HomeMy WebLinkAboutNORTH WOODS BLK 1 LT 12
Municipality of AnchoragePage / of ~'
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: ~_.~'(~ ~ ~Oc2 / ~'~ PID Number:
Name:
~z ~/~- ~, ~ A~ Wastewater System: ~ New ~ Upgrade
Phone:~
of
Bedrooms:
.~ ~ Deep Trench ~'ShallowTrench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so..~..~: ~o~a, ~e.~ ~ro~ or~¢.~. ~r~d~:
'Lot: ~ Block: / ~ ~Subdiv~ion: Depth to pipe bo~om from/original grade: Ft. Gravel depth ~-~beneath pipe Ft.
~: D ~ew D ¢ p~rade ~Gravol width: ~umber of lino[: ~istanc~ ~*~0ea l~n~s:
Glassificafi~: Total Depth: Ga*od To: Total absorption qroa: ~ip* material~ /
Ddllor: ~ Dato ~rillod: Static Water kov*l: , Installor: Dato installod:
Yield: GPM J Pump Set at: Ft. Cas~ove__ Ground:Ft. TANK
SEPARATION DISTANCES ~s~.tic u HoUr.. u S.T.E...
To Septic A~sorption Lift Holding Public/Private Manufacturer: Capacityin gallons:
From Tank Fie,d Station Tank SewerLines ~/~C ~/~ /OO O
F Material: Number of Compa~ments:
Lot / / Size ~n
Foundation /~/ ~7/ ~ "Pump on" level at: [ "Pump~ High water alarm at:
Cu~ain ~0~ /~/~ >,mpMake&Model JElectricallnspectionspedormed~
Drain ~ ~
Remarks: BENCH MARK
Location and Description:
I Assumed Elevation:
/00
inspections pedormed by: s~
uepar[mem o~ me n ~ices approv I
Reviewed and approved by:. ate: 7-2/
72-013 (Rev. 9/91) MOA 25
PERMIT NO. SW9802 ~ 5 PA~. 2 Or 5
NL~nicip. o,[ii: OF AK~choff'o, Qe
DEPARTMENT OF HEA~TH AND HUM'AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,~, Box 196650 ·Anchor-age, A[asNn 99519-6650·Te[el~hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEOAL LOT 12, BLOCK 1, NORTH WOODS S/D P.LD. NO. 051--751--69
NEW 1000
SEPTIC TANK
FCO
LOT 13
LEACHFIELD
:os SITE
/ //
/ //
/ //
/ //
~ //
SCALE I' = 40'
LOT 11
ROBERT C. C0WAN
CE-8801
P~R~i~ ~o SW980213 PAGe. 3 OP 3
Municip. aU-t o£ Anchor'aqe
DEPARTMENT OF HEA~TH AND HUM'AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 eAnchor(zge, Al(~sk0, 99519-6650oTe!ephone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 12, BLOCK 1, NORTH WOODS S/D
P.LD. NO. 051--751--69
ST1
NEW
1000 GAL
SEPTIC
TANK
ST8
FINAL
GRADE
A B
ST1 24.0' 29.0'
ST2 27.0' 54.0'
DBL1 29.5' 57.5'
DBL2 50.5' 38.5'
FD 55.5' 44.0'
C01 42.0' 51.0'
MT1 44.0' 51,0'
C02 71.5' 45.0'
MT2 66.5' 41.0'
C05 81.5' 60,0'
MT$ 80.0' 58.5'
004 57.0' 62.5'
MT4 60.0' 65.5'
MTi C03
, C03 = 75.8'
004 = 75.7'---~
'-- ' ' MT3 = 73.1~,
MT4 = 73' '
= 78.1' r
CO1 78'11'-~
C02
MT1 75.3'-/'
MT2 : 75.2'
MT3 C03
67 ' WATER FOUND
-~CAL~ 1" = 40'
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HLMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ia_LASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW980213
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:MA/fi ELAINE A
0WNERADDRESS:22714 NORTHWOODS DR
CHUGIAKi~LASKA 99567
DATE ISSUED: 7/01/98
EXPIRATION DATE: 7/01/99
PARCEL ID:05173169
LEGAL DESCRIPTION:
NORTH WOODS BLK 1 LT 12
LOT SIZE: 37461 (SQ. FT.)
NUEBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 3~ND 15.65 AND THE STATE OF .~LASKA WASTEWATER DISPOSi~L
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
C3~LLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. 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 SAlliE DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
ROBERT C. COWAN, P.E.
HEALTH AUTHORITY
APPROVALS
SEWER&WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECT[ON
ENGINEERINGSTUDIES
AND REPORTS
WELL fNSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
W,~,~ T EWATER
DISPOSAL SYSTEM
DESIGN
June 26, 1998
CIVIL ENGINEEF~S
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 12, Block 1, North Woods Subdivision
Request you issue a permit to replace a septic system to serve the three bedroom
house on the referenced property.
A test hole was excavated and percolation test performed. The approximate location of
the test holes are located on the attached site plan.
At the time of excavation 6/18/98 water was not encountered in the test hole. After
seven days the ground water monitoring tube reflected that water was found at 9.5 ft.
We do not anticipate any adverse effects on neighboring wells, septic systems or
drainage patterns by the installation of the proposed septic system. The construction of
this system will not prevent any future development on any of the adjacent properties.
We request you expedite the issuance of this permit due to the unsanitary conditions.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/mg
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
I DESIGN DETAIL
~ ~,.' m-'o = ~.~
~me~
· !" = 40'
SCALE
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3
4
5
7
8
10
11
12
13-
14-
15-
16-
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Alterc:~
Monitoring;' i ~
Township, Range, Section:
SLOPE SITE PLAN
Date: ~'~'~
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER
FT AND '~'~'~ FT
COMMENTS
x/Il?
17034 Eagle River Loop ~oa& No. ~G4 ~ ..... CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE W~'a~GLR~/TB~'~a~aV~[~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ROBERT C. COWAN, P.E.
HEALTH AL~ HORITY
APPROVALS
SEWER&WA[ER
MAIN EXTENSIONS
SEWER&WATER
iNSPECTION
ENGiNEERrNG SI'UDIES
AND REPORFS
WELL INSPECTrON
& FLOW TEST
SiTE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ONSITE
DESIGN
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
RECEIVED
REFERENCE: Lot 12, Block 1, NorthWoods Subdivision JUL 2 ]998
Jun 26, 1998 Municipality of Anchorage
Dept, Health & Human Services
GENERAL:
The scope of this project includes the installation of a 1000 gallon septic tank
and a leachfield trench to serve the proposed r/J~e bedroom residence located on
the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal Health Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of the
tank.
All standpipes on the septic tank shall extend a minimmn of 12 inches above
final grade.
17034 NORTH EAGLE RIVER LOOP ° SUITE 204 · EAGLE RIVER, ALASKA 99577
Page Two
Lot 12, Block 1, North Woods S/D
Jun 26, 1998
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts shall
be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in
line, shall be to clean toward the leachfield. The second cleanout shall be to clean
toward the septic tank. Two flow dividers shall be installed sending 3/4 flow to longer
trench and remaining 1/4 flow to shorter trench.
o
Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
o
o
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
fi:om the bottom of the trench to the invert of the distribution pipe. This is equivalent to
the effective depth of the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
Page Three
Lot 12, Block 1, North Woods S/D
Jun 26, 1998
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco,
or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
.6.
All leachfleld gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform
to current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
Page Four
Lot 12, Block 1, North Woods S/D
Jun 26, 1998
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon fmal grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre-construction meet'mg will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/iNSTALLER
, 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 ,J~HON E I~NEW
LOOAT'O ~~: ~~~ Absorp~o~ area Dwelling~ ~¢~
Inside
length
Width
~iquid
depth
~ ~ DISTA~Cfi TO: ~ell D~ellin~ PEB~IT ~0.
