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Home My WebLink AboutNORTH WOODS BLK 3 LT 38 '~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmenlal Heallh Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES /~l H ~""("'. ~ SEPTIC ABSORPTION A~d~s~ .... TANK FIELD WELL Phone(s) - JPermitNo.- ~ ' ' No. of Bedrooms WELL .~0 '~ LEGAL DESCRIPTION Lot I B]oc Subdiv'sion Township, Range. Section AS-BUILT DIAGRAM (Show location of weft, septic system, prope~y lines, foundation, ~1~ [ ~A ~' ~C~ ~ driveway, water bodies, etc.} TA~KS N Capacity m gallons ~ ~ ~ Material ~ No, of Compa.ments ~)~ C~'~ CC TYPE OF SYSTEM ~ :2 l~ ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from Total depth from original grade Fill added above original grade Gravel depth beneath pipe ~, Gravel length Gravel width Total absorption area Distance between lines t ~ I~ ~=F ~(~O ~ Number of lines Sod h g Pipe material ~ PRIVATE ~ OTHER (Identifv) Cla~ification~(~(A,B,C) ~ Total Depth FT Cased to FTi ~ 72-013 (3/85) I.,, c:,'t'., I..i::.}ga :I: Sub i::l :i. v :i, s :i. cln ~ NOi:TTHWCH]DS I,,.c:~t ~ :38 ~i:;~::,,:::: L i c~n ;~ :3 'l'c, wn sh i p: 15N Ran g ~:, = Lcri:.. S:i.'.~'.(.'.:, 2:'.C~()O() (scl,, f't'..,, cm c~c k: :]; 000 Da I i c>!'"rs ,, ))H?,? i;A] !C.,q",i F'F.,'C)M Ai::;'F:'I:;;~OVIi!!:D E]".ILY]:NEEi]:::~' S i::)iES:[GN MtJ:::H' HAV[i!: DHHS AF'PROV .... AL F'I::': :[ (IR 'I r.,' (];;I::~l'.!~ i RLIC; i i lIN ,, NC:ri' I l:::'f 0141 IS F'F;'. :I: OR 'i"(::! liii:PCH ]: NSF::'E!:C i' :[ (IN ,, Ei:Y.i.Z;,'.:~VAI iOhl!i:, !"iUS'i );cE: Cfi::'EN[EO AND C!_OS[ii:C, I'HE: SAi'-K~. DAY C)R OVIii]:;'.N :!: (iii'"l T ,, i'1"I ]: ',i~ I:::'I:LR!'4 :i. '[ :!: '..~i I:::'OR (."., :.:!, ;<h~!~Di:;-:E)C)I~i S ,, i::: ,, I::!E~B ]: ,..,.,,."M "'" '"" ........ i :?'?)~..}. r'}l [,.,,,' , ~:. i {- .,.,.,,, m,::.~, d.I. ~.,. ..,~.~ ~'~ " I ":. . i. ',::. -'- , .I..,! .,, ,~'ii:;:, E:ZX!SI]:I'qF' ~ ......... ~--",", , ri"*' ':,' ',/ Cii:i::,:'l :(F:Y l'i.hqi ~ ]: ~,,'il ia'~m:i].:i.-F.tt~ ~,.~:i.'['.h t.l'H:.;.:, piE, qi.l:LPE.)fiiE.H']t.';~i lOP C)l'"r'"'S:i.t.e:, se~,~(.:.'.)r.s ai"Id w~.;(~l:l.s as s,:::;.:,i'.. .','or. th by 'l'..!'i~.) Mur~ic:i. pa!ity c,i: Anchc, i~age (MOA) and t. he State o[ Alaska~ ]: ~.~.~:i.:!.] ins'La]], t.!-'m:~ !illy!~t.~;.~,ifl :il"l ac:c:clp,::lai"ic:~:~ ~it.h a].J. MOA .~::,.Y'icl :i.i"i l:::ompiia, nce ~:i.'~..!"i t. he d(.:~s:i.~.~!'l cr':i, te~'~ia oF t. his !: w:i.:ll ~cd::il"te;,l'-~:) t.c) .all M[iA ar'icl l~i'(.¢:,i'[:.(~) (:ii' A].aska P~.)c!L.tiPe)m,:.;.)FIt.~ili {(::)Y' '!'.he ~iet. !:::,ack C'J :i. E;t,~if]C:E)!~i ~ i" i::)('['~ ~'~.!'Y)/ 6}:'X J, %t, J. FP~j W]E,I :!. i, wa.s'Le:,~,¢ai:.er' c:! J, SpC:)S~L~. ], se(4(,,~t"ag(o):, sys'Lem cH"i 'l.'.h'.i.s c~;" any acijacen-l:, of near'by lc:U:.,, also ur'~ch.a['st, ar~d that. t.h(~-'~, c:apac:i.t.y ,:::){ 'l:.l"~e) t.o'La! syst~:.:,m :i.s 3 l::)eclr'c~(::)ms and any e:,r"~!a['gc~mi,:a:ent. ~.~¢:i.:I.I r.e~qu:i.r'e an addit, ic~na.l p~v,i*mit.,, t' ~ ~ t~.1!"