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Home My WebLink AboutNORTH WOODS BLK 3 LT 14 Municipality of Anchorage Page // of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: --~ ~ ~ ~) ~' (--)/-/ PID Number: {'~ ~J '" Name:. /~/~/Z/~2/'J, ¢'~ Wastewater System: [] New ~l~pgrade Address: ~ ~{~,~ ~c./VA/,/o% ~/-/~/~ ABSORPTION FIELD Phone: ~ No~ rooms: ~" ~I o~ ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other ! Total Depth from original grade: LEGAL DESCRIPTION s°""~i~: ¢,~ ~/s~.~. ~.~ Lot: Block: . Subdiv~ion: Depth to pipe bo~om from original grade: Gravel depth beneath pipe Town,'i.: /:: I",n,,= /~ Isootio.: : FH' added above original grade: Gravel length: ~ -- ~ Ft. ~¢ ~ Ft. WELL: B New ~ Upgrade~ Gravel width: ~ Ft. Number cfi lines: Distance~ba~n linC:Ft. Classification (Private. A,B,C): ~~ Cased To: . Total absorption area: Pipe material: Driller: ~ Date Drilled: Static Water Level: Installer: ~ Date installed: ~,. C CC 0 Pump Set at: ~ Casing Height Above Ground: Y~ ~.~ ~,., ~,.~ EX/5¢>/~ TANK SEPARATION DISTANCES ~s..ti~ u Holding a S.T.E.P. ~O Septic Abso~tion Li~ Holding ~¢Private Manufacturer: From Tank Field Station Tank Sewer Lines Sudace Wat. r ~IO0' ) F/A LIFT STATION LineL°t ~/~ ' G / 0 / Size in gallons: Manufacturer: Foundation +P' f/O/ ~14 "Pump on" level at: ~~el at: I High water alarm at: Curtain Drain >//4 ~ > Pu~ [ Electrical Inspections pedormed by: Remarks: BENCH MARK Assum~ Elevation: ~.~ ~ ~'xe~..~ o~ ~¢~.~ /DO, DO Inspections pedormed by: ~: Dates: 1st ¢ 0/~ ¢, ~':;~ .:.::.,:::'" Depadment of Health and Human Se~ices approval ~' "- ~ ...... Reviewed and approved by: Date: 8 - ¢- ¢~ - ~' 72-O13 (Rev. 9/91) MOA 25 Permit No. SW960204 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description:' NORTHWOODS LOT 14, BLK 3 PlO No.: 051-731-26 13 ? II SWING TIES: A-C = 52.3 B-C = 11~.8 A-D = 89.6 B-O = 51.2 SCALE 1"=50' · - MONITOR TUBE o - SEWER CLEANOUT EASEMENT ELEVATIONS (NOT TO SCALE) FILL VARIES 0-3' / 99.5 '~ 93.4 TOP TANK CLEAN OUT #2 m~ ASSUMED ELD.: 100.00' ~ ORIGINAL GROUND ~: LEVEL AT: 0 CWT @ 87.3 85.6 07/31/96 ENGINEER'S SEAL ' _~ Ok A/ &-"/~'& .. ........ 7- -~, '~ B ~..-' 49TH,/~ '-.?~ ~ ~ '.;'~u,¥' k'.' ~L~;-'~ ^' :.:~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960204 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:MARION BRUCE W & DOREEN E OWNER ADDRESS:22688 MCMANUS DR CHUGIAK, AK 99567 PARCEL ID:05173126 DATE ISSUED: 7/17/96 EXPIRATION DATE: 7/17/97 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 14 LOT SIZE: 20046 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: Eagle I iver Engineerin Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Hagie I~iver, AK 99577-3294 (907) 694-3297 f~ June 28, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods Lot 14, Block 3 Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are served by a community well system, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \ 1996\87-354^-NtdLDOC S E P T I C U P G R A D E P LA N LEGAL: NORTHWOODS LOT 14, BEE 3 _~','~'~ "' OWNER: MARION _--~,~'-'" CONTRACIOR: N/A ~.'~9TH~ JOB~ 87-354AlDAIE: 06/25/96~ SCALE 1" = 50' ~[?f.~%?".CP-'t~'.' .... ~"~. ,. ................ A EAGLE R[VER ENGINEERING SERWCES ~% '.LOUISA. BUTERA.' ~. ', CE-6756 EAGLE RIVER, AK. 99577 , (~07) G~4-S~S FAX.. (~07) G~4-3~7 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 87-354 Calculated By: LB Date: 7/16/96 Legal: NORTHWOODS LOT 14 BLK 3 Single Family 3 Bedroom Dwelling TEST HOLE1 Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 16 minutes per inch Wastewater application rate = 0.6 gallons per day per square foot Required absorption area = 750 square feet Trench width ON) = 5 feet Graveldepth (D) = 2.5 feet Required length = Shallow trench factor * Required absorption area / W Shallow trench factor = (W + 2) / (W + I +2 D) Shallow trench factor = 0.64 Total Excavation Depth = 6.5 feet Required length = 96 feet SPECIFICATIONS FOR ON-SITE SYSTEM LEGAL: Northwoods Lot 14, Block 3 07/16/96 A. GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and/or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health (MOA~ DHHS requirements. 