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HomeMy WebLinkAboutNORTH WOODS BLK 1 LT 17 ~ ' 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 IPHONE [] UPGRADE LEGAL DESCRIPTION Well.~ Absorptio~ ar O ~ DISTANCE TO: I ~~ Dwelling ~ Manufacturer ~ ~ ~Lq. ca~acty~ ~nga~°nsl F HOMEMADE: nsde ength Width ~ ~ ~ I No. of lines ~ ] Length of~%line  Top of tile to finish grade ~ I Length Width ~ N ~ Type of crib Crib diameter ~ ~ell DISTA~C~ TO: ~ Class~ Depth Dwelling F, oundation ,~ ,~ /' Total length o) lines Material beneath tile Depth Crib depth Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank NO. OFBEDROOMS PERMIT NO. ~ No, of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons Nearest lot line~ t PERMIT NO. Trench width ,,~ Distance between lines~///~ ( '~ (~:2 inches Total effe~i~ ~¢~sorption area ' PERM T ~O. Total effective absorption area PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS /~X~ ~ ,,~_ / SOIL TEST RATING INSTALLER REMARKS 72-0~3 (Rev. 3/78) DATE LEGAL DEF'FtF.:Tf,!ENT O'-' FIERLTH RN[> EN'v'!RONHENTRL F'"'CTE:TIZN ':": ..... L'" '.__..REET., RNOHOR. RGE:., FIK. '~'~FI' , F'ERHZT NO. ,' E:iE~46,¢ ', DR'FE OF ISSUE :4.::~.::+: I.,.tI~RNZNG -- DUE TZ CHRNGZNG RES!L1ZREHEN'F% THZS PRINTOUT HR'¢ NDT BE :+::+::~': COPY OF TFIE ORIGIONRL F'ERHI T F1PPLI[:RNT Sh::FIGG$ CON$TRUCTION PO BO::.:', D CHUGI~K ~S56'7 6SE: 2S~:~ LOC:fiT I ON NORTHI400[:,S SUB LEGRL L~7 B~. NORTHb. IOOD SUB LOT 5;IZE 2E~E~E~E~ SC!URRE FEET TYPE OF SOtL fiBSORBTION $YSTEH IS: TRENCH HFt::i!HIJH NUHBER OF BEDROOMS = 2: 50IL RfiTING (S~;! FT/BR>= THE RD;!UIRED SIZE OF' THE SOIL flBSORPTION 5h"$TEH THE LENGTH DZHENSZON Z~ THE LENGTH (IN FEET.'.', OF THE TRENCH OR DRRZNFZELD. THE DEPTH OF R TRENC:H OR PIT ~S THE DZSTRNCE BETNEEN THE SURFRCE OF THE GROUND RND THE BOTTOH OF THE ENC:RVflTZON (~N FEET.'.',. THERE ZS NO %ET H ZDTH FOR TRENCHES. THE GRRVEL DEPTH ZS THE f'IZNZf'IUf'I DEPTH OF GRflVEL BETklEEN THE OUTFflLL PIPE RND THE BOTTOH OF THE E',:4CRVRTZON (IN FEET.'.',. BRCKFILLING OF RN'¢ S'¢$TEH $4ITHOUT FINRL INSPECTION RND RPF'ROVRL B'¢ THIS DEF'RRTHENT $,IILL. BE SLIBCECT TO PROSECUTION. H!NIHUH DISTRNCE BETI4EEI"4 R P4ELL RND RN'T' ON-SITE SEklflGE DI$POSRL S'¢STEH %88 FEET FOR R PRIN,'RTE PIELL.~ OR · 5¢ TO 288 FEET FOR R PUBLIC P.!ELL DEPENDING UPON THE T'¢PE OF' PUBLIC NELL HINIHUH DI%TRNCE FROH R PRIVRTE NELL TO R PRIVflTE SEb.!ER LINE t$ 25 FEET TO R COHHUNIT'¢ %EI4ER LINE'IS; 75 FEET. OTHER RESUIREHENTS HR'¢ RPPL'¢ - SPECIF'ICRTIONS RND CONSTRUCTION DZflGRRH$ fiRE RVRILRBL. E TO INSURE PROPER INSTR[.LRTION I CERT!F"¢ THRT &: I FIH FRHILIFIR F.I!'FN THE RE~]IUIREHENTS FOR ON-SITE SE~4ERS FIND b.tELLS RS SET FORTH BN' THE HUNICIPFtLITY OF RN[:HORRGE. 2: I 14ILL IN%TFILL THE SN'STEH IN RCCOR[:,RNCE NITN THE [:ODES. 2: I UNDERSTRND THRT THE ON-SITE SENER SYSTEN HRV REE4UIRE ENLRRGEHENT IF THE RESIDENCE IE; R~lO[:,ELED ~TQ INCLU[:,E HORE THRN ~ BE[:,ROOHS. S ! GNED: ....~&.L:~:~,~__EL__G~¢~&;/~$2 ...................... INSF'EC:I~ON N ISTOF'.'~ - SEI4ER i El SEI,.IER 2 NELL INSF' Ei HELL LOG [:,RTE E~ [:,RILLER O & E ENGYr~IEERING & DEVELOF-,41ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Legal Description: Depth (feet) Soil Characteristics 5__ 6__ 7__ 9__ 10__ PLOT PLAN 11__ 12__ 13__ 14__ 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit J'~ If yes, what depth Drain Field ~' PERC. TEST Comments: Performed b~.