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HomeMy WebLinkAboutNORTH WOODS BLK 1 LT 21 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211249 PID Number: 051-731-60 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New K Upgrade Name Bill Finke and Vicki Clark-Finke ABSORPTION FIELD ❑ Deep Trench 10 Wide Trench ❑ Bed ❑ Mound Site Address 22874 Northwoods Chugiak ❑ other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.6 and 0.8 GPD/SF 5.75 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.75 Ft.2 Gravel depth beneath pipe Ft. Subdivision Block Lot Northwoods 1 21 Fill added above original grade 0.75 -0.4 Ft. Gravel length 88 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 625 Ft2 1 Ft. Well > 100' > 100' na na na TANK ❑Q Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer greer Capacity 1500 Gal. Surface Water > 100' > 100' na I na Material Number of compartments Lot Line > 10' > 10' an na NA plastic 2 Foundation > 10' > 10' an na t_lf!STATION Manufacturer Capacity Remarks Gal. Alarm location Electrica-in Iled by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer homeowner Drainfield 3034 Co/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 1s` 7/29/2021 7/30/2021 Location and description 2na da:3'' 8/17/20,l 4111 door threshhold near point A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp A�� Conditional Approval: Date F 49 •rtis;gyp • ...� .c4�.. 'eM ' ' ��'• GS ZoL1�,�`V. Septic System Q Approved Date Date �� FFG'' • No. CE 11904 , •'V mss Note: this approval does not include well permit requirements. (Rev 05/02118) DESIGN PARAMETERS BEDROOM: 1 (150 GPD) SOIL PERCOLATION RATE: 24 mpi APPLICATION RATE: 0.6 GPD/sf (TH1) AREA REQUIRED: 250 SF /SYSTEM TYPE: SHALLOW TRENCH 35'x 5' x 24" EFFECTIVE DEPTH YIELDS 250 sf MAXIMUM DEPTH OF EXCAVATION TO BE 69" DECK IS >30", TANK IS LOCATED MIN 5' AWAY FROM DECK SUPPORTS AND /NOT LOCATED UNDER STAIRS. � \ M T1 / C DESIGN PARAMETERS BEDROOM: 2 (300 GPD) SOIL PERCOLATION RATE: 6 mpi APPLICATION RATE: 0.8 GPD/sf (TH2) AREA REQUIRED: 375 SF SYSTEM TYPE: SHALLOW TRENCH 53'x 5' x 24" EFFECTIVE DEPTH YIELDS 375 sf MAXIMUM DEPTH OF EXCAVATION TO BE 69" \ ;MT2 NEW 88' x 5' x 24" EFFECTIVE DEPTH SHALLOW TRENCH \ U'\ / 5 BR HOME �O] o �O SLOPES ARE LESS THAN 25% FCO WITHIN 50' OF THE SYSTEM A SU' P tn� ST1 0 �c/ �—` o �} TH#2 EXISTING 134' x 36" x 48" ST2 DCO'~� 1 EFFECTIVE DEPTH TRENCH, SIZED FOR 3 BEDROOMS / SPLITTER VALVE NEIGHBORING SEPTIC N�' IS > 10' FROMSLOPE < 1� PROPERTY LINE RESERVE TRENCH SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,500 GALLON TWO—COMPARTMENT SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM AND NEW TRENCH. TANK WAS PROVIDED WITH A MINIMUM 20" DIA RISER SERVING THE FIRST COMPARTMENT. 3. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Septic Record Drawings Prepared for OG ELEVATIONS WERE 4 \ THE SAME AT TH#1, TH#2 \ AND AT PROPOSED SOUTHERN END OF TRENCH / 6.4 �viT4 / / FUTURE RESERVE SITE WILL REQUIRE AN AWWTS: / / / / WILLIAM FINKE AND VICKI CLARK-FINKE 22874 Northwoods Dr Chugiak, Alaska 99567 NORTHWOODS BLOCK 1 LOT 21 EKLUTNA ENGINEERING, 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 OSP211249 LLC DATE: 8/23/2021 DRAWN: CLT SCALE: 1" = 30' PID: 051-731-60 SHEET 2 OF 3 DESIGN PARAMETERS BEDROOM: 5 (750 GPD) SOIL PERCOLATION RATE: 6 mpi PROPOSED CATEGORY III APPLICATION RATE: 5 gpd/sf AREA REQUIRED: 150 SF SYSTEM TYPE: SHALLOW TRENCH 21'x 5' x 24" EFFECTIVE DEPTH YIELDS 150 sf Eklutna Engineering, LLC curtistownsend@gmail.com August 25, 2021 Subject: Northwoods Block 1 Lot 21 Septic