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Home My WebLink AboutNORTH WOODS BLK 1 LT 19t • �� i 1'! Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221317 PID Number: 051-731-62 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New M Upgrade Name MICHAEL KIMBALL C/O ARM SEPTIC SERVICES A ORPTION FIELD ❑ De Trench El Wide Trench El Bed Zound Site Address 22844 NORTHWOODS DRIVE, CHUGIAK, AK 99567 Other Phone Number of Bedrooms Soil Rating depth f r original grade 907-688-9433 3 /SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Ft. Subdivision Block Lot NORTHWOODS 1 19Fill added above original gr Ft. Gr I length Ft. Township Range Section - - Gravel width Ft. Beds: Number of Lines - Dist a between lines Ft. SEPARATION DISTANCES Tol Septic Absorption Lift Station Holding Sewer Total - orption area Number of trenches Dist. between t ches From Tank Field Tank Line Ftz - - } Well N/A _ _ _ _ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer INFILTRATOR SYSTEMS, INC Capacity 1 0 0 0 Gal. Surface Water ' 100 + EXIST. _ _ Material Number of compartments Lot Line 5'+ EXIST. - - NA PLASTIC 2 Foundation Q'+ EXIST. - _ L�' TION Manufacturer Capacity Remarks REQUESTING UPDATED SURVEY BE WAIVED Gal. AT THIS TIME. Alarm location Electricarlled by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer ARM SEPTIC SERVICES Drainfield EXISTING co/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspection1.1 10/4/2022 Location and description dates:2nd 3`d - 4w _ GARAGE/SHOP DOOR THRESHOLD ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp oo6�p � 0 0 F..: Conditional Approval: Date �� IS,4p Do off. 4 T� .v0 �........................... �......... 00 fess. p0 Q 9 •. CE 7953 �p PO *...!P. Septic System Approved Date VA/21Z 3 % Note: this approval does not include well permit requirements.AE�� ofe s0 kmev UO/Uzi 10) PERMIT NUMBER:/� n / PARCEL ID NUMBER: DRAWING RECORD ®�NG 051-731-62 n\ // 6. 713 KEY BOX LOCATION PER AWWU RECORDS DBL2 3.3 20.1 rQ / DBL2 355.9 21.1 QJ / 35. 23.7 ST ST1 35.55 30.0 4/ ASSUMED WATER NORTH WOODS SID; DBL3 39.1 28.8 SERVICE LINE LOCATION BLOCK 1, LOT 20 O \ , DBL4 40.0 28.8 /( C01 45.5 29.3 \ MT1 48.4 32.8 \ LL ; NOTE: OLD SEPTIC TANK WA DECOMMISSIONED PER UPS C NOTE: PIPE LOCATIONS ARE \� PER THE CONTRACTOR. SHOWN PER GEG SHOTS jY J TAKEN WITH LEICA DIE TO , S910 LASER DISTANCE NEW IM -1060 INFILTRATOR METER. SWING -TIES TO Y SEPTIC TANK HOUSE CORNERS WERE / \\ \ GENERATED INAUTOCADj = q9L \ o�Rw\�\\ EXISTING \\\\\ X S I FI �\ 3 -BEDROOM E I TING DRA N ELD , / HOUSE o \�\ o `. GRAVEL ......:.. UM yd , GARAGE/SHOP INSTALLED DOUBLE / CLEANOUTS (DBL3 & DBL4) INSTALLED DOUBLE CLEANOUTS (DBLi & DBL2) N j SCALE: / 1" = 40' NORTH WOODS S/D; BLOCK 1, LOT 18 i \ ( . LOT 3, \ \ NOTE: ALL PROPERTIES IN NORTH WOODS SYLEASUBD S/D ARE SERVED BY AWWU WATER. % Al. NO \�5� / 1 ENCROACHMENT NORTH WOODS S/D; CONCERNS BLOCK 1, LOT 17 \ , LOT 4, 1 SYLEA SUBD ` \ \ 41* ShCROACHMENT 1 CONCERNS ONA x ®�� o®® AF 1 E u 9L ®. ENGINEERING SALES CONSULTING - ... ..r,. _... , .e 3701E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA -PHONE (907) 337-6179'WEBSITE. �.gamessenginesringmm ai.,r...