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NORTH WOODS BLK 1 LT 5
Northwoods Block 1 Lot 5 #051-731-76 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201419 PID Number: 05173176 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New K Upgrade Name BUYSE ROY ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Site Address 22524 NORTHWOODS DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth from onginal grade 907-884-6543 14 0.8 GPD/SF 8 Ft. LEGAL DESCRIPTION JDepth to pipe invert from original grade 4Ft Gravel cepth beneath pipe , 4 Ft. Subdivision Block Lot NORTH WOODS BLK 1 LT 5 Fill added above original grade 2 Ft.I Gravel length 76 Ft. Tov:nship Range Section Gravel vrdth 5 Ft,l Becs: Number of Lines - Distance behveen lines - Ft. SEPARATION DISTANCES To Septic Absorption Holding Lift Station Server Total absorption area Number of trenches Dist, between trenches From Tank Field Tank Linc 760 Fi= Ft. Udell 100'+ 1100'+ na na I na TANK *1 Septic ❑ S.T.E.P. ❑ I-Iclaing ❑ Other Manufacturer Greer capaciby 1250 Gal. SurfacebValer 100'+ 100'+ na na Material Number of compartments Lot Line 10'+ 10'+ na na NA 10'+ na na Plastic 2 Foundation 10,+1 LIFT STATION Manufacturer capacity Remarks Septic System Replacement Gal. Alarm location Electrical installer by Installer PIPE MATERIAL House to tank D3034Tank to D3034 drai,f,eld Owner Drainfield colrvsT D3034 Inspector NOrthRlm Eng. BENCH MARK (Assumed elevation) 100 It Inspection 1.: 9/19/21 9/20/21 dates: Location and descriptio 2"' Dec k Y'9/21/21 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date OF 44 � JWr �� f t* :4 11:...Stva Septic System _ 0/—,S f� CE-U� . �a Approved 9 �, �-- ,�� Date U— Note: this approval does not include well permit reQuirements. 4 (4- 4d d O co N -t' F- O u N U u L d 1 - L d fO'w LO 06 F- ~ m0 Z ~ .- m d d O_ 01 N U � 0 "7ij F r --i W 3 W _ c � � o 3 2: 4 O —) (U Nr - a Pa N 0 O _ 01 U > Lf) 01 O� � W i__) W L m m r W caj O O Q CaJ @J j ods n, W ry 0 0 w CL > w °i > > >- a, n, Q U n/ H � W Lrl U W W Q) A d N d �Ou > QN > CuU 4 4 - v t� 0 C7 o Lo NQ Ln LL- LL-i� Q Q U �-P dE WO OD s c .�cry f4�6 W OJ +' d O4M4 *4 Lo E h Co 0 O Cq ' N -�°-, F-WWxQ � iE W rn N OR TH R / M bF 1' 40' A NORTH WOODS J, ENGINEERING SteveEng.com ....... BLOCK 1 LOT 5 RECORD 770724PO Box 77074 Qp �-&V Eagle River, Alaska 99577 *4 " �12-7-----rise- - " 44 41i /21* 'V WASTEWATER 907.694.7028 UPGRADE SEPTIC 9/27/21 j2 of 3 A B T1 50 14 T2 52 18 C01/MT 34 24 CO2/MT 92 88 CO3 50 12 C04 53 19 1--005 61 53 N OR TH R / M bF 1' 40' A NORTH WOODS J, ENGINEERING SteveEng.com ....... BLOCK 1 LOT 5 RECORD 770724PO Box 77074 Qp �-&V Eagle River, Alaska 99577 *4 " �12-7-----rise- - " 44 41i /21* 'V WASTEWATER 907.694.7028 UPGRADE SEPTIC 9/27/21 j2 of 3 SOILS �N,( INEERING Performed For: Owner LOG — PERCOLATION TEST Date Perf ormed: 9/20/21 Legal Description: NorthWoods B1 L5 DEPTH (FEET) 1 - 2 3 4 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 TA Location: See Attached Test Boring Location Map SM Silty Sand Fine Sand W/ Groundwater? No Gravel. Depth Water Depth After Monitoring, None Date; 9/20/21 # Date Gross Time Net Time Depth Net Drop 1 9/20 0 -- 7' -- 2 9/20 10 10 min. 7.5' 0.5" 3 19/20 12 -- 7# -- 4 9/20 22 10 min. 9.5' 2,5' 5 9/20 25 -- 7# -- 6 9/20 35 10 min. 9.5' 2.5" 7 19/20 37 -- 7# -- 8 19/20 47 10 min, 9,5# 2.5# q 9/20 50 -- 7# 10 9/20 60. 1 10 min. 9,5' 2,5# 21 Percolation Rate 4 min/in Perc Hole Diameter 6" Test Run Between. 4' & 5' Comments; Measured To The Nearest .1/16"', Performed By NorthRim Eng, I CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ON THIS DATE. DATE: N 0 R TH R / M 0. gtT%� 0 F NORTH WOODS TH2 ENGINEERING A�� 491]1* SteveEng. com .... .. . BLOCK 1 LOT 5 PO Box 770724 VAlk UVA VIVIII TESTHOLE LOG Ar CE -6= 90Z694.7028fop Eagle River, Alaska 99577 Date: ISHEU- GEOTECHNICAL 9/28/21 11 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 On -Site Wastewater Disposal System Permit Permit Number: OSP201419 Work Type: Septic Renewal Tax Code Number: 05173176000 Site Legal Address: NORTH WOODS BLK 1 LT 5 G:1459 Site Mailing Address: 22524 NORTHWOODS DR, Chugiak Owner: BUYSE ROY D & REBECCA D Design Engineer: NORTH RIM ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: :J � ,Q DeI)artin ent Lot Size in Sq Ft: Total Bedrooms: 10/15/2020 10/15/2021 20125 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 Ell j Special Provisions: i1. The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. 2. Locate the old trench to ensure that the required 16' separation will be met. The part of the trench within 16' of the proposed trench shall be removed and backfilled with native soils or similar. Received By: C.%ems Date: Issued By: Ij Date: ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-731-76 Property owner(s) Buyse Day phone 907-884-6543 Mailina address 22524 NOrthwOOds Dr Site address same Legal description (Sub'd., Block & Lot) NORTH WOODS B1 L5 Legal description (Township, Range & Section) Lot Size 20125 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx� Initial ❑ Single Family (SF) E (w/wo ADU) Septic Tank Q Upgrade 0 Duplex (D) F1Holding Tank ElRenewal F1 Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 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 authorized agent) Permit/Rush Fees: 'U 109, t7 5 COQ ID'1q) Waiver Fees: Date of Payment: 1? 02 0 Receipt Number: 07? 3 3 h Permit No. 0 S P a 0 1 H� I Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc SteveEng.com Steve Eng, PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 10/14/20 Number of Pages: 2 To: MOA On-Site Services Subject: North Woods B1 L5- Septic System Upgrade A new soil test was recently completed for the subject property. The test hole was excavated to a depth of 12’. The test hole was completely dry with no evidence of moisture at the bottom. The test hole was monitored into the high water period into October. The monitor tube remained free of water during this high groundwater period. System design sized at single family 4 bedrooms. A previous soil test was conducted in 1980 to a depth of 16’ with no bedrock encountered or groundwater. This test hole is just east of the proposed trench location. These soil tests demonstrate that the proposed trench @ 8’-depth will meet MOA requirements. The soil is predominately fine sand. The design calls for a new trench and a new septic tank. The terrain is generally flat at the trench site, and the remainder of the area. The neighbor property to the south was artificially cut, resulting in a slope greater than 25%. The previous issued Permit included a slope waiver to this artificial cut. The cut-bank falls into the steep slope provisions; natural vegetation within fifty feet down-gradient of the disposal field shall remain undisturbed- vegetation above & within the cut-bank will remain in place, the perk rates & vertical separation comply with the steep slope provision, the cut-bank has been in place with no sign of deleterious effect from previous absorption fields proximity. Existing septic beds are depicted on Plan view. These existing beds impact the alternate trench site, but the alternate trench will use soil below the existing beds for absorption- the existing beds can be easily stripped off if the alternate trench location is required in the future. A potential old trench site is also depicted- this old trench is not expected to deleteriously affect the new trench- portions of this old trench could be removed or blocked if necessary. The old trench is to be located & blocked by silty soil mixed with sodium bentonite. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201419, Deb Wockenfuss, 10/15/20 SteveEng.com North Woods B1 L5 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, single family home, in a developed subdivision. This is a very large lot with no conflicts. A new trench is planned + new 1250 gallon septic tank. No adverse impacts are expected from trench/tank upgrade. No conflicts to the other lots will take place by this septic system construction upgrade. A new soil test reveals Silty Sand SM w/ Gravel. An application rate of 0.8 GPD/FT². Trench Length = 750 FT²/5x .5 = 75 trench, 4 effective. Decommission old tank per UPC. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. Two compartment, 1250 gallon septic tank. Install Double Cleanouts. Decommission old tank per UPC. MOA-Spec Material Under Tank. 10 minimum between the tank trench, tank to house. 10 to property lines, 3 of cover or insulation is required for trench; 2 Minimum thickness for insulation can substitute for 1 cover. Tank & solid pipe must be set on well compacted, stable soil. 4 inch diameter cleanouts with airtight caps are required 1 to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 from the tank positioned to provide cleanout access towards the tank and towards the absorption field. All cleanouts must extend to at least ground level. In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. Trench to be placed level, minimum of 4 to groundwater, 6 to bedrock from drain-rock. Drain rock to be ½ inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. Perforated pipe to be installed level with perforations down. Silt barrier (filter fabric) to be installed above the drain rock. Smeared trench sides must be raked or scarified before drain rock placement. The finish grade must be mounded to promote drainage away from trench. Insulation must be placed over any pipe installed under driveways or parking areas. Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, Sewer Service Line is minimum 2% slope. Septic Tank to be pumped every two years or when required. Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201419, Deb Wockenfuss, 10/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201419, Deb Wockenfuss, 10/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201419, Deb Wockenfuss, 10/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201419, Deb Wockenfuss, 10/15/20 • ,`'"""ty 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 1)c N'it 1n fl t �hOMORpVE On-Site Wastewater Disposal System Permit Permit Number: OSP191141 Effective Date: 5/30/2019 Work Type: Septic Upgrade Expiration Date: 5/29/2020 Tax Code Number: 05173176000 Site Legal Address: NORTH WOODS BLK 1 LT 5 G:1459 Site Mailing Address: 22524 NORTHWOODS DR, Chugiak Owner: BUYSE ROY D & REBECCA D Lot Size in Sq Ft: 20125 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: El Disposal Field El Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: If the 1981 trench is encountered during the tank installation, a dirt plug is to be installed to inhibit the flow of wastewater to the old trench. Received By: Fi-k, /�%`¢' Date: 5 7a /9 Issued By: Date: �/ q .nuns . Municipality of Anchorage 4I1 )rpartmrnt P.O. Box 196650 0 4700 Elmore Road Anchorage. Alaska 99519-6650 0 (907) 343-7904 ® Fax(907) 343-7997 http://www.muni.ord/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV191027 COSA#: Permit#: OSP191141 PID#: 051-731-76 Legal Description: North Woods Blk 1 Lt 5 Engineer: Garness Engineering Group Applicant: Roy and Becca Buvse Your request for the following waivers have been approved. The approved separation distances are, 1. Proposed field to proposed field - 4' 2. Proposed fields to the 1981 trench - 13' 3. Field to property line— 8' 4. 35' to a slope greater than 25% This waiver approval applies to the proposed fields only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: � a/7 Approved by: Name of Revie **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department 16jPhone: 907-343-7904 Development Services Fax: 907- 343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan On-Site Sewer/Well Permit Application • For A Single Family Dwelling Parcel I.D. 0.61 - 731 - 76 Property owner(s) ROY AND BECCA BUYSE Day phone 907-382-9941 Mailing address 22524 NORTHWOODS DRIVE, CHUGIAK,AK 99577 Site address 22524 NORTHWOODS DRIVE, CHUGIAK,AK 99577 Legal description (Sub'd, Block&Lot) NORTHWOODS; BLOCK 1,LOT 5 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family(SF) Absorption Field ❑ (w/wo ADU) • Septic Tank ® Upgrade Z Duplex (D) ❑ Renewal ❑ Holding Tank ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: BED TO BED WAIVER/SLOPE WAIVER Distance: 4 FEET/35 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP,Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 515 Waiver Fees: 0 225 Date of Payment: W/Z.gky Date of Payment: 5'/l3 hq Receipt Number: C€7 LI 7 I: Receipt Number: 0 313$6 Permit No. O5 P/ q Il 4 Waiver No. O5V I Q 102.7 (Rev.01/11) • t l\ GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING May 29, 2019 (REVISED) Municipality of Anchorage Development Services On-Site Water& Wastewater Program 4700 Elmore Road Anchorage, Alaska 99507 Phone: (907) 343-7904 Reference: Septic System Upgrade for Northwood S/D; Block 1, Lot 5 To whom it may concern: The existing 4-bedroom house on the referenced property is served by public water and a private septic system. The septic system was originally sized for a 3-bedroom residence and consists of a 1000 gallon steel septic tank and two (2) 17' wide by 31' long bed type drainfields. The drainfields have been recently found to be surcharged and need to be upgraded. The owners have added a fourth additional bedroom. We are proposing the existing bed type drainfields be rebuilt in the same area and each bed type drainfield size be increased to 18 feet wide by 34 feet long. The existing drainfields will be excavated and all contaminated material removed, MOA approved filter sand will be installed so that the bottom of the drainrock for the new drainfields will be at the same elevation or higher than the previous bed bottom elevation. We are also proposing that a 1530 Infiltrator 2-compartment septic tank be installed which meets the 4-bedroom requirement. The reserve site will require the rebuilding of these new drainfields. Comments regarding the proposed design are as follows: 1. SOILS: Attached is a soil log that was performed by Louis A. Butera, P.E. in 1985. Mr. performed a percolation test between 4.0 to 5.0 feet. According to the soil log, the percolation rate was 14 minutes/inch. We are proposing to use a 0.5 gpd/sq.ft. application rate for this design with bed type drainfields. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY AND SLOPE WAIVER: The topography in the area of the existing and proposed drainfield is 1 to 5 percent slope running from approximately north to south. There is a slope that is greater than 25% (25-30%) approximately 35-37 feet downhill from the proposed and existing drainfields. This 25-30% slope runs horizontally downhill for about 35 feet and decreases to less than 25%. Attached is a cross-section detail drawing of the proposed drainfield which shows an imaginary 25% slope line starting 2 feet above the top of the 3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com Page 2 of 2 drainrock. This 25% imaginary slope line does not daylight 100 feet downhill from the drainfields. We have provided you the MOA contour map of this area for your review. Based upon this information there is no concerns regarding the slopes and the drainfield installation. We request a 35-foot slope waiver to a slope steeper than 25 percent. 5. BED TO BED SEPARATION DISTANCE WAIVER: Based upon field measurements, the existing drainfields are currently about 4 feet apart. We are proposing that the new drainfields be installed with the same separation distance. We request a 4-foot separation distance waiver be granted from sidewall to sidewall of the two drainfields. We do not anticipate any adverse effects with this drainfield installation or the granting of this waiver. 6. NEW BEDS TO 1981 TRENCH SEPARATION DISTANCE WAIVER: Based upon Lou Butera, P.E.'s 1985 as-built drawings, there is a 1981 trench that has 8 feet of effective in it and was abandoned in 1985. According to this Mr. Butera's as-built drawing, the deep trench was 18 feet from the 1985 bed type drainfields. We are proposing that the new drainfields be installed with the same area and extend 3 feet closer to this 1981 abandoned trench. This would mean the separation distance would be approximately 15 feet. The separation distance is required to be 16 feet per MOA ordinance (2 times the effective depth). To be conservative, we are requesting a 13-foot separation distance waiver be granted from sidewalls of the new drainfields to the sidewall of the abandoned 1981 deep trench drainfield. Justification for this waiver is that if this trench was a curtain or subsurface drain, then a 10 foot separation distance will only be required regardless of drainrock depth. In regard to concerns with the excavation of the new septic tank, if the 1981 trench is encountered during the installation, we would propose a dirt plug be installed to inhibit flow of wastewater from the new drainfields to the 1981 trench. We request you make this as a special provision on the sewer permit. In short, we do not anticipate any adverse effects with this drainfield installation or the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. e I fir - r' Garn_ P.E. M.S. Pre- d-nt 3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com _L _- - - _w- -W- -W- -W- -W- - _vv_ -W- _V- -W- - -W- OTE:THE CTOR SHALL HAVE THE NORTHWOODS DRIVE NOT LINE TAKEDFLAGGEDBYAREGISTERED T NOTE:NORTHWOOD S/D IS SERVED LAND SURVEYOR PRIOR TO ANY CONSTRUCTION. BY A PUBLIC WATER SYSTEM. H -1- • ' • 15 UTIL.ESMT. • • • • I DESIGN CRITERIA: ,• •' r• 2', GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER • .•• THAT PERTAINS TO THIS DESIGN.BY PROCEEDING NUMBER OF BEDROOMS: 4 a- < .. FORWARD WITH THIS INSTALLATION,THE GALLONS PER DAY(GPD): 600 ;• ' q/ ENGINEER,WELL DRILLER,CONTRACTOR AND PERCOLATION RATES: 14 MIN/INCH •>•' PROPERTY OWNER AGREE THAT THEY HAVE APPLICATION RATE: 0.5 GPDISG.FT. • r • READ THESE SPECIFICATIONS AND AGREE TO MINIMUM DRAINFIELD SQ.FT.:1200 • ••9 /A • y• ACCEPT THE TERMS AND CONDITIONS OUTLINED. DRAINFIELD DESIGN: • MAX.DEPTH:SEE DETAIL PROFILE DRAWINGI, •_1 n WIDTH: 18 FEET LL ASSUMED WATER LENGTH: 68 FEET(2 @ 34 FEET LONG EACH) SERVICE LINE LOCATION M.O.A.APPROVED SAND FILTER: 0.5±FEET EXISTING EFFECTIVE: 0.5 FEET 4 BEDROOM ACTUAL SQ.FT.: 1224 HOUSE / EXISTING FOUNDATION CLEANOUT ■II�� e EXISTING 1000 GALLON SEPTIC TANK ■/, TO BE DECOMMISSIONED PER UPC PROPOSED 1530 2-COMPARTMENT /-/ -.. I f8'WAIVER SEPARATION APPROVED INFILTRATOR SEPTIC TANK OR PER 1985 MOA INSPECTION REPORT 1250 GALLON STEEL SEPTIC TANK .. r---- '1 ' • LOT 6,BLOCK 1; LOT 4,BLOCK 1; 9. NORTHWOODS S/D NORTHWOODS S/DIFF ••� � APPROXIMATE LOCATION OF 1981 TRENCH BASED UPON LOUIS BUTERA,P.E.1985 7 4'WAIVER REQUESED BETWEEN BEDS AS-BUILT DRAWING OF SEPTIC SYSTEM —_� EXISTING 3V LONG BY 17'WIDE BED TYPE INSTALL DOUBLE DRAINFIELD(X2).THE EXISTING BEDS ARE CLEANOUTS 1 LOUIS A.BUTERA TO BE REBUILT TO THE NEW DIMENSIONS )k INSTALL POLYLOK 1985 TEST HOLE PPROX.LOCATION OF 34 FEET LONG BY 18 FEET WIDE AND FLOW SPLITTER AREBUILT TO THE SAME ELEVATION.SEE DETAIL DRAWING ON PAGE 2 OF 2 FOR o e`a a ADDITIONAL INFORMATION c o N I �I 1 _ - gi I -T-------------- -�--- ----�---------- I NOTE:THE 4 BEDROOM RESERVE SITE SCALE: I 35 FOOT SLOPE WAIVER REQUESTED— WILL REQUIRE THE REBUILDING OF THE i I e" BED TYPE DRAINFIELDS TO NEW 1"=40' LOT 5,BLOCK 2; I LOT 6,BLOCK 2; DIMENSIONS SHOWN ON THIS DESIGN. LOT 4,BLOCK 2; I LAMPERT ESTATES S/D LAMPERT ESTATES S/D I LOT 7,BLOCK 2; LAMPERT ESTATES S/D I NOTE:LAMPERT ESTATES S/D IS SERVED I LAMPERT ESTATES S/D BY A COMMUNITY WATER SYSTEM. I 1 . V611"• I, ♦♦ ,4 •GARNESS ENGINEERING GROUP, Ltd - : E! ri‘ \\* S ENGINEERING SALES •CONSULTING 0 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(907)338-3246'WEBSITE.www.garnessengineenng.corr •• . • PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ,0 fn% •• • f °.Garne- •F:4.,:: .J al ROY& BECCA BUYSE 382-9941 1 OF 2 0v J,:• C - • '�W� PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦ `J I O "1 NORTHWOODS S/D; BLOCK 1, LOT 5 J.L.M. ♦ �•"�p'••••U,1� ,�� ♦� TYPE OF WORK: DATE: REVISED LICEN1E,4�1�„S`��♦ ♦ DESIGN OF SEPTIC SYSTEM UPGRADE 5/10/2019 #AECC884 I • r 4-MONITORING TUBE 4'MONITORING TUBE--...,„%k1/4 T DESIGN CRITERIA: • i NUMBER OF BEDROOMS: 4 4'CLEANOUT • 3' LLI GALLONS PER DAY(GPD): 600 I i D PERCOLATION RATE/S. 14 MIN/INCH i }APPLICATION RATE: 0.5 GPD/SG.FT. I CO MINIMUM DRAINFIELD SQ.FT.:12004'SOLID PIPE 6, U N DRAINFIELD DESIGN: 4'CLEANOUT w MAX.DEPTH:SEE DETAIL PROFILE DRAWING 4 I �4'PERF.PIPE COCI oi WIDTH: 18 FEET I LENGTH: 68 FEET(2 34 FEET LONG EACH) 18 FEET WIDE O Z w W M.O.A.APPROVED SAND FILTER: 0.5±FEET I a Q :1:11.1 m N EFFECTIVE: 0.5 FEET ii/-4'SOLID PIPE 1 co_¢Ce 113:6e (N'pZO3 wACTUAL SO.FT.: 1224 I 6' w M L7 N F- 4'CLEANOUT a a o o I ,4'PERF.PIPE I 1 �., FROM NEW SEPTIC TANK 0 ,• 3' L _ 4-MONITORING TUBE/ 4'MONITORING TUBE) J f INSTALL POLYLOK FLOW SPLITTERI 34 FEET LONG I 4'WAIVER REQUESTEDBETWEEN DRAINFIELDS I� I /I�4.MONITORING TUBE 4'MONITORING TUBE 1 4 O • I 4'CLEANOUT I za ,i,„_4.SOLID PIPE ' r h J 6' vZ 4"CLEANOUT S Z I �4'PERF.PIPE ` — U I 18 FEET WIDE N . 0 0a LII:.; g 4 SOLID PIPE JR Q_ 0 6 n k GA 8 D- I 4'CLEANOUT I � 1 2 �4'PERF.PIPE Z= to � 1 _J . 7, ci., W o n z U L 4'MONITORING TUBE 4'MONITORING TUBE-- $2 z Ur - Y Z•• U d I34 FEET LONG I W` LU PLAN VIEW OF DRAINFIELD UPGRADE CAr� 0 0 V ) N.T.S. . V3 0 0 MT CO CO CO MT Z ;; p 3 g . . - - MT CO CO CO MT 6- w UW 3=1 25-30%SLOPE GREATER THAN 35 FEET _ 4et w i- 2'OF INSULATION DOWNHILL FROM NEW DRAINFIELD 00 W 2'OF INSULATION r Z aw FILTER FABRIC v w :•. FILTER FABRIC - I� KL OPE L ���\ ,,1 SOP p p G \`(\^�\• a ........ .. .. . . . . . . . . ... . . . . . . . . ! 0.5 OF EFFECTIVE ... ...........,. . .. .:.....:......, wITHI �FEET HIg SLO�STA �..'\ ........ , 4 ♦♦1 �WNhILL E LINE 00�2`ET i� ;•••'. EXCAVATION LIMITED TO THE REMOVAL OF ALL CONTAMINATED FROM TN Eg NOT . OVE / C�.* % ♦ ♦♦ MATERIAL.INSTALL MOA FILTER SAND FOR NEW DRAINFIELD EXCAVATION LIMITED TO THE REMOVAL OF ALL CONTAMINATED E DR9/N OEC L GMT ` *•'IN :\ *♦♦. AND REBUILD NEW BED BOTTOM ELEVATION TO THE SAME MATERIAL.INSTALL MOA FILTER SAND FOR NEW DRAINFIELD 9 I. 411b- ELEVATION OR HIGHER THAN THE PREVIOUS BED ELEVATION. AND REBUILD NEW BED BOTTOM ELEVATION TO THE SAME OP ELEVATION OR HIGHER THAN THE PREVIOUS BED ELEVATION. 