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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 30Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~.~c,.) ~['5olf'-I PID Number: o'51 -7'~1 5-0 Name: [~ U pg ride ~A~ ~ ~c~ ~)~u<~ Wastewater System: ~ New Address: ABSORPTION FIELD Phone: ~ ~- ~ No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION Sol, Rating: ~ GPD/Sq. Ft. Total~Deptho.~,from_original/, grade: Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath p~pe Township: Range: Section: Fill added above original grade: Grave~ length: r~ Gravel width: I Number of lines: ~ Distance between lines: WELL: t~tsT].~C New ~ Upg =V Ft. H J Ft. Classification (Private, A,B,C): Tot~ Cased To: Total absorption area: Pipe material: Driller: ~ Date Drilled: StaticWater Level:Ft. Installer:~¢~O ~ Date installed: Y~Id://GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~ Septi~ ~ Ho~aing ~S.T.E.P. TO Septic Absorption Lift Holding 3ubl[c/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~0 ~ ~ Well- ~00~ ~ ~OO + 2~ ~ Material:~E~L Numberof Compartments: S,,~ce LIFT STATION Water ~ O0 ~+ I O~ ~+ 1 ~ ~+ ~ Lot ~ ~ t Size in gallons: Manufacturer: "Pump on" level at: I "Pump off" level at: High water alarm at: Pump Make & Model Electrical ~nspections nedormed by: r~/~ ~? ~ Location and Description: / Assumed Ei~wtion: Department of Healt~ Huo.,.,~ ,~ ,h.'.. ....... '~ 72-013 (Rev. 9/91) MOA 25 · Permit No. 2 Legal Description: SW950114 Page 2 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 LOT 33330, BLOCK ,..5, NORTHWOODS S/D 05173333152 PID No.: SCAT,~. LOT 50 f' = 40' BED ~EW 1250 S.T.E.P. TANK / ,/ N A B FCO 13'~ 24' ST1 21'~ 27' ST2 26'i 31' MH 28'~ 32' MT1 28'~ 47' MT2 32' 60' MT3 87'i 93' MT4 86'i 99' / / i " % SYSTEM 72-013A(1/93) * MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NUMBER:SW950114 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:BRAUN TRACE M OWNER ADDRESS:P.O. BOX 671945 CHUGIAK, AK 99567 PARCEL ID:05173152 PAGE 1 OF 1 (UPGRADE) PERMIT DATE ISSUED: 6/14/95 EXPIRATION DATE: 6/14/96 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 30 LOT SIZE: 20046 (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: THE SAND USED IN THE FILTER LAYER MUST BE A CLEAN COURSE sm WiTH 4~ OR mESS PASSING THE ~100 SIEVE ~ 2~ OR LESS PASSING THE ~200 SIEVE.__A SIEVE ~ALYSIS MUST SE PROVIDED ON THE Sm USED. /~) RECEIVED BY: /~ ~ ~ ~ DATE: ,,..' ' ~ ~ 'v '- ~ ~ ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD OESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN June 5, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of H~alth and Human S~rvic~s P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 30; Block 3; Northwoods Subdivision tt~ee bedroom hou. ee o~ ti~ referee, ecL p~.ap~. A test hole was excavated and a percolation t~st performed in the ar~a of the proposed upgrade. The approximate location of the t~st hole is located on the attached site plan. At the time of excavation, w~t~r was encountered at 3.5 fe~t and after seven day ground water monitoring water was found at 3.5 feet. Attached is the proposed upgrade d~sign. This property has enough ar~a for a future septic upgrade. This property is served by a Community Water System. We do not anticipate any adverse effects on n~ghboring septic systems or drainage patterns by the installation of th6 proposed septic system. If you require additional information, pleas~ contact us. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1".= 40' SCALE SITE PLAN Z--I _.1Frl -T- 0 .--I ~or- @0 0 o Z i'q 0 ~' '' 0 F- UPGRADE r~ 0 Z ii mx Z,~O COO _..i L,O ~00 0~0 © z~ z~ o~ / ~' ~zm / -- m~ ~ z~ ~m ~m u~o <mm ~ z ~O~Z~ z~ ~ mm~mm ~0~- 0I N,.T.S. ~ALE ~oo ~z '~Z~ © DETAIL c) 0 4 Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: '~ LEGAL DESCRIPTION: 3 4 6 '~.'D, ~, 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? P E Depth to Water Afl,~j~ ' Monitoring? ,P,~ Date: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ,4.° "/,,-' ~, k~o- -~ "1 j,," PERCOLATION RATE ~'~Z~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN O,~"- FTAND //0~"~ FT COMMENTS PERFORMED BY:, 17034 Eagle River Leep Eoa~ No. 12~/~ ~ ~3D CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska 995?7 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ' Environmental Health Division (.,) 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES .,~ ~ (_o,~G. ~>¢s ~j~,~jc--~,z,.~c, ~ SEPTIC ABSORPTION WELL TANK FIELD ne(s) ~~ No. of Bedrooms LEGAL D~SCRIPTION ~SEPTIC ~ HOLDING Ma~ulactumr Capacity m gallons / ~ ~J ~1 ~ ~ ~TRENCH ~D ~ W. DRAIN ~OTHER ~ ~'" Depth to psp~ bottom from ~ota~ depth from on,md grade ~,1 Gravel length ~ravet~dLh ~l~ ~ ~ f~ ~ Date Installed Installer WELLS 5~,~ '~TS ~ PRIVATE ~OTHER fldentifv) C ,~/~ ~ ~ FT FT ~l ~ REMARKS: ' 17034 Ea~l~ River L~p Roa~ No. ~ I . ~ .. . . ~.~ d ~dily that this inspection was peHermed according to all 72-013 (,3/85} HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION July 6, 1987 ROBERTA. SHAFER Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 CIVIL ENGINEER 694-29Z9 REFERENCE: Lot 30; Block 3; Northwoods Subdivision MUNICIP.4lt1'¥ OF DEPT. OF HEAL ~'~"'~'~ ENVII~ONMEN,... TH & ~L PROT~iO ? 1 8Z RECEIVED A eondi,tZo~,~. Health Authority Approval was issued for the referenced property in December, 1986. The t~rms and conditions of this approval required replacement of the existing on-site wast~water disposal systemo Permit #870072 was issued and the on-site inspection report has been completed and is attached. ENGINEERING STUDIES ANDREPORTS The conditions spe~fied under this HAA have been satisfied. you ~al HAA at this &WFE~(~ 'V~ TS ;sETCT' O N SITE PLANS ~ Request ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 SCALE SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES,~ 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ';: ~E~qGJNEER'SSEAL) LEGAL DESCRIPTION: 7 8 9 10 11 12 13 14 15 16 17. 18- 19 2O DATE /~¢¢~../W J~J~,,~sTownship, Range, Section: /~./j., ,~'~x ? ~" ~, SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT / ~ DEPTH? ? p E Depth to Water Aftej- ~,~ Monitoring? o Date: , . Reading Date Gross Net Depth to Net Time Time Water Drop I ', ~o ~ o" ~ ~,, ~/~" PERCOLATION RATE ~' ~[' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' ~' ET AND ~ FT S & S ENGINEERING - . ..... ~ ..... ~-6r.~p~a~~ ~// / / _ CERTIFY THAT THIS~EST WAS PERFORMED iN 72-008 ~Rev. 4/85) SUBJECT: $ & $ ENGINEERING C~,)'I~IPUTATION SHEET 17034 Eagle River Loop Road No. 20~ ~E~le River, Almska 99577 DAllY: SHEET BY CKD OF i --'~_-~:.' ~ ' DEPARtS/lENT OF HEALTH & ENV RONMENTAL pRb:-~'ECTION /__f_.