• t •••.•••.•.........•..... ..0 PREPARED FOR: MICHAEL & TAMMY KIMBALL PHONE NUMBER: PAGE NUMBER: arnBSS H C/O ARM SEPTIC SERVICES 907-688-9433 2 OF 3 ®0 : CE- 95 PROJECT/LEGAL DESCRIPTION: DRAWN BY: J �14 NORTH WOODS S/D; BLOCK 1, LOT 19 J.L.M.•'......•.••0 ,•�\�� TYPE OF WORK: DATE: �P4LIC NEE "/pOFFS@a1 RECORD DRAWING OF SEPTIC TANK UPGRADE 10/12/2022 #AECC884 d� PERMIT NUMBER:/� t /� PARCEL ID NUMBER: OSP221317 RECORD DRA V INN 051-731-62 TOP OF MANHOLE = 100. TOP OF TANK @ INLET = 96.26— INVERT OF PIPE @ INLET= 95.69 J FINAL GRADE = 99.50-100.25 •2" OF INSULATION PER CONTRACTOR IM -1060 INFILTRATOR PLASTIC SEPTIC TANK TOP OF TANK @ OUTLET = 96.24 INVERT OF PIPE @ OUTLET = 95.46 ®lo:,ol®I&TA'rVi"it 1114b 77 7�.10 � I. INS GROUP Ltd..... 4 ........... .... .......� PREPARED FORENGINEERING {AEL $�UITAMjVjY KIM$/�LL -PHONE PHONE7)337-6179 NUMBER; WEasi7E: �.gaP_AGENUMBER: ' iNEERIN ti AES CONSULTING G � E. TUDOR ROAD, TE 101 *ANCHORAGE. ALASKA 9.wm 0��....i ............ ........... 10 ,,,, BER: e e Gar ess ��CCov C/O ARM SEPTIC SERVICES 907-688-9433 3 OF 3 �A % CE -7953 ®S� I % PROJECT/LEGAL DESCRIPTION: DRAWN BY: ®� •, NORTH WOODS S/D; BLOCK 1, LOT 19 J.L.M. �� D p'"••• •• •'' p�, ®� TYPE OF WORK: DATE: LICENSE ��14 RECORD DRAWING OF SEPTIC TANK UPGRADE 10/12/2022 sAECCesa Sonia Blewett From: Townsend, Curtis L. <Curtis.Townsend@anchorageak.gov> Sent: Thursday, March 9, 2023 2:00 PM To: Sonja Blewett Subject: OSP221317 NORTH WOODS BLK 1 LT 19 The IR has been reviewed for this permit. One question: Was 5' maintained between new tank and existing field? Upo 'iii c_ca �,� „d Curtis Townsend, PE�� '�S iiG— C✓aS Onsite Water and Wastewater � J �� Municipality of Anchorage 907-343-7908 # 3/53/2z I j3/2z- i 00 c \ 896 \ > -2,= 04 2 v V1 �• i+ \ } Op CO E s a � -0 o �j� Li m N o0 N w o¢# \ w1-0 N can@ N sSL \ `n 0 a an z2wiz' a O ^ �o ^ti P:j+ Zom\ N ��aLo v O W / a Z m C .y ��• N 0x V�Q . y a�\ w.0 CO vii f9 go O Odd o E 'Cu- \ 0M C o a O a �v) cr LL �� F��a, O g h a s o °�,ag 0 u cr Z'0 o f , \ ��,, iwo m m v I (D�r� >s�b ` m CO�ac��s 16 O O d c ryb`L' + N N 04 N \ �S`e m y o UN) 2>!N (� m0 rn aai moo to oE en .L m .20 a m= m Z 0 0 s v Q" 9 hh Y = � C' a° N o m - O mai 8L 5 LL CL �tm�m Yp �m (L Y O N N F a c C _C o \ Ga ti OZ hp -p N c u a d >, c L :' p u M \\ �ry ry�h Oc` v v J Lu > a O aQi v °c' r =m c �--{ v O N \ Z8Z c7 O� O F" UJ n c N °' a� L a vi oaj > N ��S \ Mry 9 y0� o<J (moi) Cc: �E@c`�ow a. V 05 0 cu ,�., > > :3 Z )jam \ c1 N, a E==co m on2 ; so0d N tli • \ _ £O2 h= s9[ ^ 9 ¢ StL °� C w C 2 o E V w ui o �L a � c tin y ._ c a v i + ` � e O in n ami s N a v f7p .F.r v N CD r 3 d Q s ni 0 U- CL U .-. o a a c v u ° 1� n p O Ln tK J O N m 17 I- w in c a o cu 16 E cu 47 y O S O\ P: ' a Y v m �N �Q• w ��0� OO ashy Q. \ �' cu �.°- (D N C /tz � • CF) c-, • J / J OffLL. 0'! /�• .� N•zI z �W O)m O y 00.S Z • O CL m O \ v m o Z v .Q . E s L.i N \ pyo \ w t7 v°�i c N E < n. \ ' 1!