~{~7~, ~,~ Municipality of Anchorage Development Services Department' Building Safety Division On-Site Water and Wastewater Program .. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051L731-64 GENERAL INFORMATION Complete legal description . Location (site address or directions) # Expiration Date: Lot 17: Block 22808 Northwoods'Dr. Chu§iak, AK 9956? Current Property owner(s) Mailing address David Chattelle same] Day phone 688- 514 7 Lending agency Day phone Mailing address Real Estate Agent Day phone e Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 e TYPE OF WATER SUPPLY: ' Individual Well [] Individual Water Storage r-I Community Class ^ Well ~ Public Water System [-'1 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations 'given in paragraPh 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, STATEMENT OF INSPECTION BY *ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm s & ~ ~,,n~4n~'~n~ Address, 17034 N. EaRle River Loop Ste. Engineers Pdnted Name Robert C. Cowan 5. DSD SIGNATURE bedrooms. ~ Approved for '~ Disapproved. Conditional aPproval for bedrooms, with the following stipulations: Additional Comments ,~"?,'~'" " ~.' 'ON-SITE: ~.~ WATER AND :rn ~ .. WP,~EWA'rER : "'-- · PROGRA~ : .~ .. .. ~,, ~-/,.~ .' · · · · ' t~.~ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory. X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ,~- c~. "~-'~) L/- (Rev. 01/02) ~ Municipality of Anchorage DeveloPment ~,SerVices DePartment ' I Buildir~g Safety Division . i . . On-~Site Wate? & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 iAnch0rage~ AK 99519-6650 ~ ci anchorage ak (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~:)'T' I":?) '"'~,o,C..~: ~O'i~-T--Hv, JOOF'~ Parcel!D:,,~"/- A. WELL DATA " ~ ~ '~ ,' Well type .~d ~B, or C provide PWSID if Date completed ' Sar~itaryse/~.~(Y/N) Total depth __ .ft. CaSedy..~ fl. FROM WELL/~6G Date of test / Static water level / .= fl. Well production / ~g.p.m. · WATER SAMPLE RESULTS: / . Coliform colonies/l? mi. : Nitrate -- mg./I. Arsenic: rog J1. ~/ Date of Sample: B. SEPTIC/HOLDING TANK DATA Tank size .( O00 gal. Number of compadments ._~ Foundation cleano,ut (Y/N) "7/ _ Depression Over tank (Y/N) Date of pumping ,~-/~, /?_OOz~' Pumper ,~ ABSORPTION FIELD DATA Date installed ~ (~l Soilrating (g.~=~~/O Length ~ fl. Width Total depth 1 7.~.. Em absorption area ~ft Date of adequacy test ~/1~ '] ~4 Results (Pass/Fa,) Elapsed Time:~ min. Final fluid depth ~. Absorption rate >= Any rejuvenation ~eatment (past ~2 mo.) (WN & ~e) Well Log (Y/N) ', Withes properly prote~¥1N) CaS~ing height (a~e ground)' ',i; in. ' ' / . · Ot~lerbacteria ! coionies'il00ml. C~llected by: Date installed Cleano~s (WN) High water alarm {W~) System type ~ Gravel below pipe ~'~ fl. Depression over field For ~ bedrooms New depth / '~.~"~ g.p.d. If yes, give date :) D; ILIF,,T STATION ~a~ tel installed /""2 / Size in gallons i PM,rap on" level at "Pump off" level at ~". in. :D~tfi'm Cycles tested E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at ' " Meets aidrm & circuit requirements? .SEP~ARATION DISTANCES FROM WE N LOT ,;tS~ eptic tanldlift station on lot,:Absorp" i, !l t I" i~ : , t,on field on lot ' . '~ ' '"' i//. ' '.' II''I' !i :" ~: Public 0n adjacen! !°ts On adjacentlots - ~/sewer manhot~/cleanout/ ~ : :, P:ub?