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Home My WebLink AboutNORTH WOODS BLK 3 LT 39 · r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 (_~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES )-~ ~C/~ ~ TO SEPTIC ABSORPTION WELL ~d~FROM~ TANK FIELD LEGAL DESCRIPTION LOT LiNE ~- ~ / ~ot ?? lBIock ? Sut~.,~ FOUNDATION ~ ~ ~ f ~/~ Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, ~ y~ ~ I ~ ~ C, ~ driveway, water bodies, etc.) TANKS N ~ SEPTIC ~ HOLDING , Manufacturer Capacdy in gallons Materiat NO. of Compadments " ~ ~ TYPE OF SYSTEM ~ I~ ,~ ...... ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ '~ ~ Depth to pipe bottom from Total depth from odginal grade ~ '77', original 9fade ~1~-- FT / FT' ~., Total absorption area Distance between lines j~ /~°So FT ~ ~ . /~ 4~ FT ~ ,~ ~ ~o SQFT ~yy~ ~3HI ~yo ~ ~ mnsta[ler ~ -- ~ l~ Date Instamled/ WELLS ~ PRIVATE ~ OTHER ~ldentifvl~ Classification (A,B,C) Total Depth ~ Cased to ~ FTm FT REMAR~: Date: Eagle River, Al( 99577 m~/ cedify Ihat this inspe~ion was pedormed according to atl ,~.,~"'~.,"~, Leu;, ,. ,,.,., . ,, .;f.,,";' :'. C5-~7~. MuniGipal and State guidelines in effect on this date: Health Depa~mentApprowh , Date: 72-013 (-3/85) Lx::H:.. S:i:.~,:".~ ;:,~O()C;C) ('.sq,, f'L,, c)p l"lax .Uc~dr-cx:,ms;; Th:i.s l:::',:.:~:,r'm:i.t.~ 3 '["cH'..al Capa'¢::L'Ly.~ rm.w~'i:, l x:;;: v :: :, a'i: :l.,'..:.>~:;..i~,'L 2 c::cm~i::~a.p'Lm.':.:~'rrL~,; O,:.?i:::,t.h t.c-., tx::)p ~:::~f sept.:to: -t. ank(s) '::: i90, ~-.) ........ (,.~ ......... Neighbor', 10~ ~,' Septic +30' I Neighbor's !, - ~' - Septic +30' ,o'-, ~ ~' . ~ ~,~ , Abo~don Ex~n9 Trench In~all cleano~ ~ : / House 1 I Commun~ Well ~ wMer line 15' Utility Easement I J B - ~ HO~ · - MONITOR ~BE o - S~ER C~O~ PROPOSED ~CHR~ NO KNOWN STR~S SEPTIC SITE PLAN LEGAL: Lot 59, Block 5, No~hwoods Subdv OWNER: Alaska Housing Finance Corp. CONTRACTOR: N/A JOB ~ 90-0721 DATE: 08/06/90J SCALE 1 = 30" ~,~ ...... ~ .......... :, ~AGL~ RIVER, A~ 99577 ,:,~, SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 39 BLOCK 3, Northwoods A. Gf:-A/E£.4L 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. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipa]ity of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family 7. The excavation is to be exactly in the area shown on the site plan, any deviatipn....r~quires engineer approval . 8. It is always' recommended that a surveyor locate the nearest lot ]i:~e position and the location of any easements. !. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed sha]] be ]eve], plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed I ' at an~ point. 4. The sewer line is to rep]ace the existing sewer line that leads to the existing trench. 5. The bed grave] is to be covered with typar fabric material. 6. Soil or combi,nation of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the ]eachfie]d. ?. The area over the bed is to be finish graded to prevent pending of surface water runoff. 8. The septic tank and ]eachfield must not be closer than 100' to any existing private well, ]50' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 1' GRAVEL DEPTH = 6" BED LENGTH = 45' BED WIDTH= 24' Soil Rating = 240 Bedroom Capacity = 3 Absorbtion .Area= 1080 S.F. )e,,~c ~=~ Tank Size = 1250 inc] . aift. station *:~:NOTE: ABANDON EX1STING TANK TO MOA REOUIREMENTS. ~::~!WOTE: LIFT STATION REQUIRED TO BE WIRED WITH WRITTEN VERIFICATION ~Y LICENSED ELECTRIAN. ~*NOTE: F~ELD AND PRESSURE EFFLUENT LINE TO BE INSULATED 2" BUR!AL FOAM AND +2' SOIL COVER. