Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
NORTH WOODS BLK 3 LT 20
Municipality of Anchorage Page ' 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 Name: /~ ~ ~ ~ Wastewater System: ~ New ~pgrade Address: Pn~e~. ~-- iNo. of Bedr~ms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mou~d ~Other Total Depth fro~riginal grade: Lo~ Block: Subdivision: 3epth to pips bo~om from original grade: Gravel depth beneath pipe Township: ~ Range: /~ I Section: , Fill added above original grade: X ' Gravel length: Number of lines: 0istance ~n lines: WELL: C New D Upgrade Gravel dc;=~ ~/P~H /~ Ft. ~ ~, ~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption ar~[O Pipe material: Yield: ~GPM J~p Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES a Septic C Holding ~.T.E.P. TO Septic Absorption LiR Holding ~/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~] Well ~/~" ~ ~ ~/A Mater~:~ ~ Number of Compa~ments: Sudace Water ~/~ >' LIFT STATION Lot ~1 /0I ~l size in gallons: I Manufacturer: Line Foundation y/ ¢51 ~1 N/~ "Pump on" level at: ] "Pump o,," level ~t: High water alarm at: Cu~ain ~//A IPump Ma~e ~ Model Electrical Inspections~edormed by: Remarks: ~* ~ff~/ iNSu~RTI~ Q~ BENCH MARK Location and Description: ENG ~R'~ ~EAL Inspections performed by: ~ ~ ~ Dates: 1st Reviewed and approved by Date: 72-O13 (r/gl) MOA 25 Permit No. -~' cO 75-~; Page ~ of ~ Municipality of Anchorage 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 PIE) No.: [] - TEST HOLE 1250 GAL · - MONITOR TUBE TANK ~//L[FT HIBUS~ o - SEWER CLEANOUT REPLACES ,.~ - KEYBOX EXIST, TAt, EASEMENT [-1/4' PVC SCALE 1" = 40' S~/ING TIES: A - E : 27.4 F - E = 81,8 B - D = 35.7 F - D = 82.0 F - H = 13.3 G - H = 32.5 F - I = 14.3 G - I = 40,6 PVC MANIFDLD PVC 1/8' HE]LES, 2.4' DC HOLES UP ~/ITH ]RIFICE SHIELDS (REBAR) ELEVATIC]NS ~F~ONT DECK "£AR STEPS <NOT TO ~:CALE) ASSUMED ELEV = 100,0 12-O13 A 12/91) MOA 25 (REBAR) 15' X 60' BED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.0. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950046 ~ DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:MATHES DUANE E & JEAN OWNER ADDRESS:22808 MCMANUS DR CHUGIAK, ALASKA 99567 pARCEL ID:05174111 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 20 PAGE 1 OF 1 DATE ISSUED: 4/17/95 EXPIP~ATION DATE: 4/17/96 LOT SIZE: 20461 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS. PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK 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 (18AAC80). 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 RE C EIV ,D BY: \ ......... %,-Z"'-fl / ;_\ h~' + - K~BOX NO SURFACE WATER EASEMENT NO KNOWN CURTAIN DRAINS SEPT,C S~TE PLAN (V2) LEOAL: NO~THWOOD~ LOT 20, ~L~ 5 ~%~.... .... ow~: ~AT~s ~.-~9 ~ ~ '..%'~. CONTRACTOR: N/A REVISED 1" JOB ~ 89-021[ DATE:04/24/95~ SCALE = 40' EAGLE RZVER, AK. 99577 (907) 694-5~95 FAX: (907) 694-3297 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · PERFORMED FOR: DATE PERFORMED: .~/..~ ~/.,~.5'-- LEGAL DESCRIPTION: ,~'."'~'~],d ,~/1'",,~ /.'V,~/~T/7'~.Jz~o,~J Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18- 19 - 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? ~J~ S L IF YES, AT WHAT DEPTH? /V~'j' 0 P E Depth to Water Alter . Z / Monitoring? 6, Date: Reading Date Gross Net Depth to Net Time Time Water Drop ,~ '/ '12 :o~, /~ ~*,~ ,'.~ ,,..~ '- A. '¢~'//. --~ '~" ~ " I~:/~ /~ ~'~ ~- 7 ~ ~ '~" __ ~/" PERCOLATION RATE z~'4~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT PERFORMED BY: ~-~'/'~ ~'/~J" I ' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/"P-/'//~ ~ '~ 72-008 (Rev. 4/85} EAGLE RIVER ENGINEERING SERVICES P,O. Box 773294 EAGLE RIVER, AK 99577 (907) 694.5195 SHEET CALCULATED BY CHECKED BY. SCALE OF NorthWoods L0t:20,, Block 3 · REVISED 04~24/95 , · Bed application rate used:. = ~.0.5 gpd/ft~ (upgraded) Total lateral length ~'162' ' ; .....: : spacing = t6T;+ :66!orifiee~ = 2,.~..alongpipe: :\Cb\WPWlb,1ffl\WPl3OfLq\lqqS\RO-fi2~It I~AI. i : B~di'mefi'~iOhS'. I5' Pressure lateral si~ing': 28 gpm + 0.,42 gpm/orifice = 66 orifices'": i ~ . LEGAL: SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM REVISED 04/24/95 Northwoods Lot 20, Block 3 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 requirements. 