~ sewer ma,n. : "':~!wl~r/septicserviceline / ". : ! !', :Holding tank ':~./ ,: ' NK ON LOT TO: , i SEPARATION DISTANCES FROM SEPTIC/~G ' ' * ' Property line ~- ~, , ! Absorption field , Bui ding foundation ~ ~ ¢-. , ~ i'I ::~Watermain:l .~. // O r~ Water service iine "/ O ,t- Surface water Wells on adjacent lots/,'~ '!'~ ..': ' : i'; ; ,', . S, EI~ARATION DISTANCE FROM ABSORPTION FIELD., . ::~.ON LOT TO:, : Prol~erty line / ~ 4-- Building foundation' i!/,(~ .~- water main . :,; ! Water Service line /"~ .4- '.Surfacewater Curtain drain ~,~MD",~,~J ~' tdJ, Wells on adjacent F.: COMMENTS i : -r--- DriveWay, parking/vehicle storage : /' O lot?: ~ ,,. ,. ,, .......... · ,fi, ~, ": ENGINEER'S CERTIFICATION , . [, !: i : i be~ify that I have determined thro~igh.field inspections ?qd'' :: ~'gv~ew' ' ' , of Municipal. records that.the.above, systems'are. conformance w~th MOA HAA guidelines m effect on this date. Engineer s Printed Name , I'- - '~,, - Date, . ~?l:..l ~ ¥ I HAA' Fee '$ ',.Date-:iti :, il Jf ;ayment I~ I; ReCeilst Number (Rev. 12/01) ;Waiver Fee $ :i :'[Date of P~-neht i Receipt Nt~mber I in. A3UUILT-NO 'CORNERS SET THIS DATE. I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY; AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY i EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI-~ VISION PLAT. UNDER NO CIRCUMSTANCES!SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR 'FOR ESTABLISHING BOUND- ARY LINES. , . SEWARD SCALE;. "DATE:! GRID: ~ ASSOCIATES LAND SURVEYING 694-0829 ..... Name of:Firrn: ..... 17034 ArirJr~.~ t~mde ~lver. - Engine,s Signature STATEMENT* OF INSPECTION BY ENGINEER ........ ~ . ::, · ' ........ ~ ......... ' "rtifiec~"~-~ly ' afi;i~"d h reto and as ofthevalidation date shown.;b~low,, .var.!fy 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 invest, i_gation 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. .. :.' : '!* *..?"~ .iF-'' '- ~-- ':',:',:'.7':; ' ; ~ *- -.. : ....... - ,,.* ,3~,~..: ;.~'..;;:',~.;~;,~,;:~*,'.;>:!~¥'~,¢~,?: 4, ,!.,'~k~[~¢~.' ' . . .r ~- ., ~ ~ .. . .. -.~. .:> . .~.¥,:~..:, ,~.,~,: .,~. ..' ,:. .¢~...~.. ' ~* *- r ' ~ .... ., ~,, ¢. ........ r ,,."'""' ''';:>''''--'7'''%r. .... ':,,''':' "~' ~:'"i' ali ' 'off'°rage Depanment'of Health and Human Saw,cas (DH~S) ~u~ Health -. ~--~e,~3u~?? ...~. J ~:.'¢ ,'----,* ..-,- ,~ ......... ta*,~ns divan in earamraDh;'5 above 'By an *: ~' -~' -~ %~~a~ ~nr t~a State of Alaska. The DHHS does this ~ a couAesy to purchase,m of homes ~ ~ * ~ erto ~tls ce~am f~eml and state requ~remen~ ~ mploy~ of DHHS do not ~'an~t~i~iendin~ in~it~tiS~'~in'°rd ' ~ ": "":" ,. cor~ " ' ' . a ze data before a certflcate s ssuecl. The Mun?pahty~of Anc;,h. orage ~s not 'r' bct nspectons or an y ~ , _ , . , . ~. ~ :~., , . ...~,. ~, , ,, ..~ .:;: ~... -. - , : ,- ..._, , -~., .... · Municipality of Anchorage '~i~-DE~ARTMENT OF HEALTH & HUMAN SERVICES ":~ '' ~ Environmental Services Division 825"L" Street, RoOm 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: ~ A. WELL DATA Well type A Log present (Y/bi) Total depth /b"// Sanitary seal (Y/N) Health Authority Approval Checklist ~ i , /bI°~' ~'~'~;-2~'J~:.~£///~ Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to .4//,4 Casing height (above ground) ...4////~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production fi.';///~ g.p.m. ?b~./'// g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /e//.~ Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed o/-~-'oP' / Tank size/~ ~,aq 5.