~ ~ ~ Manufacturer Material kiquid capacitg in oallons
~ DISTANCE TO: Well~m~ Foundation Nearest 'ot~ [~ PERMIT NO~/~FW~
~ No, of~ /~P~, Trench ~ Distance between lines
~~ ~ lin~ L~th of~ne Total len~t~f lines
~ Top of tile to finish graOe ''7 Material beneath tiJe ~[nches iTotal~sorptionarea
Lenoth Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line S~tic~ ~ ~ ~tank Absorption area(s)
OTH E R ~ ~ .~
PIPEMATERIALSr¢~X¢ -- 11~ ,
REMARKS ~
r~ ~ "~
72-013 (Rev. 3/78)
F'E F.:."! I '!"
_ 0 C Fl -!." :[ O
LEEiRL
F RF-LN K E:E'THFIRD
F'ETER "':E; F:F.'.EEK
L :.'L;2 E: t. NCRTH HOFE:,S S,,"D
i. "L T 'E ! ZE
77000 S]".!_FtRE FEET
::, ~. _*., ,.:., ]: S
h11:I,.XIMLIM NI...II"IE~EF;.': OF EE'[:r;'O['M':-: = 4 :-3OIL RFrT!NG ('Z:Q FT,.."ELF,::)
.::.,..:, I E:t
· 'FHa::: F;'[:'-I :[RED SIZE OF: THE cf]TI AE~':::;r'r,:.'F'TiEIh '-'¢'- ....~" '
! E.: 0
THE LENGTH [:,ZMENSZON ZS THE LENGTH (ZN FEET::' OF THE TRENCH OR DRF~!NF'ZELD.
THE DEF'TH OF R TRENCH OR F'IT IS THE DISTF:!NCE BETHEEN THE SURFFiCE OF THE
GROUN[:' RN[)THE BOTTOM OF ]"HE EXCF:!',,,'RTZO~4 (11'.4 FEET).
THERE IS H'] SET HI[:,TH FOR TRENCHES.
THE '3RF!VEL [,E!:::'TH IS THE hliNIMLt? [:,EPTH OF '~c'c F EE'TUFE[.a THE (}UTFFtLL
FIND THE 8OTTOM OF:' THE EXE:R'v'F!T!ON ,:]IN FEET).
PERMIT RF'PL:[CRNT HRS "tHE RESF'ONSIBILIT'¢ "f'O INFORM THIS DEPARTMENT DURING THE
ZNSTFILL. RTZON ZNSPEE:TIONS OF RN',' !.,.!ELLS RE:,JRCENT TO TFLX:5 PROF'ERT'Y RND TFiE
NUMBER OF RESIDENCES THRT THE HELL HILL. SERVE.
-E'~--.~E]) c:: ;~: ]::, Z ~..~%~F'EEC:~- % CD~-~; ,z~ E~:E~ ~;:EE~:~tLJ % ~:~7 EZ: ................
~:R(]KF'I LL. ING OF RN'.¢ S"r'S"FEM Hi THOUT F'iNRL.. INSPECT I ON RND RPF'RCWRL.
QEPRR]"MENT MiLL BE SUBJECT TO PROSECUTION.
MINZMUM DISTF!NCE BETHEEN F! HELL. RN[) RN? ON-SITE SEHFtGE DISPOSRL SYSTEM IS
:200 F'EET FOR R F'RIVRTE HELL OR t50 TO 200 FEET FROM R PUBLIC HELL DEPENDING
UF'Z¢'~ THE TYPE 3F F'USL. IC: HELl. ....
MINIMUM C, IS"f'RH'"E FROM FI F'RI'v'FITE HELJ_ ]'OFt PRIVRTE %EHER ._ZNE iS :::'5 F:'EET
TFi R Z:-MHL~.!~T'¢ ""~" ,-r- lINE l~; ',-='~i FFP'T
]THER REQUIREMENTS MR"r' RF:'P_'¢ ,=pFC:IFT"'RTZ'~- ~-,lr', 7-~-,!S'I'RUCTICfi",! DiRGRFfl"!S FIRE
RVRILFIE:L.E TO INSURE PROPER INSTF!LLRTION.