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: /Z]I /L/./~. C' , LEGAL DESCRIPTION: .~/~>~z_ ~,~ DATE PERFORMED: 7, ~"P-,~~'~ 5 6 7 8 9 10 '11 12 13 14 15 16 17 18 19 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? /v/~- ~- SL O ~<~, ~/ / P E IF YES, AT WHAT DEPTH? //£tc/ .~o ~'~yr Gross Net Depth :~o Net Reading Date Time Time Water Drop / " I~:,~? I,o~,~,. ~,_~-~ ~ ~-- /.~:~-t ~'- S- ~'/~ PERCOLATION RATE ,;~-,~ . S'- (minutes/inch) TEST RUN BETWEEN ~' $- FT AND ~'~ FT PERFORMED BY: 72-008 (6/79J Eagle River Engineering Services P. O. BaX 773294 Eagle RiveG AK 99577 694,-5195 CERTIFIED BY: '~j~ MUNICIPALITY OF ANCHORAGE ,/, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION [ii ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anehora§e, Alaska 991501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION NO. O~ROOMS ~ ~ Manufacturer . (: ~ ~ Liq. capacity in gallons I' IF HOMEMADE: Inside length Width Liquid ~pth ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufocturer Material Liquid capacity in 0allons ~ Well ! PERMIT NO ~ DISTANCE TO: e~¢ ,~~ Foundat,on Nearest ,o~,~ C _ No. of lines / Length of Total len~ n~ Tre~h~dt~. Distance betwe~7~, ~ Top of tile to finish grade ~ ~e/ ~ ~ ~hes Material beneath tile ~) G inches PERMIT NO. ~ Total eff~tive absorption area Length Widt~ Depth ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot Pine ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tan~ Absorption area(s) OTHER PIPE MATER--S SOIL TEST RATING INSTALLER , 72-013 ( 3/78) PERMIT NC DEPFIRTMENT 0:. tERL. TH FIN[.', EN',,,'IRONMENTRL [_.¢.,TECTION , 825 -"L':'-~S]"REET., t~NCHORFtGE., BK. 995E~± 264-4728 ( 8:[.8562 ) FIF'F'L I CFINT LC CRT I ON LEGflL STE'¢EN L SKRGGS CONST. f , NORTHWOODS DR_ E L ~:9 B 2: NORTH WOGDS F'O E,.,,-,, D 99567 L 0 T_,': I Z E (;88-2L::31 2(~E~E~EI SL.]UHRE FEE]' TYPE OF 'qFi l L FIBSC~RF'T I ON '-' ":' - '- ' ..... --,~_,TEM I:,. DF.:RINFIELD MFI;:-:;!MUM NLIMBER OF BEE:,F.':OOM:5 = 3 '- ' P (S6.! c,. 5 L:;OIL RH7 !Nm FT,-'"BR)= THE REL-]UIRE[:, SIZE GF THE ':-IL -FTM - iS' __ H....._~. U~..F T I UN S'¢STEM THE LENGTH DIMENSION IS THE LENGTH '-'.'IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT tS THE D!STFINC:E BETWEEN THE SLIRFFICE OF THE GROUND RND THE BOTTOM OF THE EXCFWRTION '.':IN FEET). THE GF.'R',/EL DEPTN IS; THE MINIMUM DEPTH OF GRFt',,,'EL BETklEEN THE OUTFRL. L PIPE FINE:, THE BOT'FOM OF THE EXCR',,,'FiTION ,::IN FEET). PERMIT FIF'F'LICRN]" HFIS THE: F.E:,FLN=,_BILIT'¢ TO INFnF.'M THIS E:,EF'FI~.'TMENT DLIF.:ING THE INSTRLL. FITIC~N IN:E;F'ECTIONS GF RN'T' WELL'5 FI[.',JF~CENT TF1 THIS F'ROPERT'¢ FIND THE NLHEEF' OF RESIDENCES "FHFFF THE .NELL WILL SEF:"E. TI..,..IC~ ,:: L~.:' ::, :[: t'-.~::,F EL.'T :I ~31'..,~S lflF:.,.:.:_ F:EI:-T~.Lt t BRC:KFILLING GF RN'¢ S'¢STEM I.,.IITFIOUT FINFIL IN~.$F'EF'_:FION RN[:, HFFR_~' ','F~',",,fL B'¢ THIS DEF'F!RTMENT t.4IL.L BE SUBJEC:T TF~ PROSE: _ TI ~N. MINIMLIM DISTRNCE BETWEEN FI WELL FiND RN~¢ ON-SITE SEWFIGE DISPOSF4L S?STEM IS 18~3 FEET FOR Ft PRIVRTE WELL OR ±58 TO 288 FEET FROM FI PUBLIC WELL DEPENDING UF'ON THE T'¢PE OF PUBLIC P.IELL. MINIMUM DISTRNCE FROM R PRI',,,'FtTE P.IELL TO FI PRI',,,'R'TE SEWER LINE IS 25 FEET FIN[::, TO R COMMUNIT'¢ SEWER LINE IS 75 FEET. OTHER RE~Z~U!F. IEMEN"FS MR'¢ RF'PL'¢. SPECIFICRT!ONS RND CONSTRUCTION DIFtGRRMS FIRE R',/FIILRBLE 'TO INSUR. E PROPER INS"FRLLRTION. F" E R IP'~ I -F E .