Field Waiver Narrative OSP211249 The existing house is served by a septic system. The owner desired to increase the capacity of this system to 5 bedrooms. The existing trench was left in place as part of the system and a new trench was constructed in July 2021. In an attempt to save a tree in the backyard, the new trench was constructed with a bend in it. A change order was issued by MOA to allow for this. The way it was constructed did not allow for the full 8' separation between trenches. There is a portion of the new trench that is 6.4' away from the existing trench. For the reasons below, a waiver is being requested for this. The slopes in this area are all less than 1%. The original ground elevations at test hole 1, 2 and the southern end of the trench were all the same. The soil in this area has a percolation rate of 6 mpi. The wastewater will travel vertically in this area and less so horizontally. When this portion of the trench was dug, the walls in the area near the existing trench were dry indicating that there is sufficient native soil that hasn't been compromised. This existing trench was sized for 3 bedrooms. This new trench is also sized for 3 bedrooms since the splitter valve can only split wastewater 50/50. The total size of this system is 5 bedrooms as it is limited by the septic tank volume. Therefore this additional trench is oversized. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, Curtis L. Townsend, P.E. '497H e, •eeee� eeeseemm9006e C^�s0000e •e6e�uUl;�.. Wns 0 Date �� No.CE1 ����� Municipality ®f Anchorage nT�� P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax 1907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program x x x x VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV211061 COSA#: Permit#:OSP211249 PID#: 051-731-60 Legal Description: NORTH WOODS BILK 1 LT 21 Engineer: Eklutna Engineering Your request for a waiver of the required 8 feet horizontal separation from the absorption field to the absorption field has been approved. The approved separation distance is 6 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: g ZSR Z Approved by: U(/ Name of Review ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ s ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ t ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ t t ■ ■ ■ ■ $a■ ■ ■ ■ 1 **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211249 Work Type: Septic Upgrade Tax Code Number: 05173160000 Site Legal Address: NORTH WOODS BLK 1 LT 21 G:1459 Site Mailing Address: 22874 NORTHWOODS DR, Chugiak Owner: FINKE WILLIAM ROBERT & Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: o� U�hartment 7/20/2021 7/20/2022 29259 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Com) C 0-4c2 Received By: QAk n►ovt �rowt r� n�ie�►e dig . Dog le aA&A to end o� trcriA. Date: Issued By: Date: Zf� Z 5 MUNICIPALITY OF ANCHORAGE Development Services Department y° Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-731-60 Property owner(s) FINKE WILLIAM & CLARK-FINKE VICKI Day phone Mailing address 22874 Northwoods Drive Chugiak AK 99567 Site address 22874 Northwoods Drive Chugiak AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS BLK 1 LT 21 Legal description (Township, Range & Section) Lot Size 29,259 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank M ❑ Upgrade x ❑ Duplex (D) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (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 ,Cpdes. (Signature of property owner or authorized agent) Z?