0, ,••/ I % OLD BED IS 17 WIDE • • OLD BED IS 17 WIDE • -• ' • 18'WIDE _ •• e• ey ' ess 18'WIDE • C -79 3 'mo i GROUND WATER LEVEL IN LOUIS A BUTERA.P.E.TEST HOLE IS 9 FEET DEEP BELOW ORIGINAL GRADE ON 11/1/1985 • �� ••• • BOTTOM OF 1985 LOUIS A BUTERA,P.E.TEST HOLE IS 13 FEET DEEP BELOW ORIGINAL GRADE iii sSCALE: ♦♦♦ '•..1? J �.•�P� 44, � • PROFILE VIEW OF DRAINFIELD UPGRADE 1'_5 LICENS.14k ESS\m••• #AECC884 \\\\\ / 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 NAME PHONE 0 NEW �cl ve 5 �� "�� �7`� � h ev t,, c �. 6 — �` � UPGRADE MAI LING ADDRESS , S�3 /3v,- 76/3 CtiuSi,/� LEGAL DESCRIPTION Lo 7' s- l'/h / �vr t� v�G� s Sum T/s- �� �'rec � LOCATION NO. OF BEDROOMS ,42e2ccr tVTe_q 3 Well Absorption area Dwelling ® i PERMIT NO. L) Y DISTANCE TO: �_pd /� .�O - _v / _ wQ Manufacturer e� r F Materia�_./ No. of compartments F to Liq. capacity in gallons 160 a IF HOMEMADE: Inside lengt y� Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. G F Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO. wz DISTANCE TO: J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines h2 2 inches F- Top of tile to finish grade Material beneath tile Total effective absorption area p inches Length , Width Depth PERMIT NO. L a e i e� @ l 7 ir/7. 3 Q Type QQf crib Crib diameter Crib depth Total effective absorption ea W Cie_eC /OS- L/ wWell DISTANCE TO: �, �G'U Building foundation / 3/ Nearest lot line / 9 J Class Depth Driller - Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS e- ry w W ils 7In % e P1 ,0'?Z c. SOIL TEST RATING INSTALLER LOh `fhS �v�cla�v REMA KS �• fe �r� der,( — Si � ¢��,.c �;w;,—, I/?S t. APPROVED DATE LE/GAL / J 77-r1t3 fRcv 3/781 �1 EAGLE RIV ENGINEERING SERViIIJES INC. P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694.5195 S PRODUCTMI � Inc., Giolon, Matt 01471. -�- JOB SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE_ OF HEALTH ^ CE NTAL PROTECTION 2r EAGLE RIV ENGINEERING SEIiVT 2ES# P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 JOB Z'-:� l .7_ ;Z:i/ SHEET NO. OF CALCULATED BY �l�.[�rir't DATE CHECKED BY DATE_ SCALE W {QVl _ b I F� p s M1 , L. V � a k a n c \ c r I h MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 26, l9ffi _ RECEIVED . ������......... .... ������LI������ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264~4720 'j--T�� ���W���F� PERMIT NO: 850712 D�TE ISSUED: t APPLI[�ANT: LINDA Sl^EPAN[)VICH ~ CHIJGIAK, AK 99567 LEGAL DESCRIP: SUBDIVISION: N � THWOODS LOT: 5 BLOCK: 1 SECTION: 3 TOWNSHIP: 15N RANGE: 1W LOT SI�E: 20000 (SQ"FT" OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to you in designing your septic system. Choose the option that best Yits your site, .... ..... �..... . ..... ... .... .....��^���� DEPTH TO PIPE BOTTOM (FT.> ><** GRAVEL DEPTH (FT ) 0 5 TOTAL DEPTH <FT,) �h� 4.0 GRAVEL WIDTH (FT.> - 23.0 GRAVEL LENGTH (FT.) 45,0 GRAVEL VOLUME <CU.YDS") 38"4 TANK SIZE (GALS> 1,000"0 ** SOIL RATING (SQ"FT"/B�) 228 ** DEPTH TO PIPE BOTTOM < 4"O FTMAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMpARTMENTS � �����..������..`��.� I certify that: 1. I am �amiliar with the requirements �or �n-site sewers and wells as set �orth by the Mu�i�ipality o� Anchc`rage (MOA) and the Stateo� Alaska. 2. I will install.the sys�em in accordance with all MOA codes and regulions, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State o� Alaska requirements /or the set back distances �rom any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4, I understand that this permit is valid �or a maximum obedroomsand any enlargement will require an additional permit. IF A` LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOABUILDING CODES, THEN (1> AN ELECTRICAL PERMIT AND INSPECTION MUST�BE OBTAINED; (2) AS~BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGN DATE: zz/���.��-u� APPLI��NT: LINDA STEPANOVICH ' ~� � <l�/ ISSUED BY ��"° ` DATE: ~�~���~_~~~...... ... ~�~���``~~�~_~� / EAGLE RIV `ENGINEERING SERtV OES Mt P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 '7 JOB ZoI'�5'- ody SHEET NO. OF CALCULATED BY - DATE CHECKED BY DATE_ m PROU241 =i., clam. Mm 01471. EAGLE RIVi ENGINEERING SERVICES P. 0. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694.5195 JOB `^z/ /• ,� /vor/n G✓o GGC .l 71�'-/ SHEET NO. OF 2 CALCULATED BY— DATE CHECKED BY DATE_ SCALE Pfl0011LT 2041 Inc. G,oW. Mass 01471. EAGLE RIV J ENGINEERING SER1116ESAM P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 �• r JOB l •5 `/! /v0 r %•�% t✓t/dcl_1/ SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE_ SCALE canner vne.i niM r.,m� w« mm I cert[y that: 1' I am {amiliar with the requirements 1' ls as set forth by the Municipality of AnchorageAlaska. 2" I will install the system in accordance w d regulations, and in compliance with the design criteria of this p 3. I will adher� to all MOA and State o� Alaska require the set back distances from any existing well, wastewaterdisposal or public sewerage sys{em on this or any adjacent or nearby lot" 4, I understand that this permit is valid �or a maximum o� bedrooms and any enlargement will require an addit�ooal permit. � ` ^ IF A LIFT STATInN IS INSTALLED IN AN AREA COVERED BY MOA BLU LDI ES, ~ ��� " ���������' ^r � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIQN 825 L STREET: ANCHORAGE� AK 995O1 26�1 4720 INSPECTION REPORT; AND CAKNJ}~~Es][--IfE El HE 14 ISE: How ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" � LJ 995eb'7 LDBD 1 SECT ^�.,. . '`""''S " 15" S t ce ail. the.,, upt.J.on that ce as -L F i t so your -site. 11A 13 FR lob 1 NO DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH, (FT.) GRA0EL VOLUME (CU.YDS" / TANK SIZE (GALS) 1,O00.O ** ** �� SOIL RATING SQ. FT 11 /BR> 228 0 ** DEPTH TO PIPE BOTTOM < 4.0 FT, MAY REQUIRS A LIFT STATION ** GRAVEL LENGTH >75 FT. REQUIRES MULTIPLE R �a (NOT EXCEED �nG 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I cert[y that: 1' I am {amiliar with the requirements 1' ls as set forth by the Municipality of AnchorageAlaska. 2" I will install the system in accordance w d regulations, and in compliance with the design criteria of this p 3. I will adher� to all MOA and State o� Alaska require the set back distances from any existing well, wastewaterdisposal or public sewerage sys{em on this or any adjacent or nearby lot" 4, I understand that this permit is valid �or a maximum o� bedrooms and any enlargement will require an addit�ooal permit. � ` ^ IF A LIFT STATInN IS INSTALLED IN AN AREA COVERED BY MOA BLU LDI ES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED BUILAS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" � � APPLICANT »LINDA , \ ` ISSUED B TE: ` ~^ Legal: Lot 5, Block 1, Northwoods Subdivision #1 Due to concerns with possible violation of the ground water sep- aration distance the Municipality of Anchorage has asked for a ground water monitoring of existing lots prior to Health Author- ity Approval. Two _monitor tubes were placed at a depth of 13' on the above referenced hot on -10/23/85. A monitor of the water level on 10/30/85 shows a level of 9' below the land surface.A check of the water level on 11/1/85 showed the level maintained at 9' below the surface. In order to obtain municipal approval for onsite septic the existing