4. Excavation contractors are to be certified to work under the MOA DHHS certified contractor program. 5. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 6. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. SEPTIC TANK 1. The septic .tank shall be an Anchorage Tank 1,250 gallon septic tank with integral OSI lift station pump model OSI-20-HHF and standard controls. The existing septic tank shall be pumped, removed, and properly disposed of. BED The bed excavation is to follow the natural land contour to maintain uniform total depth of the bed bottom. The bottom of the bed shall be level, plus or minus 1.5". The total depth of the bed excavation is not to exceed 2' at any point. The effluent line in the leachfield is to be a 1-1/4" PVC line with 1/8" holes drilled 2.4' OC within the bed, placed face up with orifice shields placed over holes. Sewer line from tank to field is to be 1-1/4" HDPE. The bed 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 drainfield 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 feet to any community well. RECOMMENDED BED DIMENSIONS: TOTAL DEPTH = 2' GRAVEL DEPTH = 6" under pipe, 2" over pipe BED LENGTH = 60' BED WIDTH = 15' .SOIL RATING = 0.5 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK = 1,250 with lift station Twenty-four (24) hours notice required for all inspections. C:\WPWIN60\WPDOCS\1995\89-021B.SPC 1 Louis Butera, P.E. Registered Civil Engineer April 6, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods Lot 20, Block 3 Narrative & Septic Upgrade Permit Application Dear Mr. Cross: The proposed septic system upgrade will have very limited impact on adjacent properties for the following reasons: The surrounding lots are large enough to allow sufficient room for septic sites with a community water system. 2. Immediate neighboring septic systems are all +30' distance. o Reserve space is adequate, due to the area being served by a community water system. 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. \C:\WPWlN60\WPDOCS\1995\89-021 A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Northwoods Lot 20, Block 3 ho 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 requirements. 4. Excavation contractors are to be certified to work under the MOA DHHS certified contractor program. 5. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 6. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. SEPTIC TANK 1. The septic tank shall be an Anchorage Tank 1,250 gallon septic tank with integral OSI lift station pump model OSI-20-HHF and standard controls. 2. The existing septic tank shall be pumped, removed, and properly disposed of. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5". 3. The total depth of the drainfield excavation is not to exceed 6' at any point. 4. The effluent line in the leachfield is to be a 1-1/4" PVC line with 1/8" holes drilled 18" OC within the leachfield, placed face up with orifice shields placed over holes. Sewer line from tank to field is to be 1-1/4" HDPE. [..vo~ -t t) ~ 5. The drainfield gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 6' GRAVEL DEPTH = 4' under pipe, 2" over pipe DRAINFIELD LENGTH = 100' DRAINFIELD WIDTH = 5' SOIL RATING = 0.45 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK = 1,250 with lift station Twenty-four (24) hours notice required for all inspections. C:\WPWIN60\WPDOCS\1995\89-021 A.SPC 1 ~.-L-~ 4- - KEYBOX NO SURFACE WATER EASEMENT NO KNOWN CURTAIN DRAINS S E PTI C S IT E P LA N LEGAL: NORTHWOODS LOT 20, BLK 3 OWNER: MATHES ~ .;'~, ~'..'~'~ CONTRACTOR: N/A ~. ~ .-~... )..~.~ A EAGLE RIVER ENGINEERING SERWCES P.O. Box 773294 EAGLE RIVER, A~. 99577 ~?O~ss~o~ (907) 694-5195 FAX: (907) 694-3297 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Pr:RFORMED FOR: //~ ~-¢ .7",,,~,d~..j" DATE PERFORMED: LEGAL DESCRIPTION: ~',~'~.z~ ,Z~/P"-.~ /V~'7-/7'~'.c.'o.'2J Township, Range, Section: ,~"/5-.'.: ,,~z ~.J ~¢~'c /--/' 7 8 9 10 11 12 13 ~ WAS G ENCOL ~-P IF YES --~ DEPTH Oepth lo ~ Moniterin~ I S, PERCOI WAS GROUND WATER ENCOUNTERED? AT WHAT Waler SLOPE SITE PLAN 14 15 16- 17 18 19 20 Reading Date Gross Net Depth to Net Time Time Water Drop COLATION RATE L{/-/ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN 5"' FT AND ~' FT COMMENTS PERFORMED BY: ~','~'C~-.,c I~~~~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AN[:) MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev Municipality ut Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR; ~ ~-f ~",~...,'- DATE PERFORMED: LEGAL DESCRIPTION: ,~,~e~d ,~/r"..