/'Zoz/ Permit/Rush Fees: % 5 % 5 Waiver Fees: Date of Payment: 7,Z l Date of Payment: Receipt Number: 06397D Receipt Number: Permit No. 05pa 11 2 �% �% Waiver No. GADevelopment 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 OSP211249, Deb Wockenfuss, 07/20/21 DESIGN PARAMETERS BEDROOM: 1 (150 GPD) SOIL PERCOLATION RATE: 24 mpi APPLICATION RATE: 0.6 GPD/sf (TH1) AREA REQUIRED: 250 SF / SYSTEM TYPE: SHALLOW TRENCH 6) / 35'x 5' x 24" EFFECTIVE DEPTH 000 / sf MAX MUMSDEPTH OF EXCAVATION TO YIELDS\�/ BE 69" LOCATE LOST \ SUMP X\\ DECK IS >30", TANK TO BE LOCATED MIN 5' AWAY FROM DECK SUPPORTS AND NOT LOCATED UNDER STAIRS. SLOPES ARE LESS THAN 25% WITHIN 50' OF THE PROPOSED SYSTEM 10' EXISTING 134' x 36" x 48" EFFECTIVE DEPTH TRENCH, SIZED FOR 3 BEDROOMS NEIGHBORING SEPTIC IS>10'FROM PROPERTY LINE SPLITTER VALVE RESERVE TRENCH SCOPE OF WORK 1. REMOVE EXISTING SEPTIC TANK. 2. PLACE NEW 1,500 GALLON TWO-COMPARTMENT SEPTIC TANK AND TIE INTO EXISTING ABSORPTION SYSTEM AND NEW ONE. TANK IS TO BE PROVIDED WITH A MINIMUM 20" DIA RISER SERVING THE FIRST COMPARTMENT. PROVIDE DCOs UPSTREAM AND DOWNSTREAM OF TANK. 3. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. DESIGN PARAMETERS LC -014C BEDROOM: 2 (300 GPD) SOIL PERCOLATION RATE: 6 mpi APPLICATION RATE: 0.8 GPD/sf (TH2) AREA REQUIRED: 375 SF SYSTEM TYPE: SHALLOW TRENCH 53'x 5' x 24" EFFECTIVE DEPTH YIELDS 375 sf MAXIMUM DEPTH OF EXCAVATION TO BE 69" sy \ C� NEW 88' x 5' x 24" EFFECTIVE DEPTH SHALLOW TRENCH. NEW TRENCH TO BE MINIMUM 8' AWAY FROM OLD TRENCH OG ELEVATIONS ARE ALL THE SAME AT TH#1, TH#2 AND AT PROPOSED SOUTHERN END OF TRENCH r) / / � CO /^h / / / FUTURE RESERVE SITE WILL REQUIRE AN AWWTS: / / / / Septic Design Prepared for WILLIAM FINKE AND VICKI CLARK-FINKE 22874 Northwoods Dr Chugiak, Alaska 99567 NORTHWOODS BLOCK 1 LOT 21 OSP211249 EKLUTNA ENGINEERING, LLC DATE: 7/29/2021 19162 MOUNTAIN ROAD DRAWN: CLT CHUGIAK, ALASKA 99567 SCALE: 1" = 30' (907) 406-1058 PID: 051-731-60 SHEET 1 OF 3 DESIGN PARAMETERS BEDROOM: 5 (750 GPD) SOIL PERCOLATION RATE: 6 mpi PROPOSED CATEGORY III APPLICATION RATE: 5 gpd/sf AREA REQUIRED: 150 SF SYSTEM TYPE: SHALLOW TRENCH 21'x 5' x 24" EFFECTIVE DEPTH YIELDS 150 sf 1 O q�gse�♦i 49TH 1, a ........ ................... .................. A s s..........4? ........................ .......� d� CURTIS TOWNSEND,Ps ®Gi No. CE 11904 e s ® ?""w ®��m e►®e �®e Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211249, Deb Wockenfuss, 07/20/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211249, Deb Wockenfuss, 07/20/21 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Septic System Owner -Installer Agreement The On-site Water and Wastewater Section (On-site) may issue an approval for a homeowner to perform work on an on-site wastewater disposal system to serve that individual's owner - occupied, single-family or duplex home if the homeowner meets and agrees to the following requirements: 1. The property owner and excavation equipment operator may perform work on no more than one owner -installation project in a 12 -month period. 2. Owner's projected active involvement with the instal - - - i , — rr ,1 . . I ,, _ 3. The name of the excavation equipment operator: 4. 1 agree that there will be no monetary compensation for installation services rendered. 5. The name of the inspecting engineer: _�' nLD A 6. 1 agree to discuss the following items with the inspecting engineer: a. Permit design criteria and specifications. b. Inspection requirements set forth in AMC 15.65.070. c. Advance notice given to the On-site Water & Wastewater Section for all required municipal inspections (AMC 15.65.070A). 7. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available at the construction site for the duration of all related work. 8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional installation instructions and approval from the equipment distributor. As owner of (legal description)it LTZ t I agree that the information above is true and accurate. Owner's printed name: �Lam r,Y.-L Owner's signature:L)rL., Date: Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org > �. �•.-a s,� -�.� _ � �I O 7. S LEC• �EIE�P�/f/Gell/ /o�s�� ASBUILT-NO CORNERS SET THIS DATE. g�� 6 I HEREBY CERTIFY THAT I HAVE SURVEYED THE �Et_30' FOLLOWING DESCRIBED PROPERTY North Woods Subd.,Lot 21,B1k. 1 D,4�, AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 6-12-90 INDICATID. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID] EASEMENTS, COVENANTS, OR RESTRICTIONS NW 1459 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ANY DATA HEREON BE USED FOR CONSTRUCTION 13-3 OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN DMS r. E- � �! �. -Y .0�� '"' :.. 1 � '�• `` t� m, . d�, .. ..� .� 4 � �. Duane Mark Sewar ; f: • �� ,ar d r ••. P/� a F� F � O �� � _ .� �r �" ��• i `"'  ',~, / MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE, . L EL;~'NEW MAILIN~ LOGATION NO, OF BEDROOM8 DISTANCE TO: ~ ~Z M anufac,ure~~. M ,o. of compartments I nsido length ~idth Uquid depth Liq. c~pacity in 9allons IF HOMEMADE: o W~/~ Foundatio~ ~Z Nearest lot ,i~l PE~ IT N .~ No. ofl~s Len~ ore* line ~ Totaileng~p~line~ Trenc~th// Distancebe~nes P--~ To of~ofinish rade ~/~ /~ebeueath.tile - ~ ' inches g~ p ~ ] g ~ ~ M~er~l ' Length Width uepth - PERMIT NO. ~ ~ Type of cr~b Cr~b d~er j Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DIsTANcE TO: ~ Class~. ~/~ ~ ~'~Depth. ~riller Distance to lot line Pfi~MIT ~O. m B~ild[~oundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~ ~ PIPE MATERIALS R EMAR KS ,g~:-" ..,, ......... Z~ ,v ,:/;~-~ ....... ' /9 7 ' APR~OM ,' . DATE ~EGA L 3 (Rev. 3/78) F'ERMi T NO. RPPL I E:FiNT LOCFiT I ON L. EGRL CREINER CONS'TRUCTION NORTI:-tI-,.!OODS [:,R ! L. 2± E: :L NORTH 1.4OODS S,.-"D F'O BOX 25Z LOT SIZE E;94--.2485 22.000 SC!URRE FEET TYF'E OF SOIL_ RrgSORPTION SYSTEM IS: 'T'RE.NCFI ["IRXIMUM NL.IMBER Of::' E:EDROOMS = 3 SOil_ RBTING ,.':SQ F"T,,"BR>= ;:28]: THE REE4LitF..rE[:, SIZE OF' THE SOIL RBSORF'TION SYSTEM IS: THE L. Ef'-,ICiTH DIMENSIOt'.,f IS THE LENGTH (IN FEET) OF TH, E TRENC:H OR DRF!INF'IELD. THE [:,EF'TH OF FI TRENCH OR PIT IS TH.E DISTRNCE BET[4EEI'.,.I THE SURFF!CE OF' THE GROUND RND THE BOTTOM OF THE ENCR',,,'RT!0N (IN FEET). THERE IS NO SET !.,.!I[:,TH FOR TRENCHES. THE GRR',,,'EL. DEPTH IS THE i',1!t'.,!I?ILIM [:,EPTH OF' GRR',,,'EL DETP.IEEN THE OUTFFILL P!F'E RI'-,ID THE BOTTOM OF' THE EXCF'i',,,'F!TION (IN FEET). PERMIT FIPF'LICFINT HFIS ]"FIE RESPONSIE:IL!TY TO INFORM THi'S [:,E:PRRTHENT DLti:;.:!NG 'THE INSTFILLRTION INSPECTIONS O1:: RNY I,.!EL. LS RDJFtCENT TO THIS PROF'ERTY RND THE NUMBER OF RESIDENCES "F.'HRT THE i4ELL P.ilLL. SER',,,'E. BRCKFIL. LiNG OF' RNY SYSTEM i,.!!THC~UT FINF1L INSPECTION FIND faPPROVRL BY THIS DEPRI::.-'.TMENT !.4!L.L. BE SUBJEC-i' TO PROSECUTION. MINtMUH DISTRNCE E:ETNEEN R WELL RND RNY ON-SITE SEWFIGE DISPOSRL SYSTEM IS 106' FEET FOR R PF.'..IYRTE P. IELL OR -l_SEt TO 21.'_;'i~1 FEET FF..:OM R PUBLIC WELL DEPEN[':,!NG UPON THE TYF'E OF' PUBLIC NELL. MINIMUM [:,iSTRNCE FROM R PR I ',,,'RTE WELL TO R PRI',,,'RTE SEk!ER LINE IS ;;.25 FEET RND TO FI COMMUNITY SEI,.!ER LINE IS 75 FEET. OTHER REL.