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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 32 Municipality of Anchorage Page J 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: ~uJq~-O t q°~ PID Number: O~'J-')5 I ~ Name: ~ ~, ~Hy WastewaterSystem: · UNew ~Upgrade ~dd~s: ~, A~. ABSORPTION FIELD Phone: &~ ~ r--&iQ7 N°'°fBedr°°m':5 U Deep Trench U Shallow Trench ~Bed UMound UOther LEGAL DEaORIPTION so, Rating: Total Depth from original grade: O.~ GPD/Sq. Ft ~.5 I Lot: ~ ~ Block: S~bdiv~ion: Depth t0 pipe bottom from original grade: GraveJ depth beneath pipe Township: ~ J Range: Section: ~ ..- Fill added abOVeo,_ originalo .5 ~ grade: Ft.Gravel length: ~ Ft I WELL:~x~sT~ New g Upgrade Gravelwidth: ~ Numberoflines: Oistance between lines: ~ ~ Ft. ~ ~ Ft. Classification~tTy(Private, A,B,C): /lA ii Total Depth: Ft Cased To: Ft Total absorption area~ SQ. Ft ~o~qPiPe material:/~T~S(N, dO Driller: Date Drilled: Static Water Level: Installer: Date installed: ~e,~: I ~"~" S~ at: C~,i., ,.~,~,*~ove ~roun~: TAN K GPM{ Ft. Ft r SEPARATION DISTANCES ~tic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/~r[vate Ma~;~ ~ ~ Capacity in gallons: From Tank Field Station Tank Sewer Lines Well- ~o ~ ~ ~ ~ ~ ~ ~ ~ Material: Number of Compadments: Sudace Water tool~ ~oo~ ~ ~ ~ LIFT STATION Line ~1 Io~ .... ~ ~ "Pump on" level at: u~p off" level at: igh water alarm at: Foundation ~ ~ t ~ ~ ~ Cudain Pump Make & Model Electrical Inspections pedormed by: Drain ~o~ ~( )~ - ' Remarks: BENCH MARK Location and Description: Assumed Elevation: Ioo.o Eh ENe~FAL Inspections performed b~034 Eagle River Loop Road, No'2~ates: 1st. ~-~r~ ~'~/-// -~-~ Eagle River, Alaska ~577 2nd ~-~- q ~ um~ ~ cE.eeo; Department ct Healt~d H rvices approval ~i.'+)~ ' Reviewed and approved by Date: )/ 72-013 (Rev. 9/91) MOA 25 Permit No. SW950199 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 52, BLOCK 3, NORTH WOODS S/D PiD No .05173150 [O1.2'-xx~ ~PINAL GRADE ? INSU 5ATION ~ 7-26-95 F(;O 22' 3~' NEW LEACHFIELD S"1 25' 36' ~ ~ / BED S"2 25' 57' M,~ 26' 58' M'-2 23' 68' M"3 67' 85' / S.T.E.P. TA[ 72-013 A (Rev. 9/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950199 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MURPHY ELLEN M OWNER ADDRESS:22727 NORTHWOODS DR CHUGIAK, AK 99567 PARCEL ID:05173150 PAGE 1 OF 1 DATE ISSUED: 8/08/95 EXPIRATION DATE: 8/08/96 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 32 LOT SIZE: 20046 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION 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 (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: /~ , /~~~ ~~ ISSUED BY' ~~C -~L~_~-- DATE ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. August I, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORI'iY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of H~alth and Human S~rvic~s P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 32; Block 3; North Woods Subdivision Request ~/o~ issue a pe_..