~ /V,~/ET/'7?.o'z~o~J Township, Range, Section: 7'/3-,~..' ~..,z.~ ~c~,,c ~ 10 11 SLOPE SITE PLAN 2 3 4 5 6 7 8 9. 12 13 14 15 16 17. $ GROUND WATER ENCOUNTERED? AT WHAT S L 0 P Water Alter _ 18- 19 2O Reading Date Gross Net Depth to Net Time Time Water Drop ;OLATION RATE Z-~ ~'/ (minutes/inch) PERC HOLE DIAMETER ~ // TEST RUN BETWEEN ~-- FT AND ~ FT COMMENTS PERFORMED BY: ~"'~ -~J' I ~~~ GERT,FY THAT THIS TEST WAS PERFORMED ,N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~7//~/~- EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 89-021 Calculated By: LB Date: 4/3/95 Single Family 3 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Pemolation rate = 43.6 minutes per inch Wastewater application rate = 0.45 gallons per day per square foot Required absorption area = 1000 square feet Trench width (W) = 5 feet Gravel depth (D)= 4 feet Required length = Shallow trench factor * Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.50 Required length= 0.50 * 1000 / 5 Required length = 100 feet SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 89-021 LEGAL DESCRIPTION: NORTHWOODS L20 B3 CALCULATED BY: LB NUMBER Of BEDROOMS: 3 WATER USE PER BEDROOM: 150 GALLONS PERCOLATION RATE: 43.6 MINUTES PER INCH DEPTH TO GROUNDWATER: 12.5 FEET DEPTH TO IMPERMEABLE LAYER: 12.5 FEET ANTICIPATED DEPTH OF COVER: 2 FEET MOUND OR BED SYSTEM WASTEWATER APPLICATION RATE: 0.3 ABSORPTION AREA REQUIREMENT: 1500 MINIMUM BED LENGTH 12 FEET WIDE BED 125 15 FEET WIDE BED 100 TRENCH SYSTEM WASTEWATER APPLICATION RATE: 0.45 ABSORPTION AREA REQUIREMENT: 1000 SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH S 4 5 100 EFFECTIVE DEPTH (ET) 1 2 2.5 3 3.5 4 DESIGN SPECIFICS FIELD SYSTEM: GRAVEL DEPTH: TRENCH OR BED WIDTH: LENGHT: USABLE SOIL STRATA TOTAL USABLE DEPTH: 6.5 USABLE SOIL STRATA DEPTH: 4.5 GAL/SQ.FT SQ.FT FEET FEET GAL/SQ.FT SQ.FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH LENGTH (FT) DEPTH (FT) LENGTH (FT) 175 4 125 140 4.5 111 127 5 NA 117 5.5 NA 108 6 NA t00 7 NA (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH) FEET FEET FEET TOTAL EXCAVATED DEPTH: FEET -~' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION i 825 L Street - Ancttorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOCATION NO, OF BEDROOMS ~ DISTANCE TO: Absor.g ~a ~. , Dwelling ~ ~ Manufacturer · Liq. capacity in gallons Inside lenDth Widtl~ Liquid depth ~ ' I~ HOMEN~DE: ~ ~ DISTANCE TO: ~ell~ Dwelling PERMIT NO. 0 Z 4 Manu[acturer J ' Material Liquid capacity in gallons Nearest lot line~ ( PERMIT NO. -- No. of lines J Lengtl~of each linL ~ TogaJlenqlh of lin~ ~ ~ Top of tile to finish grade ~ Material beneath tile ~ inches Total e [fective a~p~n area Length Width Deptl~ PERMIT NO. m Building foundation Nearest lot line ~ DISTANCE TO: ~ Clas~ ~ Deptl~ Driller Distance lo lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER REMARKS DATE LEGAL HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON StTE WASTE WATER DISPOSALSYSTEM DESIGN ROBERT A. SHAFER CIVIL ENGINEER 694-2979 September 28, 1986 MUNIcIPALffy OP ANCHO/~A~E DEPT. OF H ENVIRON .... EALTH & wlCNTAL PROTECTioN , $EP 91986 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 ATTENTION: Robby Robinson REFERENCE: Lot 20; Block 3; Northwoods ~1 RECEIVED Dear Robby, In accordance with the Northwoods Subdivision on-site septic system test results and conclusions published by the Municipality of Anchorage the absorption area located on the referenced property was partially excavated and insulated on September 25, 1986. During excavation it was noted that some insulation in the form of a low density bead board had been used during the installation, however, this material had greatly deteriorated and was only detected in very small pieces (irregular 2 to 4 inches in size). The lower end of both drain fields were uncovered to the depth of the sewer rock and 2 inch high density styrofoam board insulation was installed. Material excavated was then backfilled to bring the cover back to approximately its original grade. No additional fill was added. All areas not insulated have a minimum cover of 3 feet. cc: Keith Baker American