The URL can be used to link to this page

Home My WebLink AboutNORTH WOODS BLK 1 LT 11 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW q4,q43R PID Number: N~1-73'~-7N Name: Wastewater System: [] New Z]xUpgrade William & Susan Hyatt Address: ABSORPTION FIELD 22656 Northwoods ~)r.~ Chu.oiak, AK Ph°ne:KN[) Eng. - 696-6111 No. of B.~drooms: DDeepTr(~nch ~ Shallow Trench I~Bed DMound CIOther Soil Rating: Total Depth from original grade: 7.5-8.5' LEGAL DESCRIPTION 1 . 2 GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 11 1 Northwoods Subd 2.5 - 3.5~ Ft. 4I+ Ft. Township: I Range: Section: Fill added above original grade: Gravel length: I N / A Ft., 51 Ft. WELL: N/A r-'] Ne.~-~ [] Upgrade.~/ Gravelwidth: Number of lines: Distance between lines: 6'-R" Ft. 1 I ~./~, Ft. Classification (Priva~,p_.¢~,C): Total D._~ep~. Cased To: Total absorption area: Pipe materia,~ e r f .- F 81 0 H D J 612 J ~ Ft. Ft. SQ. Ft. So~. i d Dnle~' : ~ Date Drilled: Static~ter~2~vel: Installer: Date installed: ~ Ft. Anderson 2/1 -2/2/'95 SEPARATION DISTANCES [] Septic ~ [] Holding~'~"-~S'T'E'P' From Tank Field Sla, tion Tank Sewer Lines Well" ~]/A N/A ...... M aterial~....,~ Number of Co.~paC~ents: Su,aCeWate~ 00'+ 00'+ ...... ~L, IFT STATION Foundation 6' 2 2~ Curtain .......... Pump Make~& ~:lectrieal Inspections perfo~ Drain 1 Remarks: Existing tank inspected and BENCH MARK Location and Description: Co n c r e t e s 1 a b n e x t t o integrity verified as adequate. house. Existing field abanboned in place I Assumed Elevation: 5 MT/CO filled with rock. ' ENGINEER'S SEAL Inspections performed by: KNr) Enqineeri -Dates: 1st 2/1195 ~o,o. e ..... _.' 2nd 2/2/95 ~~ V ~'~e KennehM. Dutrus · Department of Health Hum ices approval '~?o..~/, ~/,..~,o.:~.e~ Reviewed and approved by: "'- Date: ,L.: AS BUII T WASTEWATER DISPBSAL SYSTEM LBT 11, ]~LBCK 1, NBRTHV/BBDS SUBD, < A-B=6' A-C=26' B-C=16' B-E=22,7' C-E=22,3' C,D, P,~ge 2 ot~ 3 P,I,]), 051-731-70 940438 PREPARED FOR, WILLIAM M, & SUSAN HYATT CHUGIA~ ALASKA 99567 C KND ENGINEERING 20441 PTARMIGAN BLVI~ EAGLE RIVER, AK, 99577 (907)69&-6111/FAX(907)696-8111 I)AT~, 2-18-95 AS-BUILT DETAILS ~/ASTE~/ATER DISpF1SAL SYSTEM P~De 3 o~ 3 LOT 11, Brock 1, NF1RTHWOODS SUB]], P,I,9, 051-731-70 S~/ 940438 I--- 4~-"1Exls~c Tank M.T PREPARED FDR~ VILLIAM M, & SUSAN HYATT EE656 NDRTHVDDgS ~RIVE CHUGIA~ ALASKA 99567 KN]~ ENGINEERING E0441 PTARMIGAN ]~LV]~ EAGLE RIVER, AK, 99577 ¢90)696-6111/FAX(gD7)&96-8111 ~T ~ ~ ~-~T ~ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 On-Site Services DHHS 825 L Street Anchorage, AK 99501 Dear Sirs: RECEIVED FEB 2 3 t995 Municipality o~ Anohorage Dept. Health & Human 8ervice~ February 20,1995 REF.: Lot 1! Blk 1 Northwoods Subdivision Attached are the Engineer's inspection report and as-built information for the on-site septic on the referenced property. The previous system failed and the owners are not refinancing the property, therefore, no Health Authority Approval has been requested. This information has been given to the owners so they may use it in the future, if so desired. This information should complete your file on permit # SW940438. Thank you for your consideration. If there are any questions, please call me at 696-6111 or leave a message at 694- 2359. Sincerely, Kenneth M. Duffu~,~.E. KND Engineering Attachments: On-Site Well and Sewer Inspection Report Wastewater