---. F Z F.: EE-."-- [:' E C: E E'i E: E F-: ]~: :IL... ::L -..':~ ---""-" "zt I CERTIFY THRT ±: I RM FRM!LIFtF.: WITH THE RE6!UIREMENT:5 FOR ON-SiTE SEWERS RN£:' WELLS RS SET FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCFIORRGE. 2: I .WILL INSTRLL THE S'¢$TEM IN RCCORDRNCE WITH THE CODES. 3: I tJNDERSTFIND THRT THE ON-SITE SEWER S'T'STEM MR"r' REQUIRE EN. LFIRGEMENT IF THE RESIDENCE IS REMODELED TO INCLLtDE MORE THFIN ]: BE[:'ROOMS. SI 3HE[,: ....................................................... RF'F'LIC:RNT SI-E',/EN L '-' ..... r",- __ _ ::,~-. H = J :, I-: -IN'--, T ~ ,NICIPALITY OF ANCHORAGE , ~ Department o~--Health and Environmental ~otection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * W~/OR ON-SITE SEWER PERMIT Legal Description: Type of Soil Absorption 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' 7 ' q~-- / LENGTH GRAVEL DEPTH ' WIDTH Phone Number The length dimension is the length(in feet) of the trench or drainfieldo 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 = /~J~'~ 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-site sewer system may require enlargement if the residence is remodeled to include more ~ bedrooms. Signed: Issued by: Applicant Date: SWP/024(1/81) 8__ 9__ 10__ 11 12__ Russell Oyster 694-2774 Performed for: O & E ENG\-NEERING & DEVELOFMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Name: ~ ~-~'/-/~' ..~ ~-~'~-~ 5 Earl Ellis 688-2280 Tel. No. ~F - Mailing Address: Legal Description: ~2'- -~'-' ,~,~c~ ~p~.~ /4~)"t-/ I/~'40~/~7 --~_./z~'. Depth (feet) 0 Soil Characteristics t3__ 14__ 15__ PLOT PLAN PERC. TEST 16__ Ground Water Encountered: Yes //" Proposed Installation: Seepage Pit Comments: _ No___ If yes, what depth Drain Field__ Performed by: ~/_:~?~ ~/- Parcel I.D. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~/ '~/2.2 NAA# 1. GENERAL INFORMATION Complete legal description Lot 39; Block 3; North Woods Subdivision Location (site address or directions) 22509 Northwoods Drive Chugiak, AK Property owner Mailing address Thomas & Catherine Hanrahar~ Day phone 688-1417 22509 Northwoods Drive Chugiak, AK 99567 Lending agency Mailing address Agent LJ. nda Hatter/ Aurora Properties Address Day phone Day phone 688-4939 UnleSs otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 -, TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone Name of Firm s & $ ENGINEERING ]7034 Eagle River Loop Roast No. 204 Address E~,,le Ii~.~e_r, Ala~l~a 9~).~77 ~/,-~---~- Engineer's signature : ~"~/~4-/~'. ~'- DHHS SIGNATURE Approved for /~'/¢~¢~, ,, ¢ bedrooms. Disapproved. Conditional approval for Date 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 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-O25 (Rev. 1/91) Back MOA f¢21 ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESt~ Environmental Services Division .~,ECEIVED 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well .type Health Authority Approval Checklist ~/-.a,$S "~n IfA, B, orC. attachADEClette}. ADEC water system number Log present (Y/N) Date completed ~/ Total depth Cased to Cas~nd) Sanitary seal (Y/N) ~ __ __ ~roperly protected (Y/N) F~ AT INSPECTION Date of test Static wate~ W,~,gr~l'fictio n g.p.m, g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: SEPTIC/HOLDING TANK DATA Date installed I qqO Tmtk size Number of Compartments High water alarm (Yg~ Foundation cleanout (~OxI) ~,~.