~ (.:.) ~:) Tom Fink, Mayor hAunicipality Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 8, 1990 Alaska Housing Finance Corporation 235 West 8th Avenue Anchorage, Alaska 99501 Subject: Lot 38 Block 3 North Woods Subdivision Permit #890267, PID #051-731-41 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as of December 31, 1989. Permits are issued on a calendar year basis by authority of the Municipal Code of Regulations. A new permit must be obtained from this office for an well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-buil% inspection, report (three-part form) must be sent to this office for review, approval and documentation~ When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, John Smith, P.E. Program Manager On-site Services JW/ljm:200 enc: Copy of Permit "Kids Are Our Future" 5 1 .....'/2!; 'I ..... 4 ~ Lot S:J. ze 20()()0 (sq,, f'L. of acr'es) .... ,=. ..... c~oms'.~ This Per. mit: 3 I{ ..........Capac:Jty: ~ ~.. I J.~.., TANI:(~ M:i.n~mum ........ " . . .OE9 }Z A'F i[ (:i)!9 Fi::;:,'C)H AF:'F'RE)VED !!.:;]',i (.:i ]J] NEEFi'. ~ S DES ][ GI',I i"IUST FIAV.':"i: DHI-..!S APPROV .... AJ... I:::i::ii ][ fiJl::;¢ ]'(] (Z]E)J~,IS J' RL](] J" ]] [)l",J ,, h..JE)"J~ ',I] J::'Y DI,,,II..,IS I:::'R(3 t Ejj::i: 'Ti] ~!]ACH ]!: I',.I!~:IF'IE(ii)T ]] Ejjxl ,. IEXE:AVA"Fi[L)N ?JL!S'i' E)F::','..z.':]'qtE).} P~ND CLO,C.'~;J!]'.D "!'HIE SAME'. DAY OF;: BE HEA')"ED OV_E]R N ]'. GHT ~ 'l'J..l I S I='IEi::;fH I 'i" I !ii; FOR A 3 I3IEDF-'.:CJOH S. l=: RES ][ DEf-,ICl{if; AND El', X },::' ]] RES ON !~:';.:/:i:!;]./::!.!9, A L}iF:'I' S'I"A'FION J:=;.'E6jL.I]iIx4ES AN Ei..,.Ef. LZ:TF;:]iC]AI... ]iNSF'ECT]iLIJ',.I.i I!~iXIS!]I"-E'.') }i::;'.Ii.:]",IE;H ["ILJ:ii~'l' B¢!!i: I:':'ROf::'ERI..Y ABAN:O(i)NED,, i-or't.h by '!:.1'~ ,::..:, Hun:i.c:i.l:::,a].'.i. ty c,f' r:;.',,richor'a(;l~:~:, (HOA) ar'id t.h~.:.:, Zi: ~..,.;:i. Zl.:l. .~:;~(::iI"i(.;;.~1"¢,:.:.:, 'Lo all i"IEIA ar'id Sta'l:.~s, of Aia~il.,:a r'equ:i.r'emim'"d:.s f'cm thc.;.) ~i(((.:'('. back ]; LU'iCIe:H"S't:.f.:ii'icl th,]vL 'l:.his i::x;:~,r'mit :i.s w~.lid f'of a max:i, mum (:::,f ::~; bedr'cm)ms~ :I: ~.]].!iiic:i t..~r'iclc,i,p!!!F~.i~;t['H::l '?..l"i~::/'t:. ti'if.i) c:;¢:~pac:;J.'t:.y c:)f' -l:.hi~.: 'Lo't'.,:;~]. ~ByEit(.:.:,fii any enZl. ar"gi.:.;.;,me]"it v~ii]. PE, C:ILiJ. PE, ar'i additic, nal /' - .- - :) A-i"i~[ ¢~ ..... ................ ...................... ~ ....................................................... COPY' August 23, 1989 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 ~EALlH AUTHORITY ~PPROVALS SEWE~{ & WATER MAIN EXTENSIONS ~EWEr~ & WATER INSPECTION ENGiNEERiNG STUDIES AND REPORTS · NELL INSPECTION ~ PLOW TEST ~ITE pLANS qOAD DESIGN SOILTEST PERCOLA?ION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE .~/AST E WATER DISPOSAL SYSTEM DESIGN Mr. Doc Crouse RE/MAX OF EAGLE RIVER I~600 Cent~rfield Drive Suite 201 Eagle River, Alaska 99577 REFERENCE: Lot~Block 3; North Woods 81; NHN'Northwoods Drive, Peters Creek, Ak. AHFC # 57680 ~)P.