leach .trench must be abandoned and replaced with an absorbtion bed at a reccomended total depth of 4'. Placing the leach bed at 4' depth will allow a buffer of 1' to guard against a possible rising ground water table. The new absorbtion system should be based on a soil rating of 250 sq. ft. per bedroom. The enclosed soil log can be used to obtain the upgrade permit. The upgraded septic system will be acceptable and meet or exceed any Municipal requirements for approval at this time. The life- span of any septic system is dependant on soil type, quality of installation, future care of the system, and water usage of the family. This report is based on water table monitoring levels recorded on 'Uhe dates shown above. Eagle River Engineering Serv- ices is not responsible for any future water table fluxuations that might require modification of the system. The buyer of this lot should discuss any concerns he has about septic systems or this report with the Municipal Health Department and Eagle River Engineering Services. avpOaOO app C1 ec^'��cocop000 o�so '—'v' aeo 000 ceaoo; G' i >Jo Louis A. Butera a° ZQ'c 9� CE -6736 a Y SOILS LOG MUNICIPALITY OF ANCHORAGE • +.c DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST B25 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 'S' "Y--/oCk "r1j 'i' ` 4 DATE PERFORMED: /0 12 LEGAL DESCRIPTION: Low .5 '?/lv/ - /f/o/ % /S-n� JetcL-J f-ec. �f SLOPE SITE PLAN 2 4 6. - I MEN Depth to Water NII■■■■■0-010 li /A X7/65' 9,74 ' .I■I IN IN IN 7 8 .I■■�i���■®I■ t,/Ck r I 1 10- 0 7, 11 11 IIIIIIIII NEE�����l� - NI■■ENM■��''. .IMMMM��ml -12 -_ N �— ■■■■■MEN 3 13- 14- 1415 15- 16-1 0, 17 , or„ 18 Loins A. Bwerct CE -6736 19- r; w I e WAS GROUND WATER S ENCOUNTERED? ,yt,7-,y L 0 P IF YES, AT WHAT / E DEPTH? `1 /!�/��r Reading MINE= Gross Time MEN Depth to Water NII■■■■■0-010 N /A X7/65' ' .I■I IN IN IN ■■■■�■.'■ .I■■�i���■®I■ 7, IIIIIIIII NEE�����l� NI■■ENM■��''. .IMMMM��ml N �— ■■■■■MEN Reading Date Gross Time Net Time Depth to Water Net Drop N /A X7/65' 7, 20 PERCOLATION RATE a 6-0 olS'G2 (minutes/inch) TESTRUNBETWEEN FT AND FT COMMENTS /Fere ✓�t. {� !/t3r >i �ivr,/ Lw �L/I�. i�..✓i•�t�. US/hr �.I-a i���c� �.S .C.�-r of fz✓oE.-e c, PERFORMED BY: Eagle River Engineering Services CERTIFIED BY: DATE: �// ���a— . U. Box 773294 Eagle River, AK 99577 72-00e (6/79) 694-5195 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 NAME k C c PHONE E3NEW ❑ UPGRADE MAI LING ADDRESS �G LEGAL DESCRIPTION LOCATION - NO. OF BEDROOMS— !'7: Uy DISTANCE TO: Well � Absorptionarea -� Dwelling PERMIT NO. LUw Q Manufacturer Mate ri I No. of compartments Liq. capacity in gallons d V IF HOMEMADE: Inside length Width Liquid depth (7 z DISTANCE T0: Well Dwelling PERMIT NO. oz 2 F Manufacturer Material Liquid capacity in gallons O w = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. Ju- Z Z w No. of lines of each Length line Total length of lines ' Trench width" inches Distance between Isn'es ��/ N NTr F � Top of tile to finish grade 7 Material beneath tile �! i7+sbfes Total effectiveOrp 'on area w Length Width Depth PERMIT NO. U Q F w° Type of crib Crib diameter Crib depth Total effective absorption area LU W DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER p al PIPE MATERIALS z SOI L TEST RATING INSTALLER / g i L.ly C REMARKS /t7 APPROVED DATE LEGAL 72-0131Rev. 3778) U�-1 /nMm/ STREET, HNCHORHGE/ HK. 2G4-4720 ^ � ���A�~��][�- �� P��� 1`10.� ( ) HPPLICANT SK��GGS CQNSTBOX D' CHUGI� LOCHTION MCMHNUS DR. Lu � LEI L5 B1 NORTHWOQD S/D TYPE OF SOIL HBSO�PTIO� S�STEM IS� TRENCH `��� ����8J[ y |^`JK-/ �w SIZ��00o MHXIMUM NUMBER OF �EDROOM� � ] SOIL RHT250 THE �EQUIRED SIZE OF THE SGIL HBSORPTION SYSTEM IS: ��ir,l 0 1- 1-0 �F� EE L_ Cu EF F`*" 7'�� � THE LENGTH DIMEN5ION I� TH� LE�GTH (I�� �EET) OF THE TREN0H OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TPENCHES. H OF GRHyEL BETWEEN THE OUTFHLL PIPE THE GRHVEL DEPTH IS THE MINIMUM F� DE| HND THE BOTTOM OF THE EXCHVHTION (IN FEET). ������ ������ ���� � ���=������� � PERMIT HPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE IN�TH-LHTION IN51PECTIONS OF ANY I-,IELLS HDJHCf-ENT TO THIS PROPERTY AND THE NUMBEOF RESIDENCES THAT THE WELL WILL SERVE 1 pDr-ASEEN �F-�. E -Z �kJ 1 F;""., FEE lEA LLING OF ANY SYSTEM WITHOUT FINAL I�SPECTION AND HPPROVHL BY THIDEPARTS �'-- -MENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND ANY [�~SITE SEWHGE DISPOSHLLSYSTEMNISNG 100 FEET FOR H PRIVATE W�LL OR 150 TO 200 FEET FROM APUBLIC WEL DEPFDI UPON THE TYPE OF PUBLIC WELL�TE WELL TO A pRIyATE SEWER LINE IS 25 FEET HND MINIMUM DISTHNCE FROM H PRIVATE TO Fi COMMUNITY SEWER LINE IS 75 FEET. EQUIREMENTS ICHTI8�S HND CONSTRUCTION D�HGRHMS HRE OTHER RMA'T' SPECI� AVAILABLE TO INSURE PROPE� INSTALLATION'. ����I[ "Ir 1 �C: FEE. M��� I CERTIFYHTHHTAR WITH THE REQUIREMENTS FOR ON~SITE SEWE�S 8ND W�LLS AS -ET 1� I HM � �l�� F� -H BY THE MUNICIPAL !TY OF HNCHORHGE� 2��/ WILL IN5TRLL THE SYSTEM IN HCCORDHNCE WITH THE CODE,::.,. IF THE ]' � UNDERSTHND THAT THE ON~SITE S�WE�� SY��T�� �AY REQUIRE � TO INCLUDE MORE THAN ] BEDROOMS RESIDC E�E I� K ` SIGNE~~. ...... HPPLICH@T SKHGGS CONST V4 0 DHTE�~ �_ ISSUED BY ~' -~-- --` �� {� �----� ' . �� Russell Oyster 694-2774 O & E EN&rNEERING & DEVELOF-MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Performedfor: Name: Tel. No. Mailing Address: -3©$ <:5y- 5T. Legal Description:—/ or /56®GK /, AkezTfi/Wee 0 jGa D, Depth (feet) 0 2 3�4 T 6 7 E. Soil Characteristics 10 / S Al? J /G7Y 12 X2/0 la.�,��,:- Cdr •�, ��,<,, 13 Vi Ve 14 7zs— Mae- 1?40U6 re) ld � /H °Tums TO C#fct< 15 16 Rom rA oh' PLOTJPLAN PERC. TEST / /' L'-5�fr -14 ")-/ -.'/ So .vl/�✓/f.� t✓ p�3„Q OF A� q®}per edO eaeO 1pO�� u�� P+ Ground Water Encountered: Yes No If yes, what depth C2 q Ct v.:m tl � GA ®QPur��a icaoo�+aoR CAOc aeOe^' �j Proposed Installation: Seepage Pit— Drain Field /1eeeeaes ooeeo aco='� 'T `t Earl K Ellis r:nmmanrc Performed by: ✓� �2 Date: �% lFe p,L 1\ V . RU5H MUNICIPALITY OF ANCHORAGE Development Services Department ° > Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 05173176 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION Complete legal description NORTH WOODS BLK 1 LT 5 Location (site address) 22524 NORTHWOODS DR Current property owner(s) BUYSE ROY Mailing address Real estate agent Cindy Wilson 2. TYPE OF DWELLING: [K] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907-884-6543 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 204_,�J6S Waiver Fee $ Date of Payment Receipt Number COSA # 0:7-? 