Absorption System Details As-Built Site Plan PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE ~ ' ~ %~'-~; t~ ~3~ D~.PARTMENT OF HEALTH AND HUMAN SERVICES'~~¢~, P.O. BOX 196650, 825 "L" STR~.ET, ROOM 502~"~ ~l~lq~[~ ANCHORAGe., A ASRA 99519-665O ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGPL~DE) PERMIT PERMIT NUMBER:SW940438 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:HYATT WILLIAM M OWNER ADDRESS:20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577 DATE ISSUED:il/29/94 EXPIRATION DATE:il/29/95 PARCEL ID:05173170 LEGAL DESCRIPTION: NORTH WOODS BLK 1 LT 11 LOT SIZE: 39731 (SQ. FT.) ~ER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4o FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: DATE: 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 h ~:~::::~:::~:,~:~:~:.,,.',.':~:~:~:~:~::::: ~::~::::,:: :::::::::::::::::::::::: ............. ~::::~:::~::~:~, ..................... ~ ,:~ ............ ~::::~::: ,:: ,::::~ ................... ,:::::::~:,:::~ .............. ~ ........ ~ ........... , ,:::~ ................ ~:~::~:~:~ (907)696-6111/FAX (907)696-8111 On-Site Services DHHS 825 L Street Anchorage, AK 99501 November 15, 1994 Dear Sirs: REF: Lot 11, Blk 1, Northwoods Subdivision Attached is our permit request for an on-site replacement wastewater sewer system for the above lot. The existing system is in failure and is being pumped weekly. This has been a common occurrence for the area which has relatively tight soils. Although this lot has a percolation rate of 4.72, due to the area history I have designed the system using the 0.8 gpd absorption rate. In addition, I have increased the system size by one-third to accommodate long term use, since it seems the soils get tighter after a time. This subdivision is serviced by a public water system; the service line enters from Northwoods Drive. As shown on the site plan, there are no conflicts with existing on- site sewer systems or with potential reserve areas. This lot is generally fiat but slopes away from Northwoods Drive and the house. The natural slope will provide positive drainage away from the proposed installation site. There is no surface water within 100 feet of any portion of the proposed installation. Thank you for your consideration of this request. If there are any questions, please call me at 696-6111 or leave a message at 694-2359. Sincerely, ~,/~K~nn/e{h M. Duffus, P.E. D Engineering Attachments: On-Site Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test DESIGN DETAILS WASTEWATER DISPDSAL SYSTEM P,I,D, 051-731-70 LOT 11, Block 1, NDRTHWOODS SUBD, xCDNNECT TD 4' SOLID FROM TANK ~ EXIST, TANK 3DTTDM DF BED 6,5 3BTTBM DF TEST HOLE 12' C,D, Exist;lng Tc~nk loooGALI OS,T, 0I DESIGN DETAILS 3 ]~EDRDOM DWELLING WITH DAILY FLOW DF 150 GPO = 450 GPO SOIL RATE 4,7~ MIN/INC~ use APPLICATION RATE DF %2 GPD/SF~ 450 GPO / 1.8 GPD/~F = 375 SF TOTAL A~SDRPTIDN USE 50'L x 4,0'" x 5'W TRENOH,-(375/5'O.5)'L33=50' PREPARE~SYSTE" HASFDR,~EEN INCREASE= =UE TD AREAKND CDNDITIDNSENGiNEERiNGSEE ATTACHMENT, 20441 PTARMIGAN BLVD VILLIAM M, & SUSAN HYATT EAGLE RIVER, AK, 99577 CHUGIA~ ALASKA 99567 907-G96-6111 ~ATE, 11-EE-94 ~R~VING NOT TO ~CALE SITE PI AN WASTEWATER DISPDSAL SYSTEM LBT lZ, BLBCK L NBRTHWBBDS SUBD, P,I,D, 051- 7~1 - TO /~hat~doned in place. ?ro?osed 5'~ X q~' /re/~c/¢ 12 /0 PREPARE]] FFIR~ ~/ILLIAM M, & SU~AN HYATT ~E656 