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Home My WebLink AboutNORTH WOODS BLK 1 LT 8I oF HEA'TH AND HUMAN Environmental Heallh Division ~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ARFo DISTANCES SEPTIC ABSORPTION iAddress PO 23o~ /0/o z o TANK FIELD WELL Perm,l No. NO of~ed ...... WELL Lot ~ F d~r~ ~ ~oo&$ ~ ~ FOUNDATION ~0/ 40' w~' ~ ~ ~ ) ~ T I 5 ~ AS'BUILT DIAGRAM (Show location o~ well, septic system, property hnes, founder TANKS ¢ ' N Manutactu,er / ~.aolty ,n gallons ~ ! TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER original grade ~, O FT ~' ~ FT' ,~ · l.O FT FT ~ / , .umber of J,nes~/ So,I rm,ng~j~ SgFT P'Pe me'erie' ~ ~O~4 /~8'0 ~ . i]~ ,',~(~__--%% ,1 Installer ~C~ I~J~ Datelnstalled WELLS ~ PR ATE ~OTHERfl ntifv) I ~ ~~ ~ ~ __ cedily th~t this inspeclion was pedormed according to all H eaithDepadmentApproval: ~~ Date: 7 72-013 (3/85) M U N I C I P A L I T Y 0 F A N (} H 0 R A G E Depar~trm.~:n'L oF Health &, Human .)ePv.~.ces ..I,~:~.; L S'L~-eet, A"cho~a(.-'~e~ Alaska 995(]1 ~43-47':"] 0 N - !3 I T E S E W E R P E F< iq I T Pe~~mit Number: 88005 Up g r' ade Eng inee~~ D6:~i Owner' Name: AHF:'I;] / S&.S IEIqGINIERINC-] O~ner' Adc:tr-e~'~: 170]!;4 EAGLE RIVER LP. Ei(-tGL. E IR I VEI":~, Al< 99577 D&~.y F'h ctrl e ,", 694-29'79 l:::'apcel Id." '}51-7::~: :1.-73 L.c)t [..e(.:ih'~ ]." Sl.~b~.J ;J. v J. s i 6.)i"1: f.]NORTHr WO['} TM :~ J: [.-(Dt ~' ~ B 1 C)C. k," ~ .E.~ec::t'. i r..~n ,1 4. Tc)wnsh ip: :LSN Range ,: ].W Lot Size R2979 (sq.£t. o~~ ack'es) Hax Bedr. oc)ms: This Pe~-mit~' 3 T~t. al Capacity: 3 SEPTIC TANI<~: Min:i. mum total septic tank capacity: 1,000 gallonf:~. Each septzc: tank mus'L have at ].east 2. compa~-tments. Depth to t.i~p of septic tank(s) .::'. 4.0 feet r, equ:i.r'es in~u;I, ation ovep {ank(s). ]:NS"r'ALL F'ER ENGINEERS DESIGN. BED: 43' X 24'; MAX ItdUM DEPTH '-3,5 PROVIDE INStJLATiC]N OVER BED. PHONE DHH8 F'RIOR 'T'Q EACH ]:NSF'ECTION. THIS F'ERMIT EXPIERS :[2/31/88. CER'T I F'Y THAT: I am f'ami].i.ar' w:i. th ~Lhc,..: r, equii*e, men'L~ for' on.....site seweps and wells as set foi-t.h by 'Lhe Municipality of' Arlczl'lr:~pAge (MOA) and l'.l"le State of Alasl,::a,, I will ins{all the sy~it, em in ac:cor'dar~ce wit. h all MOA cc)des arid regulatic)ns, and in compliance with the design cP~.t:.er.:i.a o~' this pepmit, I ~,,~:i.].1 adher'e to all Mi]A and State al' Alaska pe(:~t.tir-emer'~ts for' the set back d:Ls-Larlces ~'PL]m ally ex:i.s'L:i, ng vfe].l, wastewa'Lep disposal system oP pL~b~.c se~,~er.a%.e ~;ys't:.em ol] 'Lh~s c:)P any ad.tacent (::m near'by lot, al. so under'.s'~ capacity e¢ the total ~ys~.mm is 3 bedpooms and any enlar'gem r'equiPe an additional per'm:i.t. E]q(31 NER I NG ~ j. qr'~ed: (E)~n e r'. ) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PER FOI~ LEGAL DESCRIPTION: ~/g ~/ /¢"/~f/////--/~O~i" Township, Range, Section://,~,/~ ~ MF/7t SLOPE SEE PLAN 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT O DEPTH? p E Depth to Water Alter//.) ~ Monitoring? /u,' Date: ~ Reading Date Gross Net Depth to Net Time Time Water Drop / ._ PERCOLATION RATE ~ 0 __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN L~'~ FTAND ¢' FT PERFORMED n~O~ ~..le Ri~er L~ Roa~ No 2~ './'~'7~~ n~ ~ . ~ - ' " ~ CERTIFY THAT T~IS TES~ WAS PERFORMED IN iv~r Alaska ¢~5~ · · ACCORDANC~XLL ~TATE AND MUNICIPAL GUIDE~FECT ON THIS DATE. DATE: ~/<~/~ 72-008 (Rev. 4~85) " 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 