-~LIIREME. NTS t'dRY F!PPLY. SPECIFiCFITIONS RNE:, CONSTRLtCT!ON [:,IF!E~RRMS Fi:I'-:.':E RVRit_F!BL.E TO !NSUI:;.:E PROF'ER INSTRLI...F!TION. ! CERTIFY THI::IT i: I F!M FFIMIL. IRR IqITH 'f'I:4E' REQUIREMENTS FOR ON-SITE SEI.4ERS F-ff',!D i.,]ELLS RS SET FORTH BY THE: MLINICIPFiLT. TY OF FINCHORRGE. 2: I i.4IL. L i,N."STRL.L THE SYS'TEM IN RCCORDFINCE ktITH THE CODES. 3: I UNDERS'TI::IND TFIF:!T THE ON--SITE SEP]ER SYSTEM MRY REC!UIRE ENLF~RGEHENT IF' RESIDENCE IS; REIdODELE[:, TO INC:LUDE M. ORE TI:-tRN :.~: BEDROOMS. S ! GNE[.',: F~PPL I CRNT GRE I NER CONSTI:;..'LICT ! ON I'--';'--;t iff:, E T F'Fi] E ,,,,4 A Location: /~>~%~ ~CD~ ~, ~--~ Legal Description: CO'~ L Type of Soil Absorption System Is: Trench: /~,--Er~ain field: Maximum Number of Bedrooms: ~ Department i~ Health and Environmentai~ /rotection 825 L Street,264-4720 Anchorage, AK. g9501 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT Mailing Address: ~,,~, ~/ Phone Number: I1~''- I ~~Ot Size: Seepage Bed: Holding Tank: 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 = /~.~? 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 of 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~equire enlargement if the residence is remodeled to include mor~t.h~/3 bedrooms. Signe~' ~4~,~~/~ Issued by~~L%~~ 2D~~ A~plicant ~ ' Date: ~ ~/~ ~/~Y ~ SWP/024(1/81) 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG PERCOLATION TEST SLOPE SITE PLAN 10 12 13 14 15 16 17, 18- 19- 20- WAS GROUND WATER /,~J~ ~_ ENCOUNTERED? , O P IF YES, AT WHAT E DEPTH? COMMENTS PERFORMED BY: Rebert A, No, Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ~/'/~ FT AND--~-~'~'"- FT CERTIFIED ~~ 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-731-60 1. GENERAL INFORMATION Expiration Date: Complete legal description NORTH WOODS BLK 1 LT 21 Location (site address) 22874 Northwoods Drive Chugiak AK 99567 Current property owner(s) FINKE WILLIAM & CLARK-FINKE VICKI Day phone Mailing address Real estate agent 22874 Northwoods Drive Chugiak AK 99567 2. TYPE OF DWELLING: CADUD) 0Single Family (w/v ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System El Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 0Waiver Fee $ c _ Date of Payment 0 1 g Date of Payment Receipt Number Q 7 5 (o 9 L Receipt Number COSA # 05C Z I 1 y q7 Waiver # 5. 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 Certificate of On -Site Systems 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for S bedrooms bedrooms bedrooms, with the following stipulations: .e0.9. f K # Q, w i% 0_1v WOQ4j ." a V— 5-- 6 Qd ✓'t?c)vh C,iw, -� Vv o I-�- S S 61, ON-SITE �m VVIAI ER AN WAST�_y\I.'ATER oz J� PROGRAM By: �-� / Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: NORTHWOODS BLOCK 1 LOT 21 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected _. Casing height (above ground) in. Date of flow �beginningg Static w f test ft. Comments public water B. TANK DATA Age of tank(s) 1 years Tank type/material septic 1plastic Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping installed July 2021 D. ABSORPTION FIELD DATA Parcel ID: 051-731-60 of Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for H oform test? ❑ Yes ❑ No ❑ Coli.o a�s Negative Nitrate mg/L Arsenic ug/L Collected by Date of Sample ❑ Nitrate less than MRL (ND) ❑ Arsenic less than MRL (ND) C. LIFT STATION ❑ Required maintenance com Age of lift station ars Lift station ma Which system tested (date installed) 198112021 Adequacy test date 6/22/2021 ❑ ALL standpipes present per record drawing Results D Pass For 5 bedrooms Total measured depth from grade 6.1/5.82 ft (max) Fluid depth prior to test 29 in Measured depth to pipe invert from grade 2.1/3.70 ft (min) Water added 545 gal El N/A —pressurized field 33 Monitor tubes go to bottom of effective. If not, state New depth in Elapsed 1380 depth into effective time min ❑ Code -required soil cover over field Final fluid depth 29 in ❑ System presoaked Absorption rate '450 apd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 1981 trench was tested June 2021. 