~d,t ,to u. pgrade ,the septZc system 6~u~ ~e A t~st hol~ was ~x~v~ed and a p~col~on t~t pzrfo~d Zn the ~ of th~ proposed up, rads. Thz appro~ lo--on of th~ t~t hol~ ~ lo~d on thz ~ached s~ plan. At th~ ~e of ~x~v~on no w~er w~ encou~d and aft~ szv~n ~ ground ~t~ mo~to~ng, th~ mo~o~ng ~b~ w~ found to be ~y. A~ch~d ~ th~ proposed upgrad~ d~ign. T~ prop~y ~ s~v~d by a Commu~y W~ Syst~. W~ do not an~p~ any adv~s~ ~ff~s on n~ghbo~ng w~, s~p~c syst~s or dr~gz p~ by th~ i~a~on of th~ proposed s~p~c syst~. If you req~ ad~o~ info~on, pl~ co~a~ ~. Sinc~y, 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 ~ALE 40' I ...... SITE PLAN I UPGRADE c~O -- '~-C/)~:~:]I~ om~,~-r~--i~m"' ~ ~ ~ ~T~ m~ ~m oO 7--> o~ ZT~ '7_.4 -- ~0 ~ Z ~ ~ · od~ mo ~ ~ z~--~m ~ o N mmz ~m ~m~ Z 0--0 m O~ z ~ z~~ ~ Z 0 N.T.S. DETAIL PROFILE ,SCALE o PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 8 9 10 11 12 13 14 15 16 17 18 19 20- WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT 1~ /k, pO DEPTH? E Depth to Water After Monitoring? r..~ DATE Township, Range, Section: SLOPE SITE PLAN J I Gross Net Depth to Net Reading Date Time Time Water Drop ~) -- ~,~ ~,' PERCOLATION RATE ~ .~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '~ FT AND ~-[ FT COMMENTS PERFORMED BY; S & $ ENGINEEr{lNG ~-'~.~-t. A-~o~J, ~ CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River I.~p ROad NO, 'JO4 [ ACCORDANCE WITH/J~t~'~I~JCCe~IJ~Jt~J~NI(:~9~[~UIDELINES IN EFFECT ON THIS DATE. DATE: '~ ~")"~ '~/~ 72-008 (Rev. 4/85) ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY /~,P PROVALS 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 ONSITE W~TEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 32, Block 3, Northwoods S/D July 28, 1995 GENERAL: 1. e e Be The scope of this project incl~es the installation of a pressurized absorption bed ~ to serve the three bedroom residence located on the referenced property. The existing leachfield is to be disconnected, inlet line capped, and temporarily abandoned in place for future use. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. e The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 32, Block 3, Northwoods S/D July 28, 1995 e e Se e Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. PRESSURIZED MOUND SYSTEM INSTALLATION: 1. Any peat or organic matter must be removed from the- elevated mound site. e The bottom of the basal bed area as well as the top of the sand filter is to be within two inches of level. 0 The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. e The side slopes of the top layer of the mound system must not be steeper than 33% (3:1). Se The top of the mound shall be covered with a minimum of 6 inches of topsoil and vegetated sufficiently to prevent erosion. e The distribution pipes are to be embedded in sewer rock. Care should be taken to backfill in such a way as to prevent damage to the piping system. 70 Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Three Lot 32, Block 3, Northwoods S/D July 28, 1995 0 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the~backfill depth is less than thirty-six (36) inches. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. e The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. e Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). e Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Se A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3~ passing the %200 sieve. e When sand is being used as a filter material, its gradation specifications must conform to current M.0.A. or D.E.C. requirements. Page Four Lot 32, Block 3, Northwoods S/D July 28, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. ® The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Se The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 32, Block 3, Northwoods S/D July 28, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER DEPART"E"T .EA'T. A.D ..,.,A. SE.V,CES 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES Name ~. 