62115 75 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 9/28/21 ++! OF V Ar s * ..: *�f 6. DSD SIGNATURE is .. , , f System #1 Approved for bedrooms st10 CE ere_�r,9,_ System #2 Approved for bedrooms ���N'-s2ss Disapproved yy� 28 Conditional approval for bedrooms, with the following stipulations: BY: Original Certificate Date:_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: NORTH WOODS BLK 1 LT 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material SptcFgls Measured operating fluid level in septic tank na ❑ Standpipes/foundation cleanout per record drawing Date of pumping na D. ABSORPTION FIELD DATA new Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 05173176 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date new Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if communitywell) L-�1Yes ifNoD Septic Tank/Lift Station onLot �>1OO Wells mnAdjacent Lots: Absorption Field >�5' Community Sewer Manhole/Cleanout 100' ifNoft []Yea ifNo_ft Water Main >�10' F1 Yes ifNoM 21 Neighboring Tank >1O0' FlYes ifNoh 21 Yes Private Sewer/Septic Line > 25'F—lYes |fNoft If septic tank imunder driveway comment below Absorption Field nnLot >�1U0' [lYes |[No8 Holding Tank > 100' El Yes ifNoft 21 Neighboring Absorption Fields > 100' ifMoft Animal Containment >5U' �lYe� if D F-1 Yes ifNoM — -- ---- K8anure/Anima�Esona�o��uceg�� 1OO' Co/mnnunihySevverKJain > 7S' __ �lYe� _ if M — �� Yes if M From Septic/Holding TankonLotto:(PleaoaanterdistanceaJlesaUhomrequked) Building Foundations >10' El Yes ifNnft Surface VVabe >10O' Yen ifNoM Property Line > 5 L-�1Yes ifNoD if No Wells mnAdjacent Lots: Absorption Field >�5' R, Yes ifNoft Yes Private Wells >10O` ��Yes iYNoft Water Main >�10' ��Yog ifNoh 21 Community Wells >�20O' F-,JYms ifNoft Water Service Line >�1D' 21 Yes ifNo# Water Service Line >10` If septic tank imunder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation >1O` ED Yes if No . ft If absorption field isunder driveway comment below Property Line >�10' El Yes ifNo8 Wells onAdjacent Lots; VVohar Main >10' 21 Yes ifNoM Private Wells >1DO' Yes ifNoM Water Service Line >10` M-1 Yes ifNoft Community Wells >2OO' Yes ifNoft Surface VVoter>�1O0' 21 Yes ifMoft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION /certify that / have determined through /eld inspections and review 1* .49111 of Municipal records that the above systems are /nconformance with 0 0 r� . . EAST 100.00' : •. � ' 15' UTILITY '_ W EASEMENT o Qo 7.2'x18.2' PORCH 1.5'X4.2' CANT 4.1'x7.9' STORAGE 52.2' 2.0' CANT IJ Lot 4 CORNER OF DECK ENCROACHES ONTO LOT 4 10.5'x11.0' SHED ON-'� 12.3'x14.0' DECK /�� WOODEN FENCE-� � I 2 STORY RESIDENCE N �t t irPIPES x12.0' STORAGE 3.0' CANT 15.2'x19.7' COVERED STORAGE 6.2'x8. 1 GREENHOUSE Lot 5 20,125 S.F. I: WOODEN FENCE Lot 6 FENCE —�---- S 89'59'29"W 100.00' ----�— ( I ( Lot 5 Lot 6 I LAMPERT I ESTATES I NOTE: THE LOT IS SERVED BY A I I COMMUNITY WATER SYSTEM. PLOT PLAN __– AS BUILT _X_ SCALE _1._=40' _ GRID _ NW 1459Project No. ____ 21_60 Z61 /� 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 L a rt & A S S a C (a f e s inc. (907) 522-6476 Phone (907) 522-4625 Fox c`� F A���� Professional Land Surveyors ken0longsurvey.com jonathan0longsurvey.com ©� S p4 1 hereby certify that I have surveyed the following described property: d� LOT 5, BLOCK 1, NORTH WOODS SUBDIVISION (PLAT No. 79-245) 49TH Y*Q� Anchorage Recording District, Alaska, and that the improvements situated thereon are P4"��kE """" ••. within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed a..% M1IN ti•. .. h!G .•.. premises and that there are no roadways, transmission lines or other visible �, o G easements on said property except as indicated hereon.bi–A�2 O�_–__, at Anchorage, Alaska Qkp02.•Dated this the Z�Day of �� �t� ii �tt.� �, �:��.- Z1^21 � fl 4�QROF�'SSIONAU It is the responsibility of the owner to determine the existence of any easements, oOOslowo- � covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 N T_ 1.4'x2.0' CANT N 2 �-MANHOLE 0 I Lot 5 20,125 S.F. I: WOODEN FENCE Lot 6 FENCE —�---- S 89'59'29"W 100.00' ----�— ( I ( Lot 5 Lot 6 I LAMPERT I ESTATES I NOTE: THE LOT IS SERVED BY A I I COMMUNITY WATER SYSTEM. PLOT PLAN __– AS BUILT _X_ SCALE _1._=40' _ GRID _ NW 1459Project No. ____ 21_60 Z61 /� 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 L a rt & A S S a C (a f e s inc. (907) 522-6476 Phone (907) 522-4625 Fox c`� F A���� Professional Land Surveyors ken0longsurvey.com jonathan0longsurvey.com ©� S p4 1 hereby certify that I have surveyed the following described property: d� LOT 5, BLOCK 1, NORTH WOODS SUBDIVISION (PLAT No. 79-245) 49TH Y*Q� Anchorage Recording District, Alaska, and that the improvements situated thereon are P4"��kE """" ••. within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed a..% M1IN ti•. .. h!G .•.. premises and that there are no roadways, transmission lines or other visible �, o G easements on said property except as indicated hereon.bi–A�2 O�_–__, at Anchorage, Alaska Qkp02.•Dated this the Z�Day of �� �t� ii �tt.� �, �:��.- Z1^21 � fl 4�QROF�'SSIONAU It is the responsibility of the owner to determine the existence of any easements, oOOslowo- � covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal axed hereto and as of the validation date shown below, 1 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. Phone 337-6179 Address 3701 E. TUDOR ROAD. SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5: DSD SIGNATURE Approved for 3 Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory bedrooms. Date bedrooms, with the flowing stipulations: —� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitr Advisory Other g • (R.. 1LOS) Original Certificate Date: Municipality of Anchorage ° Development Services Department \� ^� Budding Safety Division On -Site Water 8. Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NORTHWOODS, BLOCK 1, LOT 5 Parcel ID: A. WELL DATA COMMUNITY WELL Well type Cuss A Date completed If A, B, or C provide PWSID# 213001 Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g p•rn• WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate B. SEPTIC/HOLDING TANK DATA Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Date of sample: Collected by: ft. g.p.m. colonies/100 ml. Tank Type/Material SEPTIC/STEEL Date Installed 11/21/1985 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alar (YIN) N/A Date of pumping 10/20/09 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA I•BELOW EXISTING GRADE Date installed 11/21/1983 Soil rating (g.p.ddit'o /bd 228 System type BED (TWO) Length 62 (2 ® 31) ft, Width 17 ft. Gravel below pipe 0.50 fL •3.92/ Total depth •a.o8 ft. Eff. absorption area 1054 W Monitoring tube YES Depression over field NO Date of adequacy test *011/13/200 Results (Pass/Fail) PASS For 3 bedrooms R/ DRY Fluid depth in absorption field before test DRY in. Water added 580 gal. New depth DRY in. ' Elapsed Time: -2/_0 min. Final fluid depth Min. in. • Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **PRE—SOAKED EACH BED WITH 500 GALLONS ON 11/13/09 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on' level at In. 'Pumpofrlevel High water alarm level at in. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service areas COMMUNITY WELL On adjacent On sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line •8'/••10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *PER 1985 MOA INSPECTION REPORT"PER 2009 AS—BUILT SURVEY G. ENGINEER'S CERTIFICATION 4 v' I certify that I have determined through field inspections and D i1 ... Y* a review of Municipal records that the above systems are In "" .. """" conformance with MOA COSA guidelines in effect on this Q date. Q .A •..or ess..... Engineer's Printed Name JEFFREY A. CARNESS �Q CE Date I II ti L5 ��0�°.°�''I1�IFi A odd 0 Ol�..pr/ r°esioJ\_n COSA Fee $ �1 o Waiver Fee $ Date of Payment I 1 19 ° y Date of Payment Receipt Number C 8 6 / Receipt Number (Rev. 11/05) t ZZ _I— .,_4 loo S7� l4iUTY'S'� WOO Jr b••. D<c.✓- •Chw /•IiAY. 1 100; OC•• , -'��..(�=�-moi! '�� �._^!.•:c jirr_� I AS -BUILT I bereby certify that I have naveyed the -T:6 eY-/e-p i'- . 