HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 19North'Woods
Block 3
Lot 19
#051-741-12
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. 051-741-12 Expiration Date: 8-16-2023
Legal description
North Woods Block 3 Lot 19
Site address 22776 McManus Dr Chugiak AK
Current property owner(s) Travis Harper
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
By: Original Certificate Date: �.2 z — —
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
- representations provided by an independent- professional engineer.- The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X _ Arsenic Advisory
Other' tm- r& t lid i^t c�2 !�
COSA Approval_June 2022
�� yrs, •� ��a:1 c• �E
J
Development Services Department
On -Site Water & Wastewater Section
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-741-12
Complete legal description NORTH WOODS BLOCK 3, LOT 19
Location (site address) 22776 MC MANUS DRIVE, CHUGIAK, AK 99567
Current property owner(s) TRAVIS (TOD) HARPER Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ® Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 17 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: El
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ S 50 Waiver Fee $
Date of Payment
COSA # 05G 22. I y 30
Date of Payment
Waiver #
COSA Application July 2022 copy.doc
COSA Checklist
Legal Description: NORTH WOODS BLK 3 LT 19 Parcel ID: 051-741-12
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. COMMUNITY WELL PWSID# 213001
❑ Well log is filed with Onsite (or attached) Well production at time of test _gpm
Date drilled _Total depth _ft Water storage tank volume_ gallons
Cased -eft elldisln ecte for coliform test? Yes -No
❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative
❑ Wires are properly protected Nitrate _ mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) _in. Arsenic ug/L ❑ Arsenic less than MRL (ND)
Date of flow test for COSA Collected by
Static water level at beginning of test _ft. Date
Comments
B. TANK DATA
Measured operating fluid level in septic tank 50"
Date of pumping 8/16/22
❑ Required maintenance completed, if AWWTS
Comments: 20105 IR & 2017 COSA -ST IN DRIVE
D. ABSORPTION FIELD DATA
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: STEEL COVERS & 4" INSULATION PER
IR.
Which system tested (date installed) 8/19/2005
Adequacy test date 8/16/22
® ALL standpipes present per record drawing
Results M Pass
Total measured depth from grade 7_6 ft (max)
Fluid depth prior to test 33 in
Measured depth to pipe invert from grade 2_7 ft (min) ❑
Water added 450 gal
N/A — pressurized field.
New fluid depth 48 in
❑ Per record drawings, field is insulated.
Elapsed time 1440 min
❑ Monitor tubes go to bottom of effective.
Final fluid depth 33 in
If not, state depth into effective 5' IR - 4.9' ED MEAS.
Absorption rate 450 gpd
❑ Presoaked required if
FIELD STATUS — POST RECOVERY
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Effective depth (per record drawings) 60 in
Gallons introduced gallons date
Effective depth used 33 in
Any rejuvenation treatment (past 12 months) N
Effective depth remaining 27 in
If yes, enter date
Comments/Deficiencies: TESTED LOWER 2005 TRENCH. UPPER 2005 TRENCH MOSTLY SATURATED. 2005 FIELD
APPEARS TO BE OPERATING IN THE TOP PORTION OF THE EFFECTIVE DEPTH (ED). RECOMMEND CONSIDERING
CHANGING TO OLDER TRENCH THAT WAS 4.3' FROM GRADE & DRY. ALL PIPES FOUND FOR NEWER 2005 SYSTEM &
ONLY THE ONE PIPE LOCATED / FOUND FOR THE ORIGINAL 1981 SYSTEM. ATTACHED MOST RECENT ASB PROVIDED
COSA Checklist July 2022 copy.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑ Yes if No ft ❑ Yes if No
ft
Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft
❑ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' EJ if No ft
_ ❑Yes if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water >' 100
_ ®Yes if No ft
Tank to Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑ Yes
if No *5.7
ft
Private Wells > 100' ® Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*MOA WAIVER. SEPTIC TANK INSTALLED IN DRIVEWAY PER MOA PERMIT & PES IR 2005 WITH 4"
INSULATION & STEEL PROTECTIVE RISERS.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/20/22
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWC5
COSA Checklist—July 2022 copy.docx
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Curtis Huffman
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Septic 'dank Advisory
Certificate of On -Site Systems Approval #OSC 221430
Subdivision: North Woods Block 3 lot 19
This Advisory's is for a steel septic tank being located in a driveway and also being 17yr old It
may be approaching end of life. It was approved in 2005. At time of replacement, it will need
to be relocated. A leaking septic tank may be a source of contamination to the aquifer. Typical
replacement costs range from $10,000 to $15,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of a 16 -year-old septic tank in failure and should be replaced.
Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
Municipality of Anchorage
;
Development Services Department 5t
Building Safety Division
On-Stte Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 995IMS50 Pagel of 3
www.d.anchorage.ak.us (907) 3417904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWSWO5313 PID Number. 051-741-12
Namr.
Wastewater System: ❑ New ® Upgrade
Addsts 04vhiA V—
is Drive, RR I AK 9953Fb,?-
ABSORPTION FIELD
Phar. NumOr"Baaonme
® DW lr a a snanae lr w a Ba a Mand a oVw.
LEGAL DESCRIPTION
Sol R":
TOW DOM harn"nal grade
Blom Lal
3 14 Nnrthwnnd
Depth b ppe Ddlom can OriDa+W Pada
1 -nil In F,
cr."" depth e.rr"h pipe:
To«aNp: Range: Section:
AN added above oronal Wade:
CS F,
FL
Grwal Lwvm:
AniAn
Well: ❑ NewUpgrade
❑
or'""",°m
313 Ft
M"'w Wtrra:
F1
Diwnc.b"". fines
paa"Mneon (Prw"e• A B. c):ToW
Exist'g Comm--
Depen:
Caved to
Ft
TOW absorption area.
800 Fe
pp M"rIW.
PVC/178110 HDPE
D^er'D"a
oNNd:
SWiowelr Level:
tralaw
-3934
O"a MUWlsd:
Ft
,
JRs Pumping
811812005
Y"M: PMrV SN M: ca"V 1,109111ADwa Grand:
GPM Ft. Fr
TANK
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
LIR
Holding
ublwPnvate
Maradad~
capaaly
From
Tank
Field
Station
Tank
Sewer Line
Anch Tank
1000"
wM
200+
200+moo"./:
200+
Steel
Nu W COnpanrrr"a.
2
&"acew"r
100+
100+
LIFT STATION
Lot Lina
33
5.7
Sao
Maaul w
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20
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-Poop rxr h" K
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ti
ti
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50+
Pump Mace a Mad"
Elear Mnpec"" Pwkrnw by
RamaAa:
4" Ri id Insulation over tank 8 post tank fine. 2" R.I.