�% 0 � 04 ri v MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program p0Box 1yosso 4rooElmore Road Anchorage, Alaska nss1o'omm Phone: e04 pax�(sor)a4a-7oor Permit Number: OSP221317 Work Type: SopUoTunkUpgnade Tax Code Number: 05173162000 Site Legal Address: NORTH WOODS BU{ 1LT19 G1459 Site Mailing Address: 22844NORTHVVO0DSDR, Chugiak Owner: KIMBALL MICHAEL Design Engineer: 8ARNESSENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 8/21/2022 8/21/2023 0Disposal Field RI Septic Tank 171 Holding Tank El Privy F1 Private Well 11 Water Storage All construction shall boinaccordance 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 VVautemmta/ Disposal Regulations (18AAC72)and Drinking Water Regulations (18/AC80) 3. The wastewater code requires inspections during the installation. The engineer shall notifythe Development Services Department per AMC 15.85.Provide notification bycalling (A07)343-7SO4CZ4/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Speciat Provisions: Locate the beginning of the field prior to installation to confirm that the 5' separation between the tank and field will be met. Install a cleanout or monitor tube so the field can be located in the future. Received By: Issued By:' -'-L,,4 3 Development Services Department P p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-731-62 Property owner(s) MICHAEL & TAMMY KIMBALL - C/O ARM SEPTIC SERVICES Day phone 907-688-9433 Mailing address 17933 OLD GLENN HWY, CHUGIAK, AK 99567 Site address 22844 NORTHWOODS DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS; BLOCK 1_,_LOT 19 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank Q UpgradeX (w/wo AD U) Holding Tank El Renewal Renewal ❑ (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 9 ), 5 Waiver Fees: Date of Payment: 01/8/Zz Receipt Number: Oy q 5ti G Permit No. _ o S P 3 1 7 Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221317, Deb Wockenfuss, 08/21/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221317, Deb Wockenfuss, 08/21/22 L.~- 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 PHONE [~]UPGRADE NAME MAILING ADDRESS 5/ /9/3 x 7P-Po LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer Liq., area Dwelling~ / Inside length NO, OF BEDROOMS PERMIT NO. No. of compartments. Liquid depth IF HOMEMADE: Well Dwelling PERMIT NO. DISTANCE TO: Manufacturer I Material Liquid capacity in gallons I Foundatio~..~.. ! Nearest ]ot lin2~ Total length of J~nes I Trench width ~ ~"~ J 3~ inches Material beneath tile~ ~ ~ inches DISTANCE TO: ,o.o, lines / ILengthofea~,~l[~e Top of tile to finish grade Length Width Depth PERMIT NO..~/ Distance between Ii Total effective ~s~.r. 4Pt.~ area PERMIT NO. of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Depth Driller PERMIT NO. Sewer line Building foundation DISTANCE TO: OTHER PIPE MATERIALS ¢ SOiL TEST RATI INSTALLER REMARKS ITotal effective absorption area Nearest lot line Distance to lot line Septic tank Absorption area(s) APPROVED I 7~'~3 (~e~3/78) DATE /7 LEGAL PERMIT NO. RF'PL I CFtNT LOL-:FtT I ON LEGRL KEN E:EST L t9 B t NF~RTHHOL-C:,S S,-"D DEF'RR]"MENT ': HEFIL, TH FIND ENViF.:ONMENTFIL,.