14, ~, C. ~ SEPTIC ABSORPTION WELL ~ddress TANK FIELD of Bedrooms WELL Phone(s) J Permit No. JNo. ~H - ~o ~OOosq ~ L0T LINE LEGAL DESCRIPTION Lot3~ e,o~k 3 ~OC~OO&5 ~>~30. FOUNDATION Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, property lines, loundation, Ti5 N , ~ ~ ~ , ~C ~ driveway, water bodies, etc3 TANKS U ~ SEPTIC ~/ ~;~+ ~ HOLDING Manufacturer Capacity in gallons No. of Compartments Material TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from Total depth from original grade / Cla~ihcation (A,B,C) Tol~l Depth ~ Cased to Instaaer Date Installed: REMARKS: ~T~ ~, . 5~. Z ' 72-013 (3/85) ):)I:V l A T' :[ ON i:::F~C]M EN(3 ]: NEi:IE:F~'. ' .':!; :01ii:E; I [3N F?.E[;'E.I C:(]N[i:~ I'F:;:(.IC;"I i~:)ix!, NCTI .i'F:'¥' D!'"!HE~ I"iUE) i' E]i::"E:N/C:L..i::)E~E!::O iI"'IE: Eib.':q"!E DA'Y' E)!::~: BEi: ?'[:i:T I5 i:::OF~ A :5 B[::~ ~i!~:[ :i.;2 ,':.i!; I ,/VO, :i: F::' (:::(::)i".l'l' Aid :I: NA'I'Ii::Ei~ i':~E?iii.:L', :[ Ai... AC !' I ON HU:3't 10' Lotline--/ ~ /( I' '. I/ / ~ _ o - S~ER C~NO~ . ~SEME~ NO KNOWN CURTAIN LEGAL: Lot ~2, Block 5, No~hwoods Subdv. 0~_~ R: A.H.F.C. CONTRACTOR: N/A JOB ~ 90-008 DATE: 05/07/90~ SCALE 1" = 50' A EA~LE RIVER EN~INEERIN~ SERVICE~ P.O. Box 773294 EACLE RIVER, A~ 99577 (907) 694-5~95 F~: (907) 694-329~ TH :~ressure Line 'd. 1,250 Tank 10' Setback ~ Present ~ LeoCh ~~ Area o - S~ER V + - WELL PROPOSEB ~CHRELB ~SEME~ CURTAIN SEPTIC SITE PLAN LEGAL: Lot 32, Block 3, Northwoods Subdv. OWNER: A.H.F.C. JOB ~ 90-O08[DATE: 03/07 SCALE 1 = 30' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE ~IVEB, A~ 99677 (907), 694-5195 ~AX: (907) 694-3297~ SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 32, BLOCK 3. NORTHWOODS SUBDV. 22?2? NORTHWOODS DR. GENERAL. 1. The well and septic plan are -for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. All soil ~ests are advisory to the design and are to be verified or modified in the f~e]d by the engineer° All excavations and depths are advisory and are to be verified or modified in ~he field by the contractor to meet Municipality of Anchorage and D.E.C. requirements. 6. The excavation is to be exactly in the area shown on fhe site plan, any deviation requires engineer approval. ?. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. BED The bed is to follow the natural ]and contour to maintain unffform total depth of the bed bottom. 2. The bottom of the bed shall be ]eve], plus or minus 1.5". 3. The total depth of the bed e)<cavatfion is not to exceed 1.5' at any point. 4. The sewer line is to replace the existing sewer line that leads to the existing tank. Sewer line to be rerouted under home to exit through wall just above footer plate. 5. The bed gravel is to be covered w'fth typar fabric material. 