The URL can be used to link to this page

Home My WebLink AboutNORTH WOODS BLK 3 LT 21 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 Permit Number: '~LxJ ~40t~qCo PID Number: O~ '¢-~1 IO Name: ULca~.r,~ /~-~,,-( ~ Wastewater System: ~ New ~ Upgrade Address: ~o~ ~Z~ ~ ~ ~,~ ABSORPTION FIELD No. of Bedrooms: Phone: ~¢ ~9% ¢ ~ Deep Trench B Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating:o, 8 GPD/Sq. Ft. Total Depth f~o~ original grade: Lot: B~ock: Subdivision: Depth to pipe ~ottom from original grade: Gravel depth beneath pipe Township:~ 1 ~ Ra~e~ ~ Section: 4 FilIv~added abovel ~°riginal~ t grade: Ft. Gravel length:~ Ft. WELL= ~ New ~ Upgr~ Gravel widths, Number of lines: Oislancebetweenli~es: Classification (Private, A,B,C): ~ ~ ~otalD ' CasedTo Totalabsorpt¢~a: Ft. J -- Ft. Pipe material: ~ Driller' ~% ~ ~ t. : Ft. SO. Ft. ~O~l~ ~ . ~~ Date Drilled: Static Water Level: Installer: Date installed: YieldS/ GPM ]] Pu~ ~ at: Ft. Casing Height Above Ground:Ft., TAN K SEPARATI O N D ISTAN CES ~ septic~ t ~o~ng Q S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ ~ CO ~ Well ~' ~O ~ ~t Material~ Number of~Compartments:. SurfaCewater ~' ~' *~' LIFT STATION Lot 5 ' Size in gallons: Manufacture~ ~ ~ I lot ~ ~ "Pump on" level at: ~evel at: High water alarm at: Foundation 7 CurtainDrain ~ ~, ~ Electrical Inspections performed by: Remarks: '~v~ ~[Sm~ ~¢<~ ~ BENCH MARK Location and Description: Assumed Elevation: Inspections performed by: ~~ Dates: lst~ ~$~.~a~ Department of Heal~,and Human Services approval ~. F~m~ Reviewed and approved by: Date: ['- 2~,- ¢¢ 72-013 (Rev. 9/91) MOA 25 AS-SUILT DETAILS WASTEWATER ABSORPTION SYSTEM LOT 21 ]}LOCK 3 NORTHWOODS SUBDIVISION PERMIT # SW940156 PID # 05174110 A 11,0 ]~ 54,0 , C 60,0 EXISTING FRAME HnUSE ID 27.5 CLEANOUT INSTALLED P~PE ELEV ~ , / _ ~ ~BASIS Uk LLL~ 100,0 [XIST~NG SEPTIC TANK I /~ '~4~ ~LID~ ~ 'd - ~F PIPE 6' ~9' TRENCH NBTES: 1, ALL PERFDRATED PIPE F810 2. ALL SDLID 4H PIPE D3034 3, TRENCH EXCAVATIBN USED F~R FINAL GRADING/CSVER PREPARED FBR: WAYNE & TERRI M~RE PB DBX 772591 EAGLE RIVER, AK, 99577 688-9792 KND ENGINEERING 2~041PTARHIGAN DR EAGLE R~VER, AK, 99577 694-2359 DATE: 6-6-94 DRAWING ~f N~T TO SCALE AS-BUILT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 0N-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940156 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:MOORE WAYNE J & TERRI P OWNER ADDRESS:22824 MCMANUS DR DATE ISSUED: 6/01/94 EXPIRATION DATE: 6/01/95 PARCEL ID:05174110 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 21 LOT SIZE: 22980 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 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: LINE FROM THE SEPTIC TANK MUST ENTER THE TRENCH AT THE MIDPOINT . THE TOTAL DEPTH OF THE TRENCH MUST NOT EXCEED 7.0 FEET. RECEIVED BY:~. ~ ISSUED BY: 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)694-2359/FAX (907)696-8111 On-Site Services DHHS 825 L Street Anchorage, AK 99501 May 23,1994 Dear Sirs: REF: Lot 21, Blk 3, Northwoods Subdivision Attached is our request for an on-site sewer permit for the above lot. This subdivision is serviced by a public water system; the service line enters from McManus Drive. As shown on the site plan, there are no conflicts with existing on-site sewer systems or with potential reserve areas. The existing field has failed and will be abandoned although the tank will be inspected and reused if adequate. This lot is generally sloping to the north at about 5% - 