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HomeMy WebLinkAboutNORTH WOODS BLK 4 LT 10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~£~ ~.CT ~ SEPTIC ABSORPTION Address ~'~"~-1 TANK FIELD WELL Phone(si I Permit No -- No,~Bedrooms WELL ~, ~~ ~1 ~OOg~sc.,.~,o.~ LOT LINE ~0 ' Township, Range, Section AS-BUiLT DIAGRAM (Show ~ocation of welh ~eptic system, property hnes, foundation, driveway, water bodies, etc.) TANK~ N Manulactu~er Capacdy ~n gallons Material of Compa~ments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ to p~pe bottom from Total depth from original grade ~ ~l ~ Fdl added above original grade Gravel depth beneath p~pe zVz' F~ ~" ,~ ~ ~ p~ ...... %~, ~" ~o'+ ~v~l"l~gt h Gravel w~dth - I~ ~Z'+~' FT ZO~+lO~ FT ~ ¢ Total absorption area Distance between lines 1--~ ///Z 0 sO ~T G ~ ~T L ~umber ol lines ~ Soil rating Pipe material ~ ~ ~rd~, 7/~/~ ,-,'~ , , WELLS '_ ~ ~ PRIVATE ~ OTHER {Identifv) Classification (A,B,C)~ ~ ~ Total Dep[h Cased to / ~W~~t Fi FT ~ I nstalie, ~ ~[ ~ ~ Date Installed: REMARKS: ~_.~ .~ ~-z~ ( ~~'ln~pecti°ns Pedormed by: I ce~ily that this inspection was pedormed aGcordin~ 1o all 72-013 (3/85) M U N I C I P A L I T Y 0 F A N Ill] H 0 R A G E Depar'{ment c)F Heal'Lh &J Human Ser~vice~ S25 L Str~eet, Anchora~e, Alaska 99501 343-47~0 0 N .... S I ]" E S E W E R F" E R M I T Per'mit Numbe~": 880()87 Date Issued: 06/20/8S Up g r ad e Engineer' Designed OwneP Name: KENNETI...I BEST / CORWIN & ASSC Owner Addr'ess: SRA 78-B CHUG I AK, Al'.:'. 99567 Day Phone: 68S...-9300 F'a r' c e 1 I d: 051-'7:~; ,1,- 15 Lc.d',, Lega:l.: SUbdivisic~n~ NORTH WOODS L.c¢:~ :[0 Blr.'~c:k: 4 Sectian: 4. T~wnship;t ~.SN Range: L..cR,. Size 2()0()0 (sq,, ¢'L. c~p acr'es) Max Bedr'ooms: This Per'mit: 3 'T'c)t, al Capac:i,'Ly: EiEF:q"IC "t"ANKJJ Minimum 't'..c~t. al sept.:Lc t. ank capac:it.y." 1,O00 gallons. Each sept:i.c tank i~ILts'L have a'L ].east'~ 2 campa~'Lments. Depth to top of sep'Lic 'Lank(s) < 4.0 Feet requires insu:Lat;.ion aver' tank(.s). INSTALL,. PIER ENGINI,E:ERS DESIGN~ BE:D: 27.5 X 40.0'. MAXIMUM DEPTH ..... 0.5' OF ORIGINAL GRADE. NOTIFY DHHS PRIOR TO 1ST & 2ND INSPEC'TIONS,, THICG PERMIT EY~'IRES 12/'.:~1/88. I CERTIFY THAT: 1,, I am Camilian with the i-equireme:nt.,s For' on-site :sewers and wells as set Car'l'.h by the ldunicipatity of Anchor*age (MOA) arid {he State ~)¢ Alaska. 2,, I will install the syst. em in accordance ~it.h all IdOA cci(des arid regulations, and in compliance with the design critenia oF this permit,, E;,, I will adher'e t~ all MOA and Sta{e oF Alaska requirements far' the set back dist,.ances From any existing well~, wastewater' dispc)sal r~y~tem of public sewer'age system an this or any adjacent or. neapby l~t. '; 4. I under'stand that t. hi~ permi{ is valid fo~ a maxi,mum oF ;~; bedr'ooms. I also under'stand t. hat {he capacity o¢ the 'Lotal system ;i.~ ;]'¢ bedpoc)ms and any en].ac~ment wi~ r'equire.an add~;'Lional per'mit. ~ ([]wne~ KENNETH [~ES~ / CORWIN & ASSC .................... _ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PER¢ORr~ED FOR: DATE PERFOF LEGAL DESCRIPTION:LoT [© 1 2 S; I-4/ ~4 6- 7 8 9 10 11 12 13 14 15- 16- 17 18 19 2O COMMENTS ~c~_7~4~c~ b5 Township, Range, Section: PERFORMED BY: ~ t t~-_~. ~,, tV/ LOPE WAS GROUND WATER ENCOUNTERED? S IF YES. AT WHAT DEPTH? ~-/e r- ~'ee_p pO cbt- 4 ~ E Depth to Water After ~ ,t ltdonitoring? ~ --7 .Oate: SITE PLAN -H~ u~,~ Reading Date Gross Net Depth to Net ' Time Time Water Drop ~ /I,¢ 3 6//4 PERCOLATION RATE ~,,~,~ (m,nuteshnch) PERC HOLE DIAMETER / J~N~'~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN EFFE, TEST RUN BETWEEN __ .4~ r 4eo[ 72-008 (Rev. 4/85) .