~ / Number of Compartments __ Cleanouts (Y/N) ',y' Foundation cleanou, t (Y/N) ~ O Depression (Y/N) .~ c2 High water alarm (Y/N) Date of Pumping ~"/q/c73'~ Pumper c,,'--~', ~ C. ABSORPTION FIELD DATA '~ ~ Dateinstalled 0/'~ ~3~ F Soil rating (g.p.d./fl2orft2/bdrm)'~/~Yf~/: Systemtype Length ~(9 ~ Width '~ / ' Gravel ttfickness below pipe Effective absorption area c~c9~7~;ff Monitoring Tube present(y/N) Date of adequacy test d~ L./~/~ ~,_{-- Results (Pass/Fail) /o o~r~c' For --~ bedrooms Fluid depth in absorption field before test (in.); o/'0/ ' / Immediately after9'?& gal. water added (in.): ff/ ' ' Fluid depth ~.f~ Minutes later: -~--~d'~ '¥ (in.) Absorption rate = - ¢.5-7.9 3- g.p.d. Peroxide treatment (past 12 months) (y/N) ,,~ '~ If yes, give date ,4'5/-/-/ Do mo LIFT STATION Date installed /t//// Mauhole/Acccss (Y/N) /~ High water alarm level at* /~;'f/'// Cycles tested /~ (/// SEPARATION DISTANCES Size iii gallons ~'Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tattl< on lot Absorption field on tot Public sewer mare Sewer/septic service line "Pump off' level at* Driveway, parking/vehicle storage area Wells ou adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal re~ i~ve systems are in conformance with MOA It~ ~uid~s in effect on this date. Signature :~~-~ ................................................................................................ ~ .-c~w ;~ ~, ~ - - - - ,.,. ~% ~;,~ -~ ............. HAA Fee $ ~ ~) ~) Waiver Fee $ Date of Payment ~' ~-/7~ ~ ~ate of Payment Receipt Number / ~/~) (;g ~ ~) Receipt Number Rev. 8~95 eSS: haa,wk.doc SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /dj </ Water ~nain/service line Surface water / Curtain drain SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ,~r~ / ~ './~' Property tiue ~dY //~ Absorption field__ Water mairffservice line 8////<' Surface water/drainage /~c~ '~- Wells on adjacent lots ,/6//// ; On adjacent lots : On adjacent lots Public sewer manbote/cleanout Lift station MUNICIPALITY OF ANCHORAGE O ~-~ / DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner /~"~', ,~4)'/x//~' Telephone: Home Business Mailing AddreSs ~. O,/~r,,/), 1~/~ 6 (c) Lending Institution ~ ~'~/~,~ Telephone~/7~/~/ Mailing Address' '~/ ~ ~ ~/~ ' (d) Real Estate Company~nd Agent =/~/ ~ ~~'~/~ ~'/'d~ Address Telephone ~' ¢ ~/-~d~ (e) Mail the HAA to the foflowina address: or: Check here ~if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~r,, Number of Bedrooms .5, WATER SUPPLY Individual Well [] Community,~ Public [] 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 I of 2 72-025 fRev 8f86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,/~-?--'-.~ Telephone --~'-~'/~'~-'~ Address /~ //ti .~.3'~ /~'~o Date / ~/-'~ ~"~ DHHS APPROVAL Approved for/~'-¢-,¢-~-~'~ bedrooms by Approved ,~/~-,,._ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 iRev 8'861 Back WELL DATA U~C~AL~I~ ~ ~c'- ~ ~ ,~A~S~. -~IClPALITY OF ANCHORAGE (MOA) ~v.O~w'~ HEALTH AUTHORITY APPROVAL (HAA) ,x~;.~ ]. ~ ~?o~ CHECKLIST- FEBRUARY ..... 26~-47~4 Well Classification ~--~¢)c/M 10 B, C, D.E.C. Approved ~N) og Present (Y/N) Date Completed Yield Total Det;~___ Cased to ___ Depth of Grouting __ Static Water ~ ..... Pump Set At __ Cas'rog Height Above '~t~____ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (YTN),..,~____ Depression Around Wellhead (Y/N) Separation Distances from Well: ~ To Septic/Holding Tank on Lot ~ ; On Adjoining Lots __ To Nearest EdgeofAbs roption Field onLot ~Adjoining Lots __ To Nearest P~er Line .