I F'F~'TZP'T' THF!T
f: I RM FFIMILZRR HI:TH THE RECJ'[REMENTS FOR :N-'S~TE '2Et, ERE FINE:' WELLS 1:1:~; SE'T'
FC :~'TH E:'T' THE f"l .lf.,t '[ C i F'FIt,.. ! T'¢ OF' FINCHOF4'.~GE.
h ... _.... RI...,~ ......
~ ~l LL 'rN,:]TFiL I THE. ':'~.":TFhl Th; -f'"l""l-t .' 'F~-F'F' HITH "FHE - 3[:'ES
':' ' t ?. I ..................
3:' Z JN[:,ERSTFIN[) THF!T THE ]N-::21TE SEHER SVS".'EH I"!R'¢ REQUIRE E!'dl RRGE"!ENT IF THE
RE,'!L [. _Lb .............
RESI[)ENCE IS f ]'"F -r' TO IHf":l t I[:,E M']PP- THRN 4 !3EDROOMS.
S I G[.,!E [): ._~ .....................................
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION.*
1
2
3-
4-
5-
6
7'
8
9
10-
11
12
13
14
15
16
17
18
19
20-
COMMENTS
PERFORMED BY:
Loi' 12.
k~/1UNICI?ALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch ~-~50. An~orsge, Al=ka ~S502
SOILS LOG -- PERCOLATION TEST
SLOPE SITE PLAN .
/
/
/
IF YES, AT WHAT
t~j'O.J~ .~ DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
2~A ~A~ lo ~o :z~A
~ Y4 ~A~ ~o 3a ~ V~ ~ Y~
iz ~
PERCOLATIO H RATE (minutelllneh)
TEST RUN Pl~tWel~'d q FT AND ~ FT
. DATE.*
MUNICIPALITY OF ANCHORAGE ,(~ '
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section - '
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel .D. # 051-731-69 '.'
1, GENERAL INFORMATION
Complete legal description
r.~t 12, Rl~_k 1 , Nor~hwoods S/D
Location, (site address or directions) 22714 Northwood Dr., Chuqiak, Ak 99567
Property owner
Mailing address
Lending agency
Mailing address
Victor Maki Day phone 529-1503
22714 Northwood Dr.¢ Chuqiak¢ AK 99567
City Mortgage, Eagle River Day phone 696-0701
Agent Baney-Hardman/Remax Eagle River Day phone 694-4200
Address 16600 Centerfield Drive, Suite 100, Eagle River, Ak 99577
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
xxx
Public water
tf community well system, provide written confirmation from State ADEC attest-
~ng to the legality and status of system. - _
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Co rnmunity on-site
NOTE:
XXX
Public sewer
if community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA#21
o
STATEMENT OF INSPECTION BY ENGINEER ~
As certified by my seal affixed hereto and as of the validation da-~e showl~ 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 functionai an d adequate for the number of bedrooms
and type of structu re 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 S&SENGINI~Ei~INC, Phone ~fl~/'-;~-0 7~
Address 17~4 Eagle ~iver Loop Roa~ No. 2~
DHHS SIGNATURE
Approved for .'"~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anshorage 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 courtesyto 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-O25(Rev. 1/91) Back MOA#21
Legal Description:
A. WELL DATA
Well ,type
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES '~99
Environmental Services Division JUL 1 7
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 .
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
Health Authority Approval Checklist
) B, or C, attach ADEC letter. ADEC water system number
Log pre'~s~. ~ Date completed
Total depth '--,.._ / Cased to __
Sanitary seal (Y/N)"~'~ O M---"~E~
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ~1 c~ Ioi _~ Tank size
Foundation cleanout ~N)
Date of Pumping
Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Nitrate
Collected by:
g.p.m.