-/- FT AND __ . FT '~N THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION / Z- /o LOCATION //0[~ ~JOO~ '~"~/~"~ A b s o r p~i~r e a! DISTANCE TO: ~/~,~J~7 I b Manufacturer G,/..(~ {~¢ IF HOMEMADE: Inside length DISTANCE TO: Well //fi~" Dwelling Manufacturer PHONE /~NN EW NO, OF BEDROOMS,~ P ERMZ/ ? O Z' y Z, No. of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons Well DISTANCE TO: No, of lines Top of tile to finish grade Length Type of crib Crib diameter Well DISTANCE TO: DISTANCE' Depth Building foundation Foundation Nearest lot line PERMIT NO. Total length of lines Trench width Distance between lines inches Material beneath tile Total effective absorption area inches PER T . ' --~ Cribdepth .... I Total effective absorption areT~/_~.~- ~ / Buildi i~ dati¢o ~_~(~ ~ Nearestlotline /,~ ~ ~ Driller Distance to lot line PERMIT NO. Septic tank I Absorption area(s) Sewer line OTHER PIPE MATERIALS /- SO,LTEST RAT,. ' '_.r / I NSTAELE~-) /'~. ' REMARKS ~ ~ (Rev. 3/78) DATE LEGAL F'EF4::M Z T NO. RF'F'L I CRN-[' LOCRT I ON LEGRL DE:PRF:'/T'MENT f'~"h HEFILTH FANE:, ENV I RONMENTRL ~!OTECT SKRGGS ']FtN'Z;TR[ IRT I FiN P. (3. BO[.:[ D.: CHUG IRK N ] RTHWC ] [:S S,. % LOT 1¢3 BLK 4 NLR]FiNCIJD=, S/D I_OT .~I,::E ;2EIE~E~Ef SQURF. E FEET T'¢PE OF SOIL H6:,.RFT...LN~:,,=., : tlP;.~Iril fl NUME:ER OF E:EDROOMS = Z~ SOIL. RFIT I NG '" ..... "- ] .' ""' "1 '-~ ""'~'~"'M ':; · -['FIE REQUIRED S~ZE OE THE =,LTL HE.=URFTZ,-N =,~::,~=.~. ~... THE LENGTH DIMENSION IS:: THE LENGTH (IN FEET:." OF THE TRENCFi OR DRFItNFIEL. D. 'THE DEPTFI OF ~ TRENC:H OR Pi-[' IS THE DtSTRNCE BETWEEN THE SURF:RCE OF -['HE GROUN[:, Bf',ID THE BOTTOM OF THE ENCFIk;FfTI(}N (IN FEET). '['HE GRFIVEL DEPTH IS TNE MINIMUM DEPTH OF GF.:FIVEL BETWEEN 'THE OUTF'RL.L PIPE FIND THE BOTTOM OF 'THE EXCRVFt-['ION (IN FEE'['). FERHIT HFFLI_.HN1 HRS TH.E F.E=-,FCf,L, IE, ILI]. TO !f",IFOI';.:M THIS [)EF'RRTMEHT DLtRING THE INSTRL. LS-['ION IN~F'ECTI]N'~ OF BN'¢ WELLS FIDJBCENT TO THIS PROPER-["¢ RN[)-['HE NUMBER OF EE=,IE_NCc..=, THFIT 'THEE WELL WILL ' ..... ", :,EF. ~E. .......... "~ t~q C, ,:'. ,,=."--~ ."::, I .l-~- ':" ..... F-~ E~2.7- -- ":[ C, 1'-41 '::-~_. RF.'E R E~. ,]::~ L,1% tF.:.". EZ-_- [: bH..LFIL. LINLi OF FfN¥ S'¢STEM WITHOUT FINFfL INSPEC:TION FIND FIPPFd]VFtL. 8¥ THIS r.>EP.~RTMENT WILL BE SJBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND TINY ON-SITE SENF~GE DI'SPOSRL SYSTEM IS ~.¢)~..~ FEET FOR R PRIVRTE WELL OR ~50 TO 2CW2~ FEET FROM R PUBLIC HELL DEPENDING UPON THE: 'T'~'PE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SENER LINE l'S 25 FEET RND TO R COMMUNI'T'~' SEWER LINE IS 75 FEET. O"FNER REQUIREMENTS MFI'T' FtPPL.