__To Neares-t"Cq~c Sewer Cleanout/Manhole ~arest Sewer S~,c~ne on Lot Water Sample Collected by ; Date ~ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes~N) Air-tight Capsl~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holdin/g Tank: To Water-Supply Well Size /¢,d~ No. of Compartments Foundation Cleanout (Y~) Date Last Pumped /-//-~"~' /$~'~'~ · ~,/~ ;for Temporary Holding Tank Permit (Y/N) To Property Liqe /o To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page ~' of 2 72-026 fRev 8/86~ Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design _ Length of Field ~ Depth of Field /~'" Square Feet of Absorption Area Depression over Field (Y~_.~ Results of Last Adequacy Test Gravel Bed Thickness Standpipes Present~N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ '~ To Building Foundation ~7 Lot ¢0/~4 To Water Main/Service Line /O/'¢' 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 /O To Cutbank (if present) Comments D. LIFT STATION High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Ad Pumpthg--C4/-. ~l~s during equacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha_v~ chc. cked,p'erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .¢~2---~ .~///~ ~'/~,/~_.__ /~/,~ .~/~, Date Company /¢~' MOA No. Receipt No. ,¢'/~_~ C_~ ./ d'~ ~-J ~ ,,..3 Date of Payment ___/ Amount: $ ._~..¢~_~_), d) ~ Page 2 of 2 72 026 fRev 8861 Back 3601 "C" STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: PWSID #: January 13, 1988 213001 To Whom It May Concern: According to the records on file in this office, the NORTHWg~J__ CHUGIAK UTILITIES Water System is in compliance uith the State of Alaska Drinking Water Regulations. Sincerely, /~Ronald S. Klein Environmental Field Officer MUNICIPALITY OF ANCHORAGE ENVIRONMENIAL SE[~VtCES DIVISION :CclVED ~'r MUNICIPALITY OF ANCHORAGE ~,~.~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH INSPECTION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE OF OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or direction,s) Applicant Name /~,,-'7~Y~- ~- ~".x..¢C.H' Telephone: Home /-P~- ~7/¢¢Y Business Applicant is (check one): Lending Institution E~; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Telephone ~ Address (e) Real Estate Company and Agent t~/~-~-'! ~-'~ ~ / /~- /~/d~ Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING ...... ,~ o~ Loop Road 17u.~'* ~ ..... Eagle River~ Alaska 99577 TYPE OF RESIDENCE Single-Family E~ Multi-Family [] Number of Bedrooms --~ Other WATER SUPPLY Individual Well [] Community ~.~ Public~. . Note: If corn munity well system, must have written confirmation from the State Department of En'viron mental 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 I 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 Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ....... Address ,.~n~/t ~:~te River Loop Road No. 204 Telephone DHEP APPROVAL Approved for ./~,'~,.4~_~bedrooms by _ ~ _ . _ Approved /"'/'~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. ']-he 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 72-020 (11/84) ENViRONME~ITAL SERVICES DIVtS!OF,I IVlAR 5 ! 