4. All soil tests are advisory to the design and are to verified or modified in the field by the Engineer. 5. All excavations and depths are advisory and are to be verified in the field by the Contractor to meet MOA-DHHS requirements. 6. It is the responsibility of the Owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. It is the responsibility of the Contractor to secure all utility locates prior to construction. 8. The excavation is to be exactly in the area shown on the site plan, any deviation requires Engineer approval. 9. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 10. Any remaining open test hole excavations shall be filled. B. SEPTIC TANK 1. The existing septic tank shall be uncovered as directed by engineer, and inspected for integrity. 2. If necessary, the existing tank shall be replaced in the same location with a MOA approved 1,000 gallon septic tank. The existing tank shall be pumped, crushed and either buried on-site or disposed of properly off-site. C. LEACHFIELD 1. The leachfield is to follow the natural contour to maintain uniform total depth of the trench bottom. 2. The bottom of the leachfield shall be level to the elevation noted below, plus or minus 1.5". 3. The total depth of the leachfield excavation is not to exceed 6.5' at any point. 4. A Bull-Run type diversion valve shall be installed as shown on the site plan. 5. The effluent line in the trench shall be laid level within 0.03'. 6. The leach gravel is to be covered with typar fabric material. 7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 8. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 9. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 6.5' GRAVEL DEPTH = 2.5' under pipe, 2" over pipe GRAVEL LENGTH = 96' GRAVEL WIDTH = 5' SOIL RATING = 0.6 gpd/ft2 BEDROOM CAPACITY -- 3 SEPTIC TANK SIZE = 1,000 gallons BENCHMARK = TOP OF TANK #2 CLEANOUT -- 100.00 ELEVATION OF BOTTOM OF LEACHFIELD TRENCH = 93.65 Twenty-four (24) hours notice required for all inspections \1996\87-354b-SPC.doc 07/I 6/96 SPECIFICATIONS FOR ON-SITE SYSTEM LEGAL: A. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. B. 1. 4. 5. 6. 7. o Northwoods Lot 14, Block 3 07/02/96 GENERAL The septic plan is for a single family residence only. The drawing and/or site plan shall be a part of this specification. All materials and workmanship shall meet the Anchorage Department of Health (MOA- DHHS requirements. All soil tests are advisory to the design and are to verified or modified in the field by the Engineer. All excavations and depths are advisory and are to be verified in the field by the Contractor to meet MOA-DHHS requirements. It is the responsibility of the Owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. It is the responsibility of the Contractor to secure all utility locates prior to construction. The excavation is to be exactly in the area shown on the site plan, any deviation requires Engineer approval. It is always recommended that a surveyor locate the nearest lot line position m~d the location of any easements. Any remaining open test hole excavations shall be filled. SEPTIC TANK The existing septic tank shall be uncovered as directed by engineer, and inspected for integrity. If necessary, the exi§ting tank shall be replaced in the same location with a MOA approved 1,000 gallon septic tank. The existing tank shall be pumped, crushed and either buried on-site or disposed of properly off-site. LEACHFIELD The leachfield is to follow the natural contour to maintain uniform total depth of the trench bottom. The bottom of the leachfield shall be level to the elevation noted below, plus or minus 1.5". The total depth of the leachfield excavation is not to exceed 8.5' at any point. A Bull-Run type diversion valve shall be installed as shown on the site plan. The effluent line in the trench shall be laid level within 0.03'. The leach gravel is to be covered with typar fabric material. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. The area over the trench is to be finish graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 8.5' /-'~ GRAVEL DEPTH = 4', under pipe, 2" ,over pipe GRAVEL LENGTH = ,75' \ GRAVEL WIDZH = 5 | '1 ? / SOIL RATING = 0.6/~pd/ft2 SEPTIC TANK SIZ]g = , 1,00,0/gallons , '\ {~ ~'", ~/'/ / / ! ~- / ' BENCHMARK = ~om ELEVATION OF BOTT(~I',QF I~h~ELI~ TRENCH - 91.65 ELEVATION OF ~.O.~P_~O.~..E..~,~ ~12~, ._E~___E = 95.98 Twenty-l~ur (24) hours notice requi.red for all inspectiogns \1996\87-354a-SPC.doc ~C![~)~l ~)&?~', '3~0 lO,; 07/02/96 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 87-354 Calculated By: LB Date: 7/2/96 Legal: NORTHWOODS LOT 14 BLK 3 Single Family 3 Bedroom Dwelling TEST HOLE Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 16 minutes per inch Wastewater application rate = 0.6 gallons per day per square foot Required absorption area = 750 square feet Trench width ON) = 5 feet Gravel depth (D) = 4 feet Required length = Shallow trench factor* Required absorption area / W Shallow trench factor = ON + 2) / ON + 1 +2 D) Shallow trench factor = 0.50 Total Excavation Depth = 8.5 feet Required length = 75 feet Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 8 9 10 11 12 13- 14 15 16 17 18 19- 2O COMMENTS PlA ~l oN DATE PERFORMED: Township, Range, Section: 7'~Z'/ ,~j,¢~ ~/o~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? / 5 / 0 P E Monitoring? / -~, Oate: ~)Y/~'/~ Reading Date Gross Net ~/I/d~ Depth to Net ,...~,~__~ Time Time Water Drop / - ¢['/~'~(' 3;30 ~1 ~ ~ ~:oo ~0 b5 'll~" 3 PERCOLATION RATE /~-~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN 5 FT ANO ~ FT PERFORMED BY: C-- ~ ' ~'/~ ~' ~'~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~-~ ~ ) ~ MUNICIPALITY OF ANCHORAGE %. j' " 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 ~ [] UPGRADE LEGAL DESCRIPTION '/J~"~V~ '~' LOCATION NO. OF BEDROOMS ~ ~ Manufacturer~~ I ~ ~ . Material No. of compartments Liq. capacity i~ g~llons Inside I~ ' Width Liquid depth / ~ O IF HOMEMADE: ~ - ~ DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons ~ D ~ DISTANCE TO: We~oO ~ FoundatJon~ t Nearest lot Erie PERMIT NO. Le gt of eec li~e ,ines~/~ ~Z No. o~nes Total len~ oflHnes - . . ~ inches e~orpti[, ~ Top of tile to finish grade 31 Materialb~tht~ ~ ~ inches D x Total area ~ength ~ Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line Clas~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) I PIPE MATERIALS OTHER I ~ .~A ~ > SOILTESTRATING ,/,¢____~ ~~ [ O' ~/~_ INSTAI~----~~~ ' ' . REMA~K~ A~PROVED ~ DATE 'LEGAL 72-013 (Rev. 3/7R) t.~ ~/.: MUNICIPALITY OF ANCHORAGE _,z., 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 [] UPGRADE LEGAL DESCRIPTION LOCATION D I S TA ,N.,J,~.~ O: i Well Menu facturer~._~ Liq. capacity i~' g~lJons ' DISTANCE TO: Well Manufacturer DISTANCE TO: No. of l.[,nes Le,Qgdj. of.eacJ~ li~e Top of tile to finish grade Width Absorption area Material Width Inside I ~e n g t.~.~h =- Dwelling Foundation ~,~ ~ I T°tal len~ offlines Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Clas~, ,z ./4'?'! Depth Driller DISTANCE TO: Building foundation Sewer line OTHER PIPE MATERIALS SOl L TEST RATING REMAF~KS OFBEDROOMS No, of compartments Liquid depth PERMIT NO. Material Liquid capacity in gallons INearest lot line PERMIT NO, I Trench width Distance between lines ¢ _~) inches i area ,? ~, inches PERMIT NO. Total effective absorption area ~ Nearest lot line JDistance to lot Pine PERMIT NO. Septic tank Absorption area(s) LEGAL 72-013 (Rev. 3/78) F'EEff'!! 'T' NO. E~L-::!:T,. '" L '" :E.';TREET., Fff',iCHC~F-':,'::iC)E., RK. Sa'?f/:~ECL TH.E LE'NGTH DZ!"iENE;!ON :ES THE LE'NGTH (IN FEE'T) C;F THE TRENCH OR DRF~:£NFIEL,,D. THE: E:,EF'TH OF la TRENCH OIR PIT IS THE D!STFINC:E E!:E:'T'i.,.IEE.:['.,! THE' E:LiRFFiC:£E OF THE ('3ROLtND Ri'.,![:.', THE: BOTTOM OF' THE EF::C:F:!,VFFFZC~N <IN FEET). ]"HE GF.'.'F:I'v'EL E:E':':PTH )ES THE: MINZ?