BENCH MARK
over field.
Lolation Arid waaip4arl
Garage Slab
Aswmed EN"a,on:
' 100.0 FL
Engineer's Stamp
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Inspections performed by: Pannone Eng, LLC Dates: 1"8/18/2005
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2n008/19/2005
.... ...............
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Development Services epartment approval
...........
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Reviewed and approved by: Date:♦♦c
(Rev. 12M)
, n . r CE 8149 `
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PERMIT NO:SWO50313 RECORD DRAWING P.I.D. NO: 051-741-12
WASTEWATER DISPOSAL SYSTEM
SWING TIES LOT 19, BLOCK 3 NORTHWOOD SID,
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EXISrG FIELD
IN FAILURE
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SPLITTER
(FS)-
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WALL
18 TO REMAIN
/ NEW 1000g SEPTIC
TANK. PLACE 4" R.I.
I OVER TANK & LINES.
NOTES:
1) All work shall be performed In
accordance withAMC15.65. EXIST'
2) Materials used shall be In SEPTIC
accordance with those specified In AREA
AMC15.65, Wastewater Disposal.
3) Maintain 10'separation to an lot
lines and water lines, unless noted
otherwise.
4) Lots served by community water
systems. No wells within 100' of
proposed system.
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R Pannone
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CONNECT TO SEPTIC TAN
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EXIST'G FIELD ABANDONED IN
PLACE
EXIsrG
SEPTIC
AREA
17
Robert 8 Wendy Parris
22776 McManus Place
Chuglak, AK 99567
786-8964
1
REPLACEMENT SAS
TWO TRENCHES 40LF EACH
x3'Wx5'ED, 6' TD
EXISrG
SEPTIC
AREA
'- 6.5
� EXIST'G FENCE
Nii 1%
ii
TH1
BALL TYPE DIVERTER
VALVE (OV)
EXIST'G 3
HOUSE
APPLICATION RATE` 0.6 GPDSF
(250 SF/BR)
\
BEDROOMS:3
AREA REQUIRED: 750 $F
TRENCH: 5' EFF DEP
80 LFx 5' ED, 6' TD
TOTAL AREA: 800 SF
1000g SEPTIC TANK
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
SATE: 8-28-05 LAN
P
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PERMIT NO:SWO5313 RECORD DRAWING DETAILS P.I.O. NO: 051-741-12
WASTEWATER DISPOSAL SYSTEM
LOT 19, BLOCK 3 NORTHWOOD SID,
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PANNONE ENG. SVC, LLC
P. O.
BOX 102954
ANCHORAGE,
ALASKA 99510
227-3522
P, 272-8218 Fax
DATE:
8-26-05
DETAILS
SCALE:
ITS
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street l
P.O. Box 196650, Anchorage, AK 99519-6650 (�(�
(907) 343-7904 �\
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO60313
Legal Description: NORTH WOODS BLK 3 LT 19
Date Issued: Aug 23, 2005
Expiration Date: Aug 23, 2006
Parcel ID: 051-741-12
Design Engineer: 0062 Pannone Engineering Services Site Address: 022776 MCMANUS DR
Owner Name: ROBERT & WENDY PARRIS Lot Size: 20461 SO. FT.
Owner Address: 22776 MCMANUS DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK , AK 99567-5446
This permit is for the construction of:
❑.r Disposal Field ❑.r Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
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 (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Date: 414VE 2
Issued By: ME E Date: y -1-7 0
Almucipaliiy of A,Yiehorage
K0. ha Anchorage, Alaska 745MrAM • Telephone 0)7) 343-KY)1 • rat (!N)7) 313.K(N)
47(X) I)rogaw Strcct • Andaomgc, Alaska (XM7
ximnumlorg
Mayor Mark Ilcgic/i
Building Safety Mision
August 23, 2005
Steve Pannone
Pannone Engineering
P.O. Box 102954
Anchorage, AK 99510
Subject: Waiver Request for Northwood Block 3 Lot 19
Waiver Request WR#: 050065
Parcel ID # 051-741-12
PERMIT #: SW050313
Dear Steve Pannone:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to the property line has been approved. The approved separation
distance is a 5 foot lot line waiver for leachf)eld to the east property line.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
rEn
Civil gineer
On -Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Strcct
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchoragc.ak.us
(907)343-7904
Waiver Review Worksheet
WR#:050065 PID#:051-741-12
Date Received: August 23, 2005
HA/Permit# PERMIT #: SW050313
Legal Description: Northwood Block 3 Lot 19
Engineer.
Steve Pannone
Pannone Engineering
P.O. Box 102954
Anchorage, AK 99510
Applicant: Robert and Wendy Parris
Waiver Requested: A 5 foot lot line waiver for leschileld to the east property line.
Criteria: Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
..........................................................................
Waiver Is Granted: X Waiver Is not Granted:
List Conditions or Reasons for above:
Date: $123105 By: Joe Goodall
Name of Reviewer
..........................................................................
Rec#: qLio'L Amount: $17� Date Paid: 8/2312005
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051.741.12 Permit Number SW
Property owner(s) Robert & Wendy Parris Day phone 786.8964
Mailing address (1) 22776 McManus Place
Mailing address (2) Chualak, AK Zip Code 99567
Legal description (Lot, Block & Sub'd.) Lot 19, Block 3 Northwood SID
Legal description (Section, Township & Range) _ Protect site 22776 McManus Place
Lot481ze 20.461 Acr s/Sq.Ft. Number of Bedrooms 3
061 -
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ED
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is In accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
va 't41s-vb
Date of Payment:
Receipt Number: (off&(o_9) Receipt Number:
(Rev. 12/00)
Pannone Engineering Services, LLC
Consulting Engineers
August 1, 2005
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 19, Block 3 Northwood S/D
Septic System Upgrade Permit Request
Ladies and Gentlemen:
P.O. Box 102954
age, Alaska, 99510
I am writing to request a permit to construct an upgraded septic system be issued for
this property. The proposed systems will serve a proposed three-bedroom house. The
existing bed, installed in 1981, is in failure. A diverter valve will be installed between the
two fields. The existing 1000 -gallon septic tank will be abandoned. The lot is served by
AWWU Water system.
I. Soils. See the attached soils log. Ground water was monitored for 7 days. No
ground water was measured in the monitor to a depth of 10-12 feet below ground
surface. Bedrock was not encountered in the test hole. It is my opinion that the overall
soils appearance of the soils, an application rate of 0.6 gallons/day/square feet should
be used using standard treatment system.