~,,ROTECTION :_-]25 :;"L'<'' L'-;TREET., FtNCHORFIGE., FtK. 264.-47291 SF'.R E:O::':', 78-B 9B507 LOT SIZE ¢' - "" "- "" FF EN _.H T'¢F'E OF :,UIL RE:SORF'TtON .:,T_-,TErl I2';' ' ' " MR::.::!MI_IH N.IHBER OF BEDROOMS SOIL RRTING ,.'.'SQ FT, BR.. = ,= ..... THE REQUIRED SIZE OF THE SOIL. RBSI]RF'TION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [:'RRINFIEL. D. THE DEF'TH OF R TRENCH OR PIT IS ]''FIE [:,ISTFtNCE BETHEEN THE SURFRCE OF ']''HE GROUND RND THE BOTTOM OF THE EXCRVFtT!ON (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRR'v'EL DEPTH IS THE MINIMUM DEF'TH OF GRR',/EL. BETWEEN THE OUTFRLL PIPE FIN[..' THE BOTTOM FIF THE EXCF%,'RTION (IN FEE']'). F'ERMIT RF'PL. ICRNT HRS THE F..E_-,F_N=,IBILITT Ti] INFORM THIS DEPRRTMENT DURING 'THE INSTRLLRTION IMC, F'E-TIFN'-] OF RN'¢ [,.ELL=, RDJFICENT TO THI:~, PRF~F'ERT¥ RN[:, THE N. UMBER OF' RESIDENCES THRT THE WELL WILL L=;ERVE. Ti--~ C~ ,:"..'.-?' ::* :I i~-.1 :. F EL:T :I a I'-.1 :. IF~ F..':E F~': E 6:~ LI :[ 8RCKFILLING OF RN'T' :,T:,]EI'I HITHOUT FINFtL INSPECTION RND HP'bK_,nu BY THIS DEPFiRTMENT WILL BE SUBJECT TO F'RFISECUTION. MINIMUM [."IS].'RNCE BETHEEN R HELL RND RN"t ON-SITE SENFIGE DI-:;POSRL S'¢STEM IS tEtEl FEET FOR Fi PRI'v'FtTE WELL OR 2LSF'I "FO 200 FEET FROM R PUBLIC WELL [DEPENDING UPON THE TYPE OF F'UBLIC HELL. MINIMUM DISTRNCE FROM FI PRI'v'RTE HELL TO R PRI'v'FtTE SEWER LINE I':-.; 25 FEET RND TO R COMMUNIT'¢ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MR¥ RPPL'T'. SPECIFICRTIONS RND CONSTRUCTION [."IRGRRMS RRE RVFtILRBLE TO INSURE PROPER INSTRLLRTION. F"EF-:D1 X T E:~::P ]: F-:E'--=; [:"EE:EI'"IE:EF-: Z::i.- I CERTIF9 THRT 1: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE ':;EWERS RND WELLS RS SET FORTH BV TNE MUNICIPRLIT'r' OF RNCHORRGE. -2: I HILL INSTRLL THE S'¢STEM IN RCCORDRNCE HITH THE CODES. ~:: I UNDERSTRND THRT THE ON-SITE SEHER S'¢BTEM MR'¢ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDROOMS. ............................................... ¢:. RF'F'L I CRNT KEN BEET ,-,- ',,", [,-TE L/ &/ I:,:,UE[. E r .................................... :M __:__L% .......... MUNJC[FALIIY UP AINbHUKA~ ,, ~-£-,~ Departmen~,'f Health and gnvLronmentai'Protection , 825 L Street, Anchorage, AK. 99501 264-4?20 * * * HANDWRITTEN pERHIT * * * ~~5/(:~R~'-eN-SITE SENER PERMIT Applicant: /~ ~ Mailing Address: Location: ~~ ~~ Phone Number: Legal Description: ~/~ '~/ size: Type of Soil ~sorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH ~ LENGTH ~} GRAVEL DEPTH /~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~C} GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days o.f the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if t~' nymodeled Signed: Ap~plica~~ tO include more that 3 bedrooms. Da te: ~Z.~.//~ / SWP/024 (1/81) ' o O:'"& E ENGYNEERING & DEVELOPMENT CO. Box 90. Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oysler 694-2774 Performed for: L,e,gal Description: Z~- ¢~7" Depth (feet) 0 1 2__ 3__ 5__ 7 8__ Earl Ellis SOIL LOG 688-2280 Name: Mailing Address: Soil Characteristics Ground Water Encountered: Yes /,~ No Proposed Installation: Seepage Pit Drain Field Comments: PLOT PLAN Pedormed by: PERC. TEST If yes, What depth DEPARTMENT OF HEALTH & HUMAN SERVICES . - ' ' Division of Environmental Services" On-Site Services Section _~'* .'~-*:~-' P.O. Box 196650 Anchorage, Alaska '99519-6650 ...... 343-4744 .: .... :-',,.-: ...... ' . - -.~ . ". '"..'_. CERTIFICATE OF HEALTH AUTHORITY ': ....... APPROVAL FOR A SINGLE FAMILY DWELLING :-'::: -'- ~ ' ..... "~ Parcel I.D. # ~-~ I ~rT~l-~:~°~ NAA# 1. GENERAL INFORMATION .. ' .' .' .... :' Corn Plete legal description b19 B1 North Woods-'$/D Location (site address or directions) 22844 ~ Norbhwoods Drive Property owner Mailing address Lending age, ncy Mailing address Agent Kathy-ReMax Address Michael Gatti Day phone 688-2970 HC80 Box 7529 Chugiak, AK 99567-9803 Day phone - Day phone 694-4200 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 State ADEC attest- ~ng to the legahty and status of system .... · ........ . 4. TYPE OF WASTEWATER DISPOSAL: . .' · ... .~ ~:, ..: --, -.. ndwdualon-slte .... ::~;~,~.~;~ ~.=-~ ~,~-~ ,--..~- ~ ~ ,, . Holding tank . ' .... ~-S te ....... NOTE: If communi~ wastewater system, provide Wri~en confirmation"from State ADEC and s a Us o 8~esting to' the STATI='MENT OF INSPECTION BY ENGINEER ::-:' ',: .' :-:' ~ ~. ' * AS certified bYmy 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 inves.tgqati0n 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 $ & $ Enq±neer±nq Phone · 694-2g?g Address 17034 North Eagle Ri,ver Loo~ Eagle River, AK 99577 " Engineer's signature /-'//-/ _ . _, __ Date DHH8 SIGNATURE Z' . *Approved for 3 Disapproved. Conditional approval for bedrooms. ":'~.~ '/'. "Z '~ '" :-;~ "<-~. r'~,,~'.,~-*.., ........ ...,-.~-*...' , .......... o,,....~' ~- ' b~rooms, with the followino stipulations: Additional Comments %.:, ~he ~n~ipali~ ?(Ahchorage DepaAment 0f Health and Human Se~ices (DHHS) i~ues Health Authori~ ,,'~fiApproval~:ertif~c~b~~ 5as~ only upon the represen~tions given in paragraph 5 above by an independent 'p~ofe~onal e~l~r ~ister~ in the State of Alaska. The DHHS does this as a cou~esy to purchasem of hom~ and their ending restitutions ~n order to ~tis~ ce~ain f~era and state requ rements. Emp oyes of DHHS do not conduct inS~ctions or anal~e data before a ce~ificate is i~u~. The: Municipali~ ~f Anchorage. is not responsible for errom or omi~ions in the profe~ional engine,s work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type A.. Log present (Y/N) Total depth Sanitary seal (WN) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/h~tank on lot ~ ~ -V Absorption field on lot Driller Casing height// Wires properly protected (Y/N) AT INSPECTIO~/~ Public sewer main Sewer service line Date of sample: .g.p.m. ,~On adjacent lots ~;On adjacent lots Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Collected by: B. SEPTIC/I ;CL--DtNG TANK DATA Date installed Cleanouts ~N) High water alarm (Y/~_ Date of pumping / ~ SEPARATION DISTANCES F OR~M SEPTIC/~ TANK TO: Alarm tested (Y/N) Pumper -~,~ Tank size \ ~rC:>~:::~ Compartments Foundation cleanout~ ~.