PHON~' '~-~Z~_ ~NEW MAILING A D~R ESS ' iLEGAL DESCRIPTION "' DISTANCE TO: ~ ~ ~ Absorption area,~ ( Dwe~o T ~ ~ Manufacturer ~ ~ ~ Material ~-~/' ~ No. of ~mpartments Liq. ~capacity~ ~ i~allons IF HOMEMADE: Inside length~ Width ~ Liquid d~ ~ ~ DISTA~ Well Dwelling PERMIT NO. ~ Well ~ ~ DISTANCE TO: ~ ~d~' F~~ Nearest lot ~ne~ O PERMITNO. ~-- ~ ~ No.oof ~lines~ Lengthlof~ ~!Jn~ Total length of~e~/ Trench~w~d¢~, inches Distance bet w~n~ ~ Top of tile to finish grade Material beneath tile ~ ¢ ~ ~ ~ Total effective ab~or~¢rea ~/~ Length Width Depth PERMIT NO. Type of ~ Crib depth sor~tion ~ / Building fo~ Nearest lot line v ~ DISTANCE TO: ~ Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~1¢ , SOIL TEST RATING INSTALLER REMARKS '~L~ 72-013 (Re~ 3/78) PERMIT NO. RPPLICBNT PJ&S INC LOCBTION PETERS CREEK LEGBL L8 B'~ NORTHHOODS 600 E. BENSON BLVD LOT SIZE DE:PRRTMENT Cx,~ HEBLTH RN[:, ENVIRONMENTRL '~_.~GTECTION ~L ~ 8'25 "'L'" STREET., RNC:HORRGE., BK. 99581 ~S'~. 264-4720 20000 SQLIRRE FEET 'TYPE~F SOIL RBSORPTION SYSTEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS = 2: SOIL RRTING (SQ FT?BR)= ±~0 THE REG!UIRED SIZE OF THE SOIL RBSORPTION S'T'STEM IS: [:, E F' T H == 2=~- L E f-~ ~_3 'l- H == l--- 2 ~3 F-: FI "...' E L. [:, E F' T t-~ = ~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF' THE GROUND RND THE BOTTOM OF THE E',,.,',CFtVRTION (IN FEET). THERE IS NO SET HI[:,TH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVWrION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILITS' TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY HELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE HELL HILL SERVE. T t--~ C, ,:: 2 ) .][ ~'-~ "'_~-% F' E (:~- T I C, f-~ 5; R F-: ~ R E ,;.~ LI l' F..' E [:, BRCKFILLING OF RN'¢ _,k_-',TEM HITHOUT FINRL IN~PEr':TI~qN RND RPPROVRL E"¢ THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R HELL RND RN'¢ ON-SITE SEWRGE DISPOSF~L S'¢STEM IS '1R0 FEET FOR Fi PRI',,,'W[E HELL OR 2.50 TO 200 FEET FROM ~ PUBLIC WELL [>EPENDING UPON THE T'¢F'E OF PUBLIC HELL MINIMUM DISTRNCE FF.:OM FI PRI',/RTE WELL TO R PRI'¢RTE SEHEF.: LINE IS 25 FEET RN[.', TO R COMMUNIT'¢ SEWER LINE IS 75 FEET; OTHER REQUIREMENTS MR'¢ RPPL~'. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIF'Y' THRT !: I AM FRMILIRR HITH THE REQI_IIREMENT.S FOR ON-SITE SEWERS AN[:, I.,.1ELLS RS SET FORTH B'Y' THE MUNICIPRLIT~¢ OF RNCHORRGE. 2: I HILL INSTRL. L 'THE S'¢STEM IN FtCCORDRNCE HITH THE CODES. _-'::: I UNDERSTFIND THFtT THE ON-SITE SEHER S'¢S'rEM MR'¢ REG!UIRE ENLBRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDROOMS. SIGNED: ................................................. BPPLICRNT PJ&S INC '¢4. 0 .. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: Gary Stromberg ?~/~ .~ ~ ~_ DATE PERFORMED: April 7 ~ 1981 LEGAL DESCRIPTION: 5 6 7 8 Lot 8~ Block l, Northwood Subdivision Organics and organic silt, dark brown, frozen. (Pt-0L) Gravelly-sandy-silt, brown to red-brown, moist, stiff, contains some organics, rounded gravels. (GM-ML) Silty-gravelly-sand, gray, compact to dense, moist, rounded to sub rounded particles to cobble size. (GP-SM) SLOPE 10 11 12 13 Sandy-gravel, gray, compact, dry to moist, rounded particles to cobble WAS GROUND WATER ENCOUNTERED? size. (GP) IF YES, AT WHAT DEPTH? 