1987 'IVI.SION RECEIVED RECEIVED A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~-,. ~T If A, B, C, D.E.C. Approved &N) 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~'"/~ /'~'~ Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ;:On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes CN) Air-tight Caps CN) Depression over Tank (Y/I~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size ¢'oc.~_~ No. of Compartments ~- Foundation Cleanout (Y~..~ Date Last Pumped ._~- ~ ,¢.-~!~ c-¢. ~ ;for AZ'//] Temporary Holding Tank Permit (Y/N) /V/~ (0 To Water-Supply Well To Property Line To Water Main/Service Line Course *'k//~l t To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/841 ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~. /~ Date Installed ~ ~ ~" ,~/ Width of Field ~'~-~'~ Square Feet of Absorption Area Depression over Field (Y~N~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation 25`/ Lot Gravel Bed Thickness ~c~c'/~ L/ Standpipes Present¢/N) Date of Last Adequacy Test To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field / To Property Line f~'-/ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) 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 HAA guidelines in effect on the date of this inspection. Signe~& $ ~_N~INE[';RING Date ~2_ ~;..o ~ ¢¢ ~') C~ ~ ~1~7~Q~4 Eagle River Loop Roacl No. 204 Receipt No. ~-- ~ ~ //- 6~' ~ 0 Date of Payment '~' - ~ //-- ¢~r.-- '~ Amount: $ ,/~9 ¢) Page 2 of 2 72-026 (11/84) DEPT. OF ENTVIRONM~NTAL CONS£~VATION STEVE. COWPER, GOVERNOR Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 DATE: March 12~ 1987 PWS I.D.~ 213001 To Whom it May Concern: According to records on file in this office the Northwoods Water Regulations Chugiak Utilities/ Water System is in compliance with the State Drinking Sincerely, Regional Sanitarian Supervisor MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name Applicants Address (c) Applicant is (check one) Lending Institution Buyer ~ ; Other~__~ (explaln); (d) Lending Institution Address Telephone - Home Business ~ ; Owner/builder~ Telephone (f) Mail the HAA to the following address: 2. Typ~ of Residence Single-Family- Number of Bedrooms 3. Water Su~- Individual Well~-'~ Multi-Family~ Other (describe) Note: if community well system, must have written confiz~ation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal. Onsite~ Publico . Community~ Molding TapA~ 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] ~n~ineerin8 Firm Providin~_Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date showa below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein° I further verify that, based on the information obtained from the ~nicipality of Anchorage files and from my investigation and inspection, the on-site ~mter supply and/or ~rastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. ! Telephone Name of F~r.m~~.~; .... Address t,~ ~ ..... .~'~ "%' -- ~_ ~r ~, , -./ ./ ~ . ~no ~s~~ ~ Approved for ~ bedrooms By~~ Approved ~ Disapproved ~-- Condition~ ~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH A~D ENViRONb~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFES'SIONAL 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 ~TATE REQUIRE- M~NTS. 5MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE M/INICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ae WF,,'[.r. DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (gA_A) CHECKLIST - FEBRUARY 1984 Cased to MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION rg U L 9, '7 1984 .R V ED If A, B, or C, D.E.C. Approve ) Date Completed Yield Depth