~r D0c~ A groundwater monitoring tube was installed on the referenced property on August 10, 1989. The tube was installed approximately 15 ft. South of the leachfield serving the property. On August 22, 1989 the groundwater level within the monitoring tuEe was measured ~t 8 ft. below the ground surface. The bottom of the £eachfield was measured at 64 ft. below the ground surface. From this information it appears the septic system is o~ly 14 ft. above the groundwater as opposed to the required 4 ft. separation. Prior to obtaining a Health Authority Approval (HAA) for the referenced property the septic system will need to be upgraded at a distance of 4 ft. above the groundwater. The upgrade will consist of a slightly mounded type of absorption bed with an effluent lift station. Please notify us if you wish us to proceed with the work necessary to ob~ upgrade permit from the Municipality of Anchorage. ~B~A. SHAFER, P.E. ~/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 oo'oo ~' fil-L ~90(V Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG B PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 14 16 ~7, 18- 20 PERFORMED: DATE Township, Range, Section: ~'~_~._ SLOPI' ~ ~'~4'~ i ~ ''~ SITE PI'AN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ L DEPTH? ~, 0 P E Date: Depth to Water Alter r Monitoring? ~ Reading Date Gross Net Depth to Net Time Time Water Drop " PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER / TEST RUN BETWEEN ~----~~ FTAND ~FT ' ~ ~ ~ ~. ,,~ x ~ ~ THAT TH~ TEST~AS PERFORMED IN ] 3 ale Ri~erL~P Rca No. 72-008 (Rev. 4/85) ~ ~ / / !~ ~_~.~j 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 NAME ~TF~-N E I ~W LEGAL DESCRIPTION LOCATION /~ ~' ~ ~, NO. OF"EDROOMS ~ DISTANCE TO: ~ ~ ' ~ ~ / ~ t Liq. capacity in gallons Inside length Width Liquid depth /~ ~ ~ ]F HOMEMADE: ~--~O~ ~turer/~ Material Liquid capacity in gallons ~ / Well Foundation~ I Nearest lot line PERMIT NO. ~[ D~SZANC~ ~O: ~ ~ /~ / ~ No. oflines ~ Leng~o~h~e~ motal[ength of Jin~ mrenchwidth Distance between lines E ~ / / ~ i.~, ~ ~ ~ Top of tile to finish grade I Material beneath tile Total effective ab~ption area Length ~ ~ Depth PERMIT NO. ~ ~ Type of cr~ Crib diameter Crib depth Total effective absorption area ~ ~ Well Building foundation Nearest lot line ~ NCE TO: ~ Class ~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si OTHER PIPE MATERIALS ~~/ Q ~ , ',F INSTALLER ~ ~W ' Il REMARKS ~ I ~ ~ DATE LEGAL 13 (Rev. 3/78) PERMIT NO. RPPLICFINT STE',,,'EN L. SKFIGGS CONST. F'. O. BOX D., CHUGIRK LOCFtT I ON NORTHWOO[:":; L], F.'. LEGRL L2:8 Bi: NORTH[4OODS S,,"[) LOT SIZE TYPE OF SOIL FIBSORPTION '.'SYSSTEM IS: [:,RRINFIELD MFIXIMUM NUME~ER OF BEDROOMS = .~i; SOIL RRTING <S6! FT/BR)= REI;!I_IIRE[:, :~OF' THE SOIL FfB:5ORPTION '::'¢STEM IS: THE LENGTH DIMENSION IS THE LENGTH <IN FEET.'