7% but increases sharply on the east side of the house towards McManus. The natural slope will provide positive drainage away from the proposed installation site. There is no surface water within 100 feet of any portion of the proposed installation. We performed a soil test on this property. It appears that the first 7' of soil provides for the best system design. The design we are submitting is based on the percolation rate of 13.5 minutes/inch. Thank you for your consideration of this request. If there are any questions, please call me at 694-2359 or leave a message. Sincerely, KND Engineering Attachments: On-Site Sewer Application Wastewater Absorption System Details Site Plan Soils Log/Percolation Test DESIGN DETAILS WASTEWATER A]}SORPTIBN SYSTEM LOT 21 ]}LOCK 1 NBRTHW(]ODS SUBDIVISION . D GRADE SEWER ROCK 2' HD INSULATION OVER ENTIRE FIELD & ALL PIPES W/ LESS THAN 4' CDVER FILTER FABRIC aVER ENTIRE FIELD 57' TRENCH EXISTING FRAME HOUSE EXISTING SEPTIC TANK CLEANOUTS TOBE INSTALLED IF NOT LOCATED DURING TANK INSPECTION DESIGN CRITERIA: 3 BEDROOMS x 1GO GAL/DAY/SEDROBM = 450 GPO SOILS RATING: 13,5 MIN/INCH - 0.SGPD/SF (BED> 450 GPO .'- 0,8 GPD/SF - 563 SF ABSI]RPTIBN AREA USING TRENCH DESIGN, 563 SF MINIMUM AREA 563 SF ~ (2)(5'D) 56,3' TRENCH DESIGN MINIMUM SIZE 3' b/ x 5'D x 57' LONG TRENCH 5' MAXIMUM DEPTH BF GRAVEL. 2" HD INSULATION REQUIRED OVER FIELD & PIPES IF < 4'COVER IF EXISTING SEPTIC TANK NOT INTACT, INSTALL MEN/ TANK SEPTIC TANK REQUIRES a' HD INSULATION KND ENGINEERING 22041 PTARMIGAN DR EAGLE RIVER, AK, 99577 694-2359 IDR, I . NB/ TI] S~;ALE~94-S~-0504 PREPARED F~R~ WAYNE & TERRI MOORE PB BOX 778591 EAGLE RIVER, AK, 99577 688-9792 SEPT SiTE PLAN REPLACEMENT WASTEWATER ABSBRPTIBN SYSTEM LDT 21 BLDCK 3 N~RTHW~ODS SUSDIVISION VACANT '~. gED TRENI SI- H~LE 20 SEPTIC SEPTIC _D TO BE ABAk]']~O VACANT TANK ATER TIGHTN LIN SUBDIVISIBN SERVE]} BY PUBLIC WATER LBT SIZE: LESS', PERIMETER HOUSE FO[STPRINT TDTAL AREA AVAILABLE FBR ABSORPTIDN SYSTEM ~&980 SF 16, a80 SF 6,700 SF PREPARED FBR~ WAYNE a TERRI MDBRE PB BOX 772591 EAGLE RIVER, AK, 99577 688-9792 KND ENGINEERING 2~041 PTARMIGAN DR EAGLE RIVER, AK., 99577 694-2359 DATE: 5-aO 94 J DRAWING ~ SCA,S, l' = too' 1 94-31-0504 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: Wayne / T~rry MoorP LEGAL DESCRIPTION:L21 B1 k3 Northwoods Sub DATE PER FORIV Township, Range, Section: N[ 1/4 S4 1'1 5N R1W 1 2 5 6 7 8 ~0 12 13- 14- 17 18 20 COMMENTS Organic / Silty Loam Pevc. Hole Elev, Silty Sand Sandy Gravel w/Silt Silty Sand Sandy Silt (Dense) Hardpan / Dense Silt SLOPE SITE PLAN WAS GROUND WATER NO ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? p E Depth to Wa er After.:;. :. Monitoring? Nnn~, Dale: ~/1 Gross Net Depth to Net Reading Date Time Time Water Drop 0 5/12/94 6:00 PM - 3 1./4 " 1 6:10 PM 10 mtn 4" 3/4" 2 6:20 PM 10 mtn fl 3/fl" 3/4" 3 6:30 PM 10 mtn 5 7/16" 11/16" 4 6;35 PM 5 mtn 5 13/16" 3/~" 5 6:40 PM 5 mtn 6 3/16" 3/8" Hole p~esoaked ~rior to lestinq PERCOLATION RATE 1 3.5 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND . 4 FT PERFORMED BY: KMD I K~nneth F)IJ fflJS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES tN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ._../ MUNICIPALITY OF ANCHORAGE '~.. "DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 [. Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT NAME rPHONE ~u[pW MAI LING ADDRESS LEGAL DESORIPTION Material No. of compartments ~ ~ Manufacturer ~ ~ Liq. capacity in gallons Inside length Width Liquid depth /~() () IF HOMEMADE: ~ - -- ~ ~ DISTANCE TO: Wail Dwailing PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ DISTANCE TO: ~ ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~ ~ ~ inches ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ¢ inches ~ Length 3~ ' Width ~O ' Depth ,~ ' ~ ~ Jyp~ of ~ik ~rib ~iam~t~r 6r b deEth Tatal effective ab~arptian area ~ W~ Building foundation Nearest lot line / ~ DISTANCE TO: ~ fl~ ~eO ~ ~ ~~v~ Depth ~ ~ Driller Distance to lot ]i,e PERMIT NO. ~ Building foundation Sawer line Septic tank i Absorption area(s) ~ DISTANCE TO: OTHER I~ PIPE MATERIALS INSTAELER C,~ , i[-¢ REMARKS APPROVED ~ DATE LEGAL 72-013 (Rev. 3/78) i"!F!::'::Ii"iLlh! .... F:,~:'r;, ()F !3!EDFi:Eu:;ff'!:5 .... :i: .... U.,.L ,...,I, ~,~ ........~:.. ~ ,,. .... . ........ :::~ E:Z F" '"T" ~....4: ...... '.>=':; i~ F:" :~"-.~ ~'""": ""~'" ~"-~ ....... ~:~: (Z: ~:t: ~::":: '"',"~ :; L_ ~'2::~ Eh% ~'"::' "~'~'~ ..... *" ¢:~:' ~:: ~ ........................... . "("~.-ll::' ~ ~: 'ii-z~'L4 ~.. t , ,~,,..,,..,.~ ..., ...... , ~ ~ , ............. ','.- , · ................. THE DEF'TH OF Fi TF'.ENCH OR F'!T iS THE E:,IS'T'FiNE:E E',E:T!,.EEEN THE: SURFI::IE:E OF THE GREdJH[:, Fff-,E:, THE E',ErTTOH OF: THE E;w, CFPv'FFf' I ON ,:: ! !'.,~ FEET ::,. THE GF:I:~'v'EL DEPTH !S THE i',IINZHLIH DEFT'FI OF GFff:IVEL. BE'T'HEEN THE OUTF'F:IL.L P ZF'E FIND THE BOTTOH OF' T'HE: E;;.::E:FI',,,'fYT ! ON ( I I'.,t FEET ). . PEF;:H:!:T Fff::'F:'L. ZE:F~NT HAS THE F:E:F'ONSZEtZ L. IT"/ TO i NFOF:H T'Hi: DE!:::'F:iRT'HENT DUF:! NG THE ZNST'FiLL. F~T:EON ZHSF'EE:TiI::i~'~% OF RN'.¢ i.,.IELL. S F!E:,J'RCENT TO TH:i:S PF:OF'EF:T"¢ RND THE i'.,!Uh!BER OF' RES ZDIENCES "r'HF:F THE k~E:L.L kIZL. L SERVE. .............. T ~..,..~ C:::~ ,C ;22: ::::. ::E ~'..4 SE; F:" ~E E::: 'T' % C::~ 8'...~ ::&Z; ¢::~ F'.: :E ~:;~:: EE: ~::~:~ ~....~ % E;:: EE E:> ................. E]RC:!'(F:'ZLL i NG OF i:::INY SYS"FEH !4i"FH(]tljT F i!qF!l..., iNSF'ECTZ ON i::~N!) RF:'PROVF~i.... DEF'RRThlEI'Yf' !'.!IL.L. E',E SUB.:rEE;T TO PROS!ECI...iTiON. !','!!NiHUi"! E:,]:STRNCE i3E:THEEN F~ Fl[ELL RHE:, Fff',F/ ON-S!TE SE:F!RGE [;,ISF'OSF~L SYS'T'EH tS :tE!g FEET F'OR FI F:'R!V!::YFE HELL OR j..EiEi TO Z:(!)E~ FEET Fi;:Ed"! i::! PUBLIC NEL. L UF'Oi'.4 THE T'./F'E OF F'UBLIC i,!ELL. i'"i Z N ! HUH D I STFIi'-,E:E F'F:OH FI E:'R Z ',/!:TT'E HELL. TCt Fi F'R Z ',,,'!TFE SEHEI:R L I hie i S 2~:i F:'EE T' FiND TO FI E:Eff,'iMUNIT'¢ SE!4EF;'. LINE iS 'F'.:.:i FEET. OTHEF4: F;'.EE:¢J i REt*!ENT:5 HFi'./ FIF:'PL'¢. SPEC:[ FiE CFtT ! ONS RNE:, CONSTF:UCT'i ON FR,'R ~ L..F:iE',!....E: TO I NSU!RE F'iROF'EF;: ~ NSTAL. LFIT :i: ! CE(IqTiFY THF!T ii ! ~i"! i:?ff'I!L.:!iFiR t.,.IiTH THE F~'.EEi!L!IF'.Ei'!ENTS FOR ON-SiTE 5EFiERS FIN[:, ~.4ELL. S F!:~: SET FORTH B'?' THE: i'"!l..Ji"4 2: T i,.!]:L-L, tNSTFiI....L. THEi :E;'¢STEM IN FiE:E:OF:DFiNCE !,.! :[ 'fT'~ THE E:ODES. 3:: ~ UNDE~:F;:STRHD THFFF T'HE OH-SiTE SEI.,.iER Sh-'STEH r'lR'¢ F:EQIjIFi'.E ENLFIRGEFIENT iF:' THE RESiDENE:E IS REMODEL_ED TO IFKi:L. UDE i"IORE THRH 2: E;EI)ROOHS. :":::" '~F':I' T ":'¢.F':'-* ~ :¥"'[ ['.if] t:'i" ":'[" .... , i ::~ ':~ !Er:, [:v?. ........................................ / ......................................... ~: ........... L..4 ........................ (..L...¥......~ ........ O & E EN~,~NEERING & DEVELO~ MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Legal Description: Depth (feet) Name: MailingAddress:~),/.~/'~c~-~ Soil Charecterlstl,"s Earl Ellis SOIL LOG 688-2280 ~__,,~.