¥, SPECIF'ICFITIONS RND CONS'TRUCTION DIFtGRFIMS RRE FIVFItLFIBLE TO INSURE PROPER INSTPqLLRTION. t CERTIF'¢ THRT ±: t RI"1 FF~MIL. IF4R WITH THE REF:.!UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SE-[' FORTH B'¢ '['HE MUNICIPI~LtT'¢ OF RNCHORF4GE. 2: ! WiLL INSTRLL THE S'¢S'TEM IN RCCORDRNCE WI'T'H THE CODES. ]:: t UNDERSTRND THRT THE ON-SITE SEWER E¢'¢STEM t'1RY REQUIRE ENLBRGEMEN-[' IF THE RE~IE:,ENCE 1:5 REMO[:,ELED TO INCLUDE MORE TF!RN 2: BEE,E'OFM':: S I GNEZE,: .............................................. ~L= ~ t Cf,~ BF'PLICRNT SKRGGS CONSTRUCTION -' 'O & E ENG,NEERING & DEVELOi ,VIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Performedfor: Name: ~' T'~-I/~I~I ~ ~t~ ~ ~,4/$ T, Tel. No Mailing Address: LegalDescription: ~O1-/'~, Depth (feet) Soil Characteristics w 8__ 9__ 10__ 11 12 . 13__ 14__ 15 16__ Ground Water Encountered: Yes /'~"~No__ If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: '~-~-i~_ /:/~ Earl Ellis 688-2280 PLOT PLAN PERC. TEST Date: • • O T / G •,` Municipality of Anchorage On-Site Water and Wastewater Program Lia (907) 343-7904 • Isa � law iv Certificate of On-Site Systems Approval Q v zo', Parcel I.D. 051-731-15 Expiration Date: ‘," I • • 7Lg5 1. GENERAL INFORMATION: Complete legal description NORTHWOODS; BLOCK 4, LOT 10 Location (site address) 22509 McManus Drive`CHUGIAK, AK 99567 Current Property owner(s) Louis &Ann Gallegos Day phone 907-903-0588 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex U 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 n Community Class Well ❑ Community Public Water System ® Public Sewer WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 556 Waiver Fee $ Date of Payment to m Date of Payment Receipt Number dac'356 Receipt Number COSA# 3sc iQ 019 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 3 fi/1q Q00000p�� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF 4 / ' N in accordance with the guidelines and regulations established by the Municipality of Anchorage and ' '.•.••• `� Qty industry practices. The reported results describe the condition of the system/s on the date/s of the O . • I '� . s�NO evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ! �.c /� encroachments may exist that were not identified during the evaluation. The operational life of all wells i 4 �i T �� VQ and septic systems depend upon a variety of variables, including but not limited to, soil conditions, i� • ••• groundwater levels (that may fluctuate during the year), quality of construction (materials and �� VA 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 �Q • - f A. Games-: 0 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of 01 9 CE �0� the well or septic system. GEG makes no representation whether an alternative well or septic system Ufa ) can be installed on the property in the event either of the current systems fail to perform adequately in Q4` e 3 Ari 1,-7: the future. The content of this report is for the sole benefit of the person/party that retained GEG to ' `a'P oo\., �'esslo . perform the evaluation. Reliance upon the information provided in this report by any other person or �D'o.000 party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE Y. System #1 Approved for l bedrooms System #2 Approved for bedrooms �\‘ or NvL Disapproved l�N. ,c. -:-.•approval for bedrooms, with the following tipul n p `Z WATER AND WASTE RAMR 3 % PROGRAM cs ° �c.,i ccp'd ' By:- .,-..._ Original Certificate Date: y- ..,--i 7 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.' : o , . 7. ATTACHMENTS: t COSA Checklist _7 Nitrate Advisbry'\c;I' .