!~')_ ~. Number of Compartments
Depression (Y/~.~ ~0 High water alarm (Y/N)
Pumper
C. ABSORPTION FIELD DATA
Date installed
Length I @~) / Width
Soil rating (g.p.d./fF or fF/bdrm) 0.(~ System type
~' / Gravel thickness below pipe ~, '~ / Total depth
Effective absorption area __
Date of adequacy test
Fluid depth in absorption field before test (in,);
Fluid depth .... (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
'Z~Monitoring Tube present ~__~1) ~F_,~ Depression over field (Y~ ~ 0
Results (Pass/Fail) ~ For ~'~ ~-~ bedrooms
~ Immediately after ~ gal. water added (in.): ~
~ Absorption rate = -~ .g.p.d.
~ If yes, give date ~
72-026 (Rev, 3/96)*
Date installed . Size in gallons
Manhole/Access (Y/N) '""'"'"'~' q.~p on" level at*
High water alarm level at* *Datu~
Cycles tested
E. SEPARATION DISTANCES
"Pump off" level at*
SEPAR~,TI~-ON-DI~ES FROM WELL ON LOT TO:
Septic/holding tank on lot ~A~__~ On adjacent lots
Absorption field on lot ~ On adjacent lots
Public sewer main ~ Pub~.e/cleanout
Sewer/septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation lO Property line I~) Absorption field
Water main/service line IDIJ' Surface water/drainage ~0~) I~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line { D Building foundation ~ O
Surface water I ~) f~
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
Zoo'
Curtain drain
ENGINEER'S CERTIFICATION
' certify ,hat lhave determined thru field inspections and review of Municipal
in conformance wit 0
Engineer's Name
Date
HAA Fee $ ~"~ (-7~('
Date of Payment '-h
Number C)
Receipt
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
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 12; Block I; North Woods Subdivision;
Location (address or directions)
NHN Northwoods Driv&
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
H,U.D.# 029449
605 W~.A~ 4~h
Telephone:(home)
An~horag~ Ak 99501
Telephone
Business
(d)
RealEstate Company and Agent AgR~RTATFO R~f~F~q ATTN, qa.Hy
Address 640 W&St $6th Av&nu&, Suit& #I; Anchoraq&~ Alaska 9950~:'"
Telephone 563-3333 ~
(e)
Mail the HAA to the following address: (or check here,l~ if hold for pick up.)
List contact person and day phone number below:
S & S ENG!NEER!.HG
17034 Eagle Ri,vet Loop Road No. 204
E~_g{e P. iver, A{e-'k" 995.??
2. TYPE OF RESIDENCE
Single-Family)~¥- Number of bedrooms 4
3. WATER SUPPLY
Individual Well []
Community fNX 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 ~XX 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.
72-028 (Rev. 7/88) Page 1 of 2
Address
Date
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, Iverifythatmyinvestigationofthis
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 ~q ¢"¢¢7F
S & S ENGINEERING
17034 Ea~lle Eiver Loop Road Nfo. 204
Eagle River, Alaska 99577
6. DHHS APPROVAL
Approved for '~' _bedrooms by
Approved ;~ Disapproved
Terms of Conditional Approval
Conditional
Iqi[oi
The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issuesHealthAuthorityApproval
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 inordertosatisfycertain federal and state requirements, Employees of DHHSdo not conduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
],j~UiqicIPALIT'{ OF ANCHO .~
F. NVi?,ONM~-NTAL sERVICES DI~'
. Well Classification
Well Log Present (Y/N)
Total Depth Cased to __
Static Water Level
Casing Height Above Ground
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
r CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: .~
Date Completed
Depth of Grouting
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 ~. I.,~. ~:~. ~'_.~. ~
If A, B, C, D.E.C. Approved (Y/N) ~
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ! O-IXC'g( Size J~ No. of Compartments
Standpipes (Y/N) t1 Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
~ Foundation Cleanout (Y/N)
Date Last Pumped -7 - / - ~c~
; for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
/
72-026 (Rev. 7/88} Front Page t of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed / O -- Iz¢
Width of Field ~
Type of System Design
. Length of Field
/
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area ~ ,~. O ~ Statndpipes Present (Y/N)
Depression over Field (Y/N) ~J Date of Last Adequacy Test
Results of LastAdequacyTest ~-~l~.?¢~__% f~('.,,"~('~ ~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ,¢~ Od:)
To Building Foundation .~.P, O ~
Lot /~/~ ; On Adjoining Lots
To Water Main/Service Line ! ~2/-'¢'- To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course ! ~/~
To Driveway, Parking Area, or Vehicle Storage Area / (--)
To Property Line
To Existing or Abandoned System on
Comments
D. LIFT STATION
Date Installed ~
"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
inspection.