~-z,~, ~-~,,/' No. ~- ~'- -~.~ / 10__ 11__ 12__ 13__ 14 15__ 16__ PLOT PLAN PERC. TEST Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ No /~'~'lf yes, what depth Drain Field "~ Comments: Date: /'¢¢Z)¢_~¢4 /¢// Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 .... .';¢' . -,. r -. CERTIFICATE OF HEALTH AUTHORITY ~'F~"~.,.~ ~- ';:,~¢:,;:. ~' '-'...., APPROVAL FOR A SINGLE FAMILY DWELLING L (~.~.~/,,, ~-- 1. GENERAL INFORMATION Complete legal description Lot 21; Block $; Northwoods Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address 22824 M~.~anus Chugiak, AK Don McKen~i¢, !~135 01d Glenn Hwy. S~te I00 Day phone 694-9034 Eagle Rive,r, AK 99577 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: $ '~ 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 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, Name of Firm Address Engineer's signature ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Phone 17034 Eagle Rive~' Loop Road No. 204 Eagle Rlverl Alaska 99~7'~ - ! DHHS SIGNATURE .~/ Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ¢-//~/- ~y~' 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. 72~25 [Rev. 1/91) Back MOA ~21 Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ,, Env ronmental Services Division 825"L Street, Room 502 · Anchorage Alaska 99501· (907) 343-474 Health Authority Approval Checklist ~..-~c,-¢-%~ ~c.¢.- % i,-~¢-~v.~ 0r~s Parcel I.D.: oo-"/ - '7 c/ A. WELL DATA Well type Log present (Y/N) Total depth Sanitary, seal (Y/N) Date of test Static water level If A, B. or C, attach ADEC letter...ADEC water system number Date completed Cased to Casing height (above ground) __ Wir~ FROM WELL LOG ~''~ AT INSPECTION Well production ~ WATER S~L~~ULTS: ~o~_ .~ Nitrate DEte of sample: g.p.m, g.p.m. Collected by: Other bacteria Bo SEPTIC/HOLDING TANK DATA Tank size \c>o O Number of Compartments 7~ Cleanouts kC Depression (Yt~ rj High water alarm (Y/N) Pumper ~r~ . ~ ~ ~ P ~ ~ ~ ~ Date installed ~ ~% -~7~- Foundation cleano~t ~ Date of Pumping 4"2~¢~t, ABSORPTION FIELD DATA Date iustalled b~[t-q ~ Length ,~'~ ' Width Soil rating (g.p.d./ft2 or fi2/bdrm) O,f5 System type / ~//t Gravel thickness below pipe ~ Total depth Effective absorption area ,5'-9~ / Monitoring Tube present~xl) Date of adequacy tes~{~' ~/~- ~'~ $ r~W ~. Results (Pass/Fail) ~---~ Irmmediately after Fluid depth iu absorptiou field before test (in.); Fluid depth ~ (ins.) Minutes later: Peroxide treat~nent (past 12 months) (Y~) Absorption rate = If yes. give date Depression over field (Y(~ /J For ~ bedrooms __ gal. water added (iu.): ~ ~ .g.p.d. D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size iii gallons "Pump on' level at*. ..~{tmp ofF' level at' E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/balding tank on lot Absorption field au lot Public sewer main S~ service line On adjacent lots ; On .~~~Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '"7 t Properly line /0 t ~ Absorption field Water main/service line /tv t ,-h- Surface water/drainage /o o t/-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /o t Surface xw~ter /o ~ Curtain drain Water maitv'service tine ~ Driveway, parking/vehicle storage area Wells on adjacent lots "300 t .~ Property tine F. ENGINEER'S CERTIFICATION I certiJ, p lhat I have detemnined thrufield inspections and review of Municipal records th_cl&~ ~ems are in conJbrmance with ~OA ~4.