• ,1 Septic System Advisory Arsenic Advisory,. , ay -..l Well Flow Advisory Other ' COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: NORTHWOODS; BLOCK 4, LOT 10 Parcel ID: 051-731-15 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA ❑Well log is filed with Onsite (or attached) Well production at 1.• of test gpm Date drilled Water stor-=- ank volume gallons Total depth ft - •isinfected for coliform test? ❑ Yes ❑� No Cased to ft El Coliform bacteria is Negative El Sanitary seal is functioning correctly Nitrate mg/L El Nitrate less than MRL(ND) El Wires are properly protected Arsenic ug/L ❑Arsenic less than MRL (ND) Casing height(above grou•• in. Collected by Date of flow test f. •SA Date of Sample Static w- evel at beginning of test ft. .mments AWWU WATER B. TANK DATA C. LIFT STATION Age of tank(s) 2 years ❑ Required maintenance co • - ed Tank type/material SE" S"` Age of lift station - ears ❑� Standpipes/foundation cleanout per record drawing Lift station mat- - Date of pumping X/21/18 Comm-• : N/A (414 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/3/81 Adequacy test date 3122/19 ❑■ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade *2.5 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade *2.6+ ft(min) Water added 764 gal ❑ N/A—pressurized field New depth 0 in Monitor tubes go to bottom of drainfield. If not, state Elapsed time 0 min depth into effective Final fluid depth 0 in ❑ Code-required soil cover over field 600+ ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) NONE date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies:SIT IS UNKNOWN IF 1981 BED IS INSULATED-IT APEARS THAT BED HAS 2'OF COVER THROUGHOUT COSA Checklist yellow sheet • E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ❑Yes if No ft ❑Yes if No ft Neighboring Tank> 100' ❑Yes if No ft Private Sewer/Septic Line> 25' ❑Yes if No ft Absorption Field on Lot> 100' ❑Yes if No ft Holding Tank> 100' ['Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ❑Yes if No ft ❑Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ['Yes if No ft ❑Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ❑Yes if No 5 + ft Surface Water> 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Driveway/Parking> 0' ✓❑Yes if No, comment Absorption Field > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ['Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑Yes if No UNK ft Community Wells >200' E Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft Driveway/Parking >0' ✓❑Yes if No, comment Property Line> 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' ❑Yes if No UNK ft Community Wells>200' ❑✓ Yes if No ft Surface Water> 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS REQUIRED DISTANCE AT TIME OF INSTALL FOR TANK TO FOUNDATION IS 5'+. CONDITION OF1988 BED WAS NOT EVALUATED EXCEPT MT WAS NOTED TO BE DRY. ___r 1981 BED IS ONLY SIZED FOR 3.8 BEDROOMS BUT PASSED TEST FOR 4 BEDROOMS. 4— o oo�oop�.;0 G. ENGINEER'S CERTIFICATION ,c,_ .F � I certify that I have determined through field inspections and review ;C-J'iP • J�- •.s�OQ0 of Municipal records that the above systems are in conformance with ,/, .• .1 • H /\ V. MOA COSA guidelines in effect on this date. � D OQ •,J�; f _,IA. Games.. 0 OCP ( E— 953• e;QV Sf/.. .c�O ... F,co COSA Checklist yellow sheet 4A /\.