.', OF THE TRENCH OR DRF4INFIELD. THE DEPTH OF' Fi TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUNIL:, RND THE BOTTOM OF ]'HE EXCFt',,,'P, TION (IN FEET). THE GRR',,,'EL [:,EPTH IS THE MINIMUM DEPTH OF GRFI',,,'EL BETWEEN THE OUTFFtLL PIPE FIN[:, THE E:OTTOM OF THE EXCFf,,,'~TION (IN FEET). PERMIT F!FIpLIC:FINT 1...18S THE RESPONSIBILITY Ti:) INFORM THIS DEPFIRTMENT [.',LIRING THE IN'-C, TBLLRTION INSPEE:TIONS OF BN'¢ [,.!ELLS .R[.',JFICENT TO 'THIS PROPERT9 laN[) THE NUMBER OF RESI[:,ENCES THRT THE WELL I.,.IILL SER',,,'E. BRCKFILI..tNG OF RN'¢ S'T'STEM [4ITHOI...IT FINRL INSPECTION RN[.', F!PPRO',,,'RL B'T' TNIS DEPRRTMENT WILL BE 'SLIBJEE:T 'FI] PROSECUTION. MINIMUM DISTI~NCE BETI.,.1EEN Fl .WELL ~N[.', RNY ON-SITE SEWRGE [:,ISPOSBL S'4STEM IS · I_E~EI FEE]' FOR F! PRI',,,'BTE WELL. OR J. SE1 TO 2EIE~ FEET FROM FI PUBLIC I.,.tELL DEPENDING LIPO!',! 'THE TYPE OF PUBLIC WELL.. MINIMUM D!':;TBNCE FROM A PRI'v'WFE WELL TO 8 PRIVATE SEWER LINE IS 25 FEET TO Fl COMMLINITY' SEWER LINE IS 75 FEE].". OTHER RE~.T~LIIREMENTS MF~Y .FtPpL.'T'. SPEC:IFICRTIONS FIN[:, CONSTRUCTION DIFtGF.'.FiMS RRE B',,,'FIILFIBLE TO II'.,!'.~,URE PROPER INSTFILLFtTION. F'EE F-': t--1 Z -F E".;;-CF"" ::[ F-:ES; [:, E ~2: E ~-t E!: EF.': 'Z< d_... :L E_-~ E:J_ I CERTIFY THRT 1: I Rhl FRMILIRR [,IITH THE REQUIREMENTS FOR ON-SITE SEWERS RND [4ELLS RS SE'l" FORTH B'¢ TFIE MIJNICIF'FILITY OF' RNE'.HORRGE. 2: I WILL INSTRLL THE S'T'STEM IN BCCORDF!NCE WITH THE CODE'.5. 3:: I LIN[:,ERSTRND THFIT THE ON-SITE SEWER SN'STEM MRY REIZ~LIIRE: ENLRRGEMENT IF THE RESIDENCE IS REMO[:,ELE[:, TO INCLI..IE:,E MORE THAN 2: BE[:iROOMS. ' O & E EN~-,~AEERING & DEVELO/-~MENT CO. Box 90; Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Earl Ellis 688-2280 Performed for: Name: ~'~,~Z~-__4-~' ]/C//Z./,~/d~ 7--/-/ Tel. No. Mailing Address: -'~d3oc~ ~'' '~7'-., ~/,~c/-/-~,~.,,~7~'. /'~/<'. Legal Description: Depth (feel) 0 Soil Characteristics 8 9__ 10 11__ PLOT PLAN /~J~ .5¢f/c~ 12__ 13__ 14__ 15__ PERC. TEST 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No__ If yes, what depth Drain Field Performed by: ~/~_r ~' "~~ 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~"~J -H/Jr HAA# ~1~'~<~:~(( GENERAL INFORMATION "~'Coml~iete legal description -Lot 38; Block 3; North Woods Location (site address or directions) ~2525 Norhhwoods DRive ," Chuqiak~ AK ,prOperty.owner i ':Gte9 & Amy Cor~klin .Day phone 'Mailing address,..~C/ Prudential Vista Real Estate 16635 Centerfield Dr. .... Lending agency i' Day phone 'Mailing address "' ' Agent "Laura Hamilton/Prudential Vista Address Day phone 689-6506 Eagle River, Unless, otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 ~.. TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature $ & $ ENGINEERING 17034 Eagle Eiver Loop Eoad No. 204 Eagle EiYer~ Alaska 99577 Phone 6' ¢ ~/ - ~-~1 -7 ¢? Date 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. 72-025 (Rev. 1/91) Back MOA ~¢21 i ECEIVED Municipality of Anchorage JUN DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~4UN~QP^uT¥ o~ ~NC~o 825 L Street, Room 502 · Anchorage, Alaska 99501 · (9~~4~v~c~s LegalDesoription: ~ 5~ A. WELL DATA Well ~e /~ Log present Total depth' Sanitary seal (Y/N) Health Authority Approval Checklist I,~:,F- ;~j F-~TH ~0D% ] Parcel I.D.: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well production g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~'/~/~ 1 Tank size Foundation cleanout (/~ ~!