2. Trench Design.
a.
Percolation Rate:
16-30 Min Per Inch
b.
Application Rate:
0.6 gpdpsf
c.
Number of Bedrooms:
3
d.
Design Flow:
450 gallons per day
e.
Min. Absorption Area:
750 sf
L
Total depth:
6.0 feet
g.
Effective Depth:
5.0 feet
h.
Width:
3 feet
i.
Reduction Factor:
0
j.
Minimum Length:
75 feet
k.
Design Length:
80 feet
1.
Effective Absorption Area:
800 sf
m.
Septic Tank Size:
1000 gallon.
Cont'd on page 2
C:\Work\Letters\19-3 Northwood.001.doc
Page 2
3. Surface Water: There is no surface water within 100 feet of the proposed system.
The proposed systems will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The average topography in the area of the proposed septic system is
approximately one percent in the area of the upper SAS and 10-12 percent in the area of
the lower SAS.
S. Lot Line Waiver: The proposed system will be located north of the existing house
and retaining wall. There is not adequate space to maintain 10 feet from the property
line, driveway and water line. I request a lot line waiver to 5.0 feet be issued for this
upgrade. The neighboring system is located over 10 feet from the adjacent lot line and
will not be affected by issuing this waiver.
The proposed installation will not affect the future development of the surrounding or
existing lots. There are no wells or septic systems within 100 feet of the proposed septic
location.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
SievaenR. kPannioneL, .E
Civil Engineer
Attachments:
Q\WORK\LE7TERS\19-3 NORTHWOOD.001.DOC
PERMITNO: DESIGN DRAWING P.I.D. NO: 051.741-12
WASTEWATER DISPOSAL SYSTEM
LOT 19, BLOCK 3 NORTHWOOD SID.
' PROPOSED REPLACEMENT A;
TWO TRENCHES 40LF EACH
15i i 1 x3'Wx5'ED, 6' TD \
5•,c ,� EXIST'G
SEPTIC
AREA
� TH2
w / INSTALL FLOW\� I \ 5.0 SPLITTER r % 0% ,\ 0
EXISTG FENCE
5:S
^� �G
/ EXIST'G FIELD RETWALT % •\+1
IN FAILURE
(1) TO REMAIN \ \ II
l8S \ / t II 1% NEW 10008 SEPTIC
TANK. PLACE 4' R.I. \ \ 1 .0 II
I OVER TANK & LINES. \ •+
NOTES: \
TH1
1) AO work Shan be performed In INSTAL BALL TYPE
accordance withAMC15.65. EXIST \ DIVERTER VALVE
SEPTIC \ \
2) Materials used shah be h AREA
accordance with 0ase specified N EXIST'G 3 BR
AMC15.65, Wastewater Disposal. HOUSE
CONNECT TO EXISTG 10008
3) Maintain 10'separation to an lot EXISTG FIELD SEPTIC TANK
Tines and water Tines, unless noted ABANDON
otherwise.
4) Lots served by community water
systems. No wells within 100' of
proposed system.
DESIGN CALCULA IONS:
PERCOLATION RATE: 16 MPI
EXIST'G APPLICATION RATES 0.6 GPDSF
SEPTIC (250 SF/BR)
AREA BEDROOMS:3
OF 'et" AREA REQUIRED: 750 F
+�•�P•••'•• �J TRENCH: 5' EFF DE
'' •• ♦♦♦ // 80 LFX 5' ED, 6' TD
5;
• ♦ TOTAL AREA: 800 SF
J- ••••�'; ♦j 10008 SEPTIC TANK
+ . ..\ .............�
r" ;..... .......... j� PREPARED FOR:
►� Steven R. Pannone ( PANNONE ENG. SVC, LLC
y
♦ jj.
Robert 3Wend Palls
♦ '• ' 2i
♦ 1 9 • � � 22776 McManus Placa P. 0. BOX 102954
♦♦�•''•�i Chuglak• AK 99567 ANCHORAGE, ALASKA 99510
♦1•',,, ;..... 786.8964
DATE: 6 -3522P, 572-8218 Fax
crni c• ,•-.,n I PLAN
PERMIT NO:
DESIGN DRAWING DETAILS
WASTEWATER DISPOSAL SYSTEM
LOT 19, BLOCK 3 NORTHWOOD SID,
P.I.D. NO: 051-741-12
IM Ny3M
0N3 NOV31V
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NOUVOPM.4
♦"" : .PREPARED FOR:
iSteven R. Pannone
E NG. SVC, LLC
a
Robert 8 Wendy Parris
P. O.
BOX 102954
Ce 8�4s� a
�i
22776 McManus Place
ANCHORAGE, ALASKA 99510
Q f✓,y'.�
Chuglak, AK 99567
78"964
227-3522 P. 272-8218 Fax
����,'
DATE:
6-1-05 DETAILS
_._
SCALE:
NTS
U
a;
SOILS LOG - PERCOLATION TEST
. r,P...i
PANNONE ENGINEERING SERVICES ...........
� �.,•.•
P.O. BOX 102954 TH
ANCHORAGE, AK 99510 i ` ......•• `•
.
... ... .. ..
(907)272-8218mp.111
�
• :Steven R. Pannone
ti8149
PERFORMED FOR: Robert d Wendy Penis DATE PERFORMED: 7.27-05 ••���"Op;'�`JCSrCJ'�t�l,.••'��
LEGAL DESCRIPTION: LOT 19, block 3 Northwood SID �4•,1..�.
TEST HOLE 1
TOPSOIL SLOPE ! ( SITE.PLAN
1 OR 151!3' f�
2 i� I
3 SAND Say Tw
4 GM GRAVEL I
20
SMl SAND b w 9 , ,,,, CAUnm eEEs
1 \ L
8
7
ML Sandy SILT. 881e \ rNt
8 to no gravel \
9 \
TEST EJOsrG]aR
10 HOLE NOOSE
BOH
11
12
13
WAS GROUND WATER SLOPE
14 ENCOUNTERED? N
15 IF YES, AT WHAT
TH1
18 DEPTH? -0=
17 DEPTH TO WATER AFTER
MONITORING? -DRY-
18 DATE: 8305
19
20
16(minBnch) PERC HOLE DIAMETER 6 inches
HOLE DIAMETER 6 inches
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS: Test hole excavated by JR'S. Test Hole was presoakedTeSt hole excavated by JR'S. Test Hole was before�rc testtest
PERFORMED BY: Scott Crowther P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
CLOCK WATER
READING GATE TIME NET TME LEVEL NET DROP
READING
7Q7-05 11:52 S p
2 12:02 10 MIN Sr y9•
7 12:02 � T p
4 12:12 10 MIN 61' SR'
5 12:13 p p
5 12:21 10 MIN 6t'
PEROLATION RATE
Sle'
z:
SOILS LOG - PERCOLATION TEST �����•
••••••�
40
PANNONE ENGINEERING SERVICES
P.O. BOX 102954 TM °;•��
ANCHORAGE, AK 99510 0 ........ ............•••• . i
(907) 272.8218 ••.•. ... ............ .�
••.���
•
Steven R. Pannone
PERFORMED FOR: Robert b Wendy Perris DATE PERFORMED: 7-27-05 •��� %. 8149 ,� ••��•
44441,
1 may.•••
LEGAL DESCRIPTION: LOT 19 Block 3 Northwood SID
TEST HOLE
SLOPE �.�" SITE PUN
Top Sod
OR
!!