Excavation Gale Sauer SRB 196X EAGLE RIVER, ALASKA 99577 ,, '~ / MUNICIPALITY OF ANCHORAGE DEPA~iMENT 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 NAME I~ -- ~JP~ONE I ~'~'~W LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ~~ M ateri~ -- No, of comp e nts ~ Manufacturer ~ ~ Inside length Width Liquid depth , ~el~ Dwelling PERMIT NO. O ~ Manufacturer / * Material Liquid capacity in gallons ~ DISTANCE TO: Well ~~, FoundationZ ~ Nearest lot line~ ( PERMIT NO. ~ ~ ~ No. of lines Lengt~of each line ~ ~ ~ Top of tile to finish grade ' ~ ~ inches Total effective absorptions7~ area Length Width Depth PERMIT NO. ~ ~ Total effective absorption area ~ Type of crib Crib depth ~ ~e~ Building foundation Nearest lot line ~ DISTANCE TO: ~ Clas~~ Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: INSTALLER DATE LEGAL 72-013 (Rev. 3/78) F'ERMIT NO. FFLI _.HN1 LOCRT I ON LEGAL [:,EF'F~RTHEN]' OE EFILTH FIN[:, EN',,,'IRONMENTFtL F'[ 'ECTICN · .'= 2.:, '" L ..... STREET., FIN DH']RFIGE., FIE. ,. 264-472E'~ C) ~"-,11 .... ,_.--; _-'[ -Ir E ~ E 114 ~ ,.'.' 8tEL-'.':55 ) [:,ON Z IMf'IERMRN F'O BOF:: 5'_-9.6 LINK LOT 2,c:'~ BLK 3: NORTHHOOD SUB T'¢F'E OF SOIL F~BSORF'TION S'¢STEM IS: TRENCH P!R;,-,;Ti',II..II',I NUMBER OF BEDF.:OOMS = THE REL.]UIRED SIZE OF THE___%~]TL RBSORF'TION =,T_TEM'-'"~ IS' TFtE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINF!EL[:,. THE DEPTN OF F~ TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SLIRFRCE OF THE GROUND RND THE BOTTOM OF THE EXCR',,,'F4TION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFI',,,'EL BETWEEN THE OUTFFILL PIPE RND THE BOTTOM OF THE EXCR',,,'RTION (IN FEET). F'ERMIT HFFLI_.HNT HRS THE F..E=,FUN=,IE, ILIT~- TO INFEF.'M THIS [:'EPRRTMENT [:,LIRING THE INSTRL. LRTION INSPE]TIF~N'.5 OF R.N'¢ WELLS RDJFICENT TO THIS PROPEF.:T"r' RND THE I'.gJME:ER OF F..E=,I[EN_E=, TI--IR'F THE WELL HILL SERVE. BFICKFILLING OF RN'¢ S'¢STEH WITHOLIT FINFtL 1-NSF'ECTIFflq RN[:, FtPF'F. tD',/RL B'¢ THIS [:,EPFtRTHEN. T WILL BE SUBJECT TO FF.L=,EL. UTION. MINIMUM DtSTRNCE BETWEEN R WELL FIND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±E~ FEET FOR FI F'RI'v'RTE HELL OR Z5¢~ TO 2E~'-~ FEET FROM FI PUBLIC HELL DEPENDING UPON THE T'¢F'E OF PUBLIC WELL. MINIMUM DISTFINCE FROM R PRI',,,'FITE WELL TO FI PRI',/RTE SEWER LINE IS 25 FEE]' FIND TO FI COMMLINIT'¢ SEWER LINE IS '?5 FEET. OTHER REQUIREMENTS MR'¢ FIPPI....'¢. SPECIFICFiTIONS RND CONSTRUCTION DIFIGRFIMS RRE FI',,,'FtILFIBLE TO INSURE PROPER INSTFILLFITION. F'EF-:~'I :[ T E-] ::-:.".F' ]: F:E::,, [)EE:L---_f-IBEF: Z-: 1.. 19:_:1. i CERTIFk.' THRT £: I Rr,1 FRFI!LIFIR FILTH THE REQUIREMENTS FOR ON-SITE '_----EWERS FIND WELLS RS '_'-;ET FORTH B'¢ THE MUNICIF'RLIT'¢ OF FINCNORRGE. ;-2: I HILL INSTRL. L THE S'¢STEM IN RCCORDFINCE HITH 'THE CODES. 3:: I UN[:,E.]F.'.STFIN[:, THRT THE ON-SITE SEWER S'¢STEM MR'¢ REQLIIRE ENLFIRGEMENT IF THE 'CONSTR, CTION TEST LAB PERFORMED FOR~ LEGAL DESCRIPTION: THIS FORM REPORTS: ~--n'~-'..t2~.~ ~, imm~;.-m~D Lot 2 0 Block [3 Visual Soils Examination 1800,~._~ 48TH AVE. STE. 'C' ANCHORAGE, ALASKA 9950:3 248-1333 DATE PERFORMED: Subdivision Northwood ;~1~, Percol0tion Test 4/16/81 DEPTH SOIL FEET DESCRIPTION NOTES overburden 1.5' ~,v V ~ Gravel]-Y~ Sandy S~lt *'~ ~,'~ 14' , ~ WAS GROUND WATER ENCOUNTERED No IF YES, WHAT DEPTH LEGEND. ® -- Perc zone ®S - Sornple taken I -- Frozen zone ·- Water table Kip. net,, 3656 - E GENERAL SITE SLOPE READING DATE GROSS TIME NET TINIC~.-~-'~:~ DEPTH TO H20 NET' DRAINAGE n ,~,/!6,/~ 4:40 e ]vi O 2-1/8" 0 1 " 4~55 1,5 turin. 2-1/2" 3/8" 2 " 5~10 lg rain 2-3./4" 1/4" 3 " 9:79 1S min. 3" 1/4" PERCOLATION RATE: 60 rain/inch DRAINAGE REQUIREMENTS: 325sf/br PROPOSED INSTALLATION: El SEEPAGE PIT J~ DRAIN FIELD n OTHER COMMENTS: TEST. PERFORMED BY: K.R.B. DATA CERTIFIED BY: Kinney R. Baxter DATE: 4/20/81 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEA~TH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SLOPE SITE PLAN WAS GROUND WATER /,~./~ S ENCOUNTERED? L IF YES, AT WHAT ~ ,~¢~,.~£ . E DEPTH? I Gross Net I Depth to Net Reading Date Time TimeI Water Drop I , PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT PERFORMED BY: 72-008 P. O. Box 773294 Eagle River, AK 99577 694.-5195 CERTIFIED BY: ..