NDRTHWBODS ]]RIVE CHUGIAK, ALASKA 99567 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 9DT-fgG-6111 ~TD U-IE-~4 ]DR~VINr;, ii DESIGN DETAILS WASTEWATER DISPOSAL SYSTEM LOT 11, BLock 1, NnRTH~nnDg gUBD, ~NNECTiTii' iOLID FROM TANK~=~ ~. UNCLASSIFIED FILL(FRaM TRENCH EX) ~ B' INSULATION FILTER FABRIO ~ ' 1000 G~LXL'~: ' tk S,T, --"~ SEWER RaCK ~ / '~ EXIST, TANK BgTTaM E F BED G~ 4B' BOTTOM DF TEST HaLE 1P' C,O, Existing Tank c,n, llO00 GAL C,D, C,a, 48' M,T, DESIGN DETAILS 3 3EDRDOM DWELLING WITH DAILY FLOW DF 150 GPa = 450 GPa SaIL RATE 4,78 MIN/INCK USE APPLICATION RATE DF 0,8 GPD/SF~ 450 GPa / 03 GPD/SF = 563 SF TDTAL A]~SDRPTION USE 48'L x ¢O'D x 5'W TRENCH, ENTIRE SYSTEM WILL ]E CDVERED WITH INSULATION & FABRIC. VERIFY EXIST, lO00 GALLON ~TEEL SEPTIC TANK, ALL PIPE MUST MEET M.D,A. SPECIFICATIDNS, MAINTAIN MIN, SEPERATIDN DF lO' FRaM EXISTING SYSTEM SYSTEM HAS ]~EEN INCREASED DUE TD AREA CONDITIONS SEE ATTACHMENT. PREPARED FDRI -~IkL.IA~ M. & SU~AN HYATT ~656 NDRTH~ODDS DRIVE CHUGIA~ ALASKA gg567 KND ENGINEERING / ' l P044~ PTARMIGAN/gLVD EAGLE RIVER, AK, 99577 907-696-6111 DATD 11-14-94 DRAWING # NDT TO SCALE ~4-~-1~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: Mike Hyatt DATEPERFOR LEGAL DESCRIPTiON:LOt 1 1 B 1 N'orthwoods Township, Range, Section: 2 3 4 5 6 7 8 9 10 11 12- 13 14 15 16 17 18~ 19 2O COMMENTS H{') 1 p 0rgani'cs Reddish Brow~ SM '- rc Hole Sandy Gravel$~ Med, Dense~ Silty Sand SM with increasing density w~th depth SLOPE WAS GROUND WATER ENCOUNTERED? N 0 SITE PLAN IF YES. AT WHAT .// OL DEPTH.:' / N / Ap Depth lo Water A~er Monitoring? N / A DateJ l ~/l l' / 9 4 Reading Date Gross Net Depth to Net Time Time Water Drop 0 10/14 0 0 4 5/8II 0 1 6 mtn 6 mi,n 6 1/4" 1 5/8" 2 13 mtn 7 mtn 7 1/4" 1" 3 18 mtn 5 mtn 8 1/8" 7/8" 4 24 mtn 6 mtn 9 1/2" 1 3/8" Add Water 5 26 mtn 0 4 1/8" 0 6 32 mtn 6 mtn 5 1/2" 1 3/8" 7 38 mtn 6 mtn 6 7/8" 1 3/8" Total 36 mtn 7 5/8" PERCOLATION RATE 4 .,7 2 (m,nutes/mch) PERC HOLE DIAMETER 8 ii TEST RUN BETWEEN ~ FT AND ~ FT PERFORMED BY: [M~ I k'pnnp~ F/L!f'f~_l,::] CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I 0 / 1 4 / 9 4 72-008 (Rev. 4/85J .,. J' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL~D ESCRIPTION ~ Well~ ' ~ Abso ption~ee DISTANCE TO: Manufacturer~ kiq. c~citg~n ~aHons ........... Inside length DISTANCE TO' Well Dwelbng Manufacturer No of lines Length-of e~h ne Total lenqth of Jines Top of tile to finish grad~ ~ Material beneath tile Length Width Depth Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Icl~ss Depth Driller Building foundation Sewer line DISTANCE TO: Dwelling Material .... Width Material Nearest.~gt li~e Trench ~.~lt h inches inches NO. OF B~O. OMS · ~ r,tments ! Liquid depth PERMIT NO. Liquid capacity in gallons PERM'pp¢ Total effecti(/e absorption area PERMI~r NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER REMARKS %013 ~Rev. 3/781 F'E'RF!I T NO. RF'F'L t CFtNT L. 0 L.-:F'iT I ON LE '3RL 600 E. E:ENSON LOT SIZE T'¢PE Of:' SOIL RBSCLf~:PTION S?STEH IS: TRENCH FIR'::'::If'IUH .NUMDER OF BEE:,ROOHS ;.= ~ SOIL RRTING THE REQUIRED SIZE OF THE SOIL RBSORF'TION S'¢STEH IS: THE L. ENGTH [:,IHENSION tS THE LENGTH (IN FEET) OF THE TRENCH OR C, RRINF'IELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SLIRF'RCE OF THE GROUND RND THE BOTTOH OF THE EXCRVRTION (IN FEET.'