2021 trench was not tested for adequacy. Together the two trenches make a 5 br system. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout >-fl� Yes Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' F-1 Yes if No Private "er/ eptic Line > 25' [� Yes if No ft Absorption Field on Lot > 100' F-1 Yes if No :::ft Hoolldiin'g Tank > 100' ❑ Yes if No ft Wells on Adjacent Lots: P/ Absorption Field > 5' Neighboring Absorption Fields > 10-0-1--- Animal Containment _ > 50' 1771 Yes if No ft Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' Manure/Animal Excreta Storage > 100' Yes Cor>it ewer Main > 75' 1771 Yes if Na ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' a Yes if No ft Surface Water > 100' [✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: P/ Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200'[]✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' P/ Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS INSPECTION REPORT STATES THAT 1981 FIELD IS INSULATED G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ®�A ............ ds� wis'd• �� • Date Z j ;z. a cit 11904 ,-%-"ROFESSIOtaA� EfN 1 1E�: t'S i / R=20.00 \� L=31.42 �� S 00 76, 1`SS X00, O� Q 00 / SCALE: V= 40' O,, Re{ wall . �/uns° C, OO,OO��``AAj Yv ?�tS 36 Lot 20 J' X00 N, 00 \ O a R" Lot 210 . °,-- Septic vent (typ) / 0� Manhole 0 0 0 Obs co n� \ Wood fence (typ) 0 / 0 8497v �� OF•A4�S low /_ Q. '0'- '/) • 49 th • •y �,� ® ••� ® ��, •. f�lfizabeth L. Walatka : ; �� �srF • 8036 — LSAar • • ����� pR01�Psslo0x_ Atal al -7-2-1 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that 1 have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 21, BLOCK 1, NORTH WOODS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 9th day of AUGUST , 2021. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA &ASSOCIATES, L.L.C. Engineers and Surveyors PLAT ARE NOT SHOWN HEREON FB 21-5, pg 35-36 BE 907-248-1666 y UNLESS OTHERWISE NOTED. This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. 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 I.D. # c:~"/ - ?~ / -~, 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Ad dress Day phone ~"~'~4 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: .. . Ind~wdualon-ste · .. . . - . :.. ~ . '. ' Hold ng tank __ -.-, . ..... Commun ty on-s te . Pubhc sewer : ,,. ,,/),~_ __~ _..-,..,~;~ .-? NOTE: If community Wastewater system, provide written confirmation from Sta~e ADEC attesting to the legality and SEatus"of s~stem. ' Front MOA ~J1 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone 07¢'~¢,?~'//-¢ ___ 20210 Donalar St. Name of Firm Address Engineer's signature Approved for ~ Disapproved. Conditional approval for bedrooms. DHHS SIGNATURE bedrooms, with the following stipulations: Additional Comments Date , ~ he M(Jmcfpahty of A,n.,horage Department of Health and Human Servfces (DHHS) ssues Health Author ty · . gpproval, , Cerbftcat?.based., · only upon the representabons g~ven ~n paragraph 5 above by an ndependent 'pr01~eSSional enoi~eer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes ~ ' ,/.t-'.,.- . ~",..