6. The area over the bed is to be finish graded to prevent ponding of surface water runoff. RECOMMENDED LEACHFIELD DIMENSIONS For 3 Bedroom: TOTAL DEPTH = 2.0' GRAVEL DEPTH = 6" For 2 Bedroom: TOTAL DEPTH = 2.5' GRAVEL DEPTH = 6" BED LENGTH = 38' BED LENGTH = BED WIDTH = 18' 8ED WIDTH = 18' Soil Rat.ting = 150 Septic Tank Size = 1,000 Gal + 250 Ga] Lift station. ~NOTE: THE BED IS TO 8E INSULATED WITH 2" BURIAL FOAM AND 2' MINIMUM SOIL COVER SO AS TO FORM A 1' MOUND. LINE FROM HOUSE TO TANK AND LIFT TO BE INSULATED WITH 2" BURIAL FOAM. 1" ABS PRESSURE LINE TO BE BURIED +4' WITH DRAINBACK TO LIFT STATION. BURY LIFT STATION LIFT STATION REOUIRED. ANCHORAGE TANK 1,250 GAL PREAPPROVED. LIFT STATION TO BE WIRED & INSPECTED TO MOA CODE REQUIREMENTS BY LICENSED ELECTRICIAN. CONTROLS TO BE LOCATED INSIDE GARAGE. EXISTING TANK TO BE ABANDONED BY PUMPING AND FILLING WITH EARTi4 IN PLACE WITH MINIMAL EXCAVATION. BID TO INCLUDE FINISH GRADING OF EXCAVATION AND FRONT YARD TEST HOLE AS SOON AS CONDITIONS PERMIT. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 Lo Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ,~,/'~' .~, C ,. LEGAL DESCRIPTION: 1 2 3- 4 5 6- 7 8 SLOPE DATE PERFORMED: SITE PLAN 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS ~'o ~1 r~1¥- ~ WAS GROUND WATER S ENCOUNTERED? xY~--~ L O IF YES, ATWHAT o/~?~- ~3~ //'1 DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / ,, I,~; ~.z;~, /~.-,,..:, .~ '-?0, 1-~/," :~ " la;~ Io,-~..: ~,_~ ~-~," ~ " 1~ ~'~o I~ ~,5 ~- ~ /-~/~" ~ " /;o¢ /o ~,~ ~L 7~ 1-%," PERCOLATION RATE '~ (minutes/inch) TEST RUN BETWEEN ~ FT AND --~ FT ~ / ~'~e PERFORMED BY: 72-008 (6/79) Eagle River Engineering Services F'. 0. Box 773294 Eagle River, AK 99577 694-5195 CERTIFIED BY: '~--~--ar-~ DARE:  ,~.~/ MUNICIPALITY OF ANCHORAGE ~../ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MA~LING ADDRESS LEGAL DESCRIPTION Well /~ ~ Absorptionarea t ' ' PERMITNO. ~ Z Man u fac~er M~e r/al ~ < ~-- / No, of compartments Liq.,ca~acjt~in/~ ~/ gallons IF HOMEMADE: Inside length Width Liquid depth ~ ' DISTANCE TO: Well ~,~.~ D. welling/ '~ PE'MITNO. ~O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well ~ Foundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: , ~--~ ~o. of Hnes ken~thof~J~,~ /~otallen~thofHnes Trench~,dth inches D,stanceBet~eenl,nes ~ Top of tile to finish ~rade Material B0neath tilo Tota~ effectiue absorption area ~ inches ken,th~ .(g / & ~idth / ~ Depth //. / .~ PERMrT NO. DISTANCE TO: ~- Buildin -- n Nearest lot li?~, >- " ~fi' '~1~' ' ~'7 Depth ~'/~ Driller D,st.nce to lot line PERMIT NO. ~ ~ ' DISTANCE T~: Building~ou Sewer line Septic tank Absorption area(si OTHER PIPE MATERIALS SOIL TEST RATING . / ,,. . . .~- u~ ~ ..;~' '~ ~ Robert A. Sl~F,r ;- ~= ~ .,."1:, /I/ / APP~ OV E~., /// / DATE LEGAL ev, 3/78) Departmen of Health and Envlronmenta :?rotection ~'~ .~ ~ 82~/L Street, Anchorage, AK. ~9501 ' 264-4720 OC~O I * * * HANDWRITTEN PERMIT * * * Permit ~ I ~. W4~LL AND/OR ON-SITE SEWER PERMIT Applicant: ~ r~ ) ~ T ~O~ Q~S~-Mailing Address: ~ ~N/~©n ~ Location: P~ ~Fe~ Phone Nut&her: Legal Description: ~ ~ ~ g~'~O'~/-~ot Size: ~-~ Type of Soil Ab'sorption System Is: Trench: Drainfield: __._ Seepage Bed: ~ Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) ~.~-~ The Required Size of the Soil Absorption System Is: DEPTH ~/ LENGTH . GRAVEL DEPTH / WIDTH 3('/~¢-~(~ The length dimension is the length(in feet) of the trench or drainf±eld. The depth o£ a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~-d~f) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion° Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) T will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 beseems. Signe~: S'~--.