~AJO~--f_J , ~~ 825 L Street - Anchorage, Alaska 99501 Telephone264.4720 SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME~ = ~' . ~ t PHONE MAI LING ADDRESS ~ UPGRADE W~II Absorpti~ar~a Dwelling F PERM~ ~ h ~ ~nuf~cturer ~ ~ / ~teri~ ~~ No, of ¢~p~rtments ~ h kiq. csp~ciW in g~llons Inside length ~i~th ~iqui~ ~epth i0~4~ IF HOMEMADE: ~ ~ D STANCE TO: Well Dwelling PERMIT NO, O Z ~ ~ Manufacturer Material ~ - ~ Liquid capacity in gallons D W I To~ of tile m finish grade ' '[ ~teri~l bene~¢h tile Total effective ~sorption ere~ ~ Length ~idth Depth PERMIT ~-< ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer li~e Septic tank Absorption area(s) OTHER .... .. SOIL TEST RATING ARKS ~ APPROVED ~ DATE LEGAL PERMIT NO~ DEPARTMENT r HEALTH AND ENVIRONMENTAL "'OTECTION · . ,=,,~._'"iF.., =,TF..EET., ANCHORAGE., FIK. q.~., 264-4728 ( 800564 ) APPLICANT MARCEL.L MARTIN LOCATION LEGAL L~O B~ NORTHWOOD PO BOX 2±±0 WRSILLA LOT SIZE TYPE OF SOIL. ABSORPTION SYSTEM IS: DRRINFIELD 20000 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 267 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C, EF'TF[== ,=1- LE~-~I]~]-H = J... -:-¢ 5 ~3RR%¢EL [:,EPT~--' 2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). T~4E T~E~-~C:H i.4 I [)]-H I S 5. ~Z~Z~¢Z~ FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF' THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTAL. LRTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TP~C, (2) Z ~-~5F'EC:TI~],~45 R~:E ~:EZ,]4LIZ E:E[:, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND RPPROVRL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R NELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIVATE NELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"E~:r4 Z T E~<:F' I RE:'_--] [)EI]:Ef4E:E~: ]:rt.. t:-]~- 8~} ! CERTIF'¢ THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALIT"r' OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMO[:,ELED TO INCLUDE MORE THAN ~ BE[:,ROOMS. S IGNED:__~~__~ RPPL I CANT MRRCELL MARTIN ISSUE[:, BY .... Da'rE ..... '¢4. 0 PERFORMED FOR: LEGAL DESCRIPTION: 6 9 10 11 12 13 14 15- 16- 17 18 19 2O [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /J~ PERCOLATION TEST S25 L. Street, Anchorage, Alaska 99B01 264-4720 SOILS LOG- PERCOLATION TEST c~,~0.~ DATE PERFORMED: ' ~ ~ SLOPE SITE ~ r-COz~/~ 7-(o /,.323 t/~ .9 WAS ~ WATER ENCOUNTERED? / / / / / IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop No. 14d7 :-'. :6-';; PERCOLATION RATE (minutes/inch ¢ . ·,.' . ~ :~: TEST RUN BETWEEN FTAND FT COMMENTS >;i:~ ':: : 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 05173152 1. GENERAL INFORMATION Expiration Date: 7ll Z�23 Complete legal description NORTH WOODSBLK 3 LT 30 Location (site address) 22755 NORTHWOODS DR Current property owner(s) STRINGER JOHN Mailing address Day phone 229-7538 Real estate agent Day phone 2. TYPE OF DWELLING: El 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: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 71��22 Date of Payment Receipt Number Oq- .-56D Receipt Number COSA # O S Cd Q 133 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6/22/22 Ar Ar :49TMr f 6. DSD SIGNATURE j f ,s _ X System #1 Approved for bedrooms System #2 Approved for bedrooms °�-62N?4W Disapproved 6/22/ Conditional approval for bedrooms, with the following stipulations: ALITY ?IV S �o m '�STAll) 0 By: int' Lc�l /Original Certificate Date: Zz/Z/ZZ The Municipality of Anchorpa Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Gh olist blue sheep Nitrate Advisory Arsenic Advisory Other % Ank J)LI, Sores COSA Checklist Legal Description: NORTH WOODSBLK 3 LT 30 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 B. TANK DATA Age of tank(s) 27 years Tank type/material STEPStl Measured operating fluid level in septic tank na ❑■ Standpipes/foundation cleanout per record drawing Date of pumping 6/30/22 D. ABSORPTION FIELD DATA 6/21/95 Which system tested (date installed) same ❑■ ALL standpipes present per record drawing Total measured depth from grade 3.5 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: 05173152 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 27 years Lift station material Stl Comments: 6/30/22 Adequacy test date 6/15/22 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 1 in Elapsed time 30 min ❑■ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) n0 date of test) Gallons introduced gallons If yes, enter date 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' ft Yes if No ft 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' Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' 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' 0 Yes if No ft Water Service Line > 10' ft 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' O Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No Water Service Line > 10' Q Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with ++�� OF 11 MOA COSA guidelines in effect on this date. s '� ` ..:........... �t te Steve En9� i CE-6256� COSA Checklist yellow sheet i 7/5/2 ft DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite ' 907-343-7904 Fax: 343-7997 Septic Tank Advisory Certificate of On -Site Systems Approval #OSC221332 Subdivision: North Woods Blk 3 Lt 30 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is 27 years old. 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. Mailmg Address P Q Box 1966501,,- ,ww muni org MUNICIPALITY OF ANCHORAGE Development Services Department �w Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner � . I A Street Address Septic Tank: -Sludge level inches -Pumping: required es no ump'ng completed a no Lift station: -Pump basket cleaned � no -Effluent filter cleaned es no -Control floats cleaned Qa no -Proper float settings confirmed ' es no -Operation satisfactory (je7sl no Alarm System: -Dedicated electrical alarm circuit �_& no -Audible and visual alarm inside dwelling a no -Alarm system operation esatisfacto not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection yes no -Ground water intrusion around pipe penetrations yes __&) -weep hole functional a no -Manhole lid: Functional fy-ft no Insulated es no Properly Secured es no Other -All manufacturer required inspections and maintenance completed <Res no Comments: Qualified Maintenance Provider: wy� `►�i Date of maintenance Technician C Company 'I) 7 M Date 3� Signaturey \ �/ , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 30; Block 3; North Woods Subdivision Location (site address or directions) ProP..erty.oWner . Mailing address 22755 Northwoods Drive Chugiak, AK Dave & Tracy Walker Day phone 22755 Northwoods Drive Chuqiak, AK 99567 688-5447 Lending agency M'ai~!ing address Day phone A~ent" .. · 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $&$ENGINEERING Phone ~'(¢~/ _ ~c/ Name of Firm 17034 ~agJe I~iver LO~ Road No. '204 Eagle River, Alaska 99577 Address ,, ...