~0 Depression Pumper Date of Pumping ~/(¢ I/~ C. ABSORPTION FIELD DATA Date installed 2.~ '~O Number of Compartments ~,~ Cleanouts t~-~)'N) L/~5 h~ b High water alarm ~-'"~J) '1 ~"~ Soil rating (g.p.d./fF or~) ,~, 3 ~"~? System type Length '~ ~ ~' . . Width ,~ F3 ~ Gravel thickness below pipe ~2 Total depth Effective absorption area q~ ~'~ Monitoring Tube Present~N) '~ Depression overfield (Y~ Date of adequacy test ~(i ~/~ Results ',~ail) P~ For ~() bedrooms '/ ~/ " Fluid d~p~h ig ~b~orp~ion fi~ld before ~e~ (in.); ~ ~ Immedimel~ ~fler~ g~l. w~ter ~dded (in.): Fluid depth g~l~ ~V~ (in~) Minum~ liner: ~ N,~ Ab~orpUon rme ~ ~ g,p.d. 72-026 (Rev. 3/96)* D. LIFT STATION Date installed '~%-¢1 Manhole/Access~'/N) High water alarm level at* Cycles tested ~ ¢--,.L¢/-~-~L~ E. SEPARATION DISTANCES Size in gallons "Pump on" level at* '~"~' * · Datum O ¢'~¢- ~,:~ "Pump off" level at* '2-~ ~'* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot ~,~ Public sewer main Sewer/septic service line On adjacent lots' On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line ~ ~' Absorption field Water main/service line I~)f + Surface water/drainage ~OO~° Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~O Building foundation 18 Water main/service line Surface water )00 ~ Driveway, parking/vehicle storage area Curtain drain ~otJ~, ~NlOvJ ~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records th~ ¢t~i3v~. l~J~ms are in conformance with MOA HAA delin~ in effect on this date. ,¢&r,¢¢,~ · ,,. Signature ' - ' ~ ¢~ ~OBERT C.;cOWAN ~ ;~ ,~ CE-8801 HAAFee $ ,~' Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 GENERAL INFORMATION :. Lot 38; Complete legal description Block 3; North Woods Subdivision Location (site address or directions) Property owner Mailing address 22525 NorthwoOds Drive Chugiak, AK 99567 Richard and Jenny Nims 22525 Northwoods Drive Day phone 688-5991 Chugiak, AK 99567 Lending agency Mailing address Day phone Agent carol Epton/ VISTA REAL ESTATE Address 3000 "C" Street, Suite 101 Anchoraqe, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 ~r TYPE OF WATER SUPPLY: · individual well Community well xxx Public water NOTE: Day phone 562-6464 AK 99503 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_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. Name of Firm .... ~ Phone 17034 Eagle River Loop Road No; 204 / , Address Eagle River, Alaska 99577 / .~- Date ~-~//~// - Engineer's signature DHHS SIGNATURE X' Approved for Disappt'oved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date. '7'-- 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorag~ /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow ~ Puc~ell If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected Y ~u ~ FROM WELL ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~c"-~ ~- Absorption field on lot --7.