~uidelin~ in efJkct on this date. ~ ~,,&~..,E::...:~ ..........................................................................................................HAAFee$ ._~-~ Waiver FeeS ':{~U'::::7'~;~"~:i'?x¢}~;f~Z~'-' Receipt Number ;~¢5¢¢~ ~¢ Receipt Number Rev. 8/95 aSS: haa.wk.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERV CES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-741-10 1. GENERAL INFORMATION Complete legal description HAA# Lot 21~ Block 3~ North Woods Lo,c. atiKn' (site address_ or directions) 22824 McManus Drive ,.~ .J - . t ...-¢ '¢~,'~'~e/Terri Moore Day phone 688-9792 ddress~.~..~ Box 772591 Eaole R~ver. Alaska 99~77 ..... .,,~ % Day phone Mailing address., Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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 Holding tank "' Community on-site NOTE: ×X Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA#21 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 verifythat 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. NameofFirm KND Enqineering~ Ken Duffus, P.E. Phone 694-2359 Address 20441 Ptarmigan Blvd., Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anohorage Department of Health and Human Services (DMH$) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 8bore by an independent professional engineer registered in the $tate of Alaska. The DM H8 does th is as a oou rtesy to purehasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DMM$ do not oonduct inspeotions or analyze data before a certificate is issued. The Munioipality of Anohorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOAi¢21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: m,t A. Well Data Well type A 21, Blk 3, North Woods ParcelI.D. 051-741-10 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed ~Driller Totaldepth .Casedto . ~eight ~ Sanitary seal (Y/N) .~: .Wir~otected (Y_/N) . sDt:tt ,ece fwta~tr, ev e, f~ .g.p.m. g.p.m. WellP. um]5 level1~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot + 200 ' Absorption field on lot +200 ' Public sewer main NA Sewer service line +200 ' ; On adjacent lots + 200' ; On adjacent lots + 200 ' Public sewer manhole/cleanout Petroleum tank + 100 ' NA WATER SAMPLE RESULTS: Coliform Nitrate __------- Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed q- ] 3- R 2 Tank size 1000 Foundation cleanout (Y/N) Compartments 2 Depression (Y/N) N NA Alarm tested (Y/N) JR' s +10' C ean0at~ (WN) Y High water alarm~(Y!.N.):. · :-~NA Date of pumpi~g~ 6-4- .9~41~ Pumper SEPA~{ATION DISTANC~E.~.EI~M SEPTIC/HOLDING TANK TO: ""~' ""' +2 0 ' Well(s) on 0t ,¢ ~ NA .... ~ On adlacent ors 0 To pmpe~y line + 10 ' Absorption field Sudace water/drainage + 10 0 '. Foundation '7 Water main/service line 72-026 (3/93)' Fro~t 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/~4)~ SE~ANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer ~ Manhole/~ ~ "Pump off" Level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed 6- 6- 9 4 Length 5 9 ' Width 4 ' Total absorption area 5 9 0 Date of adequacy test NA Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) 0,8 Gravel thickness Cleanout present (Y/N) ¥ 5I Systemtype Trench varies 8.5' Total depth tc~v.v~ n n, Depressbn over field (Y/N) N Results (pass/fail) fo r Bedroorns After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot NA To building foundation On adjacent lots + 50 ' Surface water +100 ' Curtain drain + 50 ' On adjacent lots +200 ' __Properly line +25 ' To existing or abandoned system on lot + 20 ' Cutbank + 25 ' Water main/service line + 25 ' Driveway, parking/vehicle storage area + 15 ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. bi nature ~~.