2 -svL
Silty SAND&li 20 21
4 SMI GRAVEL '•' ! "•
GM ��' 19 ewor¢n
6
18
e
I
7 I I
1 I
B
, aw.oaaA
9 , xur
22
TEST
Poorly graded
10 SPI SAND to Silty OLE
SM SAND
11
I
12 /BOH
13
WAS GROUND WATER SLOPE
11 ENCOUNTERED? N
75 IF YES, AT WHAT TH2
DEPTHS
78
17 DEPTH TO WATER AFTER
MONITORING? DRY
18 DATE: O -U5
19 CLOCK WATER
READING DATE TIME NET TME LEVEL NET DROP
READING
20
1 7.27-03 17:32 T 0'
2 12:02 10 MIN fiI' 32•
� 12:02 � 3' 0'
1 72:72 10 MIN 31' 6!9•
6 12:12 � e' C
12:22 70 MIN 3I' Sr
PEROLATION RATE 16 (minAnch) PERC HOLE DIAMETER 6Inches
TEST RUN BETWEEN 5 FT AND 6 FT
COMMENTS: Test hole excavated by JR's. Test Hole was presoaked before perc test
PERFORMED BY: Scott Crowther, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALLSTATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
z:
0
MUNICIPALITY OF ANCHORAGE
r- DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO -i LOTION
ENVIRONMENTAL ENGINEERING DIVISION
_
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME -
PHONE
EJ NEW
t
1�.f'-; �„_-ehLl•�� %li,
,a
''UPGRADE
--
MAILING -
qRESS
C�L- 5 2. 000
LEGAL DESCRIPTION
L, Ict 6 n W t J
LOCATION
NO. OF BEDROOMS
Well
Absorption area
Dwelling
PERMIT NO.
Uy
DISTANCE TO:
aQ
Manufacturer �—
Material
No. of compartments
wF
N
Liq. capacity in gallons
IF HOMEMADE:
ide length
Width
Liquid depth
'1
J CD
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= z F
Manufacturer
Material
Liquid capacity in gallons
O
J=
w
DISTANCE TO:
Well Foundation
r�j�i�, c
Nearest lot lin t
PERMIT0.
6v (7z
J z W
No. of lines
Length of each ne r Total length of linC. 1
Trench width Ci
Distance betweep lies
F _ UJ
h �i
tweUcs
(o
F
Top of tile to finish grade Material beneath the I
Total effective ab orpti area
inches
Leng Width Depth I
PERMIT
W
0
a F
T e crib Cr'b diameter Crib ded - T tai effective sorp - n are
wa
well
w
uil ding fo a " n VJWrest lot line
AifiC-
J
ClassDepth r istance to lot line
PERMIT NO.
J
W
Building foundatio Sewer line Septic tank
Absorption area(s)
D S ANCE TO:
OTHER
PIPE MATERIALS
'3o 3 V `t
SOIL TEST RATING
_
INSTAL E
r
REMARKS
e
0 (�,--A`•.'}�Q'v'
}v � r
b G..4
APPROVED DATE LEGAL
JJ
72-013 (V. 3/78) ��
WIN
6d
1"'-4 Lj 0°-A I A T.Fl R_._- X d "_r. A,,, -,A A--' r_9 A" -°A A._.: A•-` _n A-°=_ A—A a� A_ 1
HEALTH FIND ENVIRCSN•MEN'.THL.-_.ROTECTIOIN
E - 1-F AN•.i C:E'ICi F:AGE, AK. 99501264-4720
APPLICANT ROBIhl P. I_EN•dAE--:ER JR. Mc 1,= i'ICHAI''di_IE LiF:. 0 6 ;;
"1 �C:ATION'd
LEGAL I. -OT 19 BL.F::3, N•ORTHWOOD .LIES L -OT SIZE 999r999 SQUARE FEET
TYPE OF SOIL.. ABSORPTION SYSTEM I S : -T;-
f-lAdII'IUM N,p-IN�IE_�ER
OF
BEEf_`ROO11 = _
SOIL- RATING <:: G! i T,'BF:?= ��R=i
THE REQUIRED
-I.:'_E
OF THE SOIL ABSORPTION
S'TSTEH IS:
E—,,A EE 6 =` V VA =-
'_l- fL-3
I_. E= R --"a A -=s _F &—1 = _= ^I-
C� F = F=o °w 4 E 0
THE LENGTH D I FIEhI I CIN IS THE L.ENGTH (IN FEET) OF THE TRENCH OR DRA I NdF IELD.
'THE DEPTH OF A TRENCH OF' PIT IS 'THE DISTANCE BETWEEN THE SURFACE OF THE
GROUNdI7 AND THE' BOTT01*i OF THE E;--<;CA%;`ATION (IN FEET
THERE IS NO E 'ET WIDTH FCR TRENCHES.
THE GRAVEL. DEPTH IS, THE MINIMUM DEPTH OF GRA',[ EL.. BETWEEN THE OUTFALL-. PIPE
AND THE BOTTOM OF THE EXCA'v'ATION? (IN FEET).
PERMIT APPLICANT HAS THE REE;PCq°'a' I B T I_ i "T`'T TO INFORM THIE; DEPARTMENT DURING THE.
INSTAL l..ATI� hl INSPECTIONS S OF ANY IdELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL 'WILLEf VE-*.
.�. ._..._ @ L<^.� Cu
"-_ a_ d .9. "'� '- = if-=" . A �'-:: -T 1 AWA �-� �-� �==9 F --' F_
F --"EF- A'r A U I F! E-7 C-" --
BACI FILLINdG OF'
ANY
SYSTEM WITHOUT FINAL INSPECTION AND,
APPROVAL_ BIT' THIS
DEPARTMENT WILL-
BE
SUBJECT TO PROSECUTION.