__~' /~.4z,..~..'z~--~'//~/,'~-/d& Issued by, ~_ ~¢~*x~,~~ Applicant ..~/~__ ~2~' U -- Date: 2 /~> -- , // SWP/024 (1/81) PERFORMED FOR: [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~. PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST ~-~ /~/~/~// '~* '~'C!~ ~/~ '~'~-~-~' DATE PERFORMED: SFI-E PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS ENCOUNTERED? / O P E IF YES, AT WHAT H DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I - PERCOLATION RATE ~-~? ~ (minutes/inch) TEST RUN BETWEEN ~"-- FT AND ~' FT PERFORMED BY: 72-O08 (6/79) ENGINEERING ~RB 196X PH. 694-~979 January 4, 1982 Frank Bethard STR Box 1698K Anchorage, AK 99507 Permit ~ 810561 Subject: L 32 B 3 Northwood S/D A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. Buchholz? Program Manager~-~ Sewer and Water Program Enclosure: Copy of Permit F'ERFIZT NO. [.',EPRRTMENT L ...HERLTH RND EN',,,'IRONHENTRL ",,~.OTECTION Lq;zZ5 "L" STREET., RNCHORRGE., RF'.'.'. 9D50f 264-4720 ( 8±0561 ) RF'PL I CRNT L 0 C R T I 0 N LEGRL FRRNK E:E'F HFIR[:, PETERS ]:F.'E E'K L ]:2 B ]: NOF.:TH t.400[:,5 ~,."'[:, LOT SIZE 3:45-i6i5 20048 '--~ R'- FEET : ...... F-:.E T'¢PE OF S01L HE, z, UF F T I JN E;'¢STEM I S: [)F.'.R t NFI EL.[.', MR;:<IMJM NLIMBER OF E:E[:,F.:OOMS = SOIL RRTING (:.SQ FT,.-'BR)=, !o2~ THE REQUIRE[:, E;IZE: OF' THE SOIL. RBSORPT!ON S'¢STEM IS: THE LENGTH E~MEN5~ON ~$ THE LEN6TH (~N FEET) OF THE TRENCH OR E:,RRINF~ELE. THE E:,EPTH OF R TRENCH OR P~T ~ THE Ef5TRNCE BETHEEN THE SURFRCE OF THE GROUND RNE:, THE BOTTOM OF THE EXCR',,,'RT~ON (~N FEET). -'r H E T ~: E ~-~ C: i4 B4 [ [) T H Z S E5 _ BE~ ~ CJ~ F' E] E T. THE GRRVEL DEPTH I5 THE MINIMUH DEPTH OF 6RRVEL BETHEEN THE OUTFRLL PIPE RN[:, THE BOTTOM OF THE EXCFWRTION (IN FEET). F'EF.:MIT RPF'LICRNT HRS ]'klE F.E_-.,P_N:..,IE, ILI] T TO INF']RM THILq [:,EF'RRTMENT DURING THE INSTRLLRTION INE;F'ECTIONS OF RN'¢ HELLS R[:,JRCENT TO THIS rr~_r~r. ,~ RN[:' THE N_ME, EF- OF RESIDENCES THRT THE WELL 14ILL SER',,,'E. BRCKFILLING OF RN'¢ S'¢STEbl NITHOUT FINRL INSPEETION RN[:' RPPRO'"/RL E;¥ THIS [:'EPRF.:TMENT klILL 8E SLIE;J'ECT TO FF..U~~.EL.L rILN MINIMUM [:,ISTRF, CE E:ETHEEN R 1.4ELL RblD RNI¢ ON-'_=,ITE SEI4RGE DI:.SF'OSRL S'¢E;TEM tS i00 FEET FOR R F'RI',,,'RTE HELL OR '15~('T0 20F~'FEET FROM FI F'UBLIC HE/.L [:,EF'EN[:,ING UPON THE T'¢PE OF' PUBLIC HELL' MINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE E;EHER LINE IS 25 FEET RN[:, TO R COMMUNITY SEHER LINE IS 75 FEET. OTHER REQUIF.:EMENTS MR'¢ RPPL'¢. SPECIFIF':RTIONS RND CONSTRUCTION DIRGRRMS RRE R',,,'RIL. RBLE TO INSURE PROPER INSTRLLRTION. I CERTIF'¢ THFIT ±: ! RM FRMILIRR WITH 'THE REQUIREMENTS FOR ON-SITE SEHERS RND HELLS RS SE]" FORTH B'¢ THE MUNICIPFILIT'¢ OF RNCHORRGE. 2: I HILL. INSTRLL THE S'¢STEM IN RE:COR[:,RNCE NITH THE CODES. ~:: I UN[:,ERSTRN[:, THAT THE ON-SITE SEb.IER S'¢STEM MR'¢ REQUIRE ENLRRGEMENT IF THE RESI[:'ENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDROOMS. L--', I GNE[:,: ................................................. FFL. I_.PN F FF.:RNK BETHRRD ,~ ' L,/JNiCIPALITY OF ANCHORAGE · / _ Department o~ Health and Environmental~'r°tecti°n 825 L Street, Anchorage, AK. 99501 264-4720 · * * HANDWRITTEN PERMI.T * * * WELL AND/OR ON-SITE