Signed
Company
Date
MOA No.
5 & S ENGINEERING
17~.~4 F'.~,-jle River Loop Road t%. 204
Eagle River, Alaska 99577
/
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
STEVE COWPER~ GOVERNOR
ANCHORAGE, AhASKA 99503
:S & S Engineering ........
17034 Eagle River.Loop, Suite 204
Eagle River, Alaska 99577.
563-6775
PWSID~ #,213001
According to the records on f~le in this office,, the .Chug/ak
.Uttlities/Northwoods-Deerhorn . Subdivision . water System is in
compliance with the State of Alaska Drinking Water Regulations.
Sincerely, ' ~
VERA E. CRAIG [ I
Environmental Field O~icer
VEC~bas
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
LOT 12, Block ./_, NORTHW00DS Subdivision
Location (address or directions)
NHN Northwood Drive Peters Creek, Alaska
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
HUD # 029449
Telephone:(home)
..... . AK 99501
Telephone
(d) Real Estate Company and Agent ASSOCIATED BROKERS ATTN: Sandy
Business
(e)
Address 640 W~2 36~h Au~,.u~, SuJ~ #I~ A,oho,'~(,r.g¢... AK 99503
Telephone
Mail the HAA to the following address: (or check here rq, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
!7074 L:"=_~I,, ~.;.v,-,. I ,.~p Rand N_~= 204
Ea~,le River, Alaska 9~)577
TYPE OF RESIDENCE
Number of bedrooms
Single-Family ~
WATER SUPPLY
Individual Well []
Comm unity J~f' Public []
Note: If community .well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site [[~( 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
~ ~.
WELL DATA
__ Date Completed
Depth of Grouting
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
If A, R, C, D.E.C. Approvec~"'~N) ~/
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~~'c:~:~l ''~
; O~Adjoining Lots
_ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
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 ~ ~,,/~', ~---~, \"~. ~
SEPTIC/HOLDING TANK DATA / /
Date Installed [o-lz¥-~t Size !'~Z.-~ No. of Compartments ~'-
Standpipes(~N) ~/ '- Air-tight Caps<~N) "-/ ~ Foundation Cleanout (Y~ ~ '~
Depression over Tank (Yl~ / t~ ,, Date Last Pumped '~ ~ t ~(~:~ ~
Pumping/Maintenance Contact on. File (Y/N)~.~ / ; for '--'---" r4 /~
Holding Tank High-Water Alarm (Y/N) //~ Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Ruilding Foundation
~ ~->~"~ ~ To Disposal Field
TO Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments ~'-~-'~ ~----,~~~ ~
72-028 (Rev. 7/88) Front Page 1 of 2
D~PT. OF ~NVIRONM~NT~t
ANCHORGE WESTERN DISTRICT OFFICE /
3601 C STREET, SUITE 322
--
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE: --~, 1989
PWSID: 213001
To Whom It'May Concern:
According to the records on file in this office, the Chugiak
Utilitigs/~0rthwgods Deer Horn Water System is in compliance with
the state'of Alaska Drinking'Wa~ter Regulations°
VEC: gd
Sincerely,
Ver a~E ~Cr~a igC'" ~~
Environmental Field Officer
E/iUNICIPALITY 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
GENERAL INFORMATION,
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ,~~-/)~-tC.<~,Telephone: Home ~/OP~C'Z'~ ¢/0C,2¢ Business
Applicant Address ~,..~/r~. -~z¢-,..~ ,~ ~¢,.'5~ ~/ ,~ d-~.,~-.cc,-Fj,Z~~
(c) Applicant is (check one): Lending Institution []; Owner/builder/[~; Buyer []; Other E] (explain);
(d) Lending Institution .,~'~ ,/'~¢-~_ '~ ~/~Telephone
Address
(e) Real Estate Company and Agent _~.4¢~7/.~/"~,¢
(f) ~ the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family,[/ Multi-Family [] Other
Number of Bedrooms ~
WATER SUPPLY
Individual Well [] Community [] Public,J~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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.