.". THERE IS NO SET HI[:,TH FOR TRENCHES. THE GRRVEL DEPTH IS THE HINIFIUFI DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE RND THE 80TTOH OF THE E',:.'.:CR'v'RTION (IN FE:ET). PERH~T RPPL. ZC:RNT HRS THE RESPONSZDZL~T? TO ZNFORf'I TFtZS DEPRR'rHENT DURZNG THE ~N?TRLLRT~ON ]NSPEE:TZC)ND OF RN'¢ HEL.[_S RDCRCENT TO THZ~ PROPERT'¢ RN[::, THE NUHBER OF RE:DZDE:NCE% THRT THE HELL HZLL SERVE. DRE:KFZLLZNG OF R[-,1Y %'¢S'FEH HZTHOUT FZNRL [NSPEC'TZON RND RPPROVRL DEPRRTHENT HZL. L E:E %UD.3EE:T TO PROSEE:UTZON. HZNZHUH E:,Z%TRNCE BETI4EEN Ft HEL. L RND RN'¢ ON--%ZTE :tOO FEET FOR R PRZVRTE HELL OR ~50 TO 289 FEET FROH R PUBL]C HELL. DEPENDZNG UPON THE T'¢F'E OF PUBLIC HELL. HZNIHUH C,Z%TRNCE FROH R PRZVRTE HELL TO R PRZVRTE SEHER LZNE ZS 25 FEET RND 'FO R COI'ltdUNZT'¢ SEI,.!ER L. ZNE ]~ 75 FEET. OTHEF: REC4UZREHEN'r% ftf:!'¢ RF'F'L~L 5PEC~FZCRTZONS RND C:ONSTRUCTZON R',,,'RZLFIBLE TO ZNSURE PROPER ]N%TRL. L. RTZON. '_,.'. C:ERTIF'.r' THFtT -J.: I RH FRHILIF!R HITH '['HE REC!UIREHENTS FER' ON-SITE 5EI.4ER5 RND I.,.!ELL~ RE; ~E'F FORTH E:'T' THE FILIHI'ZIF'¢ILIT'?' OF RNC:HORRGE. :;" f NZLL ..N=,IHL.L THE 5'¢%TEH IN FITC:3~'DRNCE HITH THE CODES. ,2' U ,~ "r ~ ~d . ]:: I UNDER~TFIND THF!T TFIE ON-SITE SEHER .......... HR'¢ REQUIRE ENL. FIRGEHENT IF THE RESIDENCE I~ REHODELED TO INCLUDE t, IC~'E THF]N ~: E:EE:,ROOH~. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: PJ&S DATE PERFORMED: 7-2-81 LEGAL DESCRIPTION: 2 4 Lot 11, Block #1 organics and organic silt, dark brown grading to red- brown, soft, roots and tree debris (Pt-oL) silty-gravelly-sand, gray, moist, compact, rounded and sub-rounded particles to cobble size (GM-SM) 7 8 9 10, 11 12 13 14 15 16 17 18 19. Northwood Subdivision SLOPE / / / / / / / WAS GROUND WATER ENCOUNTERED? NO IF YES, AT WHAT DEPTH? SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop 3 7-2-81 3:40 Dm 30 min. 46 " 2 1/2" 4 " 3:50" 40 " 47 " 2 1/2" 5 " 4:00" 50 " 48 3/4' 1 3/4" 6 " 4:10" 60 " 50 " 1 1/4" 7 " 4:20" 70 " 51 " 1 " lO 0 10 20- PERCOLATION RATE 10 ,~.%'~'~,.,. (minutes/inch) TEST RUN BETWEEN 6~"~.,,~A COMMENTS ~ .:% . ~ ~ Richard A. towman 7-6-81 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O-~l- ~/. 7~ HAA# ~"~t~'-.'~-~J°~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Prc-;erty owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well ~' Public water NOTE: If community well system, provide written confirmation from St.ate ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q)25 (Rev. 1191) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm /~,/~ ~_E~-z,~/'4~f*/~_~' Phone ~'~/~- ~'/// Address * ~ 4/- ¢--/ .~/~..~~I ~.-'( ,,l ~/' ~- ~/~- ,E~,'~ E-r-, 4-'~- '9 5-'7F Enginee¢s signature DHHS SIGNATURE ~ Approved for /'n'~'~Z~- ~"'¢bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Addition,?J Comments [)ate 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. E~ployees 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-O25(Rev. 1/91) Back MOAfY21 Legal Description: A. WELL DATA Well type '~ Log present (Y/N) Total depth Sanitary seal (WN) t:HV[~Ul"tM"H~,~l. ~RVICI~$ DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAY 3 0 RE¢ I 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist /--'~ // ~/~' / /~/o,~ ~-~ ParcelI.