SEWER PERMIT Legal Description: L '~ ~ 3 -~O~Dc~ Lot Size: ~ Type of Soil Absorption System Is: Trench: Drainfield: ~Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) Maximum Number of Bedrooms: ~ _ The Required Size of the Soil Absorption System Is: DEPTH V LENGTH. ~------~' GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOLDING) TANK SIZE = /d~' GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days Of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 1 * * * I certify that: ~ (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-si%e sewer system may require enlargement if the residence i~ remodeled tO include mor~3 bedrooms. Signed ~~~~~ Issued by ~ 7~ ~32~-~L~ ,. '~-~plicant -// /~ Date:, SWP/024 (l/S1) k ,.~iUNICIPALITY OF ANCHORAGE '"-~.-; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROT~=CTION Pouch 6-~50, Anchor&ge, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 -- 2 3 ~ 4 · I---r~ n ~ 5 6- 7 8 9I DATE SLOPE SITE PLAN . 10- 11 12- '13 14 15 16 17 18 19 20 WAS OROU.D WATER E.COUNTE.ED? " IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Dete Time Time Weter Drop 3 ~ ~'At, o o 3~ o 7 ~ zo ~o 7 i '/e PERCOLATION RATE COMMENTS PERFORMED BY: TE~T RUN G T1A/Err~ 4 ET AND ~ FT DATE:. 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-731-50 --. HAA # HA950342 Lot 32; Block 3; North Woods Subdivision Location ~ite adrdress or directions) 22727 Northwoods Drive Chugiak, AK 99567 Property owner Mailing address Lending agency Mailingaddress Matt & Ellen Welk Day phone 'P.O. Box 671841 Chugiak, AK 99567 688-6227 Day phone Dick Brown/ Ta~g~ Agent Address 17034 N. Eaqle River Loo~ Road Eagle River, Unless otherwise requested, HAA will be held for pickup. XXX NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone 694-2388 AK 99577 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: XXX 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 st~ows 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 invest_i_gation 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. Phone ~/~'-~ ?~ Name of Firm $ & S ENGINEERING 17034 Eagle River L_-,~ Roa¢l No, 204 Address Eaale River, Alaska 99577 ..~'~ DHHS SIGNATURE /~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 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'~25 (Rev. 1/91) Back MOA ~1 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 05- ~ - 7~I -3-0 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description HAA # ~. ~'~Cq Lot 32; Block 3; North Wood~ Subdivision Location (site address or directions) 22727 Northwoods Drive Chugiak, AK 99577 Property owner Mailing address Lending agency. · ..Mailing address M~ & E~en WeZk Day phone 688-6227 P.O. Box 671841 Chuqiakt AK 99567 Day phone = e t~,g,en.t, 'Dick Brown/ Tar,qe~ Rely Address 17034 N. Eao.ee._,, RiveR. Loo~. Road Day phone 694-2388 Eagle, River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water I'll If community well system, provide written confirmation from State ADEC~ot~st- ing to the legality and status of system, z TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O2~ (Rev. 1/91 ) Front MOA ~Y21 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 inves_tLgation 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 ;.-~.~4 E.,;. ~;.