~7' Depression (Y/~ / Well(s) on lot ~-~:>c> ~.c On adjacent lots To property line /~> Absorption field Surface water/drainage 'J/~ Foundation ~' / Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DISTA~IGEI~ROM LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access (Y/N) at Surface water D. ABSORPTION FIELD DATA Date installed ,5% ~/ Length ~3 ' Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ Soil rating (GPD/Ft2) ~-~61¢'//~:¢~ Systemtype Width .-~ / Gravel thickness ~ ' Total depth /// ~- ~ '~ /DO -~ /5 Cleanout present ~'q) V/ Depression over field (V/.J~) ~'/ ~, p After test ~-- '7~~ ~.o ~¢c 1~4 ~ t..J~ If yes, give date To building foundation On adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '~c~ [~'- On adjacent lots ~-~ 4,- Property line To existing or abandoned system on lot / Cutbank ~JA Water main/service line Surface water ,/~ ¢ "¢ Curtain drain /J~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect~r~ta¢~.~a(¢ of this inspection. Signature Date / /.~0 /¢/3'- HAAFee$ ¢cO~ ' ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-028 (3/93)* Back S & S ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~EALTH DEPARTMENT OF ~ALTH AND ENVIRONIIENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY A2PROVAL .CERT/3ICATE 1. General Information Application Date ~ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) "~¢17 .d~../__...~.y~d_~.~_~ Telephone- Home Business Applicants e ~,~ ? ,, (c) Applicant .is (check one) Lending ihstitution ~-~ ~ Owner/builder ~ ; ~uyer ~ ; Other [[~ (explain); · (d) Lending Institution Telephone (e) Address ',-. " . ' ,~. .... t -'~C'";' Real Estate Co. & Agent ~ Address~(~), _ ' Telephone (f) Mail the ~IAA to the following address: .../C') . ' 2. Ty~e. of Residence Single-Family~ Number of Bedrooms Multi-Family~ Other (describe) 3. Water Sup~ly- Individ=l Well Community Public Note: If community well sysgem, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status.. 4. Sewage Disposal Onsite~ Public ~-~ · Community ~-~ Holding Tank~ Note: If community well system, must have written confirmation from the Sta~e Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] e Engineering Firm Providins~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 Mnnicipality 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 regula- tions in effect on the date of this inspection. Name of Firm Address Date DHEP Approval Approved for Approved X. bedrooms Disapproved Telephone Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTb~NT OF HEALTH AND ENVIRONb~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGIh~ER REGISTERED IN TH~ STATE OF ALASKA. TH~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NA.LYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALT~ AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: N,bN,C P,,,I.I~ OF ANCH, C)': ' D~H', OF HEALTH & ENVIfiGNM'~NT/.i ?RC, TECt-IGix Well Classification /~ Well Log P~esent (Y/N) Total Depth Static Water Level Casing Height Above Ground · Electrical Wiring in Conduit (Y/N) 'Separation Distances from Well: To Septic/Holding T~nk on Lot Cased to Date Completed If A, B, or C, D.E.C. Approved(Y/N) Yield Depth of Groutinq Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots To NeareSt Public.