-o ~ Public sewer main Sewer service line WATER SAMPLE R~ Coliform ~ Nitrate Bathe of sample: .g.p.m. g.p.m. ; On adjacent lots .; On adjacent lots Public sewe~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed '~ ~- ~ -~ % [ Cleanouts (~N) High water alarm (Y~ Date of pumping To property line "'5 5'" Sudace water/drainage Tank size I ~ o ~ Compartments ~ Foundation cleanout~N) \/ Depression (~Y/~ ~ Alarm tested (Y/N) ~-~'/,~ ~'"--~'~ Pumper ~-_~, L"~-P--~¢'~ ~- SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: / Well(s) on lot '7.----c, ~ ~ On adjacent lots ' /'-~,~- Absorption field ~-~ ~ Foundation Water main/service line 72-026 (3/93)' Front CONTIN U ED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent CN) High water alarm level - ~ o Manufacturer . ~-O E:::> Manhole/Access (~N) "Pump on" level at .-~o_~" "Pump off" Level at '~ L~¢ Cycles tested Meets MOA electrical codes ~4) ',,/ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot "~o On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed '% ~ ~, - ~1 Length ~ ~ ' Total absorption area Date of adequacy test Width ~ '7 ~7 ~¢ Cleanout present~/N) L~ ~ '5 c~ ~ ~ '5 Results ~[i~'fail) Water level in absorption field before test ~./~roxide treatment (past 12 months) (Y~jD SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water \ Curtain drain ~ I.~ Soil rating (GPD/FF) 'Z4.D ~' l f>~ ,System type '~;)6-~ '7--~~ Gravelthickness O,~- ~ Totaldepth ~ ~ ~/' Depress/¢.n over field (Y~ X ?,~-~ & for ~ '-~ Bedrooms After test ~ If yes, give date On adjacent lots ~ / ~ Property line ~. ~_~ 4- \,¢¢~ T;Ixisting or abandoned system on lot Cutbank ~/'~.- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, ~.¢e?formed to all MOA and HAA guidelines in effect on Signature .,; , ::,:~;:::~::. ~ Engineer's Narc[ ~ o - p · ~agle River, A,la.,¢ :a~9577 Date '7/./~ //¢2 HAA Fee $ //~/7~ Date of Payment Receipt Number~O-~/¢? ¢:;-4. Waiver Fee $ Date of Payment Receipt Number this/nspecton. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~/- -~\ - ~-\L~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 38; Block 3: North Woods Subdivision Location (address or directions) NHN N~hwcJc~ds Drive (b) Property owner A.H.F.C.57860 Telephone : (home) Mailing Address 520 E~ 34~h Avenue, Eagle River, Alaska 99577 (c) Lending Institution Telephone Mailing Address Business 561-1900 (d) Real Estate Company and Agent RE !MAX 0F EAGLE RIER ATTN: Doe Crous¢ Address 16600 ~.t~_~f~'¢?~ D~SU¢, E~g£¢ R~'u~; A£a&ka 99577 Telephone 69~-4200 (e) Mail the HAA to the following address: (or check here r~, if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Roa~ No. 204 Eagle River~ Alr,~,ka 99577 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status, 4. SEWAGE DISPOSAL On-site [] Public [] . Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 Add ress Date 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION' As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone /jrE~",¢ -?~ ~'~ ~ ~ S & S ENGINEER!NG ~703:~ E~-~!~ ~iv~r Loop ~ ~O. 204 Eagle River, Alaska 99577 ~ .~ ~'~ 6. DHHSAPPROVAL ~-~"~.,~,¢,.