~r ~ ERIe Ri¥~r. Alaska ~577 Address r ~ Phone Se DHHS SIGNATURE '/-~.. Approved for ' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Additional Comments Date 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. 1~31) 8ac~( MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT 5~., "~co¢~.~, ~ot~'THC~7ooc>$ ~/C, Parcel I.D. A. Well Data Well type "~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: / Septic/l*~&~;~,~-tank on lot Absorption field on lot Public sewer main Sewer service line Wires properly protected (Y/N) ATINSPECTION .g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/~ ,.'I'AI~,K DATA Date install~l ~ · ;.i ~ ~.~)- ~'C).~ ?,. Tank size / ;25'o Cleanouts [~/N) 'iVES .. :. !. ".Foundation cleanout ~_~'N) High water alarm (Y~ .~k,/,,~ ..... Date of;pumping ~ - ~-~-"/'. Pumper SEPARA~ ON'D STANCES FR~M SEPTIC/HeL-DiNG TANK TO: Well(s) on lot ~o~/+ .... On adjacent lots ;oo ! To property line 5// Absorption field /o Sudace water/drainage / oo ~+ Compartments Depression (Y/~) Alarm tested (Y~) /'.Jo; /~///~ Foundation Water main/service line 72-026 (3~93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (~) ~-/E' "Pump on" level at High water alarm level z/&, ,, Meets MOA electrical codes(~N) Manufacturer ~4,~p~ Manhole/Access (~N) " "Pump off" Level at · ,Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~oo .J- On adjacent lots ~oo /-/- Surface water /oo /¢- D. ABSORPTION FIELD DATA Date installed ¢~- ¢- g' ¢' Soil rating (GPD/FF) O. 5' Length ~- 5 ' Width / ~¢ ~ Gravel thickness Total absorption area ¢ ~ ~/ '¢ Cleanout present (Y/(~ ~k/'o Date of adequacy test ~//A -/,,,'~,-~'~;/5~''¢~' Results (pass/fail) / Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) System type ?~ £'L> ©, 5-- Total depth ~ / Depression over field (YCj_~ f''''/¢ for / Bedrooms After test If yes, give date / SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 200 To building foundation On adjacent lots Surface water On adjacent lots ~oo '~- Property line To existing or abandoned system on lot Cutbank ¢'O /¢- Water main/service line Driveway, parking/vehicle storage area /7'z/' / Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Parcel I.D. #  MUNICIPALITY OF ANCHORAGE ~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUT~IORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING '¢~/ -- "7.~/--~ HAA# ~ ¢ c, o ~.~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 32~ Block 3; North Woods Subdivision; Location (address or directions) 22727 North Woods Drive (b) Property owner Mailing Address A.H.F.C. #38268 W.A.#75246 520 East 34th Avenue Telephone: (home) · Anchoraqe, Alaska 99503 (c) Lending Institution Telephone (d) Business (e) Mailing Address Real Estate Company and Agent Re/Max of Eagle River ATTN: Sharon Minsch Address ~6600 Centerfield Drive Suite 201 Eagle River, AK. 99577 Telephone 694-4500 Mail the HAA to the following address: (or check here~if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family l~x Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~x Public [] Note: !,! community well system, must ,have written confirmation from the State Department of Environmental Conservation attesting tO th legality and status. 4. SEWAGE DISPOSAL . On-site (23~ Public [] Community [] Holding Tank [] : Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, 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 end 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 $ 8, S ENGINEERING ]7034 E.