~.. . Engineer's signature ~/~_ / ~¢~/'. ~--¢'~"--"~ Date '~/ DHHS SIGNATURE ?(- Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments 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) Bac~( MOAtff21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.oT '~0/q~,~-t< '~/h,/o~'r~o~o~ Parcel I.D. o~ I '75 ( ~ ~ A. Well Data Well type 'T~ e,~-I~- Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well ~ Pm11~ levell If~B, or C, attach ADEC letter. ADEC water system number '~u,)% I'b--~ Date completed ~ - Driller Cased to Casing height Wires pmpe~/N~'~~ FROM WELL ~~.~-~T INSPECTION .g.p.m. g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESU~I$.'~~~~ Coliform ~ Nitrate ; On adjacent lots ; On adjacent lots Public se~ .P~um tank Collected by: Other bacteria B. SEPTIC/~ TANK DATA Date installed~.i ~ ~/- ~.. Tank size /~-~ Cleanou{~i.(~N) ~$ ".'..Foundation cleanout (~) High water alarm,(Y~)./~/o Alarm tested (/'~ Date 0~ PUmping ~/~ ~,./~!"T-,4~' Pumper SEPARA,T,.iON D~STANCES':FRO~ SEPT~C/~ TANK TO: Well(s) on lot .~ ~ ~,~ ~ ~q: ," On adjacent lots To property line y'~ ' Absorption field ~ ' Surface water/drainage /~ -~ Compartments ~ Depression (Y/{~) ~o Foundation /~ Water main/service line 72-026(3/93)°Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent ~xl). t/o-<o "Pump on" level at High water alarm level z/?" Meets MOA electrical codes(J~N) -..( SEPARATION DISTANCE FROM LIFT STATION TO: h Manufacturer ~ ¢-~ ~I.~\L Manhole/Access ¢~N) "Pump off" Level at Cycles tested Well on lot ~ oo '+ On adjacent lots ~/"~ D. ABSORPTION FIELD DATA Sudace water Date installed /~-~'/- Length ~ ~/ Width Total absorption area 1~1~ Date of adequacy test ~.',,/~, - ~'J ~'ST,~', Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Soil rating (GPD/FF) o. ~ System type 2'/' Gravel thickness o G' ' Total depth Cleanout present (Y~) JJo --'-'/~ Depression over field, / yes, for // After test If give date Well on lot To building foundation On adjacent lots ~o ~,- On adjacent lots ~/A Property line To existing or abandoned system on lot Cutbank ~o '-,~ Water main/service line Sudace water /oo '-~ Curtain drain /.,,,o~,g N,-,/ou,.~-,-,' E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in Bedrooms Signature Engineer's Name Date CE-8801 HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE /~ t ~' ~ DEPARTMENT OF HEALTH & HUMAN SERVICES D ~' I ''/ DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H86-1305 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 30 Block 3 North Woods Subdivision Location (address or directions) Northwoods Drive (b) Property Owner Fanny May Telephone: Home Business Mailing Address ID ~8-50-000-5-48-5, California (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Mary Ann Scott %Jack White Company Address Telephone 694-5500 Mail the HAA to the followincl address: or: Check here [], if hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road ~204 Eagle River,Alaska 99577 (e) TYPE OF RESIDENCE Single-Family I[]x Number of Bedrooms three ( 3 ) WATER SUPPLY Individual Well [] Community []x Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~x 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 I of 2 72-025 fRev 8/86) Front 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 Address 17034 Eagle River Loop Road ~204, Eagle River 99577 Date Engineer'sSeal This department has received written confirmation from the engineer regarding the Conditional Approval of December 8, 1987. The correcti have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. Attached is a copy of the inspection report. DHHS APPROVAL b~ Approved for three (3)bedrooms Approved XXXXXXXX Disapproved Conditional Date J~Ly 7, 1987 Terms of Conditional APproval CAUTION 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. Page 2 of 2 72-025 fRev 8/86) Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES /./~ DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 30 Block 3 NorthWoods Subdivision Location (address or directions) Nor thwoods Drive (b) Property Owner Fanny May Telephone: Home Business Mailing Address ID #8-50-000-5-48-5, California (c) Lending Institution Telephone Mailing Address (d) Real Estate Company andAgent Mary Ann Scott % Jack White Company Address Eagle River, Alaska Telephone 694- 5500 Mail the HAA to the followino address: or: Check here ~;~ if hold for pick up. List contact person and day phone number below. S & S Engineering 694-2979 SRB 196X Eagle River, Alaska 99577 (e) TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms ~-- WATER SUPPLY Individual Well [] Community [] Public []xx 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 ~x 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 {Rev 8/86/ Fronl 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. 694-2979 Name of Firm S & S Engineering Telephone Address SRB 196X Eagle River, Alaska 99577 Date Engineer's Seal Approved for ~ bedrooms by Date Approved Disapproved Conditional xxxxx Terms of Conditional Approval Existing septic system must be upgraded system installed by July 15, 1987. data for permit(topo map, soils/perc data, 2) Ensure 30 foot separation fr( g 3) Obtain permit from Public Works into Right-of- Way. December 8, 1986 abandoned and an ~tin¢ 1) Provide DHHS with necessary water monitoring, etc.) ditch to upgraded system; for curtain drain discharge CAUTION 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. Page 2 of 2 72-025 fRev 8/86) Back "'~J 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 October 6, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, Lot 30; Block 3; Northwoods Subdivision ~ge) Location (address 'or directions) on Northwoods Drive (b) Applicant Name Fanny May Telephone: Hon ID ~8-50-000-5-48-5, Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/bui Business Buyer []; Other [] (explain); (d) Lending Institution Address phone (e) Real Estate Company and Agent Jack White Address Eagle River, Alaska Ann Scott Telephone 694-5500 D (f) f~aXi~he HAAtothefollowing address: S & S Engineering SRB 196X Eagle River, Alaska 99577 TYPE OF RESIDENCE Single-Family I'~ Multi-Family [] Number of Bedrooms 3 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. 