-.,4 / (/'/ '~"//~ate Approved for ~ bedrooms by /_' ,¢¢ . Approved ~ Disapproved Conditional Terms of Conditional Approval The MunicipaiityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraphSabovebyanindependentprofessionalengineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasers of homes and their lending institutions in ordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88} 8¢ck Page 2 of 2 A. WELL DATA Well ClaSsification Well Log Present (Y/N) Total Depth . Cased to Static Water Level Casing Height Above Ground' Electrical Wiring in'Conduit (Y/N) 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 5t'~-e- /~. ~L'~ MUNICIPALITy, O_F ANCHORAGE (MOA) ~ JNiCiPALI fFl~ilth~:~;~",.~,.~!t.y .Approval (HAA) ~0 NMENTA~ ~l~Ll~¥~'l~ a R UA R Y 1984 343-4744 F_ ]990 RECEIVED ss A Date Completed Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Legal Description: If A, B, C, D.E.C. Approved (Y/N) L~ Yield ; On Adjoining Lots ~/~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~ - ?-_~1 Size _iLOJ~ No. of Compartments Standpipes (Y/N) u/ Air-tight Caps (Y/N) Depression over Tank (Y/N) /~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~//Jq Foundation Cleanout (Y/N) Date Last Pumped _..2_ ~ ._~ -- ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ;~, O~:~ ~'~' To Property Line ..~! To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments _~ ~"~1~..~ I~ I'~/ ~)0 To Building Foundation To Disposal Field 72-026 (Rev. 7/88} Front Page 1 of 2 C. ABSORPTION FIFLD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field 3 Depth of Field ~Gravel Bed Thickness ~ -~' .'.~ Statndpipes Present (Y/N) /~ Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: 't-' To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~/.z::~ -'~ ' / ~ t To Cutback (if present) v/a z-/O '-/-- To Water-Supply Well To Building Foundation ! Lot ~*~ O To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for .,2.-I -- ~'O Dimensions ~ //D ¢" X /¥: ~ ~'OO ~ ¢, J Manhole/Access (Y/N) ~1 · ~ --~ "Pump Off" Level at ,~ ~ ~/ · :~ ~" Vent (Y/N) U~ ~/f/~f Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) tl Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e~.~ inspection. S & 5ENGINEERIN~ ..... ~ E;:¢J!9 _l~ive~ LooI~ Road No. 204 Eagle. River, Alaska 99577 Signed Company Receipt No. Date of Payment -~)-' ~'- ~'~ Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ANCHOI~AGE, AI~SKA' 99503 S & S Engineering ....... 17034 Eagle River.Loop, Suite 204 Eagle River, Alaska 99577- STEVE COWPEPv GOVERNOR 563-6775 PWSID: #213001 According to the records on file in this office,, the Chu~lak Utilities/Northwoods-Deerhorn · Subdivision · Water System is compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEC~bas APPLI . 'T-FILLS OUT UPPER HA[ . ' -NLY · - · ~ ~ '/ ~ " ' Phone Property Owner ~)L'~ ~ /~ ~ '~ .. !~)tL)t C'.. ,~,.t.,( It'~. J'~ · .... :' . ~ ~.--~ ~ ~.: .~ ~--~-~'~ ~ ¢ .~- ~) ~ ZipOode ., Mailing Addre~ .~ / [ ,__/ _ . .~ . ~ ~ .... )k.~) --~.~ F ~ · ~__ ' Zip Code . ~ J ~ Address ' / ~[ '~ {.'~/' / '~ ~'~' ~ . / , ~. ~ . z (J-- - /F [ ~ , - Lending institution [__, .:~ k ~ ~' /k..)(:~:~ ~ [ ~j~'" ' Phone -. ' /'gLT)G('), 1! ~'P Code Address ~-'~ ':~(~(~ (~) :~'> {' '~ ~J I ' / Realty Co. & Agent ' ' ~(~'! {.