~ie River Loop J~oad Address EagJe ~iver. Alaska 99577 Date Telephone 6. DHHS APPROVAL Approved for '~- bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional ;'l'lll The Municipality of Anchorage Department of H~alth and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain.federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~ :57.., ~"~.,'~ Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~-~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~:>¥,.~% ~'~>' Date Completed Depth of Grouting If A, B, C, D.E.C. Approved(~N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; O'n Adjoining Lots '7~,~-~ ~- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDIN~K DATA Date nsta ed .F'~=~-----"T'~- Size Standpipes ~'N) ~ Air-tight Caps {~)/N) Depression over Tank (Y/~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well 7.-c> o ~ To Property Line ~0 ~ To Water Main/Service Line lo To Stream, Pond, Lake or Major Drainage Course \ No. of Compartments Temporary Holding Tank Permit (Y/N) Foundation Cleanout {~/N) Date Last Pumped ; for To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page ! of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~. ~'c>~/~' Date Installed .~ ~\~--~ o Width of Field \~ Square Feet of Absortion Area Type of System Design Depression over Field (Y,~ AJ Results of Last Adequacy Test "'"//~- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ¢-.oc, ~4- Length of Field Depth of Field ..~¢ ~-¢ Gravel Bed Thickness Statndpipes Present ~__~YN) Date of Last Adequacy Test To Building Foundation Lot ~4-~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~,E To Property Line To Existing or Abandoned System on ; On Adjoining Lots '~o To Cutback (if present) ~-,/,~ D. LIFT STATION Date nsta ed Size in Gallons "Pump On" Level at '~'.~ High Water Alarm Level at Tested for /'//'~ Meets MOA Electrical Codes 4~/N) Comments Dimensions _._._._._._._._._.~'~ ~/~/,4./-/,¢~-,,¢..¢_ X 12-/" Manhole/Access~/N) "Pump Off" Level at .~17 ~' Vent (~)/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect~ inspection. Signed Company Date MOA No. this Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA ..99503 November 21, 1990 SI'EVE. COWPER, GOVERNOR 563-6775 .S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 ATTN: Ray PWSID: #213001 'According to the records on file in this office, the Chu~iak Utilities Northwood/Deerhorn Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Environmental Specialist VEC:bas Time Time Date Date Date. Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed ~ ~ Permit No. Septic Tank Size L-7/--~O .-oC~"/._. Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner /J~'/,~ f '~- ~,~ '" Phone Buyer / Address Lending Institution Phone Realty Co. & Agent ~ ., Phone Address Street Location t~j,~ ~ Type o~sidence ,~. ~ Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply I~dl~ividual ATTACH WELL LOG. A well log is required for all wells drilled since June [] Community 1975. For wells drilled prior to that date, give well depth (attach log if [] Pub,[Jc Utility available./ [] Individual Year Individual lnslalled: [] Public Utility When Connected to ~ublic Utility:_ [] Hold}n~ Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.