To Property Line /D i�
To Building Foundation 36, To Existing o: Abanda*d System on
Lot /-( O/J- 5- ; On Adjoining Lots Le' N 491-F U
To Water ita2apService Line 5V 4— To Cutbnnk(if present)
To Stream/Pond/Lake% Major Drainage Course /V l /�
To Driveway, Parking Area, cc Vehicle Storage Area
Comments /LJ O ' J 15
D. LIFT STATION
Date Installed I Dimensions
Size in Gallons ole/Access (Y/N)
"Pump On" level at Level at
High Water Alarm Level at Vent (YM)
Tested for Pumping Cycles dicing Adequacy Test. Meets MDA
Electrical Codes(YM)
Cat nts
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have decked, verified, or conformed to all MDA HAA Guidelines in effect
on the date of this inspection.
Signed .. Date
Conpany- SRC'1.3:.
MDA No.
PIi. G; y-, 570
KBl/d5/s
(Page 2 of 21
Mbr1 A.
tic. 1�3)•E .•�"�
.ter
2-15-84