Page 1 of 2 72-025(11/84)
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 Heaith
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the dumber 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
DHEP APPROVAL
Approved for
Approved
bedrooms by ~..~.¢_/____.C?.~ Date
Disapprove~.-~
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
MUNICIPALITY OF ANCHORAGE (MOA)
.EA'TH AUT.OmTV AP.ROVAL (HA^) 9
CHECKLIST- FEBRUARY 1984
264-4720 NOI.LD~.[O;~d 1VJ-Ni/~NO~/IAN=i
WELL DATA
Well Classification ~ ~ If A, B, C, D.E.C. Approved~)
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to _ ~ Depth of Grouting
Static Water Level ~ /. Pump SetAt
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~Tank on Lot ~ ~ ~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~'~ ; On Adjoining Lots
To Nearest Pubiic Sewer Line 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 [~Jr~,l
Size 1 '~"O %
No. oi Compartments
Standpipes ~xl) Air-tight Caps~N) Foundation Cleanout (YO
Depression over Tank (y~ ,._~/ Date Last Pumped ~- ?->~". ¢.~'
Pumping/Maintenance Contract on File (Y/N) ~ ~-//_.4 ; for
,0
Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/HcM=.ag Tank:
To Water-Supply Well '~...~c:~
To Property Line t 0
To Water ~-a+~r/Service Line kc:> I Course t~
To Building Foundation [ ~:> I ~
To Disposal Field ~ I
To Stream, Pond, Lake, or Maj6r Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (y~r~
Results of Last Adequacy Test
900 "~'~'/f~;:~l¢----"' Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
? -~'~ Standpipes Present~)N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well '~--'¢'-L~ I ~
To Building Foundation
Lot I~/~,
To Water.Mefrr/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
, To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
~t.~Cutbank (if p resent)
Comments
D, LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA. and HA.A guidelines in effect on
Signed
Company.~ ~:: ~ ,~ J~z~ ~. .... MOA N
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
the date of this inspection.
~,/. P~ ~,
~EIP~. O~ ENV[RON~tENT/~L ~7@N~ERV/~TItON
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
RILL SHEFFIELD, GOVERNOR
Telephone:
274-2533
To Whom it May Concern:
According to records on file in this office the S/~ ~-~
/~ ~ Water System is in compliance with the state Drinking
Water Regulations
APPLIC' NT FILLS OUT UPPER HAl ONLY
PropertyOwner /~)~/'~.:/~/ /l\/.~]~' /~0~}~/\0/~) ~ t~O(~//~J Z_~ Phone
Lending Institution /2£ i~ /~ ~ ~'~ ~,~/,/'¢','~) ~,/,,j/~ j~,J~ )~.,)J~, 0/;' tt~ ~'")C',/~I')I~'~,.L':' Phone
Address '~ ~ ~') } ~ ~:%)~ }J ~"/~ J~
Street Locatio~q
Type of Residence
/Single Family
Multiple Family No. o[ Bedrooms
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
[] Community For wells drilled prior to that date, give well depth (attach log if available},
/gJ,~Poblic Utility
Sewer Disposal
[] Individual Year Individual Installed:
[] Public Utility When Connected to Public Utility:
Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH
ENVIRONMENTAL PROTECTION
Jg, 2
RECE! ED
( ..~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL "
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3/82)
L!i:',?~James Bi Roberts, P. E.,
Engineer and Surveyor
C L I ENT :'
First National Bank in Bartlesv. ille
c/o Lee Houston &i, Associates, Ltd ....