1-15-- XJ . rK i FV, . Anchorage Recardini precinct, Aja$]- and that the improvements situated thereon are within the property lines and do not overlap or encroach oa the property lying adjacent thereto, that no !m to on prop- erty I171ag adjacent thereto en on the premises, in goesbon and that them are no roadways, tramm=on linea or other visible easements on said property except as indicated bereon- Dated at Eagle River, Alaska }hie r% 2 ,gay I,r r".G ._ ,' 1 10 7 ROBEI>zf C JI' —;b tP ::- SCALE: o / � d 456, Eagle �tatarey�0886dS Phone 6M-2513 �- MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # n1)� HAA # W,:�NCM,' ; QSD 1. GENERAL INFORMATION Complete legal description Lot 5, Block 11 Northuoods S/D Location (site address or directions) 22524 North woods Drive Property.owner Mark & Agnes Bignell Day phone K Vailing address`, Lending agency Day phone Mailing address 522-1155 Agent RPm w Pngle Riuc-r/Brook Stiltner Day phone 694-4200 Address 16600 Centerfield Drive, Suite 201, Eagle River, Ak 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \4 3. TYPE OF WATER SUPPLY:` Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA 021 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. S & S ENGINEERING Name of Firm Phone e River op oa o. 204 Address Eagle River, Alaska .99577 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. By: 7-/- R Ebedrooms. Conditional approval for Additional Comments aUTla 6gy—a-Cl7`) Date gr1r .e"W'k, O F q ROBERT C. COWA14 Q CE -8801 bedrooms, with the following stipulations: Date 9 - 2- 1 ` 9 q 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 orderto 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 (Rev. 1/91) Beck MOA #21 Municipality of Anchorage SEP 1 DEPARTMENT OF HEALTH & HUMAN SERVICESi Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Le' t5 &'�Y_ I 'L4_r'-'A Loop s S �, . Parcel I.D.: A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 1- 1 ZJ v o ) Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE Colifor ate of sample: _ LTS: Date completed Cased to FROM WELL LOG B. SEPTIC/HOLDING TANK DATA Nitrate Casing height (above ground) Wires properly pr ed (Y/N) Collected by: ECTION Other bacteria Date installed "I F1 Tank size I ao 0 Number of Compartments Cleanouts 01N)_t_ cf Awisr"<r� Foundation cleanout. (J)N), Depression (Yo vJ High water alarm (Y/N) Date of Pumping q, H& -IV Pumper -1� Mf'OJ C. ABSORPTION FIELD DATA Date installed '.Soil rating (g.p.d./W or ft2/bdrm) ZZ& �$t� System type 3 Length J x 3/ ` Width 1Y 17 ' Gravel thickness below pipe (a H Total depth 3,v` Effective absorption area /os Monitoring Tube present (:YJN)-I— Depression over field (Yo A) Date of adequacy test al 'f S'l Results Fail) Y9�5 For 3 bedrooms u v ., Fluid depth in absorption field before test (in.); DImmediately after gal. water added (in.): N r Fluid depth / (ins) Minutes later: 30 Absorption rate =yro 'g.p.d. Peroxide treatment (past 12 months) (Yo �*06, 14'✓U If yes, give date .114 72-026 (Rev. 3/96)* ¢��'i �� % if�l.'r � '!�/ L� � � �3 (r. o R��nA�•.✓�� /��' �'dy /�dr/T 7'�� D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic se On adjacent lots On adjacent lots manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: at* k - Foundation T Property line In Absorption field Water main/service lineO� \� Surface water/drainage loot Wells on adjacent lots SEPARATION DISTANCE FROM /ABSORPTION FIELD ON LOTTO: Property line 6 vlM�t�n I�/�✓ Building foundation /� t� Water main/service line _ /6 `� Surface water. ob Driveway, parking/vehicle storage area o 14, Curtain drain 'J4 Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that f have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature Z Engineer's Name i 0 13 C C', Date -7 h q HAA Fee $ �-/ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number T� ROBERT'C. COWAN '';e �Q- c� .� CE- 8801 tl y are MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051 - 731 -7�o HAA# 1. GENERAL INFORMATION Complete legal description /UOY2uJ�DCS�� Bl� Ltsz` Location (site address or directions) &-925,27 b21 - Property owner ff0l161',6 Elie✓S Day phone-41ye69"S623* 4� Mailing address Lending agency Day phone Mailing address Agent 444,'a e 14'zzz�l Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. KND Engineering Name of Firm 20441 Ptnrmigan RiVd Phone 6YZO -6/11 Address Eacle River, AK 99577.8736 Engineer's signature 6. DHHS SIGNATURE A Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments By: Date .OF••A:'4 %j5� A • , •f 4 r 9F Kenneih i,1. Duff'/ CE 7116 1•a� bedrooms, with the following stipulations: Date la - /� — `/S r CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 821 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description:,A/, r, �iaJoocpS 5c b V K I Lo+ S Parcel I.D.: 051 — 73/ — 7!, A. WELL DATA Well type A If A, B, or C. attach ADEC letter. ADEC water system number Z/ 3 OD 1 Log present (Y/N) Date completed / Total depth Sanitary seal (Y" Date of test Static water level Well production Cased to FROM WELL LOG Casing height (above ground) Wires properly protected (Y/;Z O z n M AT INSPECT[o D K r s ti C m T < D �i9 c® n z cr9 y ® o C G' Vi C g.p.m. g__ rr WATER SAMPLE RESULTS: Coliform Nitrate Oth actena Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Date installed 8 Tank size 1000 Number of Compartments 2 Cleanouts (Y/1)__L_ Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/1) IVA Date of Pumping 2 9S Pumper IR6, l errs C. ABSORPTION FIELD DATA Date installed 11 1Z1 185 Soil rating (g.p.d. 069 2 Z8 System type Bed— 5fep ,2 bea/s each --� — Length 31 , Width 17 Gravel thickness below pipe � Total depth Effective absorption area 1o,5q Monitoring Tube present(YIN) Y Depression over field (Y/N) M_ Date of adequacy test q 20 lq5 Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth q4o Minutes later: (in.) Absorption rate = i" g.p.d. Peroxide treatment (past 12 months) (Y/1) Al If yes, give date D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level a Cycles tested _ E. SEPARATION DISTANCES Size in gallons "Pump on" level at* / " Pmnp off' ;aVe1 at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic On adjacent lots On adjace' ' ver manho Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5 -4' Property line I D I + Absorption field 4 - Water Water main/service line 95 + Surface water/drainage 100 ' + Wells on adjacent lots /DD I + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain 1\I /D1 + on I -� Water main/service line 2:5 ) + Driveway, parking/vehicle storage area 60 4 Wells on adjacent lots I C) (2:) ' i F. ENGINEER'S CERTIFICATION 0 A � 1 certify that I have determined thru field inspections and review ofMunicipali seedhw? °A4q-au, hems are in conformance lvith MOA HAA guidelines in effect on this date. Hca co . ''° �' Q tr Signature 0 °a.•,°t s• •e• °°° ••°° ° s ese•e°°u • a•°••s : °fid' Engineer's Name keri N D Liqineer-In �Y� Kermem M. Dufi t ° E ®� o CE 7116 0 Date lou b5 Q���q�••.�°l��l`�°^°�F�� P WpROFESSIO\�P -------------------- ----- ----- ---------------- ----- �' � -?°------ -_— HAA Fee $ �'V Date of Payment Receipt Number �P Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # HAA # Q9 I n��('c 1. GENERAL INFORMATION Complete legal description Lot 5; B.2ock I; North woods Subdivision; Location (site address or directions) 22524 Nonthwoods DiLive Property owner A.H.F.C. #10783 Day phone Mailing address 520 Eaht 34th Avenue Anehonage, Ataska 99503 Lending agency Day phone Mailing address Agent Sharon M.Lnech RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Cen-ten4ietd Dj i,ve,- Eagte Rivet; Ak. 