~ ,, , . . and themlend mg mst~tubons ~n order to sabsfy certain federal and state requirements. Emp oyees of DHHS c o not conduct inspect OhS or ana yze. data before a cert f cate s ssued. The Municipality of Anchorage is not ro~ponsible for errors or omissions in the p.rof~ional enginoor's work. 72-025 (Rev. 1/~1) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~Z/o~'- ~/ '~/~ / /V/~-'~'~'~< ~'~ Parcel I.D. A. Well Data Well type ~fS~-/c-- Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION g.p.mr"1~ ; On adjacent lots ~; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ColleCted by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Z~ /~'? Cleanouts (Y/N) High water alarm (Y/N) Tank size Foundation cleanout (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ~ Compartments ~ Depression (Y/N) )/ Alarm tested (Y/N) /t~//,'~ Pumper J--/~ '-~ Well(s) on lot ~'J~4-- To property line ~-z~- Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3,'93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed /~///~ Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / Length / Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width ~5/ Cleanout present (Y/N) ?/3~,/¢ fi' Results (pass/fail) Soil rating (GPD/FF) 7~ .3 Gravel thickness Y After test If yes, give date System type ?'~c-a.,~.~/ Total depth y" ..... '~'~ ~ Depression overfield (Y/N) .xo/ for ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ,/ / Well on lot To building foundation ,/~"-- On adjacent lots 3 o/- Sudace water /~' ~' /- Curtain drain On adjacent lots /t///i'¢ Property line To existing or abandoned system on lot Cutbank /~/.///~ Water main/service line Driveway, parking/vehicle storage area /.~'~' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guide~oes in effect,, o_n, t.h~e date of this : . · ,. ,%..¢ Signature Engineer's Name Date HA& Fee $ Date of Payment Receipt Number 72-026 (3~93)* Back David IL Dayton P.E. 20210 Dona]ar St. Chugiak, Alaska 99567 inspection. 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 lot, block, subdivision, section, township, range) Lot 21; Block I; North Woods Subdivision Location (address or directions) 22874 Northwoods Drive (b) Property owner Mr.& Mrs. D.Lowrie Ma!ling Address P.0.Box 671347 Chu~iak, (C) Lending Institution Telephone:(home)688-3931 Ak. 99567 Telephone Business Mailing Address (d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER ATTN: Linda Malone Address 16600 Centerfield Drive Suite 201 Eaqle River, Ak. 99577 694-4200 Telephone (e) Mail the HAA to the following address: (or check here~ if hold for pick up.) List contact person and day phone number below: .S & S ENGINEERING Eagle River, Alaska 99577. 2. TYPE OF RESIDENCE Single-Family~;Y- Number of bedrooms 3 3. WATER SUPPLY Individual Well [] Community [~x 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-siteD Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION · As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat 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 6~-~'¢/¢'' "~'~'~ '~ S & S ENGINEERING Address 17034 Eagle River Loop Road No. 204 Eagle Rivor, Alaska 99577 ~/~/ Date 6. DHHS APPROVAL Approved for' ,,~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5above 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 DHHSdo not conductinspection~ or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev 7/88) Sack Page 2 of 2 v,~'~~ MUNICIPALITY OF ANCHORAGE (MOA) · ~ , O ~""~'~ Health Authority Approval (HAA) D't'~ ~ CHECKLIST- FEBRUARY 1984 A. WELL DATA'-~ Well classification O{~SS & -. ' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Cased to Static Water Level Cas!ng Height Above Ground Electrical Wiring ih Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ,~_ OO" To Nearest Edge of Absorption Field on Lot Date Completed Depth of Grouting Yield Pump Set,At Sanitary Seal on Casing (Y/N) - Depression Around Wellhead (Y/N) ; On Adjoining Lots ~__ oc~ '--/- ; On Adjoining Lots -~--~ To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by ; Date Water Sample Test Results Comments 5~e A B. SEPTIC/HOLDING TANK DATA Date Installed ~oq~! Sze J©oo?