4. SEWAGE DISPOSAL Onsite [] Public [] C~)mmunity [] 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 I of 2 72-025 (11/84) ENGINEEItlNG FIR[Vi PROVIDI~ INSPECTIONS, TESTS. FILE SEARCH, DA. A AND INFORMATION AR certified by my seal affixed nero[o and as of tile validation date shown below, I verify that my investigation of this Health Authority Apf~roval shows that tho on-site water supplyand/or wastewater disposal system is safe, functional and adeeuate for the number of bedrooms and type of structure indicated nerem I further verify that based on the nforcnabon obtained from tile MunicioalKy of Anchorage files and from my investigation and mspecuon, me on-site water supply and/or wastowater disposal system is in compliance with all Munici oa~ and State (;()des, ordinances, and regulations in effect on tile (late of this insoocuon. Name of Firrn Date Telephone \ ,.,, \ \ -,,. '..._ 'x \. \ \ x. DItEP APPIqOVAL Approved fei _ _ hedrooms by Date CAUTION Tho Muncipality of Anchorage Department of Health ane Environmental ?rotection (131qEP issues Health Authority Approva~ certificates based solol~/upon tho re presentations g,ven in paragraph 5 above Dy an indepeneem professional ea~ neet regmw, mr~ m tho Stato of Alaska. The DHEP does this as a commsy ~o purchasers of homes arid their lending .qstitutions m orde~ to satisfy certain federal and state reouirements. Employees of DHEP do not conduct inspecuons or analyze data before a certificam s issued. Tile Municipality of Anchorage k'; not responsi 91e for errors or omiss~oas in the professional engieear's work. Page 2 of 2 72-025 ( I 1/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~,)' HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGECHECKLIST ' FEBRUARY 1984 DEPT, OF HEALTH & ENVIRONM~_NTAL Pi~O ~'ECi'IQN .DEl? 1986 264-4720 Legal Descrip, ti.¢n: ~' '-~ (D /~' "~ Well Classification If A, B, C, D.E.G. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date / To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed Standpipe,~N) Depression over Tank (/~ Pumping/Maintenance Contract on File (Y~I,.~ , /(~//3r ; for Holding Tank High-Water Alarm (Y/N) /'~J'//'~ Temporary Holding Tank Permit (Y/N) Size //~::~__,,~L~ No. of Compartments Air-tight Cap (~N) Foundation Cleanout (~N) Date Last Pumped ?~ ~,./'-¢ Separation Distances from SepticR-ioiding'Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course / To Building Foundation ~ To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11t84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .,,/ Width of Field Square Feet of Absorption Area J'~-/-,/ Depression over Field (Y/~.~_ Results of Last Adequacy Test /~ ~ Separation Distance from Absorption Field: To Water-Supply Well ~ ~ ¢'- To Building Foundation Lot ~ To Water Main/Service Line Type of System Design Length of Field .~/,..~ Depth of Field . Gravel Bed Thickness Standpipes Present (~N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~ ~ Comments ,~'~ ~'~,.~.,,¢ ZT~,~'/ /~'~ /~~ ~' Datelnstalled% '~P~ / U~DimCro~ ~ Size in Gallons~ Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at To Property Line /~2 To Existing or Abandoned System on ; On Adjoining Lots /O ' To Cutbank (if present) Tested for Electrical Codes (Y/N) Comments ~.._ ~'"~ "Pump Off" Level at Pumping Cycl'Es-d~quacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha l a e [C l [C, j or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signed --r~ '~ Date /'¢~' --~;¢ ~' Company ~,,"~-, ~ r~.~MOA No. ~P6 - ~o '~ Receipt No. ~¢-~1 ~ (_2.)0 \ 'L/ '~' Date of Payment ~, :'-~''- ~'( - ~ Amount: $ (¢~' '~(--~ Page 2 of 2 72-026 (11/84) ROBERTA, SHAFER 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 SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 CIVIL ENGINE~H 694-29zg ATTENTION: Steve Morris REFERENCE: Lot 30; Block 3; Northwoods Subdivision Request you issue a conditional Health Authority Approval for the residence located on the referenced property. Based upon recommendations by the MOA, monitoring wells were installed prior to performing an adequacy test of the absorption trench. The wells were installed on November 1, 1986 and after a period of ten days, a water table level of approximately 57 inches below the ground surface existed. Measurements also indicated that the bottom of the drain field was approximately 44 inches below the surface. This leaves a separation distance of approximately 13 inches which is in non-compliance with both Municipal and State regulations. Considering the time of the year it is also suspected that the water table has lowered as much as 18 inches below the seasonable high. Request you also review the attached sketches which will be used for future permit application. This concept is as discussed with you in your office on December 3, 1986. It is our opinion that the outfall to the road ditch in the front of the property from the existing curtain drain and foundation drain will provide only intermitten discharges of water and need not be considered as a surface water discharge for establishing horizontal set backs to the proposed mound. If we may be of further service, please contact us. SRB 196X EAGLE RIVER, ALASKA 99577 SCALE SCALE MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRO~M~NTAL HEALTH DEPARTMENT OF [{EALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date .~4 June. lqSq (a) Legal Description (include lot, block, subdivision, section, township, ra~lge) Lot 30~ Blk 3, Northwood Subdivision Location (address or directions) Northwoods _Dr. ~ Peters Creek, AK (b) Applicants Name Jeff Keene Applicants Address Star Rto 3, Box 7556, (c) Applicant is (check one) Lending Institution Buyer 222; Other ~--q (explainS; (d) Lending Institution Telephone - Home 688-3161Business 694-2511 Peters Creek~ AK ~--~ ; Owner/builder ~ ; Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: Jeff Keene Q~(-k~--~ Star Rt. 3, Box 7556 Peters Creek, AK 2. Type of Residence single-Famiiy~-~ Number of Bedrooms Multi-Family~-~ 3 Other (describe) 3. Water SuPply'- . 'Individual Well.~ Community~ Note:,,!$ gpm~unity well system, must have written corkfirmation from the State Department of Environmental ConsezTation attesting to the legality and status. 4. Sewage Disposal Onsite 521 Community Holding ank Y--] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and sfatus. [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 regula- tions in effect on the date of this inspection. Name of Firm CRW ENGINEERING GROUP Telephone, Address 3900 Arctic Blv_d..