--/~~- DATE: MUNICIPALITY OF ANCHORAGE Development Services Department I' p �`.,: -�' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-741-11 1. GENERAL INFORMATION Expiration Date: !N oU Complete legal description NORTH WOODS BLK 3 LT 20 Location (site address) 22808 MC MANUS DR, CHUGIAK AK Current property owner(s) ANDREW BROWER Day phone Mailing address 1050 WEST DAKIN ST UNIT G-1, CHICAGO IL Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well [] Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 Date of Payment�� _z 1 Receipt Number 6/g53001 Waiver Fee $ Date of Payment Receipt Number COSA # 05C-2_116 17 Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-$$64 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-13-21 *r. 49TH •• f� 6. DSD SIGNATURE �....,. ;.. J System #1 Approved for 4 bedrooms �• • • • • • • • • • r' •• MICHAEL N. ANDERSON a System_#2 Approved for bedrooms CE r 94 )69 Disapproved Qp • • �� �aa PRt;FE�SI�.��4 Conditional approval for bedrooms, with the following stipufatib�il���� 0-6so r p 4' on -fie l d -l-o Prn pQ.tr4-y I i n� ``�kkw 1(�((��( rr� a 5 'to / o w e �,, .�\�S a (C.o rd ah Ce w � Ae Li Cn� . ON-SITE E m VVA-TER AN �- o S7_V rATER oz PROGF\.AM ljjBy: Original Certificate Date: i I 17 20 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 COSA Checklist blue sheet Legal Description: NORTH WOODS BLK 3 LT 20 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments COMM. WATER B. TANK DATA Age of tank(s) 8 years Tank type/material S.Paww- Measured operating fluid level in septic tank * 44" ❑ Standpipes/foundation cleanout per record drawing Date of pumping * ADVANTEX SYSTEM D. ABSORPTION FIELD DATA Which system tested (date installed) 10121113 ❑ ALL standpipes present per record drawing Total measured depth from grade 3.6 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A -pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective of Parcel ID: 051-741-11 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station 6 years Lift station material Plastic Comments: SEE INSPECTION COMMENTS. Adequacy test date 10/14121 Results QPass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in ❑ Code -required soil cover over field 600+ Absorption rate gpd ❑ System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) if yes, enter date Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5 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' Water Main > 10' Q Animal Containment > 50' ❑ Yes if No _ ft ❑ Yes if No ft Water Service Line > 10' Q Yes if No_ _ Manure/Animal Excreta Storage > 100' comment below Community Sewer Main > 75' ❑ Yes if No _ ft ❑ Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5 ft Surface Water > 100' 0 Yes if No _ ft Property Line > 5' Q Yes if No _ ft Wells on Adjacent Lots: Water Main > 10'v❑ Absorption Field > 5' Q Yes if No _ ft Private Wells > 100' ❑✓ Yes if No _ ft Water Main > 10' Q Yes if No _ ft Community Wells > 200' Yes if No _ ft Water Service Line > 10' Q Yes if No_ ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No _ ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5 ft Wells on Adjacent Lots: Water Main > 10'v❑ Yes if No _ ft Private Wells > 100' Yes if No _ ft Water Service Line > 10' ❑✓ Yes if No _ ft Community Wells > 200' ❑v Yes if No _ ft Surface Water > 100'✓❑ Yes if No _ ft F. ENGINEER'S COMMENTS * OLD CODE 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. COSA Checklist yellow sheet 08/10/2021 07:21 8686770 APLUS PAGE 01 404 468 ml• ■■'1 p■o p■ ■p■o p■■l p■■ pl o p ■op■■■ 1 on on ■ol pp p ■ *vanTex '' Field Maintenance Report Annual Inspe ;tion properly 0w rfTroEking Andrew Brower SHe Addreee 22BOB McManus Or re, Chugiak AK 99567 AX gho ID # OoontY if1 # Pod M AX -133137 417872 Retrieve O&M Info Daily flow -- Recirc ratio_ Timor senings_ Perform Field Scmpl ng/Observatlons NM (15 s NTUs) pi (6-9) Odor of Sample Typical 0 Must ❑ Earthy ❑ Moldy Non -typical ❑ Sulflc is ❑ Cabbage ❑ Decay Olty film In PVU r f Yee ❑ No Foam In tank t .� Yes ❑ No Check Control Panel Recim Amps Discharge Amps Audible and visual ale ms OIS Dial tone (telemetry of Iy) ❑Yes No Inspecl/Clean PumV System Inspect Clean Ris9ili.id .......... ......... Cpl �I Splice Box ...... . ........... . Float Cords . . ............. . Pump ........ ............. BlvtubeO FiR9r..... . . . . . . . .. . Blatube Pump Vault .... , ..... . Recirculating Splitter Calve.. , ... . Comments /w Signalture -4 ■■ p pool M AnchorageTank 997-272-3543 bporator Larry Betts 0onlact phone (.907) 655-5555 ];Frw -,muL N Dete of Los! Inspection F TU128133 09128/2020 measure Sludge/scum Sludge Scum tstCompartment Current' prevlau I Gu-r�' Previous 2nd Compartment I purrs I Previous I CUrrei I Previous Inspecit/Clean AdtranTex Filter InrP4 ct Clean Odor; /Normal ❑ Pungem La#¢rals/Orlficer Blomltt: 4lormal 71Excessive Pod BoStom Bridging/Ponding: Norm&linor ❑ExceSSIVe Intake Vent Inspect/Gleam Discharge Pump System inspect Inspect Glean Riaor/Lid Floats ,{ splice Box Pump Float cards Inspect/Service Other System Components inspect Clean Inspect Clean Disinfection Equlpmerrt !<I �ispersel L�t9r�i1910Y1llees Observations../ . Additional Services Rendered ❑ Cleaned textile sheets? C] Replaced UV items? ❑ Replaced/Used other items? Parts Used, VII m warranty, B = Billable (f appropriate ealection) W a Item Number description FinralllSafety Inspection I� $V reinstalled )2I q�Aanifold reconnected; flush valves closed Summary/Recommendations ystem porfommlrmt no further action needed Gall f r service Lids hotted an ontrol panel reactivated [:]Tank needs pumping ❑ oth*r? Fax completed form to 1-888-384-7404 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT° made and entered into asofthis Z.Z Day of O&ry he,- of 20 Z J by and between W KM herein the "O °° WNER, and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as loccat�jed/at (legal description) / / q p �,� {�w 1w1 Mk 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AW WTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AW WTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AW WTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Ad Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. j N Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 O"ER: By: _(signature) Date: 22 04�- 2v 2/ :el (print name) STATE OF ALASKA } ss. THIRD JUDICIAL DISTRICT } The foregoing instrument was acknowledged before me this D-day of 20 P- 1, by ard.�.4! i' K-0- 5 r MOW Slat NOTA R PUB FOR AT STATE OF ALASKA �KoshRailingMy Commission expires: !Z s~ �h ... Ec-, MUNICIPALITY: By: (signature) --R� �e CCti. CAI -r0 //_(print name) Date: Title: (rev. 05/18/20I8) Page 3 of 3 NUMBEF Municipality of Anchorage D,epartment of Health and Human Services AUT.OR T¥ APPROVAL C.ECKUST Legal Description: /,/~)£Sh'Wo~$ /o?'~ ~ ~ Parcel I.D. 051 - 2~1~l/ A. Well Data Well type Log present (Y/N) Cased to If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Casing height Wires properly protected (Y/N) ~ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow FROM WELL LOG g.p.m. ~ Pump level1 ~'~' SEPARATION DISTANCES FROM WELL TO~.,~ Septic/holding tank on lot ~'~ ; On adjacent lots Absorption field on lot J/' ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Public sewer main Sewer service line WATER SA.~1PI_~E RESULTS: ~ple: Collected by: B. SEPTIC/.HOLD~.,NG TANK DATA Date installed ¢) ~/~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / ~-~ ~ Compartments Foundation cleanout (Y/N) )/~ Depression (Y/N) /-//.,~ Alarm tested (Y/N) /~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: Well(s) on lot /~//.'~ To property line ~ I Surface water/drainage On adjacent lots ,,~/.A Foundation ~ / Absorption field '~ / Water main/service line '-/- / o ' 72-02S (3/93)° From CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons / Vent (Y/N) ~/~ "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) Y~ "Pump off" Level at SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot /'//,~ On adjacent lots l-/lA Sudace water /'-///] D. ABSORPTION FIELD DATA Date installed O~,/9 ~ Length UO ] Width Total absorption area SOO Soil rating (GPD/Ft2) (~, ~ .System type / ~ / Gravel thickness O, ~ / Total depth Cleanout present (Y/N) !/~ Depression over field (Y/N) Date of adequacy test ./'./,//~ ¢ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Results (pass/fail) ?~..~ S for ~_~ Bedrooms /,~ lA After test /~/ /L//.A If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~/,//~ To building foundation On adjacent lots '~ ,~ Surface water ~ lA Curtain drain ~J //~ On adjacent lots /,d//~ Property line ~ z~ / To existing or abandoned system on lot Cutbank .'~//.'