HIN MUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL E.4'STEll IS
100 FEET FOR A PRIVATE WEL-L.. OF' :150 "TO 200 FEET FROh1 H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WEL-L.
M I Nd I MUM DISTANCE FR011 A PRIVATE WELL TO A PRIVATE SEWER LINE i S 25 FEET' AND
TO A COMMUNITY _ EkIE R L.I N'dE IS 75 FEET.
OTHER REQU I REI'IE:N•dTSS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION D I AGRAI''I' ARE
AVAILHBL.E TO I1''d'=URE PROPER INdSTAL.I_ATIONd.
F" I F-" F-: E " @_ g F= C E °I C= IEE ="
I CERTIFY THAT
i: I AM FI= M I L . I AR WITH THE REFI U I REN•IENdT_ FOR ON—SITE 'SEWER' AND, WELL_` P -I`5 SET
FORTH BY THE ill.lN'' I C:I PAL I T'T' OF ANdC:HC RAGE.
I WILL- INSTALL HE SYSTEM IN ACCORDANCE WITH THE CODES.
I UNDERSTAND THAT THE?Nd '_ I l"E EI-IEF: Y T Ei''I I'IAY REQUIRE ENdLARGEI''IENdT I F' THE
RE `I D.. _.. F.,E'1'-10DE ; TO I N CL -UDE MORE THAN.W BEDROOMS.
_ z -
WFF 1 _:-Nd' �RO_[IN•d P. LENdAE- JR.
Xl
DATE.6st V4.0I_-EIEC BT - __ _ _ — ____.- f
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL
ENGINEERING
DIVISION" n
825 LStreet -Anchorage,
Alaska 99501
�
Telephone 264-472 , �i nn
„o,
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RET nb '
NAME
PHONE -- EW
�O �I
❑ UPGRADE
MAILING ADDRESS
Pic
LEGAL DESCRIPTION
LOCATION
NO. OF BEDROOMS
•�/�
DISTANCE TO:
Well
.�- �Ci �.�,�.
-
.Absorption area
—7
Dwelling
7
PERMIT NO.
r
� G
Uy
J
wQ
Manufacture
-
Materiap�
No, of comp�r�tments
I
I QP
))
®L,
y
Lie. ca acity in gallons IF HOMEMADE:
ffic '}
Inside length
1+
Width
Liquid depth
'_� ►
OO�z
DISTANCE II
Dwelling
PERMIT NO.
OZ F
Manuf rerterial
iquid apacity in ns
DISTANCE TO:
W
Foundation 7
-j- D's-
Nearest lot line
y-- ( t)
PERMIT NO.
w =
No if
u U
w
No. of lines 2
Le th of e ch line
Total len Th f h es
Trench width
Distance betwe n�li
1 e
t�
FTop
of tile to finish grade 7
Material beneath the
Total effective ab orption area -
inches
Length
Width
Depth
PERMIT NO. -
Lu
C7
Q H
Type o rib
fib dia eter
Crib depth
Total effective absorption area �
as
w
/
wWell
ti
-�
'
Building -foundation
Nearest lot line
DISTANC O:
J
a
Depth
Driller
Distance to lot line
PERMIT NO.
J
w
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
a
PIPE M ERIALSy
363
)
J
SOIL TEST RATING
7
------ -----"_--
INSTALLER
11
IT
fill
REMARKS
-/
T_
:Ipat-
IJ
v
c
i
t
i
f
j
ROVED
T LEGAL
/�
2' W ILCti
72-073 (Rev. 3/78) /1101W J�tXi! Dat ei Z � ..�fy /.gyp. 7 / ®%1 /�y
m
I W " W n� W -Hi .b. n�.. .1L S ""3 @.-._ ..W.. W 3 _ ,n...._W` 6"'9 W 'M! n—: C i'•'_ W"-tl n__W W-:= � ; p I -
DEPARTMENT' l.,. HEALTH HYID "EY• VIF:ONtIENTAL ITEi=TION
825 `L STREET, ANCHORAGE, AE::. _.I.a50 s
E~ � -Al-T-
CH ®i -°6 " Ems. F7 F�::^ �="= E : " g=� 1 -T
PERMIT NF.i. 81EE1256
APPLICANT DON E I MMERMAN FEi BOX 596 688-2603.
L C:AT I ON IJP4K
LEGAL LOT 1.9 BLK 3 NOR:T'H!•BCFOD 'LIEN LOT SIZE 200LAO S-;Q..JARE F E -T
-1
�1 F k -"LL
T'r'F'E OF SOIL ABSORPTION SYSTEM I S : TRENCH
MAXIMUM NUMBER OF EEC:R:IiC�t! _ SOIL R- •�I! F I .,E.R,; � ': 0 .1
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I'S:
THE LENGTH DIMENSION I 'THE LENGTH (IN FEET) OF THE TRENCH OR: DRA I NF I ELF).
THE DEPTH OF ri TRENCH OR PIT IS THE DISTANCE CE BETWEEN THE SURFACE OF 'THE
GROUND AND THE BOTTOM OF THE EXCAVATION < IN FEET;.
THERE IS 610 SET WIDTH F CSR: TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F`IF'E
AND THE BOTTOM OF THE EXCAVATION (.1P.4 FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIEDEPARTMENT I±I_IR:ING THE
INSTALLATION IY• SPECTIi iNS OF ANY WELLS ADJACENT TO THIS PROPERTY AND 'T'HE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE,
-'a a_: ;2 >1 E°-.9 " . r-- 8 �e" T I CH r.4 S ° � =P F^:;� E= �: IE �� � �_. � �[ F E -- � — ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION FIND APPROVAL. gi' THIS.
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
t4I YB I Y'iUM DISTANCE BETWEEN A WELL AND AY'q'r ON-SITE SEWAGE DISPOSAL _.'T'•= TEM IS
10 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING
UPON THE T'A'PE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL Ti � A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE 15 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER: INSTALLATION.
�=° EH,_ F -f fi"l E: 7" FE Oz F•° 1: FP= =° [:-d F= (== 0 =-- 1-4 ED E= F_` _-=W D :j_.
I CERTIFY 'THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR: ON-SITE SEWERS AND WELL :=: AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM TEM I N ACCORDANCE I.B I TH 'THE CODES.
r . I UNDERSTAND TFIYdD TFIFI f 'THE -N `_=ITE ' EkIER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE 5 R:EMODE'. ED INCLUDE CL!_ DE MCR THAN BEDROOMS. n• O T t
SIGNED: __ _.