of G~outing_ Pump Set At Casing Height~. Above Grcund. Sanitary Seal on Casing (.Y/N) Electrical Wiri~g-.in Conduit '(T/N) ,] Depression Around Wellhead (Y/N) Separation DistanCes f~om We~l- ''~ To Septic/Holdi~'gJa~J~ on IJot: '~o jL/LO%~.. /'1~'; TO Nearest Edgb !;o~..Absorption Field on ~ ; On Adjoining Lots To Neares~ Public Sewer Line "-~"~~ To Nearest Public Sewer Cleancut/Manh01e'i'~,'. '"' To Nearest Sewer Service Line on Lot Water Sample Collected By' ; Date Water Sample Test Results CQt~nts Be Standpipes ~/N)~'/' Air-tight Caps ~) Foundation//Clean°ut (Y~ Depression over Tank (Y~? Date Last P~d/__ r~/~.5-~/~ Pumping/Maintenance Contract on File (Y/N)~/~--.; for Holding Tank High-Water Alarm (Y/N)~ Temporary Holdirg Tank Pe~'mit (Y/N) /~/~-- Separation Distances frcm Septic~ Tank: To Water-Supply Well To Property Line To ~ater MaiQ/Service Line Course . To Building Foundation ~.~%-~7~ To Disposal Field /~ / To stream, Pond, Lake, c~ Major Drainage [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~//~/. Width of Field ~ ~ 2 tO v/~>/z~ Type of System Design , ~ngth of Field ~p~ of Field /~.. Grail ~d Thick,ss Square Feet of Absorption A~ea ~)~Q ~? Standpipes lhresent ~/N> ~p~ession ove~ Field (Y~ ~te of ~st A~qua~ Test Results of ~st ~equa~ ~st , ~-?LF:~ ~_~.. Separation Distan~ f~ ~sorption Field: To mte~-Supply ~11 ~/C -To ~o~ty Li~ ,/O To Buildin~ Foundation ,~_~/~ To Existing or ~ndo~d System Lot ; ~ ~joining ~ts .~ ~ To Wate~ Main/~vi~ Line ~ T© Cut~(if~ p~e~nt) TO Stre~ond~ke/~ ~jo~ ~aina~ C~se / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High k%ter Alarm Level at Tested fo= Electrical Codes(Y/N) Conments Dimensions Manhole/Access (Y/N) "Pum~ Off" Level at / Vent (Y/N) ~ .~cles du~ing Ad. equacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformad to all MOA HAA in effect on the date of this inspection. C~any ~ KB1/dL/s [Page 2 of 2] 2-15-84 DEPT. O~ ENV~BO~EN~/~L ~@NSE~V/~T~ON SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 SHEFFIELD, GOVERNOP~ Telephone: (907) Address: 274-2533 To Whom It May Concern: r~,isg to records on file in th ~ Water System Water Reg~lat~ s in compliance with the State Drinking Sincerely, ~;~ .,_j DA, j. AECEIVED INSPECT'ON APPO:NTN~ ENt~S LA TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR.-. MUNICIPALITY OF ANCHOI~AGE MUNICIPALITY OF ANCHORAGE DEPT. OF'F',:.'-.L]H &  DEPARTMENT OF HEALTH & ENVI RON~ENTAL PROT~Nh~Fiq  ~ ~ A_ P~OfECTION 825 L Street - Anchorage, Alaska 99501 ENVI RONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S S DIRECTIONS: Complete all parts oe page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing. PHONE MAILING ADDRESS PHONE PROPERTY RESIDENT (If different from above) 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ] PHONE MAILING ADDRESS 4, REALTOR/AGENT [ PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION Z- n /7 t z_ I /'1/: ;, t) STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7, WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well 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 RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY [] ONE ~THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED ~ PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I~INDIVlDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTILITY Connection Verified INSTALLER ~JSeptic Tank or ~ Holding Tank Size: Ib) Of-~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line Nearest Lot Li~ WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~¢d~PROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY DEPT. OF ENVIRONMENTAL CONsERvATION SO UTHCENTRA L REGIONAL OFFICE JAY S. HAYHOND, GOVERNOR 437 E. STREET SECOND FLOOR ANCHORAGE, ALASKA 99501 (90?) 