~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I ce¢'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect or~_ .,.th¢ date.qf~this. ~.~ inspection. Signature ~ Engineer's Name Date -~/'-7,/~ HAA Fee $ Date of Paymer~ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~7_~\ - -1L&\- \~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Northwoods Sub. Lot 20 Block 3 T15N, R1W, Sec.4 Location (address or directions) NHN McManus (b) Property owner Mailing Address H.U.D'. . ~ Telephone.: (home) 605 W. 4th Ave. Suite 081 Anchoraqe, AK (c) Lending Institution ,v//~ Telephone 99501 -Business 271-2792 Mailing Address The Realty Store Amchorage: AK 99502 (d) Real Estate Company and Agent Address 8040 Op~l C~cle Telephone 24,3-1044 (e) Mail the HAA to the following address: (or check here F3, if hold for pick up.) List contact person and day phone number below: Pick-up by Engineer 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3 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 status. 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 legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~ As certified by my seal affixed hereto and as of the validation date shown below, 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 Eagle River Engineering Srvs. Telephone 694-5195 Address P.O.B. 773294 Eagle River, AK 99577 Date 6. DHHS APPROVAL Approved for ,~ bedrooms by Approved t~..~ Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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) 8ack Page 2 of 2 · , _~(,,¢,u,,~,~ MUNICIPALITY OF ANCHORAGE (MOA) ~ ~ O~ ~.~,o~ Health Authority Approval (HAA) · ' ~ ~ ~/ CHECKLIST - FEBRUARY 1984 ,~c~;~ %~ 343-4744 ~x~ 0~' O~ ~km %9~%~ ~ Legal Description: ~¢_ A. WELL DATA~~ " ,-~ ' Well Classification Well Log Present (Y/N) Total Depth. Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining LOts ; On Adjoining Lots TO Nearest'Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLp}N¢i TANK DATA Date InstalleCd//¢//~¢/ Size Standpipes (Y/N) ,Y Air-tight Caps (Y/N) Depression over Tank (y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /O¢0 ~1, No. of Compartments /v Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To WaterTSupply Well ~.~¢'~ ¢ To Property Line ~'/~ ~ To Water Main/Service Line "° / To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in ?~)/¢./..~.rption Strata Date Installed ~?p'~ Width of Field t/¢ .3 Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~o,¢ ' To Building Foundation */0 / Lot Type of System Design Length of Field /~ ~ / Depth of Field ¢ / Gravel Bed Thickness ~ / Statndpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line ?¢ / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments2.'' ~r~' ~-~¢e~ ~o~,¥~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots ¢ ~'~ / To Cutback (if present) /,~','¢, '¢ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines-in ef.fect on the date of this inspection. .-- ".~, Signed Company Eagle River Engineering Services P. 0, Box 773294 Date "///'*/¢'~ Eagle River, Al( 99577 MOA No. 094.-5195 Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ 72-026 (Rev. 7/88) Back Date of Payment Page 2 of 2 ~"~-~' 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 1. GENERAL INFORMATION (a) (b) Legal De~,n (include I o t, block, subdivision, section, t, - v' - ~ ,~'"~ "~ '~~°wnship' range) ~,~~ / Location (address or directions) Applicant blame . _ Applicant Address ,~? ~,~ Telephone: Home ~~- Business 7~'~ ' 2700// ,¢,,y, ?¢/,¢- · . (c) Applicant is (check one): Lending Institution []; Owner/builder~r; Buyer []; Other [] (explain); (d) Lending Institution Address ~r (e) Real Estate ComPany aqd Agent Address Telephone (f) Mail the HAA to the following address: SRB.196x Eagle Rlv~, alaska 99S7'7' TYPE OF RESIDENCE ¢~' Multi-Family [] Single-Family Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community [] Public ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~" Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72°025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA ~ID INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date s & s Eagle River, Terms of Conditional Approval: 1. Telephone Install two(2) test holes at sites selected by the department to a depth of five(5) feet below the bottom of the trench. 