$ Depression ~ ~'~O ;Dat¢~fPumpiug :'~..4 ~q? Pumper ~J~, ~0~~ ~. C. A~SOR~ION F~LD DATA ~Date installed ] ~ ~ O Soil rating (g.p.d./ft2 o~ ":':; ~ I Length ~ ~ Width 2 q Gravel thickness below pipe '2 ¥o System type Fluid depth ~) (ius.) Minutes later: ~Y 5" Absorption rate = treatment (past 12 months) (Y~ /,~/,-- /~t0)-av) [ryes. give date Peroxide z/6--o 4- g.p.d. Effective absorption area lo ~o ¢ Monitoring Tube present(~YN) ]~ Depression over field (YJ~ gl o Date of adequacy test ,-C--d ~ - ~ 5~ Resul~ail) fv/g,.; For --~ bedrooms 0'~ Fluid depth in absorption field before test (in.); Immediately after ~-0 gal. water added (in.): Total depth Do LIFT STATION Date iustalled Manhole/Access ~}~N) High water alarm level at* Cycles tested ,.~ Size in gallons [ I "Pump on" level at* '~ · $3 "Pump E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer On adjacent lots On adjacent lot~,.~ ~/cleanont Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 0 I Property line ~ ~ ~.,~ Absorption field Water mai~ffservice line ] o 14- Surface water/drainage t o~ ~+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Water mailqservice line /o L~ Drivexvay, parking/vehicle storage area .~o ~ _+ Curtain drain ~g"' / I ~ ~o ~ Property line I ~ ' Wells on adjacent lots ~ z~/q7 F. ENGINEER'S CERTIFICATION ; I certify that 1 have determined thrufield inspeclions and rm iew of Municipal recorr~ ~ re ................................................................................................. ............. ....... HAA Fee $ '~ 0'"~ Date of Payment Receipt Number ~-~.~-~ ~'~ Rev, 8/95 OSS: haa,wk,doc Waiver Fee $ Date of Payment Receipt Number DEPARTI~ENT OF HEALTH & HLJMAN SERVICES ,~Division of Environmental Services On-Site Services Section P.O. ~ox 196650 .Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING MUNICIPALITYOFANCHORAGE - ~".' ' - . .1 GENERAL INFORMATION ~- ~,.~ ..... . Complete legal descri ption kocafiod (site address or directions) 22509 Northwoocts Drive Chugia~, AK 99567 ~.,.~.-...~ -- , ..... . .......... . - . · : ..... :-; -:-. .._ ~¢ ;: Pro peily owner ' Para Yande~erg ' ~': -- Day phone''; 688-0825 .... ~:-- - Mailing address' ":-22509 Northw0~ds ·Drive Chugiak, ~ 99567 "'-'-:~-'~ - - · "~ /-~ :¢endin0~a~enc~. Day phone. ' Mailing address ' · .. · - ~.}~_.._ Agent ' ~-. . .:. :Da~- ph~ne':',:~,'_ - ~OTfi: ff commun/~ ~e//,~tom, prov/~o ~r~en confirmat/on ~rom lng to the legali~ and status of system. ' ' 4. ~PE OF WASTEWATER DISPOSAL: ....... ,.~ ................ ~ -. NOTE: If communi~ wastewater system, provide wfiRen cbnfirm~tio:n''from State ADEC a~esting m the legali~ a~d~status' of system. .,~:.. STATEMENT, OF INSPECTION.ByENGINEER , As certified by my seal affiXed hereto and;as of the validation date shown below, I verify that my investigation of this Health Authorit~ 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 complianbe with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING F.~gle Rlver~ Alaska 99577 Phone Date ~"//)'~/~J-- DHHS SIGNATURE ........ //~ Approved' for',.'Y ConaJitional approval-for Tj~'~ ROBSR? C COWAN ~,~,~' ' .. i~ ~ ' . ~, .'/ /..-.~[ bedrooms, with the following stipulations~ Additional Comments "~' ..... By: 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 fo~' errors or;~missi°n~ in' the professional engineer's work~ --:" 72-025 (Rev. 1/91} Ba~ MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription:~-.