~ .... , .............. EnnineeCsName KND Eng~neerzng, Ken DuO,us, P.E. H~ Fee $ ~¢¢ ' ~ ¢ Waiver Fee $ Date of Paymem ~ '-/¢ ~ ~ Date of Payment Receipt Numar ~'O¢¢ %~ ~ ¢ ?'~f ? Receipt Number 72-026 (3/93)' Back ,j, .. APPLI ~,NT FILLS OUT UPPER HAl 'ONLY Property Owner ~L_,~ ~:.~,~ ~ - ~ j~ ,~ j~ ~'y -. Phone / Zip Code Address Phone Address ~' ~ ~~~ '~5 ~C~, Zip Code ~--2 t Address Zip Code LegalDescription ~ I --~ ~O~TH ~Oob~ ~ Ty~ o~esi~nce ~inole Family ~ Multiple Family No. of Bedroo~ ~ ' ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. 0mmunity For wells drilled prior to that date, give well depth (attach Icg if available). ublic Utility Sewe O,s.o a, / ~dividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DFPT O ENVIE ;~ iL'. ] i,A. RECEIVED ( '"~APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Dale Sewer Installed Well To Absorption Area Well Log Received C~ _ ~ ,-~ Well to Tank Septic Tank Size 72-023 (3182) 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 '~' -- GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions). , Ap'plicant N am e"~/'/'~ ~J/~' ° ~'' ~-- Telephone: Home ~-'~ ~ ' ~ 7 ,~'~- Business (b) Applicant Address DO f~bv,. '-~'~Z..,.~'~/ ~--z..~:' (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone /.-/~ ~ 0 (f) the HAA to the following address: S & $ Englneerln~ SRB 196x TYPE OF RESIDENCE Single-Family,S. Multi-Family.~/[] Number of Bedrooms ~ Other WATER SUPPLY Individual Well [] Community [] Publicv~ Note: if corn munity 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 [] 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) 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 S & $ Engineering Telephone SRB 196x Address Date ~"'-- Z--'~' -~' Appr°vedf°r /'/I~E~-~'-,. / bedr°°msb~~' '~ ~ 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 DEPT. OF ENVIRO~T~ENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 According1 to records on file in this office th ~_ ~[~ LL, Water System is in compliance with the State Drinking Water ~egulations Sincerely, MUNICIPALITY OF ANCHORAGE (MOA)~/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 ENvIP, ONMENTA,. ' r'E 2 WELL DATA Well Classification '"'-~b~_'~,Lt~_. Ift~)B, C, D.E.C. Approved Well Log Present (Y/N) Date Completed / Yield Total Depth Cased to Del:~o/~Grouting /~,~mp Set At Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ,~,4~ o t ~L To Nearest Edge of Absorption Field on Lot ~1~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~/.N~' Air-tight Caps ~N~' Depression over Tank-('~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well ~ To Property Line /~ ¢ ~ To Wate~ Line Size I. OO C) No. of Compartments Foundation Cleanout~J/,N)~-_ Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed O~ _1 '~ _~ ~_~ Width of Field ,~'-~ ¢ Square Feet of Absorption Area Depression over Field (-~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~.-~ To Building Foundation Lot Depth of Field Gravel Bed Thickness Standpipes Present ~/N)' Date of Last Adequacy Test To Water Main/So.ice Line Z.,O I +'-- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field 3<~, To Property Line lOt ~ To Existing or Abandoned System on ; On Adjoining Lots ..-'~ / ~' To Cutbank (if present) "~'//~- Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Receipt No. Date of Payment ~ -"~-~"-~.~, Amount: $ Date 2~ - 'Z-2.- ~ ¢ ~' MOA No. ~'~'-c2° ~ Page 2 of 2 72-026 (1 ~/84)