2. Monitor for ground water for a fourteen day minimum. If water is found in either tube, test for: (1) fecal coliform (2) fecal stre~ (3) nitrites In the event'that the system is found to be in non-coformance, the system must then be satisfactory upgraded or replaced with a holding tank. Funds to be escroed to assure work is completed no later than July 1, 1986 DHEPAPPROVAL ~ ~ /~_~, , , ~ ~7/ Approved for-~/~-c-~ bedrooms by.(~'f/~ ~~.~_~e ~/1 I~ ~ Approved Disapproved GondJtiona~qEE CONDITI~N~ SET ~ORT~ Terms of Conditional Approval ~ ABOVE 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) MUNICIPALITY OF ANCHORAGE (MO~/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description' ENVIRONMENTAL PROTECTION. MAR 2 6 1986 WELL DATA 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: If A, B, C, D.E.C. Approved Y~¢~t'~ Date Completed / Yield D~bt~/of Grouting J~Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank bn Lot .~.r~ ~ 4-- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot. '7~oO t 4- ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanopt/M.anh(~le To Nearest Sewer Service Line on Lot Water Samplb.C~)ilePted by ; Date Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed ~¢1~'~¢~::~1 Size ~O''-~ ~ No. of Compartments ~-- Standpipes~.N')'" Air-tight Caps~'.CN~ Foundation Cleanou~dr"~ Depression over Tank.~ Date Last Pumped ~" Pumping/Maintenance Contract on File (Y/N) r-4 JA~ ; for ~ Holding Tank High-Water Alarm (Y/N) r'J~'N'~-~ Separation Distances from Septic/Holding Tank: To Water-Supply Well 7~c~' ~ --"~,-~,--,~ ~ To Property Line ~'O~ ~', Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/,L~°-~ccft~ Line Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11184) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (-~ ~'~ "~ Width of Field .~ i Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Length of Field ~""z--~ ~ Depth of Field Gravel Bed Thickness Standpipes Present ~ Date of Last Adequacy Test Typeof System Design '"~ Separation Distance from Absorption Field: To Water-Supply Well ~.(:~, 4--- "~t,%~---~..-t (__ To Property Line To Building Foundation ~'"~(--~ Lot I'lL To Water MainC.~ervic9, Line ::!i/ ~_To Stream/Pond/Lake/or Major Drainage Course ~ ~'~'.,;%To Driveway, Parking Area, or Vehicle Storage Area %(* "~. ~Comments To Existing or Abandoned System on ; On Adjoining Lots ~z~ ~ .b To Cutbank (if present) IFT STATION i~,~ ~,.,Date Installed S~:e m Gallons t'-?}"Pump On" Level at ~'~,High Water Alarm Level at · i.Zested for ~ Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) //NW._ "Pump Off"VentLevel(y/N)at Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S 8, $ E~¢neeri~ Date' J~* ~ / 2 .-~'/~ ~" SRB 196x C°mpanYEagle ~ive~, Alaska ~7577 MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) D~PT. OF ~NV~RONM~NT~L COnSeRVATiON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL .SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: PWS I.D.# According to record.s qn file in this office the ~~/~~e~ System is in compliance with the State Drinking Water Regulations Sincerely, ~, .... D~-:i-'E~R E C E i V E D INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL SANITATION DIVlSIOIF~NVIRONMENTAL p2©TECTION Telephone 264-4720 ~,[.~ ~ ~. 198'i REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete ail parts on page 1. Incomplete reques~ will not be proce~ed. Please allow ten {10) days for processing. ~ROPERTY R~ENT (If different PHONE PHONE 2, BUYER MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAI LING ADDRESS '4. REALT~GENT ~"~ - 5. LEGAL DESC.~IPTIO · STREET LOCATIO~I., 6. TYPE OF RrfSIDENCE NUMBER OF~BEDROOMS [] One [] Four J~J.~..~l N G L E FAMILY ~-wo [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other~ 7. WATER SUPPLY [] iNDIVIDUAL* [] COMMUNITY [~'PUB LIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM []~_1N DIVI DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [~ INDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified NUMBER OF BEDROOMS [] ONE [~] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED [] OTHER LOG RECEIVED PERMIT NUMBER DATE INSTALLED __ INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line 5, COMMENTS DATE [~PRovED FOR ~ . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-016 (Rev, 6/79)