AF'PLIC DON F I Y•1Y-1E IF d _
ISSUED BY -./-A.-
t {4.A
�r
k(, , Y, VJ- V.,,P
�C
r
P"�k S
�Aj/0L
1JO T o vl,� o � < <� � < �o E:. -7 t W C1,
5. LEGAL DE. GRIP SON
-�
DATE RECEIVED
INSPECTION APPOINTMENTS
-
TIME
TIME
TIME
DATE
-DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC74bb1CIPALITY OF ANCHORAGE
825 L Street - Anchorage, Alaska 99501 DEPT. OF HEALTH &
ENVIRONMENTAL PPOTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 AUG J
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWR AM IV
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for pr99oceesssing.
1. PROPERT WNER
�l�%Z-;' c'� �� ..?'.Yl..[ •i,i% i l��' 6�_.�-'� lUl9 E�=3CL"��_
MAILIN A RESS
— ef„
�
PROPERTY RESIDENT (If differ nt from above) --
PHONE
2. BUYER 0
PHONE
_j
MAILING ADDRESS -
3. LENDING INSTITUTION
PHONE
n NJ
MAILING Ab RESS -
4. REALTOR/AGENT '
PHONE
MAI LING ADDRESS -
6/1
5. LEGAL DE. GRIP SON
-�
�!`7�f`✓( _�r��%4< _ d- _ z
STREET LOCA ION /-
-
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
SINGLE FAMILY
❑ One ❑ Four ❑ Other
Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
❑ INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
CA COMMUNITY
since June 1975. For wells drilled prior to that date, give well
dd! PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM --
1XL_ INDIVIDUAL/ON-SITE**
4e YEAR ON-SITE SYSTEM WAS INSTALLED.
El PUBLIC UTILITY
1..� _( t_Y//=1;-p C r LOC h �_a e AI
� ;� j—� I rt
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
o -u IV Mev. 13//a)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLE FAMILY
❑ ONE ❑ THREE ❑ FIVE
❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
PERMIT NUMBER
DEPTH OF WELL
❑ INDIVIDUAL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
RECEIVED
Connection Verified_LOG
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY
Connection Verified
INSTALLER
❑SepticTankor ❑Holding Tank
SOILS RATING
Size: If Tank is homemade
give dimensions:
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
Septic/Holding Taok
Absorption Area
Sewer Line
[Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
Conditional approval if monies are escrowed to have the
standpipe
on the first compartment
of the septic tank replaced.
This needs
to be completed by
September 9r 1981 and reinspected by
this
office. See final
inspection report dated 9-•l-81.
APPROVED FOR
BEDROOMS
1� CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE n
BY
111 ^' ppG B L
`• Municipality of Anchorage
On -Site Water and Wastewater Program a MAR j 0
(907) 343-7904 s -
6
Certificate of On -Site Systems Approval
Parcel I.D. 051-741-12
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: 9' 11 -T7
North Woods Block 3 LotJ9
22776 McManus Drive
Current Property owner(s) Parris, Robert & Wendy Day phone
Mailing address
Real Estate Agent
22776 McManus Drive Chugiak 99567
Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class A Well
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request
Received by:�,t�Z �4Z� Date:
COSA to be released to the engineer, unless otherwise requested th engineer.
COSA Fee $�j 2-(e Waiver Fee $ _
Date of Payment ?✓ 1 lb ((i Date of Payment
Receipt Number Qa3(Cl 6) Receipt Number
COSA# if1'JG19!10—t9 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the lest,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory lest results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
4L System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
By: 11 X %A
bedrooms
Date 3/9/2017
bedrooms, with the following stipulations:
WATER AND
WASTEWATEI
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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet r . -
If more than 1 septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: North Woods Block 3 Lot19
Parcel ID: 051-741-12
A. WELL DATA
Well type A If A, B, or C provide PWSID # 213001 Well Log (Y/N)
Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping 8/11/2016
31li1*101c7j111t11177yIMIR r7rZrld
Depression over tank (Y/N) N
Pumper JR's Pumping
Date installed 8/18/2005
Cleanouts (Y/N) Y
High water alarm (Y/N)
Date installed 08/19/2005 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench
Length 40/40 ft. Width 3/3 ft. Gravel below pipe 5/5 ft.
Total depth 2]91062ft. Eff. absorption area 800 ftz Monitoring tube Depression over field _
Date of adequacy test 3/8/2017 Results (Pass/Fail) PASS For 3_bedrooms
Fluid depth in absorption field before test Water added 481 gal. New depth in. �n Q
Elapsed Time: 60 min. Final fluid depth44 95j 5
in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons _
"Pump off' level at
Cycles tested
in
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 5.7* Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
*Waiver on file.
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name Steven Pannone
Date 3/9/2017
COSA canary sheet_2-6-15.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
in.
i
RECOVERED 5/8•
REBAR BENT
LOT 18
BLOCK30
� � AN/DRIVE
S
MC M
98 66 tGi
E 986�,tRi
N� A•p0 0 � �11UN PED tTY4i � �-
1iroyAW66
20,461 S.F
O 1
CONC.
PAD
i
wv U'0`7� EASEMENT _ � _
LEGEND,
(C)=CALCULATED DATA
(M)=MEASURED DATA
(R)=RECORD DATA PER PLAT
U.G.=UNDERGROUND
T&E=TELECOMMUNICATION &
ELECTRIC
NAT.=NATURAL
PED=PEDESTAL
(TYP.)=TYPICAL
N
® O
O
®4• PLASnC m
RISER (TYP.)
)�Ejp,1N1N
CANT
NAT GAS
U.G. T&E
RECOVERED 5/8"
REBAR (TYP)
1"-30'
M1 g8o'T) 1 LOT 22
�"E 98661 ISG
N'BAS15 OV �E LOT 17,
NOTES:
1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY.
2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY.
3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT
BOUNDARY SURVEY MAY DISCLOSE.
4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS.
5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE t1 FT.
6. THIS SURVEY PERFORMED FOR WENDY PARRIS, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF
THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC.
IS A VIOLATION OF FEDERAL COPYRIGHT LAW.
7. THIS LOT SERVED BY A MUNICIPALITY OF ANCHORAGE WATER SYSTEM,
EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS. OR
RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON
BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
�P• •,...... `rte
*.'49TH
•
/�••Rob ert•J• F
.Q
�^s 10615-S
�4fd pROFfSSIDNA� L�49 S�
AS -8U
ALASKA RIM ENGINEERING, INC.