\/"rQo f ess�000� #AECC884 0000 O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel !.D.,# O ,? I - '7 j~ ) - i 5- 1. GENERAL INFORMATION complete legal'description Lot I0; Block 4; North Woods Subdivision Location (site address or directions) 22509 McManus Street Chugiak, AK Property owne'r Mailing address Lending agency Mailing address Agent Address Sally Roudebush Day phone 688-6977 22509 McManus Street Chu~iak, AK 99567 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well NOTE: XXX Public water 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 NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA If21 '){JOM %Jeeu!6uG leUO!SSajoJd eql u! suojss!uJo Jo sJOJJ~) JOj alq!suodseJ ~ou s! e6e~oqouv ~o ~l!led!o!unl,~ eq.L 'penss! s! ale3!j!pao e eJojeq elep eZ,{leUe Jo suo!~oedsu! lonpuoo ),ou op SHHQ jo seaAOldUJ:l 'slueLuaJ!nb@J elm, spue le~epeJ u!epeo ,{jsp, ss ol J~)p~o u! SUO!),Ie),!:ISLI! 6u!puel ~!eql pue seuJoq jo sJaseqo~nd o1 ,~sepnoo ~ se s!q), seep SH HO eq/'eHselV jo elm,S eql u! paJe),S!~),I Jeeu!l~ua I~uo!ssejoJd luepuedepu! ue ,{q 8AOqB ~ LldBJ§EJed U! UeA!6 suo!leluese~da~ eq~ uodn ,quo peseq se~o!j!p@O le^oJddv ,~Ipoqlnv qlleeH senss! (SHHO) sao!aJeS uBmnH puc qllSeH jo lueuJpedeo ~)6eJOLtOUV .~O ,{l!ledio!unpJ Ii ' SlUemmooIBUO!l!pp¥ '~u~dsp peru,26 s~ I~ao~dd~ I~U~ I~un ~o~Ds~ u~ u~x [L~qS pu~ (ps~inb~ 'UT~,E) ~@AOO ps~In5@~ ~AeIqa~ O~ psq Sqg ~SAO III~ I~uoIgIPP~ sD~Id (I) :o~ X~sssasu ~ox IIp m~o~sd o~ s~Iuo~ ~o~asa :suo!lBInd!is fiU!MOIlOt eql ql!M 'smooJpeq (C) a~q3 JoJ IBaoJddB IBUO!]!DUO0 XXXXX 'peAoJddBs!O 'SLUOOJpeq 9Nla~NIgN'~ $ '~ S JoJ paAoJddv :aan~VN91S SHHa eJnlBu§!s s,Jeeul6usI sseJppv uJJ!_-I to euJBN · uo!loedsu! s!41 jo elBp e41 uo loejje u! suo!lBIn§eJ pUB 'seouBu!pJo 'sepoo elB1S pue IBd!o!UnlAI lib ql!M eeue!ldLUoO u! s! LUelSAS IBsods!p JelBMelSBM Jo/puB/[Iddns JeleM el!s-uo eql 'uo!loedsu! pUB UO!le§!lseAu!/[LU moji pue selg eBeJoqouv LuoJt peu!elqo UO!IBLUJOIU! eql uo peseq 1BH1/~J!JeA JeqlJ nj I 'u!eJeq pelBO!pU! eJnlonJlS jo edA1 puc SLUOOJpeq JO JeqLunu eql JOJ elenbepe pue leuo!lounj 'ejes s! LUm, S/~S leSOdS!p JeleMelSeM Jo/pue /~lddns Jm, eM el!s-uo eql ~,eq~, SMOqS uo!leo!lddB IB^oJddv Al!Joqlnv qllBeH s!ql Jo uop, BB!lse^u! /~LU 1Bql ,{J!JeA I 'MOleq UMOqS elep uo!lep!le^ eql Jo se pue oleJeLI pex!JJe IBeS ~u/~q pe!jp, Jeo sv '9 I:I:IgNI~Ng Aa NOI.LO=IdSNI dO J.N:I~=I.LV.LS 'G 825"L" Legal Description: Lo-r A. WELL DATA Well type Log present (Y/NJ Total depth Sanita~ seal (Y/N) *, ' checkliSt Date of test Static water level Well production Nitrate Colifor .. , B. SEPTIC/HOLDING TANK DATA ~:~ Date installed (°//3 /~l) Tank r _ size I o'o0 6,~. Nt/mber Of Compartments. ~ Cleanout Foundation Ci~ah~di,~}~ ~'~ Depressi0n'(¥~, ~q -High Water alar~(Y~) Date of Pumping. 5 - ~'t ~ q pUmper C. ABSOR~ION ~LD DATA '~ ' - - Soil rating (g.p.d./~, or fl ~drm) ~ I. ~ Date installed ~ - 1~'~$:" ' -~ 2" Len~h 32 ~ ~ Width- ~ ~ Io Gmvelthmknessbelowp~pe Effective abso~ti0n ama '"1 i ~ ;' Monitohng Tube:present) ~ Dep ~A~ , ., For Fluid depth in abso~tion field bbfore ~test (in,); ~, ~ ,I~ediately ~er q~O g~l, water, added -(i~.)~ - Fl~ddeptb ~ (ins.) Minutes: later: '~¢ n~¢;.: Abso~tmn rate = Peroxide treatment D. LIFT STATION Date installed S~ Manhole/Access (Y/N) ~.