14 Silty-gravelly- sand, gray, 15- compact to dense, moist, rounded to sub rounded particels to 17- cobble size. (GP-SM) 18- 19- COMMENTS PERFORMED SY: Howard Grey & Assoc.; Inc. SITE PLAN ' ; r f Reeding Date Gross Net D~th to Net Time Time Wat~ Drop 4 4-8-81 310 Hin. 10 Hin. 62½ 2 5 4-8-81 310 Min. 10 Min. 63~ 1 6 '4-8-81 310 Min. 10 Min. 64¼ 3/4 7 4-8-81 310 Min. l0 Min. 65~ 1 8 4-8-81 310 Min. 10 Min. 66 3/4 15 .~- .u PERCOLATION RATE ~~Lr re,inch) TE~ RUN BE~EEN CERTIFIEDBY ................... ~DATE' April 8, 1981 !:ii~,:,.!.~,!i?';i,MUNICIPALITY OF ANCH ' i' . ; ~ .... . ?, .. :.';]!['!DEPARTMEN? OF HEALTH & HUMAN SERVICES..:.. ~ 4 ..",. '-.-'_. ;, ' ~. =D V Sion'of Environmenta SerVice,s, ....'r "~-'~liLa~ -',%: i;': ?" "v!.~ ':" · '..' ;i~"se~vices Section ,': !:':: ''~ :;'~ '! "~. :i ~LLI;~..,,.,:.:?~?.: ,:::.' ",.' .-;~: ';' ~"i'~i:' ;!'~9!~ 9-6650 ': ;:-;:'--'? ::'~ :.;?~"~!'.::;f'",:??!r['",. 2 :?;:"-";1;;: ;??~."'.: ;'. 343r~744 . .-:,r.,~,:.,.':,t. ",~,-'.;-,,,, . ..,.. ..... . . . - ;ERTIFIOATE OF HEALTH AUTHORITY ::~-.:~. 1:[.; '::~. :..:]:::[(:'~" ":'~ ' ". ; ?-'- APPROVAL FOR ASINGLE FAMILY DWELLING ' ~- ' ' ' : - 5. :.'STATEMENT OF INSPECTION BY ENGINEER ..' '.,:-*:.~::' '-.*.:.:.'...'v"::.:'"'...-.. r, - '~r S certified by my seal affixed hereto and as of the validation date shown below,'i ver fy that my -,'. ,' investigation Of this'Health-Authority Al~Pr0val ap~lic~JtiOn'sh'o~'~ that ti~e' 0'~"-'~i~!;~t~' supply - ~ and/or wastewate~ disposal SYstem is safe, functional arid adequa'te"i0r ~th'~':'i~ ~,.;m, '~'i~f ~edroom's' ..' . . arid type"0f StrUctd'r'~'i'hdiC~ted ~erei'm I fdrther verifythat'baS~d 0~'th'~'ih~'~;m~i~"~'l~i~ined fi.6'm"~.: ' , "*'/ the MUniciPality of AhCh'brage files'and from my inveStigation-"and inspectior{;.it~ ~h'site ~/ater ..... ' '~" sUPply and/0~- Wa'~e~,~i~r :dis~sal:S~t~m is in Co'~pl'iance"With'all'UU'niCil~l~a~'d s~ate c~des, ' ' ' . -. ,. ordinances, and regUlat ons' n effect on the date of this inspection.. :~, ....... ;: The .Mur]!rC!pal!ty, ?.f_.~nch~[ag¢~,D~partment of:Hea!th and Human ,Serve.cos (DHHS)~ssues Health Author ty '; 'ApprOVal ce~ificate,s, based'ohl~ bpon the'representat ons'g yen n :pJ~ragraph~5'ab0ve':by ~n'i~dep~ndent professional engineer, registered n the State of Alaska. The DHHS does th s as a courtesy to purchasers of. homes ~' and ~heir lending:iri-~it~fion§'in °:~J~i'~6'~ti~fYCertain federal and 8tate'reqUirementS~:EmPiOy'~'s~0f'DHHS do'not ':: conduct in.~pectlon~ or anal~z8 data before a cerbflcate ~s issued. The Municipa!ity,'~f AnchOrage is'not . : :.: respons b e for,err~~ o'r~ ss ~'ns 'n'ih~ pro~'~i6nai eng r~e~r's WOrk :.~!,!':~'~ i~i'~ ;i;:-~: i;~i;~ TM ~.iL~:;~i.-'"'~:i?:~!.'?~i~ ~. ';,':;';~'; .F~;:; : Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist Legal Descriptioa: ~:>'V- ~ q~t.,g-- / t~o~--'~v,[bvt>s Parcel I.D.: A. WELL DATA Well type If A. B, or C, attach ADEC letter. ADEC water system number 7.--~ '~ t~O k Log present (Y/N) Date completed Total depth Sanitary seal (Y/N). Date of test Static water level Cased to FROM WELL LOG Casing height (above ground) Wires properly AT INSPECTION Well production g.p.m. WATERI Colifon Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Co Date installed / q e> \ Foundation cleanout (~N) Date of Pumping' /o ~ lo,- ABSORPTION FIELD DATA Date installed G, ~ I '} - O Length ~ ~ ' Width Effective absorption area Date of adequacy test \[ ~'~0 Fluid depth in absorption field before test (in.); Fluid depth , D,~ (ins.) Minutes later: Peroxide treatment (past 12 months) (Y~[}> Tank size ~ 6~0 Number of Compartments Z--- CleanoutsO/N) Depression (Y/I~ r3 High water alarm (Y~ Pumper ..IT~. ~0~ e,,J C~ Soil rating (g.p.d./fl2 or fi2/bdrm) 2-1~?