9131 E. FRONTAGE RD.
PALMER, ALASKA 99645
PH: (907)745-0222 : FAX: (907)746-0222
EMAIL akrimOalaskarim.com : WEB: www.alaskarim.com
W0: 1700083 FB: 17-01
PAGE: 1 of 1
SCALE: 1" = 30' 1 FILE: 1700083AS
I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED
UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY:
NORTH WOODS SUBDIVISION, BLOCK 3, LOT 19,
PLAT _79-195, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, AK.
SURVEYED ON THE 1st OF MARCH 2017. C2017
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES dhllSj
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 1. D. # _06 i --) L� � - \ a HAA # 0 Qcj �'-n an --I
1. GENERAL INFORMATION
Complete legal description Lot 19 • Btock 3 • Nonth Wood Subdiyi6ion
Location (site address or directions)
22776 McManus D4.ive v
Riven, AK 99577
Property owner Robin Lenakex (D,i) Day phone
Mailing address house i6 tenant occupied by Dave and Jan Poole 688-5212
Lending agency Norwest Mon.tgage Day phone
Mailing address 16635 Centek4ietd i=rate R.i.ve!c AK
Agent Walt Redi,6ke / Witt .waw Realty Day phone 276-8069
Address 3333 Denati. Anchoaage, AK
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
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:
Individual on-site XXX
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 H21
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 '11 a a 13NGIPI21111INO Phone
17034 Eagle .204
--
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Z
Additional Comments
bedrooms.
Date
_0�19
A
11, J. ' 1-1AF n
No. 3235 -
bedrooms, with the following stipulations:
IIITIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Servicesi
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L -o -r \9 Pa L-3 � o 9:srh �Ioous So Parcel I.D.
A. WELL DATA
Well type Ins,
Log present (Y/N)-
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
PuTrip level
If A, B, or C, attach ADEC letter. ADEC water system number 2\ 3go
Date completed
Cased to
Wires properly
FROM WELL LOG
Driller
Casing height
AT INSPECTION
SEPARATION DISTANCES FROM WELL TO: I, "o y
IZ7c
Septic/holding tank on lot 2=b `� ; On adjacent lots
O m
Absorption field on lot vo o ; On adjacent lots Z
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform Nitrate —
Public sewer manhole/cl
Date _sm ple: Collected by:
B. SEPTIC/HOLDING TANK DATA
Other bacteria
Date installed \'A 5�>\ Tank size Joao Compartments
M
Cleanouts (Y ) Foundation cleanout (Y/ l� Depression (Y/10
High water alarm (Y&N Alarm tested (Y/N)
Date of pumping - yo —,=t 3 Pumper S� �Ssea o L
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
vrell(s)onlot I-Z:,dtJr- On adjacent lots �IA- Foundation o S-14-
.k
To pioperty line \ Absorption field
Surface water/drainage \ u fl , k
Water main/service line
\O��
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
oz
;. 6
g.p.m. 9-1).
:Z,
a y
v;
r
®
07
m T
A D
ce
SEPARATION DISTANCES FROM WELL TO: I, "o y
IZ7c
Septic/holding tank on lot 2=b `� ; On adjacent lots
O m
Absorption field on lot vo o ; On adjacent lots Z
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform Nitrate —
Public sewer manhole/cl
Date _sm ple: Collected by:
B. SEPTIC/HOLDING TANK DATA
Other bacteria
Date installed \'A 5�>\ Tank size Joao Compartments
M
Cleanouts (Y ) Foundation cleanout (Y/ l� Depression (Y/10
High water alarm (Y&N Alarm tested (Y/N)
Date of pumping - yo —,=t 3 Pumper S� �Ssea o L
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
vrell(s)onlot I-Z:,dtJr- On adjacent lots �IA- Foundation o S-14-
.k
To pioperty line \ Absorption field
Surface water/drainage \ u fl , k
Water main/service line
\O��
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed —
Size in gallons _
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y.
Manufacturer
Manhole/Access (Y/N)
"Pum
vcles tested _
SEPARATION ISfANCE FROM LIFT STATION TO:
lot
D. ABSORPTION FIELD DATA
On adjacent lots
Surface water
Date installed _ \ CAb3 Soil rating ?'3' llr'f-- System type
Length 1 e `t Width
Total absorption area i 7°
Depression over field (Y/6I
Gravel thickness
Z�
Cleanouts present&N)
Total depth
S
Date of adequacy test — 4- 23-93
Results Cgjjjfail) /��SS for -r94� bedrooms
Peroxide treatment (past 12 months) (YIQ � 1-1"Id�J � If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
1 d- On adjacent lots
To building foundation i
I �
On adjacent lots 3�
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
4A --Property line
C. `
To existing or abandoned system on lot
—Cutbank 'J Water main/service line.
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on_the z68td gJ this inspection.
n ir�
3 h, S r:NDINEERING
I %034 Eagle River Loop Road No. 9.04
Signature
asci a River, ivaska 1
1 ��
Engineer's Name A;
17
Date 2(p
iii j�"f ,f (}�1�j17y.✓
HAA Fee $ /70- Waiver Fee: $
Date of Payment `� - Z,� c/7.3 Date of Payment
Receipt Number e?z �� 3 L, S � �� Receipt Number
T'E OF
p L p S
N
[11,
�WALTER J. NICKEL, GOVERNOR
DEOF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
April 5, 1993
Mr. Ray Shafer
S & S Engineering
SUBJECT: Northwoods Subdivision
Class "A" Public Water System, PWSID 213001
Dear Mr. Shafer:
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on March 4, 1993. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on April 21, 1992. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on July 1, 1992. This does meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC)
were submitted to this Department on June 2, 1992. Based on analysis of
the previous VOC samples results have been satisfactory. This does meet
the provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
. I I?I,,1,
• MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date '5_7 _1/Z
1. GENERAL INFORMATION
(a) Legal D�esccr tion (include lot, blockbdivision, section, township, rang
/(/or:lti/oat9 s
Location (address or directions)
-`J.N� - IJt� `/ /C �/1i/5 / /ioi✓F G/�(/Gif�/-y L S��i�c�i�
(b) Applicant Name/��' L���.s.t�� Telephone: Home Business X58 i3
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/buildey; Buyer ❑ ; Other ❑ (explain);
(d)
(e)
(f)
Lending Institutiorv`%��—Q�
Address
Real Estate Company and Agent
Address
Telephone
AAnil iho 1-144 In Tho fnllnutinn nririroccr
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms -:
3. WATER SUPPLY
Individual Well ❑ Communityx Public 13Note: If community well system,
/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 13Not If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025(11/84)
g, ENGINEERING FIRM PROVIDING�wSPECTIONS, TESTS, FILE SEARCH, DATk4ND 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 �E� °'��✓�✓ `� Telephone
Address
Date
-Date a�
d�lhU1' c/c
,ti
/e-7e/es ne411 eft ^U4- -7 7--oz-6) q�✓Fk,�'e-al 6y mol,
— F�
Ak. t����
Ile •07��- °° ��.