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample~ B, SEPTIC/HOLDING TANK DATA Date installed ~/~2, ~ ¢/ Tanksize Foundation cleanout (Y/N) ~/' Date of Pumping FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. ~ g.p.m. Number of Compartments __ Cleanouts (Y/N) High water alarm (Y/N) Length ~/~ Width Effective absorption area Date of adequacy test .5~- Monitoring Tube present (Y/N) 7 Depression over field (Y/N) __ Results (Pass/Fail) ~,~ ~ For Fluid depth in absorption field before test (in.); ¢~// Immediately after~'-~gal, water added (in.): Fluid depth ~ ~' '/ (ins) Minutes later: ~ ¢-/-/~z,¢¢~ Absorption rate = //~5-z; 'fi' .g.p.d. Peroxide treatment (past 12 months) (Y/N) /w/ If yes, give date ~ Soil rating (g.p.d./fF or fF/bdrm) /. ~-- System type ~/~-~/~'~ ~/~ Gravel thickness below pipe /~'/~- Total depth bedrooms 72-026 (Rev. 3/96)* C. ABSORPTION FIELD DATA Date installed · ~ ~ / ' ~ 5- Depression (Y/N) Pumper Nitrate .~ Other bacteria Collected by/~ D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level at* High water alarm level at* ~ Cycles tested ~ Size in gallons ~ ~~uump off" level at* SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~ SewerJ~~e line On adjace~3t-lets-"-' ~-~n adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation -4"/-¢ Property line .~,¢,. 7 / Absorption field Water main/service line 'p' .5- / 4 Surface water/drainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 2..~. ~ / Building foundation '~' Surface water / ~ / /~ Curtain drain / ~ Wells on adjacent lets Water main/service line ¢~'~- / y- Driveway, parking/vehicle storage area ~ / ¢- Wells on adjacent lots ~,~t¢-- ~ ?,..~,,&¢~ ENGINEER'S CERTIFICATION ~.~?. ~,~.~ , certif that, have determined thru field inspections and review of Municipal recor~.,~tft~o~ 4~s are in oonformanoe with MOA HAA guideline~ in effeot on thi~ date. ~a.." . ~ ',~ ~ . , Engineer, Name /:'~ ¢~ ' ~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE CF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # /(-~_~\ - -')~\---~¢% HAA# ~--~'~qf"~'h.£1.,"~(,~. 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 11; Block 1; Northwoods Subdivision Location (address or directions) 7577 Northwood Drive (b) Property owner Bonnie Delimont Telephone: (home) 688-9794 Business Mailing Address 7577 Northwoods Drive (c) Lending Institution Mailing Address Telephone (d) (e) Real Estate Company and Agent Address 3000 A Street¢ Telephone 562-7653 FORTUNE PROPERTIES/Ron Bower Anchorage, Alaska 99503 Mail the HAA to the following address: (or check here [~, if hold for pick up.) -i List contact person and day phone number below: -- S & S ENGINEERING/694-2979 17034 Eaqle River Loop Road, Suite 204 Eaqle River~ Alaska 99577 2. TYPE OF RESIDENCE Single-Family r~ Number of bedrooms 3 3. WATER SUPPLY Individual Well [] Community E] 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 r~ 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 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 inspection. Name of Firm Telephone 5 & S ENGiNEERiNG Address 17n34 Eaqle River Loop Road No. 204 Eagle River, ALaska 99577 /, / /,.....) Date /O,/?// -,~ o 6. DHHS APPROVAL~ ~a Approved for__bedrooms by te Approved . Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of H~althand 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. The MunicipalityofAnchorageis 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) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Date completed If'A, B, C, D.E.C. Approved ~'N) Yield ,,/ 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 Depth: of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ;On AdjOining Lots 7,-~c~ ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments '~ ~ ~-"~ :~ B. SEPTIC/HOLDING TANK DATA Date Installed ~-~,~O -~) ! S ze \ ~ ~ No. of Compartments 'Z.. Standpipes ~fN) ~ Air-tight Caps (~N) \/ Foundation Cleanout (~/N) Depression over Tank (Yt~ 1~ Date Last Pumped ~ - I~-" _O~ D Pumping/Maintenance Contact on File (Y/N)/,,j/ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well '~.c.~ To Property !~ine 1, 'C~ To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course ; for - Temporary Holding Tank Permit (Y/N) To Building Foundation "~' ~'~- To Disposal Field ~-~ ~- Comments, 72-026 (Rev. 7/85) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~l - '%,¢~- ~.\ Width of Field '~(~* Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test ¢P/~¢Z-- Type of System Design Length of Field '~'"'\ ~ Depth of Field -)~ \'~ Gravel Bed Thickness ~ Statndpipes Present ~'4) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ¢"~1/~- To Water Main/Service Line \ 1'~ ~ ~'~ To Property Line \ To Existing or Abandoned System on ; On Adjoining Lots '?~\ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'~ ~.~.~--~ ~ ~ FC~C__...~z~A ,~¢tb~¢-~('5 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) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection. Signed S 17034 Eagle River Loop Rea~ No. 204 Company Eagle Rive. l~, A~,astca 99577 Date Receipt No. ~ Date of Payment Amount: $ 72-026 (Rev. 7/881 Back /o-- 6--90 Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION STEVE COWPER, GOVERNOR ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 September 21, 1990 563-6775 FOR: S & S Engineering Attn: Ray PWSID: 9213001 According to the records on file in this office, the Chuqiak Utilities/Northwood/Deerhorn Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. Environmental Specialist VEC:pf '~ DANTE RECEIVED ~ INSPECTION APPOINTMENTS TIME TIME TIME MUNiCiPALiTY ~F ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~JVI~ONM~N],:~. :.CTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 DI~ClIO~S: Complote all O~rts on Oa~e 1. Ineompleto roques~ will not bo processed. Please al[o~ ten (10) dags for processing. 1. PROPERTY OWNER I PHONE PROPERTY RESIDENT {If different from above) ' 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ] PHONE MAI LING ADDRESS ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS i~ [] 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 I~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [~] ONE E~3 THREE [] FIVE [~3 OTHER [] MULTIPLE FAMILY [~] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL. DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI I.ITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMtT NUMBER []INDIVIDUAL/ON SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER E~]Septic Tank or [] Holdin§ Tank Size: __ If Tank is homemade SOILS RATING give dimensiom;: TYPE OF TANK MANUFACTURER TOTAL ABSO~'TION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line WELL TO: I I Absorption Area to nearest Lot Line 5. COMMENTS ~ APl)ROVED FOR .~ BEDROOMS ~1 CONDITIONAL APPROVAL (letter must accompany certificate) Gl DISAPPROVED DATE BY 72-010 (Rev. 6/79) McMANU$ 4 5 2z RAMSEY SUBDIVISION / ATE TRACT B 50 997 ACRES r/q~ Iq~ iL£GEN~ NORTH WOODS SUBDIVISION