//~r..-- System type Gravel thickness below pipe Monitoring Tube present~/N) t/ Results ~TFail) Immediately Mter ~'Jo gal. water added (in.): Absorption rate = t./.¢~ ~- g.p.d. p~o~O~lf yes, give date "J ~ tg,~-- ~ Total depth Depression over field (Y/~ For "~ bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) High ~vatcr alarm level ~ *Datum Size in gallons "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ge~ line ; On acijacent lots ; On a~~-''''''''''~'~ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM~----~OLDING TANK ON LOT TO: Building foundation q ~ Property line lc> ~ ~ Absorption field Water mai~gservice line Io t ~ Surface water/drainage t'oO ~'* Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /o t g- Surface water / o o Cnrtain drain ~J/~- Water maitffservice line / o Driveway, parking/vehicle storage area Wells on adjacent lots .Zoo Property. line / "/" F. ENGINEER'S CERTIFICATION 1 certiJ, i~ that 1 have determined th,'ufield inspections and review of Municipal records in con)br,nance , ,ith MOA I'[yM guidelines in effect on this date. Date I ~ / q / q 5 ~,~' ........................................... h5 ............................................................. HAA Fee $ ~ ~)h}~ Waiver Fee $ Date of Payment Receipt Nnmber Rev. 8/95 eSS: baa.wk.doc 05 Date of Payment __ Receipt Number Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Northwoods ~,'.'~>~: ~"~ Lot 8 Block 1 T15N R1W Sec. 4 Location (address or directions) 22618 Northwoods Drive, Peters Creek, Alaska (b) Property owner Christopher Kelly Telephone: (home) 688-9016 Mailing Address HC 80 Box 7595, Chuqia_k, AK 99567 (c) Lending Institution NortbC_a~d Mortqaqe Telephone 694-7872 Mailing Address 11421 Old Gle~q Hwy., Eagle River, A~ 99577 (d) Real Estate Company and Agent N/A MUNICIPALITY 0F ANCHORAGE Department of Hea th & Human Services DIVlS ON OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF NsPEcTION FOR HEALTH AuTHoRITY ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY Business N/A Address Telephone (e) Mail the HAA to the following address: (or check here:4~, if hold for pick up.) List contact person and day phone number below: Eagle River Rngine~rin? S~rvic~s 694-5195 2. TYPE OF RESIDENCE Single-Family:~ Number of bedrooms 3 3. WATER SUPPLY Individual Well [] Community ~: Public [] Note: If community well system, must have.written conf rmation from the State Department of Environmental Conservation attesting to th legality and smtuS;: '~ ' 4. SEWAGE DISPOSAL On-sit~ 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 (Rev. 7/88) Page 1 of 2 E~GI"NEERING 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, functionalend 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 Eaglo ~-i,~r~r l~n~inoar~nO $o'~'5r'o" Telephone 6qa-~,lq5 Address P.O. Box 773294. Eagle Rvier. AK 99577 Date '~ .Z/-~'¢'/~/ Approved for J~ be rooms b - Date Approved . Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections 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. 