-c~'~ ~1~-~ i~OAT~.lo~,~,ParcelI.D. C)5'~/ 73.~ /--/$ If A, B, or C, attach ADEC letter. ADEC water system number A. Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) / / g.p.m, g. r,o ~> ,/'1'On adjacent lots Date completed Driller Cased to FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ?.-,, ~ Casing height Wires properly protected (Y/N) Absorption field on lot Public sewer main ATINSPECTION Public sewer manhole/cleanout Petroleum tank Sewer service line D oo~sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (~N)' ,.~ High water alarm (Y~ Date of pumping Tank size ~'z-,5-'-~ Compartments Foundation cleanout ~N) ~ Depression (Y~ Alarm tested (Y/N) 7~ ~'~ Pumper "~,~-~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot --'~ To property line Sudace water/drainage On adjacent lots Absorption field ~c~.~ ~'~' Foundation ~ ~ ~ Water main/service line 72-o2s (3/93)- Fro~t CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent,.~4) "Pump on" level at Manufacturer Manhole/Access,~N) ~ 2' "Pump off" Level at High water alarm level.. ,,~,'~" Meets MOA electrical codes (~N) ',7/ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ~ l~ On adjacent lots Cycles tested ¢,¢,~, ,3¢ Sudace water. D. ABSORPTION FIELD DATA Date installed Length L//% r Width Total absorption area. Date of adequacy test Water level in absorption field before test Gravel thickness ¢/~,~- System type ~ / Total depth .~ //~/~ ~ Depression over field (Y~ ~ for ~ Bedr~ms A~er test ~ ~ If yes, give date Peroxide treatment (past 12 months) (Y~--~ Cleanout present (~/N) R e su itS:;~[j~f ail) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot "J;/4 To building foundation ..~2, / On adjacent lots .~o ~ 'c- Surface water. / ~o ' + On adjacent lots ~ ~ ~ ¢'' Property line To existing or abandoned system on lot Cutbank '"//,~ Water main/service line Driveway, parking/vehicle storage area Curtain drain E, ENGINEER'S CERTIFICATION I ceNfy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date HAA Fee $ ~DLO ¢ ¢-~) Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 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 Complete legal description Northwoods Subdivision, Lot 39 Block 3 T15N R1W Sec. 4 Location (site address or directions) 22509 Northwoods Drive, Peters Creek Property owner Mailing address Lending agency Mailing address Alaskan Home Properties ~(L Day phone 561-4746 701 E. Tudor Rd.~ Ste. 100. Anchorage, AK 99503 N/A Day phone Agent Sharon Minsh Day phone 694-4200 Address 16~NN C~nf~r Wie]d D~-¢ ~- ~01, Eagle River: AK Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 ~v 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: X 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 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 furtherverifythat 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 Eaqle River Enqineerinq Services Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature ~-- 6. ,D~GNATURE Approved for ~0 Disapproved. Conditional approval for Phone 694-5195 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 ¢f21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal DescriPtion: ~¢--'7~ _?,2 /'~¢'//,/¢"¢ ~ ,/¢/,4,-~,~,~,~.r Parcel I.D Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~/~ Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test FROM WELL LOG AT INSPECTION Static water level Well flow Pump level