Lot 12:Block 1 NoPthwood ~ubdivision (PetePs .Creek
1207 East 74th Avenue . SEPTIC SYSTEhi ADEQUACY TEST
Anchorage, AlaSka 99502 ' ' ": . '..
-(907) S49-2526 ..-..' : i -. '-:! .~ ~. .' :
'" '- ~i'/::.: ~ - ' " ': ' ' ~' '
Date: I~lay 23, 1983 ' ,., ~est No.', 9-83118
SEPTIC TANK:
Size,-" 1,250 gal
ABSORPTION FIELD:
Telephone."-, (907) 276-5909
Tilde ~ Time
Date Date Date
Inspector inspector inspector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner Letharc~ - ~ Construction, [n.c. Phone
Mailing AddressSIVA. ~()X 1698-K, Anchorage, AK 99507 345-1615
Buyer Jim an(~ Cathy Gather
Address 3201 ~. Street, suite 303, Auchorage, Alaska 99503
[ending Jnstitution National ~{ank of Alaska Phone
C st. ~no Northern Lights Blvd. 265-2~83
Address
~ealtyOo. &Agent RE/!ffA~ Properties, Inc. , Attn: Will
Address 2702 Gambell St. suite 101, Anchorage, AK 9,.uO~ 276-27~
Legal Description
LOt 12, ~lock 1, North~.~oods
Street Location b]}{]'~ Northwoods Drive
Typ~gf Residence
~ Single Family
~ Multiple Family No. of Bedrooms
~ Other
Water Supply
Q Individual A~ACH WELL LOG. A weil log is required for all wells driiled since JuDe
~ Community 1975. For wells drilJed prior to that date. give well depth (attach log if
~ Public Utilit~ available.)
Sewage D;sposal
~ Individual Year Individual instaJled: /~/
Q Public Utility When Connected to Public Utility:
~ Ho~d~n~ Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ALASKA I~I1UIROrImI~rITAL cOrITROL Si~RUIC~S, Il'lC.
I~nclinecrin§ ~ I~nuironmenlul Studies
Les Bucholtz
Department oF Health and Evironmental Protection
82~ L. Street
Anchorage, Ak.
Dear Les:
¥!he Droken stanUpipes for the sewer systems on Lot:~ 14
Block 1 and Lot 12 Block 1 Northwoods Subdivision have
been repaired and now meet the municipal codes.
you have any questions please let me know.
Sincerel
President
, PE
1220 LU~:st 25lh Auenu~.' ·/~nchorage, /~laska 99503 * (907) 276-1361
ALASK -'ErlUII OFIITI8FITAL COF1Ti OL' $ i UiCSS, IrlC.
· ,?~ ~ntin¢~rin~l ~, ~n~i~onm~nlol $ludi~s
' In my linspection I found a cap missing, and final grade,
needed' for Lot 12 Block 1. All construction of the sewage
systems~ except for Lot 12 meets Municipality of Anchorage
code. All had dry sump pipes.
If you have any que~-~.~35b%l~ease contact me. ~
.~,~ OF' 4L '3%~
nt
January 29,1892
Mr. Les Bucholz
Department of Health and Environmental Protection
Pouch 6-650
Anchorage, Alaska
99502:
Attn: Les Bucholz
Dear Le~: '
On the 29th day of January 1982, Alaska Environmental Control'
Services Inc. inspected the on-site sewage system for 5 homes
located at Northwoods Subdivision. Lot 10 Block 3 '
; ' Lot 25 Block 3 '"
: -' Lot 13 Block 1
Lot 16 Block 4
~. Lot 12 Block 1
1220 ~J¢~l 251h ~¢nu¢ · An¢~orog¢' Alas~ 9,9503 · [907) 2764361