~S~lk-~ ~3f,~ ~nchorm~_. Ak 09503 Date 14 June, 1985 Approved for ~ bedrooms Approved ~ Disapproved 562-q752 Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALT~ AUTHORITY APPROVAL (~AA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Legal Description: Northwood Subdivision Well Classification Community Well Log P~esent (Y/N) Total Depth N / ^ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Sepa=ation Distances f~cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewe~ Line C leanout/Manhole Water Sample Collected By Wate~ Sample Test R~sults CoLorants If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed Yield Pump Set At Depth of Grouting Sanitary seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public sewer To Nearest sev~ Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 11 /26/80 .Size 1 , 000 No. of Cu~artm~nts Standpipes (Y/N) Yes Air-tight Caps (Y/N) Yes Foundation Cleanout (Y/N) See Note Depression over Tank {Y/N) No Date Last Pumped 13 June, 1 985 Pumping/Maintenance Contract on File (Y/N)N/A ; for Holding Tank High-Water Alarm (Y/N) N/A Tempora~y Holding Tank Permit (Y/N) N/A separation Distances f~om septic/Holding Tank: To Water-Supply Well Community To Property Line ~k) Water Main/Servi~e Line Course N / A To Building Foundation 9 To Disposal Field 6' To Stream, Pond, Lake, c~ Major D~ainage Coniwents Pump station installed between septic tank & house. House service line can be cleaned from pump station. [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 11 / 26 / 80 Width of Field 48" Square Feet of Absorption A~ea Depression over Field (Y/N) No 267 535 Standpipes P~esent (Y/N) Date of Last Ac~quacy Test __ Type of System Design Drainfield Length of Field 136 ' Depth of Field 4' Gravel Bed Thickness 24" Yes 11/30/81 Results of Last Adequacy Test Adequate 3 BR Separation Distance from Absorption Field: To Water-Supply Well r. nmmnni t.y TO Property Line 17 (closest) To Building Foundation 22' To Existing or Abandoned System ca Lot N / A ; On Adjoining Lots 1 O O ' To Water Main/Service Line 50' To Cutbank(if present) N/A To Stream/Pond/Lake/c~ Major D~ainage Course N/A To D~iveway, Parking Area, or Vehicle Storage Area 50' Conm~nts Do LIFT STATION Date Installed 11/81 Size in Gallons 52 per cycle "Pump On" Level at 15" (See Note) High Water Alarm Level at Tested for 3 Electrical Codes(Y/N) Yes Dirrensions 36" dia. x 80" tall MarYhole/Access (Y/N) Yes "Pump Off" Level at 3" 16" Vent (Y/N) Yes Pumping Cycles du~ing Adequacy Test. M~ets MOA Co~m~ents Levels fr©~ bottom of lift ststion. ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect on the d~~pection. Signed Co~mpany CRW ENGINEERING GROUP KB1/d5/s [Page 2 of 2] Date 6114185 MOA No. ST 85-253 2-!3-84 .. " ~ - "-~ .... D~-~"R ECEIVED INSPECTION APPOINTMENTS TiME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION  825 L Street - Anchorage, Alaska 99501 ~ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, 1. PROPERTY OWNER . ~H~ PROPERTY RESIDENT (If different from ./ PHONE BUYER ~ ~ PHONE 3, LENDING~O~INSTITUTIO~ ~~ I PHONE MAILING ADDRESS 5. LEGAL DESCI~IPTION ~,~ STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One [] Four [] Other I~ SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY [] INDIVIDUAL* ~ COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, '" -'/', THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified 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 Septic/Holding Tank 1Absorption Area Sewe? Line Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENT~- [~%P"*~APP ROV E D FOR "~-- BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED  L.,,l' STATE OF ALASKA MUNICIPALITY OF ANCHORAGE , " .~,. CONSTRUCTION AND OPERATION CER HEALTHL PROTECTION & ~ for PUBLIC WATER SYSTEMS ~r, ~[ 4 1985 Ao RECEIVED 6 q ~,4g5 ~ ' public water system located , Alaska, submitt~ in accordance with 18 ~C ~.1~ ~ ~ ~ ~, have been review~ and are approved. conditionally a~I~roved (so~ attached conditions). T~TLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference Approved by Date APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and sig~ed by the Department before any water is made available to the public. The construction of the ~(~'~Ti~L.L~"~L'5 ~ ,.._'.~J. _/~LS~ ,,I ~,~.lO:~J L.t'.:J I[~._.~ U.~,--~..' public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. ~, ~.~ ~c'~-- /~- / ?- &7 ~"-I~ ~ TITLE DA~ DISTRIBUTION: 1. WHITE - ENGINEER (C<xnplete Saction CJ 2- YELLOW - WATER SYSTEM FILE (Comptele S~ction C) 3. PINK - ENGINEER/MUNI-BOROUGH (Comptete Section C) 4. GOLDENROD o MUNI-BOROUGH (Co~plele Section A} January ,i~ 19°° !~ebbie Cal!~ Risk ?~ana~,er~ent Robert Pratt, Departr~ent of ~{ea!th & Env!ronmental protection Lot 30, ~!ock 3, .,'7orth~oo~s Subdivision This depertment di~] approve the sewer system on the above subject pro,~erty. ~he svster~ ~-;as anprove~ by a reqistered enqineer on !1-26-80. At that time a li~t station had not been installed. Our ~pproval was b~sed upon the enqineer's re~orh. It should] be note~] that lift stations are not addressed in the ~unicipal or~] inance ~ Upon the secon,~ request for bank approval it ~as note~ that %be lift station ~-~as installe(] i~propertv, ~hich would affect the operation of the se~er svsten. Therefore approval was not ~ranted. Robert oratt Associate Dnvironmental Soec.ialist RCp/cl of Anchorage MEMORANDUM DATE: TO: FROM: December 18, 1981 Les Buchholz - Surface Water & sewer Control Debbie Call - Risk Management Division SUBJECT: Request for additional information regarding: Employee or Incident Accident Date Jan 1981 Vehicle No. ~/a Adverse Operator WARREN C. & OurFileNo. SWS7039 Location T,t 30 R]W 3 N~r~hwoods S/D YOUNG SOON LEE JR. Please furnish the following information to Risk Management so that we can give further consideration to this claim. E~] Workmen's Compensation Claim Form ADL-210 [~ Supervisor's Report [~ Request to Doctor [~] Return to work notice ~ Medical Authorization ~ Exactly how many working days has this employee lost from work ~ Auto Accident Report (completed by employee) ~ Police report -- APD , AST E~] Notice of claim (completed by claimant) E~] Itemized repair cost - after the damage has been repaired [~J Itemized repair estimate (vehicle damage) [~ Complete copy of your file and/or all back up material ~ Supporting documents ~ Other: [~ Per the attached we need the items marked above If the information requested above has not been sent, please do so immediately. If you are unable to give information pertaining to this incident, please advise Risk Management at 264-4201. Please attach this request to your return correspondence. Thank you, Debbie Call Risk Management 95-013 (Rev. 11/77) ALASKA enUlROilmellTAL CODTROL SeRUICe$, IDC. ~ncjineerin§ ~ I~'~uironmental $~udics 11/3o/81 WARREN ' LE~ SR2 BOX 1435 CHUGIAK AK 99567 SE[,T,ER - BUYER_ SUBDIVIS ION-NORTHWOOD SUBDIVISION BLOCK-3 LOT-30 ADEQUACY TEST FOR S~TER SYSTEM THE TYPE OF ~RqORPTION $%STSMIS A DRAINFI~¥DWITHANAREAOF 544 SQFT. THE SYST~I IS CAPABLE OF ACC~TING 450 GATZDNS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYST~i IS 450 GAT/ONS. BASED UPONS~tETEST DATA THESYST~MISACCEPTABLEFOR A 3 BEDROOM HOME. THE SEPTIC TANK W~S PUMPED ON 11/19/81 . SEPTIC ~ AD~']QUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 RWnROC~ HOUSE. 