~l Nc. of Compartments Standpipes (Y/N) ~1 Air-tight Caps (Y/N) Depression over Tank (Y/N) /~J Pumping/Maintenance Contact on File (Y/N) · Holding Tank High-Water Alarm (Y/N) c/ Foundation Cleanout (Y/N) Date Last Pumped K,)/~ ;for Temporary Holding Tank Permit (Y/N) /~/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well TO Property Line /D To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation / To Disposal Field 1,2, -,. , 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ f~ ~/~ Date Installed ~. / '~r ~9~,, ~1 Width of Field :~ 6, Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ( ,5¢/ Depth of Field Gravel Bed Thickness /--tL ~ Statndpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area SEPARATION DISTANCE FROM ABSORPTION FIELD: [ 2~- C:6;~ / ~- To Property Line [(~ To Existing or Abandoned System on ; On Adjoining Lots ~-~C) '7~ { (2 ~ TO Cutback (if present) /UI/~ Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments '%, Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideli e¢~ ~.~'~J~N,t. he date of this ~ ' ,¢4 ~ ' inspection. Signed 5 & $ ENGIN[i,~!14~N6 . , 17034 Ea~¢e Company ~&_~ ~¢. Alaska e¢~ ¢ ~,'2 ~ ~.'~"~. '* ~ -.,. Date Date of Payment Amount: $ J~ 72 026 (Rev. 7~88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 OF EN¥1RONMENTAL CONSERYATION Ai~CItO~GE ?~ESTER~I DISTRICT OFFICE 3601 C STREET, SUITE 322 A~ICHOP~AGE, ALASKA. 99503 l.lay 24, 1990 SI'EVE COWPER, GOVERNOR 563-6775 PWSID: ~213001 According to the records on file in this office, the Chuqiak Utilities/Northwoods Deer Horn Water System is in compliance %.;ith - the State of Alaska Drinking ~ater Regulations. Sincer~ely, VEC:bas '~.~.., Db :E RECEIVED INSPECTION APPOINTMENTS INSPECTOR INSPECTOR v~/ INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF I{~AL~il &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI~.NVIRONMENTAL Pi~O £ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEI~\FI~A~TI~'~I'IVES~jJ )IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROP~'Y OWNoER PHONE MAI,~LI~G ADDRESS3 ' ' PROPERTY RESIDENT (If different from above) (~/ · ' ' ' PHONE 2. BUYER PHONE V1AI LING ADDRESS VIAl LING ~R~S'~ '~ ~ 7'~i/'~ / I PHONE 4. REALTOR/AGENT ] PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 5. 'tYPE "ES, DENOE []~"~ N G L E FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [~] Five [~Three [] Six Other 7. WATER SUPPLY [] INDIVIDUAL* ,~-COMM UNITY [] 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.) SE.AGE D,SPO A. SYSTEM J~NDIV(DUAL/ON-SITE** /2~C'~'f YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY ~ I-~ I 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 PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~3 INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER E~So0tic Tank or E~]Holding Tank Size:. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL i 4, DISTANCES .... Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Li~'e I WELL TO: Absorption Area to nearest Lot Line 5, COMME-~TS ~ROV E D FOB BEDROOMS [] CONDITIONAL APPROVAL {letter must accom0am/certificate) [] DISAPPROVED DATE~