g.p.m, g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Public sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) 7 High water alarm (Y/N) Date of pumping ,¢re¢~, Tank size / ;2.5'0 _~,,~, Compartments Foundation cleanout (Y/N) ~/ Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~'?,,¢ On adjacent lots ,,¢~ ~ To property line ,~"' / Absorption field /'~ / Surface water/drainage /¢/~ Foundation Water main'/service line 72q)26 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed' S iz e,i¢, g al I o n so,_~'~ / ,,' . ~,~ -N~ S~ ~ent (~)'~' ~~ Pump on level at High wat~ ~1~ level Meets ~A~Velectrical codes SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer ,,¢.~.~.4 2%~,~ Manhole/Access (Y/N) ,/y _2. ,v .t / "Pump off" level at '~"-? / Cycles tested ~/~ "~ / ~, ,- ,, ,'~ Well on lot ~/4- On adjacent lots "~"'~"" ' Surface water D. ABSORPTION FIELD DATA Date installed Length z¢5- / Width Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating ~z. Gravel thickness Cleanouts present (Y/N) Date of adequacy test for Peroxide treatment (past 12 months) (Y/N) System type Total depth If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water /"'/"¢ Curtain drain_ ~5'-~ On adjacent lots ~-..z ¢ ,~ / Property line -/¢ / To existing or abandoned system on lot /'~ / Cutbank .,"%-/4- Water main/service line ~'"/~ ' Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date Z/~//,~- y.//,i HAA Fee $ /~¢,,) a'-¢"~ Date of Payment ~(/~ '~ 5% 7/ ,~ Receipt Number ~',~ ;.,L ¢ 4:./,~ , E o)~3.~,L ~/X) 72~026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR 563-6775 March 26, 1991 FOR: Eagle River Engineering Services PWSID #213001 Northwoods--Deerhorn Park S/D--ER/Chug My review of the records on file in this office reveals that the Northwoods--Deerhorn Park S/D Class A Public Water System is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Environmental Engineer primed or} recycled paper MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~.~ - "}.~ ~ - L-~.~.O.~ HAA# ~-'~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) GOt 39, p, lnn~' ~. Nn'r't-hwnn4~ ~h~'~z'in~nn TlC, N RI~ ~nn. 4 Location (address or directions) NHN Northwoods Drive (b) Property owner A.H.F.C. Telephone: (home) Mailing Address 70] q~]r~nr R~c]; Anc. ho'r'~; A]~.~ka 99503 Business 694-4200 (c) Lending Institution N/A Telephone Mailing Address (d) RealEstate Company and Agent R~A× Address 16600 Centerfield Drive ~201, Eaqle River, Ak 99577 Telephone 694-0214 (e) Mail the HAA to the following address: (or check here Fi, if hold for pick up.) List contact person and day phone number below: Engineer 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3 3. WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation, from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [] Public [] Community ~] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat 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 aH Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineerinq Services Telephone 694-5195 Address 11940 Business Blvd, Suite 205, P.O. Box 773294, Eagle River, Ak 99577 Date 6. DHHS APPROVAL Approved forT-~,°~=-e~2edrooms by Approved AV~ Disapproved Terms of Conditional Approval ,'~-~ '~"~ Date Conditional The Municipality of Anchorage Department of Healthand Human Services(DHHS) issuesHealthAuthorityApproval cerificated based only upon the representations given in paragraphSabovebyan 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 - Well Classification Well Log Present (Y/N) __ MUNICIPALITY OF ANCHORAGE (MOA) ~ Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: 'Z~?z~ ,~/,~.2 ,,,~,~-z'~o¢.,,.