~!..tH DEPTH OF' EJ!:R£:~VEL E[ETb.!EEN THE'. (]U]'FRLL PZPE' RND THE E~OTTOM OF THE: EXCFr",/R]"IC~N (IN FEET). BFIC:KF'tLL:[!'.,!G (:iF F'ff',!'T' S':V'f!~;TF-:H i,!]:'TH/ T !::' ]: NFiL. :[N':':;PE.:::'/':C~I'.,i ?',E:' f::IPF'E"£"F:i .... E.:"/ THIS; DE?F!RTHEENT m..L.t .... .... F2,['{ :~;IJEI.J'F?: T' T".. l'-~.hJ.:':,c.L.l..!?~' ''" r ......... ZOI"& !"!ZNZHUH !:.', ]; E;TF:INC:E E~ET!4EEN F! 14ELL F. iN[:, RN? ON-SiTE SEI4F!GE DZSF'OSF~L S?S'T'EFI J..~:~E~ F:EE]" FOR F! F'R!VRTE: !4ELL 0R &SE~ TO 2E~E~ FEET F'F?.Ohl F~ PUBL..~C i.,.!EL.L. DEPEN[:,ZNG UPON THE T?PE OF PUBLIC I.,.!ELL.. PiZNZHUM [:,ISTRNCE F:'ROM R F'F4'.I',,,'RTE !.,.!ELL. TO FI F:'RZMRTE SEP.IER L:[NE ZS 25 FEET F!!q[:, '!"O F! COFff'II. JNZT? SEk!ER LZNE ZS 7"5 FEE:T. OTHER REQU!REME]'.,I'!"S Hff'r' F~F:'PL"r'. E;PECZFZCRTZONS RND C:ONSTRUCT]:ON BVRZLRE~LE TO INSURE: PROF'ER INSTRLL. FIT:[ON. ~ CERTiFb' 'THRT :!.: I FtM F'BHIL]:F'II.;: .'4:['rH THE REL::!U!REHE]',!TS FOR ON-SITE SEHEI:;:S Fl.,hE:, NELLS FIS SET FORTH E:T' THE i'"II...INtC!PF:IL!T'.r~ OF FiNCHORRGE. 2: :[ N:[L..L ,!S'i"RM... THE S?STEH ]:N RCCORDFff',ICE ~qITH THE CODES. ]:: Z UNDE "Rt',ID THE: OB!..-.E;:[TE SEi.,.!EiR S'T'Si"Ef'! !"'iR'~" E'.Eg~UiERE EF.iLRRGEMENT ]:F' T'HE RESIE:,ENC REMO TO iNCLUE:,E HORE THRN 2: BEDROOHE:. ~J '~ SUE'[' E:"r'... ,~ DRAGi, ALASKA 9950/ ~'~' ,'~i. .%7][ January 4, 1982 Dale Greiner Lugene Lane Eagle River, AK 99577 Permit ~ 811141 Subject: L 14 B 3 Northwood A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. Buchholz?/R./g. Program Manager~--~ Sewer and Water Program Enclosure: Copy of Permit THE REL=!U Z RED :5 :[ ZE OF THE E;O Z L. FiE::F.,CdRPT I ON L:i;'¢LSTEH :[ 2:: . -.~,,, ,,--~ -..-~ .'.~..'. --. a · '~ ....... ~--~ ~ ::2 n~-~=.. "u- ~-~ =m THE LENGTH D:[?tE:NSZON }:S THE LENGTH ,:::IN FEET) OF THE TRENE:H OR DRFIZNF'ZELD. THE DEPTF! OF F! TRENCH OR F'ZT Z:B THE E:,I:~;TFINE:E BETt,.IEEN THE :SU!;:FF~CE OF THE GF:OL!ND FIN[:, THE E 3TT ': H 3F THE. EXE:F¢.~'RT Z ON ,:: ~ N ..... ~ ....... THE GRRVEL DEF'TH Z5 THE H]~N~HUHL.BEP:FR OF' GRR',/EL BET[,~EEN THE OUTFRL. L. PIPE RND THE E:OTTOH OF' THE EXCFI',,,'FtTZON <IN F'EET>. F:'ERH ]: T F1PF'L I: F~NT HFI:E; '1"PIE!: F:ESF'ONE; ZN'_=,TRL. LF]T]:ZH iNSF'EE:T:[E$4~; OF RN'm' !4ELLE; FI[::,..TFtCENT TD THZ:~, F'ROF'E'F4:T'¢ RN[ THE NL!hlE;E;R OF F:EE; '[ E:,ENE:EE; THF!T' THE !4E:LL !.,.II. LL E:FIE:I<:F tZ L.L :[ NG OF F!i'-,t'T' ?¢:iST'EH .,. :[ TH ': UT F' :[ NFIL Z N%F'ECT _T ON RI'-,iB, F:.F:'F'.R "~ 'v'P_, E:'=," TH Z B, EPFtF.':THE:I',!T fi'ri.. _ L ,...,r:'~:',_. :~;UE:..IECT TO F'¢'-'=;FZ:. ........... F['IELN. HZNZHUP! [:,I~;TRNE:E: E:ETFIEEN FI FIELL RNE'., FtN'¢ ON-...S:;ZTE E;EHFIGE [::,!:SPOE;RL. '.L=;'¢:STEi'! .T.E; ±E~E~ FEET F:OR FI PRZVR'i"E !.4ELL. OF'. ::!.DO TO 2OE~ FEET FRO.h'I F:I F'UBLZC !.,.fELL., DEF'E:NDZ.H.G LIF'ON THE T'.¢F'E OF F'UE&..ZC !.,.tELL. HZN!HUH [:,I::..;TRNCE FB:OH R PRI',/FITE: !,.iELL TO Fl F'F:IVRTE ~:iEI.,.!ER LINE !.'F: 25 FEET FiND TO R CEIHMUN]:T'¢ SEI4E:F.: L]:NE IS 75 FEET. OTHEF: RE(.:.!L! ]: RE:HEN"FE; HR"r' FIPPL'f. SPEC ! F I CRT :[ OBIS FIN[::' CO.NL=;TF4::L~C:T I ON F.:,:I: FtGRF!f"I::5 FiRE Ffv'F~..T. LRBLE TO ]: N:E;URE PF'.OF'EF: ]: NE;TRL.LFiT I ON. I CEF..':TZ F"T' T'HFIT i.: I FIl'd F'taI'd:[LIRR P.!iTH THE: REQL!IrRE:PIENTf::; F'OF.'~ ON-SITE SENE:RS FINB', t-4EL. LE; RS rE;ET FORTH E','T' THE: HLINICZPF!I_:[T? OF RNCHORFIGE. 2: ]: HZLL !NE;TRLL THE: f'~;¥:STEH _TN RCE:OF.!DF!NC:E: [,.!:[TH THE COB, ES. 2:: ]: LfNB, EF:E;TFIN[:' T'HFIT THE EIN--S:[TE SENEF: :SYfSTEH f"lFt'T' F'.EC!L.!IF;:E ENLR~'.GEHENT IF T'HE REE;IE:,ENC:E ]:EX F..'.EHODE:L.E[> TO IB!E:LIJE>E I"IOF.'.E THRN 3: :E;, :~NE[:,:_ _~~2~ ............................................................. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE [] SOILS LOG PERCOLATION TEST 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ?,~.,,./ R~'~r t A. No. 1457-E WAS GROUND WATER ~.OOU",TERED? ///0" PO IF YES, AT WHAT E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I ~r~r, lc;,~'l~ ---/~ ~" -' PERCOLATION RATE TEST RUN BETWEEN ;!