1000 IS ADEQUATE FOR 1220 ~esl 251h ~uenue · ~nchora~e. ~las~a 99503 · {901] 276-1361 ~./ STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 (}I;)[~(;E M. SULLIVAN, MAYOH DEPARTMENT OF HEAL.] II AND L:NVIIt~ November 20, 1981 Howard M. Erickson ERICKSON'S BACKHOE Star. Route 2 Box 4380 Chugiak, Alaska 99567 Subject: LOt 30 Block 3 Nortb Woods 'Subdivision An inspection of the lift station serving the subject property revealed the following descrepancies: (1) The electrical wiring to the pump was not buried or placed in conduit. (2) There was not~a metal plate welded and sealed to the bottom of the lift station. (3) The outlet of the lift station was not sealed. The above items will need to be corrected prior to our approval of the lift station. If there are any further questions, pl'ease call this office at 264-4720. Sincere~, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Warren Lee Star Route 2 Box 1058 Chugiak, Alaska 99567 ~Z"VLN L..~c"~C-C-C~,-, ~ :~ CONSTRUCTIO'~w~ P. O. LOX D CIiUG IAK, ALASKA 99567 688-2831 TO: Warren Lee We are pleased to quote you on 'the following. Provide all equipment, parts, and labor to replace lift sta- tion for Lot 30, Block 3, Northwoods Subdiviszon, as per the lift station detail provided by you. $1800.00 Sincerely, Steven L. Skaggs Z 0 aLASKA 81RonmenTAL conTr OL ser lces, Inc. ~n§ineerJnq 6 ~nuironm~nlal $1udies SPECIFICATIONS FOR LIFT STATION, LOT 30,BLOCK3, NORTHWOODS SBDN. 1.0 GENERAL 1.1 THE DRAWINGS SHALL BE A PART OF THIS SPECIFICATION. 1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERMIT. 2.0 THE LIFT STATION 2.!..THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER '"~' GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT, CAPABLE OF BURIAL TO 10 FT. 2.2 THE 36" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED WATER TIGHT BOTTOM OF THE SAME THICKNESS AND COMPOSITION AS THE CULVERT. 2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG. WELDS ON GALVANIZED STEEL WILL BE. SPRAYED WITH ZINC RICH PAINT OR COATED WITH BITUMASTIC. 2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED WITH SCREWS. 2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT SERVICE. 2.6 THERE SHALL B~ A HIGH LEVEL ALARM SET AT THE LEVEL OF THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A LOCATION DESIGNATED ~BY THE HOMEOWNER. THE ALARM SYSTEM SHALL BE PEABODY BARNES 6147 OR EQUAL 2.7 INSULATIN SHOULD BE APPLIED TO A DEPTH OF 4' BELOW GROUND. 1220 LUest 25lh' Auenue · Anchorocje, Alaska 99503 · {907) 216-1361 · ANCHORAGE., ALASK/~"99503 CALCULATED BY 'Z /2< / (¢ DATE //-- / ~ --~/ : * ' ' ,Phone 276-'1361 / C'ECKEDBV ~T~, ' . . ~ i. ~ ~ ~ ~ · ' ' . . ~ ,. , , ~ , . ,,.,,,,,~ ...... ~ ,: .... ALASKA I1UII Ollm nTAL COI1TI OL S [ UIC S, lilC. {~nqineering $ ~nuironmentcd Studies" Specifications of Curtain Drain-For Warren Lee 1.0 The drawings, sheets 1 through 2 shall be part of the specifications. 1.1 All elevations and depths of the trench are advising only and should be verified by the contractor. 1.2 It is the responsibility of the contractor to obtain necessary permits and easements. 1.3 The rock fill for the drain shall be .5 to 4.0 inches clean rock. 1.4 The rockfill shall be wrapped with engineering cloth per drawi'ngs. Typar, proper 4545, Mirafi or equal are acceptable. 1.5 The slope of the bottom of the drain shall not be less than 0.0125. 1.6 Particular care should be noted of the location of the electric or gas line. 1.7 The pipe shall meet the ASTM codes as follows ; perforated - ASTM 3033 ; Solid - ASTM F481. 3220 U. Jest 25th ~uenue · ~nchora§e, ~lasJ~a 99503 * (907) 276-1361 CONTROL SERVIC\-~'INC. 1220 West 25th Avenue ANCHORAGE, ALASKA 99503 Phone 276-1361 CHECKED BY SCALE / '~ ~ ' SHEET NO. CALCULATED BY. ~' ~ t'°/ DaTE /0 - ..~0 ~>,/ DATE 9 INC. CONT, ROL 3,-~v,u.~/ ~HEE~ .0. ~-- O~ 1220 West 25th Avenue. ANCHORAGE, ALASKA 99503 CALCULATED BY ~'~ ~-! '~ DATE' Phone 276-1361 /' / CHECKED BY ~ DATE SR2 Box 1058 Chugiak, AK 99567 August 31, 1981 Mr. Clifford I. Martin c/o Klondike Kliff's Konstruction P.O. Box 2110 Wasilla, AK 99687 Dear Cliff, In regards to our conversation, the following list of deficiencies still exist at my residence (L30, Blk 3, Northwoods Subdivision). 1. Septic tank system overflowing 2. Water in the crawlspace 3, Lift station check valve 4. Lift station outside wiring 5. Vinyl seal in the bathroom 6. Cracked sheetrock in living room ceiling 7. Cracked window in rear bedroom 8. Squeaking floors Per your request, Mr. Leroy C. Reid, AECS, Inc., surveyed my septic system, He stated that an umbrella drain around my lot would solve both the septic tank problem and the crawlspace problem. In the past month, I have had to pump the septic system six times at a cost of $285.00. Do you plan to have the umbrella drain installed? If so, it is important that work begin immediately to insure completion prior to frost. Request you inform me in writing prior to 10 September 1981 of your inten- tion in correcting the septic system and the other problems outlined above. Yours truly, Warren C. Lee, Jr. ' AGAINST: NO"P . ,E OF CLAIM :",, I ~ Municipality of Anchorage [] Anchorage School District NOTE: This form should be filled out in as much detail as possible to assist the Municipality in evaluating your claim, and upon completion it should be filed with the Municipal Clerk, Municipal Annex, GSt0 W. 5th Avenue, Anchorage, Alaska within two years after the date of the occurrence of injury or damage. I, the undersigned, do hereby submit, under oath to the Municipality of Anchorage, Alaska, this Notice of Claim for