[,~ ,~. Date Completed If A, B, C, D.E.C. Approved (Y/N) ,~ Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on LOt ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public SeWer Line To Nearest PubliC Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Date Inst~lled. ?¢~'~ Size Standpipes (Y/N) ,,v Air-tight Caps (Y/N) DepresSion over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments .:2_ :~ ,z,~:~- )" Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~-~"~ z To Property Line ~--t To Water Main/Service Line '~'/~ ~ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field , Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD 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 Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /2-~ / To Water Main/Service Line ~/'z~" To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line '/~' / To Existing or Abandoned System on ; On Adjoining Lots '/-~ / /~//,4 To Cutback (if present) Comments D. LIFT STATION Date Installed I Size in Gallons "Pump On" Level at High Water Alarm Level at .,,2, ~' / Tested for /~ Meets MOA Electrical Codes (Y/N) Comments /'"~-'~ ~---~' Dimensions Manhole/Access "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. /- ,~ ~,-~ ~_1,¢- ...... ,,~/ .... **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ' Eagle Rivor Company Date ~ Eagle River, 694-5195 MOA No. Receipt No. Date of Payment 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION Ak~CHOP~AGE WESTERN DISTRICT OF~'I~~, 3601 C'STREET, SUITE 322 AJCHOP3tG~, ALASKA 99503 STEVE COWP£R,. GO; t ~ ; O, 563-6775 September 5, 1990 FOR: Eagle River Engineering Attn: Russ PWSID: f~2!300! According to the records on file in this office, the Chuqiak Utilities Northwoods/Deerhorn Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, ist DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE ~(~ / j DATE INSPECTOR INSPECTORx I NSP ECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~iI~. OF HEALTH & ) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL pF, OTECTiON ENVIRONMENTAL SANITATION DIVISION JUl\'j 2 6 198i Telephone 264-4720 .- i-- REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND ~ DgL~ES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1' PROPERTY OWNER /~,1¢,-_.~_ IPHONE MAILING~ ADDRESS PHONE PROPERTY RESIDENT (If different from above) PHONE 2. BUYER MAILING ADDRESS I PHONE 3. LENDING INSTITUTION MAILING ADDRESS PHONE 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION Id- 7Fl iSTREET L~CATION / 6. TYPE OF RESIDENCE ~LE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five [~"~h ree [] Six [] Other~ WATER SUPPLY [] INDIVIDUAL* I~-"'~'(~ M M U N I TY [] 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~dl~D I V I DUAL/ON-SITE [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM ~ I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or E~]Flolding Tank Size: I Er'/'~O If Tank is homemad~ give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILSRATING MANUFACTURER MATERIAL OTHER 4, DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line WELL 'FO: I I Absorption Area to nearest Lot Line 5. COMMENTS [Z~/~APPROVED FOR __~ BEDROOMS [] CONDITIONAL APPROVAL (Petter must accompany certificate) DATE 72-010 (Rev. 6/79)