~p ou" level at* "Pump off' level at* H~igl~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~ Public sewer manhole/cleanout Se~ Lift station SEPARATION DISTANCES FROM_]'~'~OLDING TANK ON LOT TO: Building foundation ~ t~' Property line t o~ 4' Absorption field Water main/service line ! O}4- Surface water/drainage Ioo !4- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Water main/service line ! o ~ + Surface water ~ oo t 4- Driveway, parking/vehicle storage area Curtain drain Wells on adjacent lots "Zoo t 4- Property line Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc F. ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review of Municipal re t~_~q, ms are in conformance with MQA HAA guidelines in effect on this date. ........................................................................................................ . ,~~: ........... . . ~~ Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description In~ 10; B2nok 4; Nn~h Wnnds Subd~u~s~.nn Location (site address or directions) 22509 Me,anus S~te.a.~t, Chugiak Property owner Mailing address Lending agency Mailing address Agent Address Kan B~s~ P.O. Box 1282, Day 3hone Chugiak. Alaska 99567 Day phone 688-9300 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~., TYPE OF WATER SUPPLY: Individual well Community well X×X Public water 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 fRev. 1/91) Front MOA #21 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 Firm $ & $ ENGINEERING Phone ! 7034 Eagle River Loop Road No~ 204 Address Eacjle River, Alaska Engineer's signature Date I- '~ D~/S SIGNATURE Approved for ¢ ,/ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21  Municipality of Anchorage , Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~-~'' \C:) ~..V-- ~ ~c4--~'~ ~c~::~s~arcel I.D. A. WELL DATA Well type ~' Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ ~'~"~" Cased to Casing Wi~Y/N) FROM WELL LOG_~- AT INSPECT!ON Date of test ' I~ Static water leve Well fl~..~~'~ Pump"level g.p.m, g.p..nl~'l SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '7,-o,~ ~'~ Absorption field on lot Public sewer main Sewer serVice line WATER SAMPLE RESU~ DC~/ Nitrate B. SEPTIC/HOLDING TANK DATA Date installed "] - 1'~- ~:~ Cleanouts~/N) '~ High water alarm (Y~ Date of pumping ; On adjacent lots Public sewer m~ ..EetroT~ tank On adjacent lots Other bacteria Compartments ~'~ Depression (Y/N) Collected by: Tank size Foundation cleanout ('~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TA~K TO: Well(s) on lot "~'c>~ ~ On adjacent lots ~'"~ ~' To property line \ o Absorption field ,~- Surface water/drainage ~ C:> c> Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) ~.---- Vent (Y/N) "Pump on" level at ~f" level at High water alarm level ~-"~~ Cycles tested Meets MOA electri~ W'~II on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed "~ '~' - Length '~' '~ ~:)~ Width Total absorption area \ \'~'~ Depression over field (Y~) Results~ail) Soil rating ~ ~ ~/I~;¢.- System type ~--~ Gravel thickness L~ Total depth t~'-~3~c~'Cr.~'> Cleanouts present~YN) ~ ~ Date of adequacy test ~ \ ~,~ ~?"z---;.~:) for ~'"~ ¢-~z_ ('"'-~'") ~' ........... '~ bedrooms If yes, give date ~'1/~. Peroxide treatment (past 12 months) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~-c)~> ~J¢ On adjacent lots ~\/~ To building foundation ~ o~ On adjacent lots Surface water \ ~,c:> ~' Curtain drain 2--~' ~'~' Property line To existing or abandoned system on lot Cutbank ~'-~[ .,~-- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~ date of this inspection. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Signature Eagle River, Alaska 99577 Engineer's Name Date HAA Fee $ /7~' Date of Payment / ~7~ ~ Receipt Number ;;~//-,.~7 / ('-~--~}~ .) 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 WALTER J. HICKEL, GOVERNOR (907) 349-7755 December 15, 1992 Mr. Roger Shafer S & S Engineering SUBJECT: Northwoods Subdivision Class "A" Public Water System, PWSID 213001 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the aboVe-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on December 3, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on April 21, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. o The last Radioactive Contaminants Sample results were submitted to the Department on July 1, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on June 2, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" pUblic Water System is in compliance with other Provisions of the State Drinking Regulations. If You have any questions on the'above information, please do not hesitate to cOntact this office at 349'7755. Sincerely, Michael Lu Environmental 'Eng. Asst. II printed on recycled paper b ~.,,~,~ Y ~ ' ~ D, .,~ RECEIVED ' ' '""" (~N ~ PO NTMENTS DATE DATE ~/,~ ~ J~ [~~ ~ DATE INsPEcTOR ~/' ~ INSPECTOR INSPECTOR MUNICIPALI~ OF ANCHORAGE MUNICIPAL TY OF ANCHORAGE DEPT OF HEALTH ~  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~JRO~ENTAL PROTECT ON ~ 82~ L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION SEE 1 7 1981 REQUEST FOR APPROVAL OF,INDIVIDUAL WATER N E DIREcTIONS: Complete all par~s on page 1. Incomplete reques~ will not be proces~d. Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) PHONE 2. BUYE~ PHONE MAI LING' ADDR ESS 3. LENDING INSTITUTION . PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ;TREET LOCATION 6. TYPE OF RESIDENCE E~""SI NG LE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY i~1 ",IDIVI DUAL* COMMUNITY E~ PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~NDIVI DUAL/ON-SITE~ ~ PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other [] Two [] Five ~ Three [] Six * ATTACH WELL LOG, A well log is requl red for all wells drilled since June 1975. For wells drilled, prior to that date, give well depth (attach log if available.) ¢::~/ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) · ' .. ! ~ ~THI8 81DE FOR~)FFICI.~L USEONLY ;. ~¥pE ~FRESIDENcE ~ ~ = - _~ NLIMBER~OFBEDROOMS ~ siNGLEFAMfL¥ : [] ONE, ~-'~:THREE' ' '-E::] FIVE -Fl OTHER .2, WATEh-S.UPPi;Y' ' : - PERMIT N~MBER- . ' ' - : [] i~DiViDUAL ~ 'DEPTH 6F~/VELL" ' · ~ PUBLIC'UTILI-TY - . _ · _, . __ - ~' Cpnn~Cfion Verified _ LOGRECEIVED 13. SEWAeS:DiSPOSAL S~TE~ -' P"RM~rNUMB~R' - Cohneotion Verified ~ ~ "'JN~ALLER ' "' -- - -~ize:. - If Tahk iS homemade sb LS RAT ~G ? --- " ' '~PE OF TANK~ - - ' - ~MANUFACTURER ' ' " ' ' 'TOTALABSO~P~IO~ ~A nl ; -MATERIAL ' ' ' ' ' * ............ ~EL .... ~ _' . "."~,.LT~=_ . . ., ] Absd~ption Area to nearest [ot-Ei e . ' . ' , , ' r ~' coNDITiONAL APprOVAL {letter mu~t accompan~ certificate) -- --~ r ~ __DISAppRbv ED ,- - ' r _-- -~~/" ~~ - _ ABSORPTION SYSTEM PLAN VIEW SEWAGE DISPOSAL SYSTEM LOT 10 BLK. 4 NORTHWOODS SUBD.