~' (minutes/inch) /'~ T AND %,~"~ FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-731-26 1. GENERAL INFORMATION Complete legal description Northwoods Lot 14, Block 3 Location (site address ordirections) 22688 Mcmanus Drive, Chugiak Property owner Mailing address Lending agency Mailing address Agent Address Bruce & Doreen Marion 22688 HmManuR Drive, Chugiak, AK City Mortgage/W.Gossett P.O. Box 92810, Anchorage, AK Day phone 99567 Day phone 99509 Day phone 694-9035 263-0700 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: X If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 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. Name of Firm Eagle River EDg~neering S~r~iqe,~ Phone ~94-5195 Address p,rh, Engineer's signature Date DHHS SIGNATURE Approved for 2 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date r~'- f- ¢~' The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cer[ificates 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 profes.."}nal engineer's work. 72~)25 (Rev 1/91 ) B<3C~. MOA r,21 ENVIRONMENTAL SERVICES Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES U Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90 Health Authority Approval Checklist Legal Description: /~'~/'//~/~m.Z)~ ~¢7'//*/ /~/~/~---~ Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (WN) Date of test Static water level Well production cW~;~,Rm SA ~: ~~of sample: If A, B, or C, attach ADEC letter. ADEC water system numb~ Date c~3mpleted ~ Cased to C~t (above ground) ..V~res properly protected (Y/N) FROM WELL LOG/ AT INSPECTION ~ g.p.m. Nitrate Other bacteria Collected by: g.p.m, B. SEPTIC/HGL-BtNG TANK DATA /W~Rc/¢ / 7 Date installed /~'~'2- Tank size /0¢O ~,4/_ Number of Compartments 2 Cleanouts (Y/N) ~J~ Foundation cleanout (Y/N) y_F:¢ Depression (Y/N) ./I/~ High water alarm (Y/N) /"///~ Date of Pumping /x'---_ ~/- ¢~' Pumper ~"--/'~ ~ C. ABSORPTION FIELD DATA Date installed ~2 7/~ Length / o G Width Effective absorption area 75z~ Date of adequacy test Fluid depth in absorption field before test (in.); ~//~L Fluid depth ~//~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) ~' A///~./~0~ Soil rating (g.p.d./fF or ft~/bdrm) ¢-2, E, System type ~' / Gravel thickness below pipe ~ '~'- Total depth Monitoring Tube present (Y/N). ~ Depression over field (Y/N) Results(Pass/Fail) );L}/~S~ For ~ bedrooms Immediately after ~%--gal. water added (in.): Absorption rate = .g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* cyc e. s ste Size in gall.~J~s------- "P~el at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ,/'///'~ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/se~p~tjc_serv~ On adjacent lots O.O~j~( lots sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/PI~L=BtNG TANK ON LOT TO: Foundation 5- ~ Property line ¢-/o ~ Absorption field Water main/service line "Pump off" level at* Surface wateddrainage '~/¢¢ / Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line io ~ Building foundation .¢-/c)" Water main/service line Surface water "/-/O('~ / Driveway. parking/vehicle storage area Curtain drain ,/,/~/t/~ ,,'¢/)/~ ~/'7~ Wells on adjacent lots ,~z- ~--L:~)E~ ENGINEER'S CERTIFICATION . I certify that I have determined thru field inspections and review of Municipal record¢i~¢~;th~',~b~)C/~;s~i~,~ are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name HAA Fee $ '~ ~0 ' ~ .a,. o, . .m nt Rece ptNumber (-'//¢ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment. Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property ownerHOWARD R~OCAT~ON GROOPm~e~e~e~ ~uslnes8 Mailing Address 190 Soath O~ange Avenue~ ~v~gston N~ 07039 (c) Lending Institution Telephone (d) Mailing Address Real Estate Company and Agent Address ~t 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: .J i'/7? ~ 7 ~_~,¢¢¢~ ~ ~ - ,~ "/- ~ ---/:5 2. TYPE OF RESIDENCE Single-Family J~ Number of bedrooms. 