damages to my 3erson or property.. I do hereby intend to hold the Municipality liable for such damages claimed herein. I. PERSON OR PERSONS MAKING CLAIM Name Telephone 688-3701 Warren.C. Jr. and Young Soon Lee Home Address Lot 30 Bk 3 Northwoods Sub. II. DATE, TIME, PLACE OF INJURY OR DAMAGE Date (Mo., Day, Year) I Time (am or pm) Jan 1981 I Unknown Mailing Address SR2 Box 1435, Chugiak, AK 99567 Place/Location Lot 30 Bk 3 Northwoods Sub. III. PROPERTY INVOLVED Description Lot 30 BE 3 Northwoods Sub. If Vehicle (Year, Make, Model and License No.) IV. MUNICIPAL DEPARTMENT INVOLVED (if known) Department I Municipal Employee Dept of Health & Environmental Protection I Unknown V. INJURED PERSON/PERSONS (Use attachment if additional space is necessary) 2) Name 1) Name ] Age None Address Telephone Occupation Employed By , Person's location when injured Person's activity when injured How did injury occur? Address Occupation Person's location when injured Person's activity when injured How did injury occur? Employed By VI. AMOUNT CLAIMED (Please attach an estimate or itemization of the dana as claimed) $ 1,900,00 VH. DESCRIPTION (Nature and extent of injury or damages. Please describe in detaiL) September through December 1980~ I had a new house constructed on Lot 30 Bk 3 Northwoods Subdivion (Peters Creek). The excavator installed a lift station in my septic system. The lift station is improperly installed: , 1) The bottom is not sealed and ground water leaks into the lift station and is subsequent- ly pumped into my septic tank. The lift station pump comes on every 3-4 minutes.; 2) The pumt wiring is not waterproof.; 3), There is no check valve in the~ump.; 4) The builder did not install a prope~ coyer on the lift station.; 5) The lift station is made from an 18 inch steel irt instead of a 36 inch culvert. Vllh MANNER OF OCCURRENCE OF INJURY OR DAMAGES (Please explain in detail what happened and why the Municipality is liable. Use attachment if additional space is necessary) ift station was approved in Jan 81 by the Municipality Dept of Health and Envirou,,,ental Protection. I am being transferred out of state and have sold my house. The septic system 'will not pass an acceptance test until an approved lift s~ation is installed. Since this ~house is only eleven months old and the Municipality passed the septic system, I don't feel that I should pay for any work to make the septic system acceptable now. IX. WITNESSES: (~nclude automobile passengers, Police, Doctors and ah others having information concerning the claim) Name of Witness Address Telephone 1) Leroy C. Reid 1220 W 25th Ave, Anchorage 99503 276-1361 2) Bob Pratt 825 L St., Anchorage 99501 264-4720 3) Steve Skaggs .0. Box D, Chug~k 99567 ' 685~20ii 4) Helmut Staschel SR Box 1245, Chugiak 99567 688-3922 SIGNATURE OF COMPLAINAJ)~i7 Date Prepared STATE OF ALASKA )V ) THIRDJUDIClALDISTRICT ) I,. , being first duly sworn upon oath, depose and say: That I am the claimant in the above NOTICE OF CLAIM for damages, that I have read the foregoing NOTICE OF CLAIM and that the information and statements therein are true as I verily believe. SUBSCRIBED AND SWORN to before me this day of , 19 ,. NOTARY PUBLIC IN AND FOR ALASKA My Commission Expires: SIGNATURE 95-012 (Rev. $/80) MUNICIPALITY 0f ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services O n-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 30; Block 3; North Woods Subdivision Location (site address or directions) 22755 Northwo0ds Drive Chuqiak, AK Property owner Mailing address Lending'ag~nby ; Mailing address Agent Address Dave & Tracy Walker 22755 Northwoods Drive Day phone 688-5447 Chugiak, AK 99567 Day phone Day phone Unless otherwise re,quested, 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 A~EC attest- lng 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, ordinances, and regulations in effect on the date of this inspection. S & $ ENGINEERING Name of Firm 17~34 Eagle River Loop Road No. 204 Phone ~ ~/- ~- c? 7 '~ Eagle River, Alaska 99577 Engineer's signature Date '3/~e / '~ 7 DHHS SIGNATURE '~-Approved for ~-{-~-'(~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments . ~--~ '~I ~I ~.. Date ~- t; · 'The MunicipallY'of Anchorage Depa~ment of Health and Human Se~ices (DHHS) i~ues Health Authori~ Approval Ce~ificates based only upon the representations given in paragraph 5 above by an independent professional engin~r registered in the State of Alaska. The DHHS does this as a cou~esy t0 purchasers of hom~ and their lending institutions in order to ~tis~ ce~ain federal and state requirements. Employ~s of DHHS do not conduct inspections or anal~e data before a ce~ificate is issued. The Municipali~ of Anchorage is not responsible for errom or omi~ions in the profe~ional engin~Fs work. 72-025 (Rev. 1/91) Back MOA#21 Municipality of Anchorage ~,R ~ ~ DEPARTMENT OF HEALTH & HUMAN SERVICES" ..... Environmental Services Division ~;~t~i~z~V 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) Health Authority Approval Checklist Legal Description: ~.~<'7-~ ~ ~z~ Ao~%~-\~.\oorp5 Parcel I.D.: A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level ~ 5'-1 -23 / If A, B, or C, attach ADEC letter. ADEC water system number .,2 / ..3 0 o / Date completed ~--'~ Cased to Casing hei  ~!rot~cted (Y/N, __ FROM WELL LOG~ AT INSPECTION Well production ~ WATER SAMPL~.R~SULTS: C~ Nitrate Date of sample: g.p.m, g.p.m. Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed (~ ¢~.t-c1~' Tanksize Foundation cleanout (~N) ~ Date of PumPing :~ .. c~-~ /~-~-L~ ¢~-Number of Compartments ~ Cleanouts(~N) ~ Depression (YJ~ ~ High water alarm (Y/N) ,.31 ,~ Pumper '~'.]~ . ~:;20¢.A¢~ .3 L1 C. ABSORPTION FIELD DATA Date installed (~9-\ -~"~ Length ~, '3 ' Width Effective absorption area /.5~/2 /~ Date of adequacy test la/A- - ~ ¢ u./ Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y~) Soil rating (g.p.d./ft2 or ft~/bdrm) Gravel thickness below pipe Monitoring Tube present ~q) Results (Pass/Fail) ~ Immediately after O~ 3 System type ~ .5" ' Total depth . Depression over field (Y/~ For '---gal. water added (in.): Absorption rate = g.p.d. If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access ~4) '~ High water alarm level at* Cycles tested ~ Size in gallons "Pump on" level at* , z'/''z' *Datum "Pump off" level at* /~v'~.~ 3.2. ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main S~.u~W~rvice line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROMLS.EP~'~..