7/88)Back Page 2 of 2 A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~ f A, B, Date Completed Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Eots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Stand. pipes (Y/N) ~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) ,,J Holding Tank High-Water Alarm (Y/N) /v )4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line 4/~'" To Water Main/Service Line ¢'¢¢ ' To Stream, Pond, Lake or Major Drainage Course Comments SEPTIC/HOLDING TANK DATA Date Installed 4//~/~/ Size ,/'~'~,c~¢' No. of Compartments '~ ~ Foundation Cleanout (Y/N) Date Last Pumped :~ -~ '- P'/ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~ 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FI.E"LD DATA Soils Rating i?~Absorption Strata Date I nsta,!l~d sortlon Area Depressio~ Field (Y/N) Results of Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ¢' D_~,¢ ¢ To Building Foundation z¢,~" Lot ,2-~ ' To Water Main/Service Line ¢'/¢' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ,25- To Existing or Abandoned System on ; On Adjoining Lots :,'o 3'¢ / To Cutback (if present) ~/.~ Comments D. LIFT STATION /~/,¢ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines,i.n efie~:t~bfith~e,date of this Company F.~gts_Riwr FnrjIneerir~0 Serv[ce~ P. 0. Box 773294 Date 3-¢2, g'-?/ Fa. ole niw~, ~F 995? 69,1.5195 MOA NO. ~'/-P'4" Receipt No. Date of Payment Amount: $ 72 026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 e Seal Eagle River Engineering Services A 11940 Business Blvd, Suite #205 P.O. Box 77.3294 694-5195 Eagle River, Ak. 99577 Fax 694-3297 Type of test: U Well Flow Test ~ Septic Test Only U Well & Septic Test ~ Other: Meter Monitor Well Tank GPM PSI Remarks Time Redding Level Level Level DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99505 WALTEF~ J. HICKEL, GOVERNOR 563-6775 March 26, 1991 FOR: Eagle River Engineering Services PWSID ~__213001 Northwoods--Deerhorn Park S/D--ER/Chuo My review of the records on file in this office reveals that the NQrthw~ods--Deerhorn park S/D Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations, Sincerely, Environmental Engineer MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (~)~\ - q .~ ~ ~-1 ,--~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot,8; Block I; Northwoods Subdivision Location (address or directions North~¢oods Drive (b) Property owner AHFC Telephone: (home). Mailing Address #32095 · .' Business (c) Lending Institution Nort~Eand Mortgage Telephone 694-7872 Mailing Address Eagle River, Alaska (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER - Ev<z Loken Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Telephone 694-4200 (e)Mail the HAA to the following address: (or check hereY~, if hold for pick up.) List contsct person and day phone number below: S g S EIN¢INEERIN~/~9~-¢979 17034 Eagle. FagYa. R~ua~; A2~ba 99577 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms 3 3. WATER SUPPLY Individual Well ~ Community ~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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 inspect[on. Name of Firm S & S ~N~INF. F.~,iNG Telephone Address 17034 Eagle River Loop Road No. 204 Eagle River, Ala~k,~ 6. DHHS APPROVAL Approved for Approved _bedrooms by Disapproved Terms of Conditional Approval Conditional TheMunicipalityofAnchorageDepartmentofHealth and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: ~ MUNICIPALITY OF ANCHORAGE (MOA) (,~_~/ Health Authority Approval (HAA) MUNi~F ANCHORACHECKLIST - FEBRUARY 1984 ENViRONME'J~'J'~L SERVICES DIVISION 343-4744 : · MAR 0 1989 RFCFIVED Date Completed Depth of Grouting Legal Description: IfA, B, C, D.E.C. Approved(~N) ~ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank onLot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments F,k~'~`S- ~ 1~:;), :~ '~--~'"~ ~l ; On Adjoining Lots ~ ~r' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Datelnstalled 4'-///~ ~"'~ee'~'~ ~ No. of Compartments Standpipes~) './' Air-tight Caps<~i~TN) Depression over Tank (Y~l~p r.