3. WATER SUPPLY Individual Well [] Community/~ Public~' Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and statusl 4. SEWAGE DISPOSAL On-site~¢,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page I 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 flies 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, ordin,ances, and regulations in effect on the date of this inspection. Name of Firm J~,'/'?~----~ b ,' ;;~¢"/~"~ ~ A .~¢~'~ephone ~--~¢~ --~ 7'~ 6. DHHS APPROVAL Approved for '~ Approved '/~- ¢ bedrooms by , ' 'Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88)Back Page 2 of 2 -- MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) MUNICIFAL;'~.~,~/HOi:AOE CHECKLIST- FEBRUARY 1984 D,VI,SION 343-4744 Well Classification Legal Description: Well Log Present (Y/N) Date Completed If A, B, C, D.E.C. Approved Y~_.~N) Yield Total Depth__ Cased to __ Depth of Grouting Static Water Level '~'i~ ' Pump Set At Casing Height Above G'C~o~nd ; Sanitary Seal on Casing (Y/N) Electrical Wiring in CondOi,t~/N) ~ , £ / Depression Around Wellhead (Y/N) ~;PsAe:~cT/IHOo~d~;;TT~:kCoEns LFo~OM WELL.~/ /Y~ ;On Adjoining Lots_ Field on Lot /-_ ¢' ~ '"'""---1..; On Adjoining Lots_ ' ______ 'c Sea(er Cleanout/Manhole WaterTONearestSeWerServiCesamp/e COllected bY Line on Lot Date~. ; Water Sample Test Results Comments .~ ~ ~-- / B. SEPTIC/HOLDING TANK D,~,TA ~N Date Installed 3 --l')---~. 2. SCCze o. of Compartments Standpipes~N) Air-tight Cap~) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) / SEPARATION DISTANCES F~R~M SEPTIC/HOLDING TANK: To Water-Supply Well ~//'I' \ To Building Foundation To Property Line ?.-- ~ ~--~-,) To Disposal Field , To Water Main/Service Line ToStream, Pond, Lake or Major Drainage Course '/~/Ot"~'~ ~/~/')~,.//~¢~,~.~ _ Foundation Cleanou~?/N) ,. , Date Last Pumped //'~,~/i/~;:~/~) ; for 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ~// ~ Design '/'/?/~/~ Soils Rating in Absorpt on Strata ~ /.~ Type of System ~ /~ . Date Installed .~ --/ ~ ~ Length of Field ~' / Depth of Field ~ / ~ Width of Field ~ ~/ ~ ~ravel Bed Thickness , ~ ~ Square Foot of Absortion Area ~ ~ Statndpipes~resont(Y/~) ~epression over Field (Y/~) Date of kast Adequacy Test Results of Last Adequacy Test ~ ~ ¢/5 ~ ~Cg~~ SEPARATION DISTANCE FROM~BSORPTION FIELD: / To Building Foundation To Existing qr~ndoned System on /u// To ' '~ WaterMain/ServiceLine~ ~~ ~] ~oCutback(ifpr~sent) To Stream, Pon~, L~k~, or M~jor Dr~in~g. Cou~s~ ' ~~ ~ To Driveway, Parking Area, or Vehicle Storage Area D, LIFT STATION / Date Installed ~' ,S,~o in Gal, ons /~/ 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,..5(erifie~, or conformed to all MOA and HAA gui~eHff~jih*"e~t,e(;:t on the date of this ~~ ........ ~gineer's Seal '~ ~OF~o$~~ D~te of Payment / ~ '¢ '~'- ~ Waiver Fee: $ A~o~nt: $ /'Z~~. ()~ ~te of P~y~e~t 72-o2~ (Rev. 7/~8) 8¢c~ Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 316 / ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: January 17, 1989 PWSID: 213001 To Whom It May Concern: According to the records on file in this office, the CHUGIAK UTILITIES Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Vera E. Craig Environmental Field Officer ~ MUNICIPALITY OF ANCHORAGE ,~j '~ ./ .~ ~/ 2,-~' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HE.,~LTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~:/~7- ~..~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) NORTHWOODS I: LOT 1~, BLOCK 3, T15N, R1W~ SECTION 4 Location (address or directions) MCMANUS DRIVE, PETERS CREEK AK (b) Applicant Name f,~QNARf') P. t3RTN Telephone: Home 68~-4524 Business 271-4572 (CAI(CA) Applicant Address .~R 3 ~' ~¥ 7876; P,,~'GTAK; AT,ASf~A 99567 --.:-'~ii%~'(-:.;.<:;:Address POUCH 7059. ANCHORAGE, ": ,-: ::-(':(e)":~:Re~ll- r'''----'''~ B Esiate Company and Agent ' '_. '--: ": '~ ;- Address (c) Applicant is (check one): Lending Institution []; Owner/builder [~ Buyer []; Other [] ~explain); (d) Lending Institution HkfTrFiq~ RANT4' O~ ANC~ORAC~ Telephone ?76-1 911 AK 99510 ' "- ,' ..... ' Telephone · ' '-¢,':,'~.r~:h(f) ~!'~'ai, the HAA to the following address: ..... "?,".,""':':'"?-':-""-'" "." .... "" 2. ': TYPE OF RESIDENCE j/-~Single~-Family~. _Multi-Family [] . Other -' Number of Bedrooms ~ 3. 