-, I ',~rt) '~(('f% / '"' /~ t t- L--'-~t ~ '~((.'[ ~ ~ Phone ' ,'x '. --~ ~ ~ Z ', [' ( -~ Zip'Gode -J~'~ : ~ Address ' ~"%(..-C/ ~ '~--' ~ ~--,( .' j. --~L ~ [ ' ~,~- ~:'~ ~ ~ t - ~' ~ k~ Leg~ g~o,ipt~o. %.-/ 'L~,, ".~/= ~.. /~.' ~'~-tJ~°~J~~'~ ' . StreetLocati~ 'x~ · ~" ({~P¢ '"-. - ~'~" ~ [ ~ .... · Type of Residence . ¢ . . ~-~'Single Family- ' ~' (,~" - '~ '~ ~ ~:-~- <f.' ;: ' .~ ', ' %~ ~ ~' · .. : ~ Multiple Family , No. of Bedrooms_ ,_~- ~ Other ..~ Water SuPply ~ I~dividual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~. Community For wells drilled prior to that date, g~ve well depth (attach Icg if available). ~ Publib Utility ' '". Sewer Disposal ~ Individual '~.%. Year Individual Installed: ~ Public Utility *'% When Connected to Public Utility: ~ Holding Tank i '~'- , / NOTE: THE INSPECTION FEE MUST ACCOMPANY EAC~ RE~EST BEFORE ~OCESSiNG CAN BE INITIATED. Time Time ' Time Time C%_ ,C~ (,,~.~- .......... Date Date Date Date Inspector Insp~tor Insp~tor Insp~tor DEPT. OF HW,LTi[ ~NVIRONM~NTAL P~OTECflON ( ~ APPBOVED BEDROOM8 'GONDITIONg OF APPROVAL ( ) DIgAPPROVED ( ) CONDITIONAL APPROVAL' BY: Soils Rating Date ~wer installed Well To Absorption A~a Well Log Received ~7~ ~ --~--~ ~ We[ltoTank ~ ~ Septic T~k Size Dece~v~ber 12, 1983 ~{arren and Debra Hoftich 7521 Old Seward tli~jhway Anchora~3e~ AK 99502 Subject: Lot 3~], Block 3, North¥;oods Approval for the individual sewer and water facilities cannot be granted until the followi~]9 items have been completed: o The septic tank pumped witi~ a feceS, pt submitted to this departn]ent o £~leas(~ notify this Department for a reinspection when the noted discreDancies have been corrected. If there are any further questions, please call this office at 264-4720° Sincerely, CW70/ej/EI uory '~- Acting3 Se%~er & ~ater Pro~ra~ ~ianager ~ .~ ~ DA~__~"R EC EIV E D INSPECTION APPOINTMENTS TIM.= DATE DATE, , DATE I NSPECTO R I NSPE~'~OR I NSP ECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IP, ONMENTAL P,~O]'ECTION 825 L Street - Anchorage, Alaska 99501 AUr 198i ENVl RONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED 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. pR/~I~RTYO.~VVNER I PHONE MAILING ADDRESS ~ · pR~)P~ERTY'~RESIDEN'¢ (if different from above) ~/ ' PHONE 2. BUYER/f MAILING ADDRESS 3. LENQING INSTITUTION PHONE MAILINGA~I - ' ' ' ) ~ ' ' (/ 4, R EA~_.T..~/AG ENT MAI LII~G A D dFN~SS 5. LEGAL DESCRIPTION STREET LOCATION 6. T~E OF RESIDENCE [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five J~'~hree [] Six [] Other 7. WATER SUPPLY CODIVIDUAL* MMUNITY [] 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 · .--.~/ . I~'~-~DiViDUAL/ON_SITE** ///¢/t~C::/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 [] 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 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 TQTAL ABSORPTION AREA MATERIAL 4. DIST,~N'CE~ Septic/Holding Tank Absorption Area Sewer Line 1 Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMM'~:NT~ [] CONDITIONAL APPROVAL (letter must accompany certificate) []t,::' DISAPPROVED DATE BY