-J Pumping/Maintenance Contact on File (y/N)t~ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~_~¢;:,~:?gr- TO Building Foundation To Property Line \ .:~ To Disposal Field To Water Main/Service Line \ c--'~t '~ To stream, Pond, Lake or Major Drainage Course \ ~::>~=' Comments ~ ~?~c::~ Foundation Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) 72-026 (Rev, 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strat.~ Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/~) Results of Last Adequacy Test '~'~2 ~¢---~~ Type of System Design 4~"/7~ Length of Field '¢l;'~t;~'p' Depth of Field ~'~ Graveq Bed Thickness o,1~' Statndpipes Present) ~/~ 14 Date of Last Adequacy Test i'/ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ ~ To Property Line To Building Foundation Lot ~ To Water Main/Service Line ~t.4- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area I To Existing or Abandoned System on ; On Adjoining Lots ~ ~ To Cutback (if present) Comments D. LIFTSTATION ~/ Date ~stalled Size i n"G~o n s "Pump On" High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) n~ Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec inspection. Signed Company Date MOA No. S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Aiask~ Receipt No, D.) Date of Payment Amount: $ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OP ENV~ONMENT/~L ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 316 ANCHORAGE, ALASKA 99503 STEVE COWP£R, GOVERNOR 563-6775 DATE: March 10, 1989 PWSZD:. TO Whom It May Concern: A~oordtng'to the records on file in this oSfice, the ~ ~Q~T~qOODS/DEE~R...HN is in compliance with the Etate of ~laska'Drinking Water 'Requlations. Sincerely, Environmental Field Officer ,x .- D,_..,.--' RECEIVED INSPECTION APPOINTMENTS TIME TIME "~ ~)r-~ T, ME DATE DATE DATE 825 b Street - Anchorage, Alaska 99501 ~'4VIRONMENTAL P2L;¢ECTION ENVIRONMENTAL SANITATION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S~( DIRECTIONS: Complete all parts on page 1. I~complete requests will not be processed. ¢lease allow ten (10) days for processing. PHONE 1. PROPERTY OWNER ~AIEI~G ADDRESS / PROPERTY RESIDENT (If different from abc ) PHONE 2, BUYER MAILING ADDRESS ] PHONE 3, LENDING INSTITUTION MAILING ADDRESS PHONE ~. REALTOR/AGENT MAI LING ADDRESS 5, LEGAL DESCRIPTION ;TREET LOCATION NUMBER OF BEDROOMS TYPE OF RESIDENCE [] One [] Four ~ SINGLE FAMILY ~;~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six Other 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY PUBLIC UTILITY ATTACH WELL LOG. Awell log is required' for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. 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 RESIDI.:NCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OFBEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON ,SITE []PUBLIC UTILITY Connection Verified []Septic l'ank or [~] Holding Tank Size: If l'ank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding' Tank Absorption Area iSewer Line Nearest Lot Line 5. COMMENTS DATE [~?'APPROVED FOR ~ .BEDROOMS E~ CONDITIONAL APPROVAL (Petter must accompany certificate) L~ DISAPPROVED ? 72-O10 (Rev, 6/79)