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 Depart m'~mt~of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (1~/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~J~G~ P&WER ENGZNEBR~NG SER~rfCES Ad~ress P,0. BOX 77~294: ~AGL. F,, RT'CR, R: AK Telephone 694-5195 99577 DATE, October'13,: 1987,.B]~'~ COMPLETED:' '..: ":': ' to- ensure' th&t adequate separation:' ' . ' ' " ' ' ' - Althou h ,,'~.'¢~ '." .'. "-..,'- ;.' ~ .",-" .'~; · - - ,., the.d~aznf~eld a~d ground:wa~er... . g ~.,~. .,..... ~%~ ,.. .... ,. water retention' ~s a factor ~t does not appear~'~eO;t.-......:k~., ' ' his' ~ ¢~0~ffSStu~'%~ ..... -: to be'hindering' .~he systems, performance at t , ' %%~%~ ' , "".," time¢;~, · . .... . . Dan Bolles, On-site Services .. /~: ~:. ~)-z¢:f~:.~._ j~.y,..;~;)~/ . . -:.'~.,': ~/* ' . .~ '~' // ..... ' :k:- ' ..,. ~',. '. .~ · .: . -' ' Appr~d f6r ~be'drooms by '~~/~~ Date 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, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 .! 7<i'; NOtSh^,IO SSD[/',iJiS 5v.LNP~NONAN:J ~OV~;OIqDNV gO )i A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification 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 IfA, B, C, D.E.C. Approved (Y/N) 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 Comments B. SEPTIC/HOLDING TANK DATA Date Installed //¢;~"~ Size ,/~':¢~¢,~'~ ! No. of Compartments Standpipes (Y/N) ,Y Air-tight Caps (Y/N) )'/ Foundation Cleanout (Y/N) Depression over Tank (Y/N) '},4] Date Last Pumped .~,~ Pumping/Maintenance Contract on File (Y/N) ,4/j~;. ; for Holding Tank High-Water Alarm (Y/N) /,-//4 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '+~-POo ~ ' To Property Line ~-.,2~ t To Water Main/Service Line ~-/~ / Course To Building Foundation ¢ ~ ' To Disposal Field ~-~z// To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/841 C. 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 "~/~ ''~ Lot 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 ¢' "' Gravel Bed Thickness Z¢ / Standpipes Present (Y/N) Date of Last Adequacy Test / To Property Line To Existing or Abandoned System on ; On Adjoining Lots /- Z~¢" 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 Gycles 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 g uidelines in effect on the date of this inspection. Signed ~ Company MOA No. Receipt No. Date of Payment I(Z.~ -'~ - c~::~ '-) Amount: $ t CDC~, Page 2 of 2 72~026 (11/84) A CHORAGE/ EST 3601 "C" STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: _SaaIambaL22~_l~Z PUSID #: _21~QQ1 ............ To Whom It May Concern: According to the records on file in this office, the _~UU~I65 ~IiLiIiESZNOBIH~OOBS_. ...... Water System is in compliance uith the State of Alaska Brinking Water Regulations. .. Sincerely, Louis fa] Engineer MUNICIPALITY OF ANCHORAGE DMSION OF EN~rlRO~ENTAL HF~ZLi~H DEP~J~fMENT OF HEA. 3~TH AND E~MRO~MENTAL PROTECTION APPLICATION FOR HEALTH ADTHORITY p - · AP REVAL CERTIFiC~PE (a) Legal [kTrs.c~ipti~n ( include lot, ,Block, subdivisionj section, to~oship, range Location 0(~dress or directions)~ Appl icants Addre ss--~f (o) ApPlicant 'is (check one) Lending Institution ~ ; fXmer/b~i~~; (d) Lending Institution ~,~__~.7/~g //~3ffO,be~' ~U~ Telephone (e) l~eal Estate Co. & Agent Add~ess Te !e phone 2. ~ _~pe of Resideno~ Single-Family ,[~' N~d0er of Bedrc~s Multi-Family O~.er (~s~i~) 3. '%~ater Supp]3/ Individual ~11~ Community F-~ Public ~. ~-~/~ ~' ~ /~ Note: If c~m~unity ~11 system, must have w~itten confirmation ~cra the State Department of ~vironmental Conservation attesting to the legality ~nd status. Is the ~11 adequate for the number of bedr~ms specified in this ~3~ (~._v~) 4. Sewage Disposal Onsite~ Public ~ C~unity ~ Holding Taxi< r-~ . ' Is the wastewater disposal system adequate fc~r the rmmber of t~dr ) [Page 1 of 2] 2-15-84 50 Engineerinq Fiz~n Providing Inspections, Tests, Data and Information I oertify e f fecL°~Y~'Lpecti°n° // //~/~~, Name ~6ff Finn Telephone ~ ' Address ( ENGINEER