2?4-2533 P.O. BOX 615 KODIAK, ALASKA 99615 (907) 486-3350 P.O. BOX 1207 [] SOLDOTNA, ALASKA 99669 (907) 262-5210 P.O. BOX 1709 [] VALDEZ, ALASKA 99686 (90?) 855-~698 P.O. BOX 1064 [] WASILLA, ALASKA 9968Z (907) 376-5038 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH ENVIRONMENTAL PROTECTION August 7, 1981 Ralph Strickland AUG ? 1981 A. D.H.E.P. Pouch 6-650 RECEIVED Anchorage, AK 99502 SUBJECT: Northwood S/D As per our phone conversation on 8/7/81, this Department has approved construction of a storage reservoir, pump house, and supply pump system for the Northwood subdivision.' These improvements will meet our requirements for supplying water to the 97 home subdivision. If you have any questions, please call me. Thomas L. Murrell Environmental Engineer TLM:jt Enclosure cc: Ralph Jokela Contracting Engineers & Assoc. 212 E. International Airport Rd. Anchorage, AK 99502 18-09LH 825 "L" ,>1 ,,It-:,.:-! ANCHORAGE, ,':-~LASI(A 99501 (907) 2644111 GEORGE M. Z~Ut_LIVAN, MAYOr~ I)EPAR IM~NT ,L)F HEA[.I-H ANI-,'- E~'qVii~ON~',IEI'~!'I-I',I Pi~,O Fi}C~rl£)fq June 18, 1981 Keith Swanson, Britton Crosley Clyde Sherwood, ¥okio Imada George Wilmouth NORT~OODS, INC. 308 G Street Anchorage, Alaska 99501 Subject: North Woods Suod~v.:[~]_on As of this date, this department has issued forty-six(46) on-site sewer permits for the subject subdivision. According to the State of Alaska¢ Department of Environmental Conservation, the water supply is approved, at this time, for seventeeen(17) connections. This department has issued eight(8) health authority approvals to various lending institutions~ Until. we receive approval on additional eonnections for the subject w~ter supply, this department cannot issue any more health authority approvals other than the seventeen(17) already~Approved by the State. If there are any further questions, please c~ll this office at 264-4720. Sincerely, Robert C. Pratt, ASsociate Specialist RCP/ljw SUBJECT Nor thwoods Subdivision NIESSAGI~ Per DEC, as of this date, Northwoods community well s~stem is approved for seventeen(17) connects. Information received from Mike Matthews over phone. SIGNED Laura J. Ward Senior office Assistant REPLY SIGNED DATE ,/ SENO PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. ~Tg~]~ 4S 472 CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT ~ Plans for the construction of ,'~ ~ ~i',i ., by /"'.- public water system located _, Alaska, submitted in accordance with 18 AAC 80.100 have been reviewed and are ID; approved. [] conditionally approved (see attached conditions). DATE TITLE bY If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS. Approved by Date Change (contract order no. or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE ~.. ~ i , / ,r ~ public The construction of the /'¢; '.' ~"~ ; water system was completed on I ~ ~' ;? L.; /¢~('~ (date). The system is hereby granted interim approval to operate for 9¢0 days following the completion date. ~ " , / r~;' /,~) ''' '" ' ' ' ' /l/"' > .... DA~E As-built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. DATE TITLE BY