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 Be SEPTIC/HOLDING TANK DATA Date Inst~ll~d /~7 ~f~/ Size ./~ NO. of Compartments Standpipes (~.~ ~.,Air-tight Caps (~$/ Found~.tio~ Cleanout (Y~) Depression over Tank(y~)~ Date Last P~u~d //"/~//~ Pumping/Maintenance Contract on File (Y/N~//'~- ; for~ Holding Tank High-Water Alarm (Y/N)/~//~- Temporary Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well ~C~ '~ To Building Foundation To Property Line /~) .fu To Disposal Field ~ / To ~Water Main/Service Line , ~ Course '/-~ /- Commnts TO Stream, Pond, Lake, or Major Drainage Receipt ~ Date Paid: Amount: L( [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~ ~ / Width of Field ~ ~/ ~ ~ Length of Field ~ ~ ! Depth of Field z// / ':' Gravel P~d Thickness " .,~ ?/ Square Feet of Absorption Area //~3 D Standpipes Present/~) ~ ~ ' ~ / / /~ Results of Last Adequacy ~st ~.3 ~ ~/~d~O~ ~ .... ~ ....... '-~ Separation Distan~ frcm ~sorption Field: / To ~ter-Supply ~!1 ~ ,~ To '~o~rty Li~ /O ~ To Building Foundation ~ ( To Existing or ~ando~d System ~ Lot /~ ~ ~ ; ~ Adjoining Lots ~ '~ To Wate~ Main/~vi~ Line ~ ~ To Cutbank( if pre~nt) ~ /~ To Stre~ond~ke/or Majo~ ~ainaGe C~se__ ~ /~ To ~iveway, ParkinG ~ea, or Vehicle Stora~ ~ea ___ ~)~' _ ....... Co~nts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Di~nsions Map~ole/Access (Y/N) ~Ptunp Off" Level at Pumping CycYes during Adequacy 2%st. ~et:s Coranents ** Check Permitted Bedrcx~r~ Rating Against HAA Request I oertify that I have checked, verified, or conforr~d to all MOA HAA C~]idelines in effect on tlne date of this inspscticn. KB1/d5/s [Pa~e 2 of 2] MOA Nc5. "~"" DAlE RECEIVED I NSPECTI ON APPOI NTM ENTS INSPECTOR INSPECTOR INSPECTOR MU~CIPALI~ OF ANCHORAGE ~UNIOIPALITY OF ANOHORA~E DEPT, OF HEALTH & ~EP~T~ENT OF HEALTH & ENVIRONMENTAL P~OTEOTIO~NVIRONMENTAL P2OTECTION 825 L Street - Anchorage, Alaska 99501 ( MAY 8 1981 ENVl RONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES ~IRECTIO~S: Complete all parts on page 1. I~complete requests will ~ot be processed, Please allow ten {10) days for processing. - - PHONE MAI LING ADDRESS PROPERTY RESIOENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. I PHONE 4, REALTOR/AGENT ] PHONE MAILING ADDRESS i5. LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~BEDRQOMS [] One [] Four [~'~l NG LE FAMILY [~wo [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [~COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. Awell Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE ~.POSAL 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 E~ SINGLE FAMILY [] ONE [] THREE [] FIVE [~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED E~]PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~/~~~ 72-010 (Rev. 6/79)