SEAL) 6. DHEP Approval Approved for '-~ The Municipality of Anchorage Department of Health and Enviromrental Protection dces not guarantee the continued satisfactory performance of the. water supply and/or the wastewater disposal system. This approval indicates that, as of the v~lidation date shc~rn above, based on the data and information furnished by an ecx~ineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrccr~ and type of structure' indicated. (DHEP SEAL) 7. Mail the HAA to the follc~ing address: KB2/d5/s [Page 2 of 2] 2-15-84 ae MUNICIPALITY OF ANCHOPAOE MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALTI~0RITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAY '1 Ig84 RECEIVED Well Classification Well Log P~esent (Y/N) Total Depth Static Water Level Casing Height Above G~ound Cased to If A, B, or C, D.E.Co Approved(Y/N) Date Completed Yield Pump Set At / Depth of G~outing Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/~0 / ) Sepa~ati°n Distances from We tl: ~/~ //~ To Septic/Holding Tank on Lot///// f-t- TO Nearest Edge of Absorption Field on/~Lot To Nearest Public Se~ Line Cleancut/Manhole Water Sample Collected By Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lo~s To Nearest Publia Sewer To Nearest Sewer Service Line on Lot ; ~ate Water Sample Test Results C~,.e nts Be SEPTIC~ TANK DATA Date Installe_d ~--/~'~'~' Size //~?' C3 No. of Campartm~nts Stand~in~s/(~ _Ai~-ti ht Cap~/W~) Foundation Cleanout (~) Depre:s~[-~'~Tank (~.~/ ~te Las~d ' ~/~/~ P~ing~intenan~ Con~a~ ~ File (Y~/~ ; fo~ Holding Ta~ High-Wate~ Ala~ (Y~/~' Ternary Holdi~ Tank Pe~t (~ ~p~ation Distan~s ~ ~ptic~ Ta~: To Water-Supply ~11 / ~ To ~ilding F~ndation To ~o~ty Li~ /~ ~ To Dis~sal Field To ~ter Main/~vi~ Li~ ~/~ To S~e~, Pond, ~e~ ~ ~jor ~aina~ Co~ Co,~nts ~{~ ~d~ /~ ~/~ [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ._~ '-/-7--{f~ ~ Width of Field ~ 63 ~ / Length of Fie ld '7 D / Depth of Field ~ Gravel Bed Thickness Standpipes Squa~e Feet of Absorption A~ea Presen~_(.Y~ Depression over Field (A~_~_~ Date of Last Adequacy Test / Results of Last Adequacy Test ,~ ~//~/4~ ~/~ ~ Separation Distance from Absorption Field: To ter-Suppl To To Building Foundation ~9--O / To Existing or Abandoned System cn Lot /~3 / /~ ; On Adjoining Lots ~ / To Water Main/Service Line z/~/ z~-/~/~/ To Cutbank(if present) To Stream/Pond/Lake/c~ Majo= D~ainage Course ~/ / //4 To D~iveway, Pa=king Area, c~ Vehicle Stc~age Area //,3 /~ d~3 D. LIFT STATION Date Installed Size inGallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Electrical Codes(Y/N) Co~a~ents Meets MOA ** Check Pe~mitte~L~droom Rating A~ainst HAA Request ** I certify tha~_~, h.. a~/~.he/~.x~, verified, o~ conformed to all MOA HAA ~_C~.~!~lines in effect ~- '~'; ~ -. . , MOA NO. ~"~t"~' ~' ~..~.C~ ~f~F2~X"~>~'~~/~'~ ~2%~ ~ [Pa~ 2 of 2] ',,,~ ....... 2-15-84 Time . ~e Time Date Date Date inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY P. hone Property Owner ~Jc Mailing Address '"P,, ~), Buyer Address Lending Institution ~/a 5 ~ ~ /~/~'~ ~' ~ Phone Address ~j¢ _ Phone Realty Co. & Agent "~ Address Legal Description Street Location Type~esidence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Water Supply A~ACH WELL LOG. A well Icg is required for all wells drilled since June ~odividual 1975. For wells drilled prior to that date, give well depth (attach tog if mmunity ~ Public Utility available.) ~,_ Sewa~isposal Year Individual Installed: ~ individual When Connected to Public UtilityL ~ Public Utility Q Holding Tank NOTE: THE INSPECTION FEE ~UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. April 5, 1984 ~Nphone: ~0~ 274-2533 Address: 437 E. Street Suite 200 Anchorage, AK 99501 To Whom It biay Concern: According to records on file in this office Northwood Subdivision (Phase IV) Water System is in compliance with the State Drinking Water Regulations. Sincerely, Anchorage/Western District Supervisor JCA/msm cc: Alaska Environmental Control Services 1200 W. 33rd Avenue Suite B Anchorage, AK 99503