X07 �� _• �
ee •a-r.o- 0.04 q°s0••°°;�
6,
a on %nson !r
° CE 5101
6. DHEP APPROVAL Z�
Approved for edrooms 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
72-025 (11/84)
nnUNKIPALITY OF ANCHORAG
DEPT. OF HEAL( &.
MUNICIPALITY OF ANCHORAGE (MOA) ENVIFONMENTAL PROTECT ION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
IN,
&�
Legal Description:, ��%h 'o .'E
/9_ G�alit
A. WELL DATA
Well Classificatio - Z,1_ ' ` A C, D.E.C. Approve YEN)
Well Log Present (Y/ ) Date Co pleted Xid—
Total DepthCas d to -� Depth of Grouting
Static Water Level i Pump Set At f
Casing Height Above Ground Sanitary Seal on Casing (Y/N) —
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Ali
Separation Distances from Well:
To Septic/Holding Tank on Lot �� � ; On Adjoining Lots
To Nearest Edge of Absorption Field o tot ! ; On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by —
Water Sample Test Results
Comments
B. SEPTIC/H'TANK DATA
— To Nearest Public Sewer
To Nearest Sewer Service Line on L t'
Date
i�
Date Installed ./%�?� Size No. of Compartments 1Z
Standpipe) Air -tight apjCVD) / Foundation Cleanout Q;07 ) e--,
Depression over/Tank Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ✓— ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well
To Property Lines ,
To Water Main/Service Li c3
Course
Comments �r=
Page 1 of 2
72-026(71184)
To Building Foundation
To Disposal Field
CJ
I/
'-_5"-n;
-
i
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
_;
Soils Rating in Absorption Strata Type of System Design
Date Installed Length of Field �� /�` `�� / 7� ��
Width of Field / Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area . �� S Standpipes Prese / )
Depression over Field (L� Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well �'�' / To Property Line
To Building FP/Undation <� — To Exist�g or Abandoned System on
Loth/'°= z �J ; On Adjoining Lots
To Water Main/Service Line S� /To Cutbank resent)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or V
Comments��" /�
Bk-, J/(f, tzc_GC�,/yGfJlG
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level ,at
Tested for
Electrical Codes (Y/N)
Comments ti� F
le Storage Area
ic^/cS !i%D/ � c"i ��Grf �j/ iJl'a✓ccL GPS ">/lull7
— Dimensions
Manhole/Access
_ "Pump Off' L(
Vent (
** Check Permitted Bedroom Rating Against HAA Request **
Pumping Cycles during Adequacy Test: Meets MOA
I certify that I Ffave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
/ ��� %YA
/2 -��
Signed .-��. -� -- Date - `� �' OF
�, ......
Company i—�-�a�i✓s� / 7�--MOA-Ne-
Receipt
fv10A Ne- ��'• •°•:r,�t.
Receipt No. `�JJ� l db o�Z_ 0 49� *9
Date of Payment �' 1 �' tS�o a l ��/�% L- _—• • ,1
Amount:$ LCL. AN�lt
CE 5101 .; y
Page 2 of 2
72-026 (11184)
3'
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
DATE: August 11, 1986
PWS I.D.# 213001
To Whom it May Concern:
According to records on file in this office the Northwoods
Water System is in compliance with the State Drinking
Water Regulations
�1Sincerely, ��
� ��{ � ;.,.Kir ,���j.�, ��u�e�__ �����/
II f
1,33
100
Iii
I j/10
I L4 1w
0 -Y
eJ
ro
14
door
el-s
aec
4v9
Se'1 rl
IS
CIA0111)4e-lol evIt-1-I C/ 6,L2 0/4 q'I wr
d4a?,,,X-e4vLles3ql?r oc lol
(c ?gvz�j &-I vzt
16-1
i.
C,k IPN y el U
o �V)
A
9" ve-/
'.i
J
Department Health and Environmental -mon--
825 ,'A L , Street, Anchorage, AK.
# 264-4720
j� HANDWRITTEN PERMIT (�
Permit # OR O(�-SITE SEWER PERMIT
Applicant: Mailing Address: �eZ ZS
Location: &9G rz Phone Number:
Legal Description: ��� /J f �D✓�'/G��t7s Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: X Seepage Bed Holding Tank: _
Maximum Number of Bedrooms: � j _ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:'
DEPTH LENGTH GRAVEL DEPTH WIDTH ( S
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 t 's department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* # * TWO(Z) 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 3 3
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 sy tem in accordance with codes.
(3) I unn1ers a d tha t, on-site sewer system may require enlargement if
th ire e mo-ele--'to include more that 3 befro ms.
Signed: Issued by: "
p licant
Date:
SWP/024(1/81)
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTION
'I ENVIRONMENTAL ENGINEERING DIVISION i
825 L Street - Anchorage, Alaska 99501 Telephone 264-472 UiL�S ✓2 L�1�f�f
ON- y E SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RE�ERT
NAME PHONE
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MAI LING ADDRESS -
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LEGAL DESCRIPTION
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LOCATION NO. OF BEDROOMS
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Well Absorption area
DISTANCE TO: .� �0/L,�.
Dwelling
PERMIT NO.
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Materialp y�
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No. of comparriments
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Liq. cal achy in gallons IF HOMEMADE:
Inside length
Width
Liquid depth
y'
DISTANCE luiII -
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PERMIT N0.
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iquid apacity in ns
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Foundation / Nearest lot line* t
PERMIT NO.
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No. of lines 2 Lab of e ch line
Total length f li es Trench wic1th --
Distance between h n
la.
Top of tile to finish grade
Material Material beneath the _ ..-'
Total effective ab orption area
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nches
'Length
Width
DepthPERMIT NO.
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Cr'n depth Total effective absorption area
W
DISTANC O:
Well
Building foundation
Nearest lot line -
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Dep�ffound�ation
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
BuilSewer
line
Septic tank
Absorption area(s)
OTHER
-
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PIPE MATERIALS
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SO I L TEST
INSTALLER
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REMARKS
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