~HOLDING TANK ON LOTTO: Foundation 13 ~ Property line __ ~/~' Absorption field Water main/service line 1~' ~-V- Surface water/drainage 'lc~ot ¢¢ Wells on adjacent lots Zoo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / ~- ~ Building foundation ~(~ ' Water main/service line Surface water I c,,~ I ~ Driveway, parking/vehicle storage area Curtain drain /¢o/¢- /z...~..,.~cJ Wells on adjacent lots ~ o HAA Fee $. Date of Payment Receipt Number ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records '~~*~tems are in conformance with MO/ ~/cHA/ -- --g~eli~ in effect on this date. Signature ~ ~ ~'""~"'---""~ Engineer's Name ~Og,,,~x-C, Ce~/W / / Date 3/%0/. 7 Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/96)* 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, 1 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 ~ype of structure indicated herein°. I further verify that, based on the information obtained from the l~anicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or w~stewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection° Name of Firm Approved for drooms By ...... ate Approved ~ Dtsappr o Te~s of Condition~ Approval Telephone CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH A~q) ENVIROnmENTAL PROTECTION (DIIEP) ISSUES ~R. ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEN~ ATIONS GIVEN IN PA/IAGI~ 5 ABOVE BY AM ~NDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AMD THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL tND STATE .REQU!3_E- MENTS, EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ~RRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° i '~'RR4.I ej/D 18 }5[Page 2 of 21 7-19-84 W~LL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH A[rf~ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAG~ DEPT. OF kT~:,~,_Th ~ ENVIRONMENTAL PROTECTION Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~ ~- To Nearest Edge of Absorption Field on Lot?--om ~ To Nearest Public Sewer Line C leanout/Manhole Water Sample Collected By ; Date Water Sample Test Results If A, B, or C, D.E.C. Approved(Y/N) Date Completed Yield ; On A~joining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Depth. of Grouting Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPTIC/HOLDING TANK DATA Date Installed ~ \ ~ ~[ Size /~O cD standpipes ~ ~ Ai~-~i~ht Caps ~/~ Depression over Tank ~ Date Last Pumped Pumping/Maintenanoe Contract on File (Y/N) ~/~, for Holding Tank High-Water Alarm (Y/N) /~ Temporary Holding Tank Permit (Y/N)~./~ Separation Distances from Septic/{~Tank: To Water-Supply Well To Property Line To Water Main/service Line Course No. of Cc~%~artments ~ Foundation Cteanout ~ To Building Foundation ~ To Disposal Field ~' To Stream, Pond, L~ke, or Major Drainage Co~,ents Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ~ ~ ~ LO % ~ ( ~ ~ -~ Width of Field ~'~ Square Feet of Absorption A~ea ~/ / Depression over Field (~_~ Date of Last Adequacy Test Results of Last Adequacy Test ~5 ~F+C.~Tc)~'~-~g ~"~ Separation Distanc~ frc~ A~sc~ption Field: To Water-Supply W~ll ~~t9 ~ To P~operty Line _ ./~ / To Building Foundation ~4 To Existing or' Abandoned System cn Lot . /%//~ ; On Adjoining Lots ~-~D' + To Water Main/Service Line ~/D 7~ To Cutbank( if present) To Stream/Pond/Lake/c~ Majo= D~ainage Course To D~iveway, Parking A~ea, c~ Vehicle Sto~age A~ea t~ ! Comments t%Y ~ ~ ~- Type of System Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent 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/O~" Level at k~p'~g ~ycIes du~ing Adequacy Test. Meets MOA Con~ents ** Check Permitted Bedrocm Rating AGainst HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA Gu Date MOA No. KB1/dL/s in effect [Page 2 of 2] 2-15-84 DEPT. OF ENVfRONM~NT.~L CO~S~R~//kT~ON // ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: [907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the/~(2~}~'~'~'~), ~ ~_.~~ ~~ Water System is in compliance with the sta~e Drinking Water Regulations _Sincerely,, ~/~. ' ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME ~%. TIME DATE DATE ',~ ,, ,i DATE INSPECTOR I NSP INSPECTOR / MUNICIPALITY OF ANCH©RA~ MUNICIPALITY OF ANCHORAGE DEPT. OF HE,'~LTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~'~ONMENTAL F;~©TECTION  825 L Street - Anchorage, Alaska 99501 ~ ~-, ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E [ V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEKFAClLiTIES DIRECTIONS: Complete all parts on pa~e 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHQNE 1. PROPER~Y OW~B r~ PROPERT~ RESIDENT (If different from above} ; t ' PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~ PHONE MAI LING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS / / 5. LEGAL DESCRIPTION ;TREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four ~ Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM '~ INDIVIDUAL/ON-SITE** //OC~(~ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY E~ ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEIVi PERMIT NUMBER E~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified 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 Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED // ) DATE 72-010 (Rev. 6/79) Date Date Date Inspector Inspector Inspector Comments Conditional Approval MUNICIPALITY OF ANCHORAG£ DEPT. OF HEALTH & [NVIRONMENTAL ?~iOTECTION RECEIVED Date Sewer Installed ~ ,, ,~'z~ Permit No. Septic Tank Size /0__~ ~t Holding Tank Size Sods' Rat'g~n ~ Well To Absorption Area Well Log Received ~ Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner l~c.hh~r(~ Construction, ~nc. Phone ~ ~ ~ .... 307 345-1615 .Mailing Address Buyer ]-[ich~l an{] Ka~hryn Lurr. u Address 3605 ~rctJ. c ]?lvFt., A~c.hoze. gj6, AIl 99503 Lending lnsHtution },~ational ]qan]< of Alas]fa, Att~: ~arb Catalino Phone CsSt. and ~,~orthern Lights 265~2873 Address Rea!tyCo.&Agent ..... /,~.p ~operties, A%~-n. ~'Cii1 E~son or ~:o~ ~J.c~'e%% Phone 2702 ~;ambell .t';t., suite 101, Anchora~e, A~'; g9503 276-2761 Address LegalDescription Lot 29, ~;].ocJ]{: 3, ],~orth. N}~},' Northwoe{~s Drive Street Location Typ~ Qf Residence ~ Single Family ~ Multiple Family. No. of Bedrooms Q Other Water Supply Q Individual A~AOH WELL LOG. A well log s required for all wells drilled since June ~ Community 1975. For wells drilled prior to that date. give well depth (attach log if Public Utility avaHabJe.} Sewage Disposal 19 _~ Individual Year Indiv~dua{ Installed: ~ Public Utility When Connected to Public Utility: ~ Ho~din~ Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE iNITIATED.