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 g 6 ENGINEERING Phone Address 170341 Eagle River Loop Road No. 204 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. 0 Disapproved. Conditional approval for /I1,�5:- Additional Comments Date 1 ROGER J. HA, R, P.E. Qjj ��c�pROF•.S`�N_ 4� �' bedrooms, with the following stipulations: ,l1TIC 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: `--t"T a5 $L-tiz- 1 r4ng_�ON4ccvssi,Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number '4-1`200 1 Log present (Y/N) Date completed Total depth Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FR /nankding tank on lot field on lot er main iced' eMPLE RESULTS:ple: B.SEPTIC/HOLDING TANK DATA ELL TO: Nitrate Driller Casing height Wires properly protected 9 -p.m INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Z UJ 00 Z '— 01). (7) 1L.LJ > u W Q N00 Ljj g.p.m. Z V u g © !J z z0 Z 2 2: '> z W Date installed __kr gL Tank size 10 Oc--> Compartments Z CleanoutsON) Foundation cleanout (WN)y� � Depression (Y&�Y High water alarm (Yg A Alarm tested (Y/N) aha Date of pumping 1�— 1 q;:. -CA1 Pumper -T(?- C�-Sl;e SOV SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wel I(s) on lot ?-Do k +- On adjacent lots Al A- Foundation To property line ((�>%A- Absorption field s Water main/service line Surface water/drainage * j,n c'� 1 A 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y — Manufacturer Manhole/Access (Y/N) " ;mo off" level at Cycles tested SEPARATION-P48T'ANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed - qt,5 Soil rating 2'7'g4I&f— System type 53�b Length Z Kik Width 7- Gravel thickness LP ' Total depth 3�i2 Total absorption area toy �i Cleanouts present O/N) Y Depression over field (YU%f I.} Date of adequacy test Result ass ail) ('A,,�S for _rf.R-Et= ("3) _ bedrooms Peroxide treatment (past 12 months) (Ya r o,�(-_ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots ala Property line 8� To building foundation i.L)+ On adjacent lots -'s, o "- Surface water Ivo t 4 - To existing or abandoned system on lot I �� Cutbank ' /t5r Water main/service line Curtain drain ��1h lOT L NIGH 1a,vGo t -7_-L-- 435 E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in 5 & 5 ENGINEERING Signature 110:34 Eagle River Loots Road No. 904 Cagle River, Alaska 99571 Engineer's Name Date HAA Fee $ -170 - UU Date of Payment ./—/ E / Receipt Number 9:2? L), ) 2- C q 7ZI 72-026 (Rev. 3/91) Back MOA 21 of this inspection. •:Fp elod e°°soa uY°eno�p • •..• apa°^e c� N�. o e e'e ° .• eke °�'a ems•-s'Te e .5HAI4•(iNP.E e °n n ES5�1�"� Waiver Fee: $ — Date of Payment Receipt Number J r WALTER J. H/CKEL, GOVERNOR �..! i.J t_Il.l DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering November 8, 1991 PWSID # 213001 563-6775 My review of the records on file in this office reveals that the Northwoods Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf " MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5 Block 1 Northwoods #1 T15N R1W Sec.9 Location (address or directions) Northwoods Drive (b) Applicant Name Stepanovich , DayicVelephone: Home 688-3759 Business N/A Applicant Address SR 3 Box 7613 Chugiak AK. 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 11; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Commonwealth Western Telephone 562-6477 Address 3601 "C" St Anchorage AK (e) Real Estate Company and Agent Area Realty— Bob Martin Address Eagle River AK Telephone694 9555 (f) Mail the HAA to the following address: 1 ,; Pickup by engineer f 2. TYPE OF RESIDENCE Single-Family9l Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY c ` F � a 5 , l f�' 1 % � 1 Individual Well ❑ Community13 Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) 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 Address Date Telephone EAGLE RIVER, AK 99577 9V9 694-5195 1� Engineer's Seal , `J \�' L•l �aoc C9C'v-O 2.•ls �� 6. DHEP APPROV Approved for I ooms b L Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level 6c c5 � c Cased to DEPT. OF HEALTH & �J ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) Nov 2 6 190-1 CHECKLIST - FEBRUARY 1984 264-4720 R E C E 11I L D Legal Description: �� f /` If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield — Depth of Grouting Pump Set At Casing Height Above Ground- Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA ; On Adjoining Lots On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed / % S i Size /Gr��' No. of Compartments Standpipes (Y/N) y Air -tight Caps (Y/N) IV Foundation Cleanout (Y/N) Depression over Tank (Y/N) oL / Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A ; for Holding Tank High -Water Alarm (Y/N) A/4 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: t / To Water -Supply Well 20' To Building Foundation 8 To Property Line `� To Disposal Field /%i Y � To Water Main/Service Line /° To Stream, Pond, Lake, or Major Drainage Course IVA/ Comments Page 1 of 2 72-026(1 1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata xw, Type of System Design Date Installed /9�J- ��� Length of Field 2 e�, Width of Field �� � � Depth of Field 3�` Gravel Bed Thickness G Square Feet of Absorption Area /a S' Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test Ne`�' Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation 3/ Lot /� J )r� r Y. To Water Main/Service Line is To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments Jee E<+ti/^'e rs C(rc 1-.�», D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line A_JLc(" To Existing or Abandoned System on On Adjoining Lots 30 l To Cutbank (if present) /l�UawC — Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that IIhhave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed / Date �!Za s AT7 Company r te` f MOA No. `' T _,-) aj Receipt No. Date of Payment � UU Amount: $ Page 2 of 2 72-026 (11/84) re aoo it r i �.`��r�rlgln��gYs JSP�c�t'°-r),�j• UH001: C'- �, ��F' �=�d9EllJa CooClu<+ncoo��Ui�n as `1} if.1 � - I.n E715:�..'i�)iCY!•'. /j ®\. D>,_,:_ RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P tQTECTICN • ENVIRONMENTAL SANITATION DIVISION A�i(7 Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVIR&AUl// E) DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER - PHONE S� MA G ADP G ,� �6 d C. P OPERTY ESIDENT (If ifferent from above) PHONE XOT c 6LO ! j (l ' 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALT—QWAGENT PHONE / C? C:!5� -0 / L-2 22 —orsJ MAILING ADDR - 5. LEGAL DESCRIPTION // o STREET LOCATI N 6. TEO�F NUMBER OF BEDROOMS RESIDENCE k FAMILY One Four L__1 Other E]One ❑ Two ❑ Five ❑ MULTIPLE FAMILY PRI 'Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ZI—COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM Ly�INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. ElPUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE l� SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE 2 L-- THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL Q-`dOMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM �l-Ii�7DIVIDUAL/ON -SITE9/0 El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or El Holding Tanl< Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK 'MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line [7ot Line Absorption Area to nearest Lot Line 5. COMMENTS OAPPROVED FOR Ij BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE? ( BY