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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 42 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~/..~ ~'"'/OO~ PID Number: O:~l- 7'~1 Name: ~'~v~ FL~ ~'~ Wastewater System: :d New ~Upgrade Address: P~ ~ C~o~%& C~.~, / ~ ~q~&7 ABSORPTION FIELD Phone: ~ ~ . ~ }~5 No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~Bed ~ Mound ~ Other LEGAL DESCRIPTION SoilRating: O-~ GPD/Sq. Ft Total Depth from~i~/nalgrade: , ~ubdiv~ion: Depth to pipe bottom from oJigina[ grade: Gravel depth beneath pi~e Township: ...... ~ Range: ~ Section: Fill added aboveo original~ { ,grade: Ft. Gravel ~ength:~v Ft. WELL: C~ue,~ew ~U~ Gravel width: ~S' .umbe~ lines: Distance between ine, Classification (Private, A,B,C): ~th: Cased To: Total absorption area: Pipe material: Driller: ~ Date Drilled: StaticWater Level: Installer: ,,. '~ I ,.mp S~t at: C..i.g ,eig~t*~ove GPM Ft. Ft. TANK SEPARATION DISTANCES ~s~pti~ ~ Ho~ng ~ S.T.E.~. To Septic Absorption Lift Holdin~ =ublic/Pdvate Ma~r;: ~ Capacity in gallons: Sudace ~ Water l~'t I~ ~ -- LIFT STATION Lot / ~~ siz, ~, ,~,on,: Line J0'~ j ~ Manufacturer: Foundation ~ ~ 10~+~ ~ ~ "Pump on" level ~ff" level at: High water alarm Remarks: BENCH MARK Location and Description: ~  Assu~ed Elevation:]~ ~f, Inspections performed by: s s s EMGSNEERING Da~S' 1st ~ -B -~7 J Reviewed and approved by:/=/~ ~. /~ Date: .. 72-013 (Rev. 9/91) MOA 25 PER'MIT No.'SW970004 PAGE 2 OF 2 Munlclpa/i±y oF Anchomage DEPARTHENT OF HEALTH AND HUMAN SERVICES ENVIRONHENTAL SERVICES DWISION p. FI, Box 196650® Anchor'age, ALaska 99519-6650 ®TeLephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 42, BLOCK 3, NORTHWOODS S/D P.LD. NO. 051-751-40 li_TTFC° 1 2 EL1 EL2i 'COlI 711 Co2 A B 20.0' 22.5' 39.5' 70.5' 45,5' 76.5' 50.0' 81.0' 51.0' 82.0' 67.5' 106.0' 78.0' 115.0' 67.0' 76.5' 77.5' 89.0' NEW BED- -- NEW 1000 GAL./ SEPTIC SYSTEM ST 1 ST2 :D ~ ~ ~oo ~' .~ ~A~. GRADE 96.'7' ~ lO00 GAL ~ I ~ ~ SEPTIC ~96.5' [ PRIOR EXISTING SEPTIC T~K EXISTING BE~ MT1 CO1 lC02 MT2 UTIL ESMT. / 91Lt' /100.1' 00,4' / / FINAL GRADE ~ m ~ '~'-"-~-INSULATION WATER FOUND 87.6' 85.9' PAGE 1 OF 1 MUNICIPALITY OF A~NCHORAGE 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) PEP, MIT PERMIT NUMBER:SW970004 DESIGN ENGINEER:S & S ENGINEERING OWNER NiZLME:RODERICK KENNETH J & TERRIE L OWNER ADDRESS:21707 OBERG RD CHUGIAK, ALASKA 99567 DATE ISSUED: 1/08/97 EXPIRATION DATE: 1/08/98 PARCEL ID:05173140 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 42 LOT SIZE: 22104 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~_~,~>~, .;k <_~,...~ ISSUED BY: DATE: Rick Mystrom, Mayor Mumc p W of Ancliorag¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 9, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 42 Block 3 North Woods Subdivision Waiver Request #WR960064, PID # 051-731-40 Dear Mr. Cowan: Your request for a wai'ver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 1 foot from the absorption field to the north property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If you have any concerns or questions regarding this waiver, please call our office at 343- 4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljm:Roderick RECEIVED NOV 2 5 1996 [viunJ¢~pah~¥ ot ^nohorage Dept. Health & Human 8ervioe~ ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. November 20, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS S EWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SiTE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 42, Block 3, Northwoods Subdivision Request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property. Also, request you issue a 1 foot lot line waiver from the proposed bed to the North property line. Prior to construction, a test hole will be excavated and percolation test performed in the area of the proposed upgrade. For your review, we have attached neighboring soils logs verifying ground water and soil types. Request you issue this permit with a special provision. Attached is the proposed upgrade design. This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, AI../~KA 99577 40' SiTE PLAN SCALE OBERG ROAD I I oO~- 0 ~-] ~0 r._~ '~ 9 Cog 0 o r- 15' UTIL. ESMT. I' 0 m --I~ ~>0 ZO m cD i-- ROBERT C. COWAN, P.E. ROBERT A. SHAFER, RE. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORI~r' APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 42, Block 3, Northwoods Subdivision November 1, 1996 GENERAL: 1. e e Se The scope of this project includes the installation of a 1000 gallon septic tank and an absorption bed to serve the three bedroom residence located on the referenced property. The existing septic tank and the existing bed is to be abandoned such that it may be used in the future. 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. ~EPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 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 42, Block 3, Northwoods Subdivision November 1, 1996 3e e All 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. LEACHFIELD BED INSTALLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be as shown on the design but, no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Page Three Lot 42, Block 3, Northwoods Subdivision November 1, 1996 e Silt barrier material must be installed between the final gravel layer and the native soil backfill, unless insulation is used, then the silt barrier should be installed over the insulation. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed at the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. 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. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. 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. Insulation shall be at least 2" thick extruded direct burial'polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Lot 42, Block 3, Northwoods Subdivision November 1, 1996 Dm 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. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wast,water 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. e 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. Page Five Lot 42, Block 3, Northwoods Subdivision November 1, 1996 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. $ & 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 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 625 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~';~'~ 4~,' ~x~.~ 1 2 3 5 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 19 2O I DATE PER FORM~=~E~~ ~.~r~g~-~Bl~o~p~ownship, Ran§e, $ection: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? I} ,~ Dote: Gross Net Depth to Net Reading Date Time Time Water Drop · z t~ ~ ,~ ~/· t PERCOLATION RATE ["~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~'~ FTAND ~'~' ET COMMENTS S &S ENGINEERING ..~/~.~/' PE,FO,MED ,~' - ...................."'"'"' 4 ~._/...~..z.//'.~-,----- CE,T,F¥ ,N · ,xv.~.~,.a~j,~,. ....... [~ ......... ~ ~, ~/~ ~-z THAT,THIS TEST WAS PERFORMED 72-008 (Rev. 4/85) PERFORMED FOR: ROBERTC. COWAN, RE.' ROBERTA. SHAFER, RE.=~ CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1 2, 3- 4- 5- 7 8 9- 12 13 17 18 20- Township, Range, Section: SLOPE WAS GROUND WATER ~,~ ENCOUNTERED? ~ Depth lo Waler After Mo.ilorinD? ~-'>"/ DaLe: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~- 0 {minutes/inch) PERC HOLE DIAMETER TEST RUN EJETWEEN ] '/'::'~ FT AND ~ '/'~' FT PERFORMED BY~'~.~ ~&~[~ ~[¥~i ~.GG~, '~b,=~; ;-~. ~-~ I ' . _ _ . CERTIFY THAT THIS TEST WAS PERFO~II~IED IN ^CCORDANC~ ~eR_iff~hb~k~o~i~:~p^L ~U~DELINES IN EFFECT ON TH~S DATE. DATE: PERFORMED LEGAL DESCRIPTION: 1 2 3 4 5' 7 8 g 10 12- .13 .14 .15~ '17- .18- 2O MUNICIPALITY OF ANCHORA~ DEPARTMENT OF HEALTH AND ENq/IRONMENT,KL PRC~T~EC~rL~ ~ILS L~ - PERCO~TION TE~ E CE I V~ D P~& S LO~ 1, Block 3, Nor~h~ood Subdivision Offg~nJcs ~nd o~gsnJc silL, derk bffown, ~e~ , sof~, ~ree debris. ~ Gravelly-sandy-silt, l~ght brown stiff, moist, with s~e Si ] ~y-gravel 1y-sand. gray, · o~. ~omp~t. ~o,,~ to ~,~- ' ~ T~S rounded particles to cobble ~ ~. s~ze. ~~ ~' :,: , :,, ,.~ ...... ~ ~_~ .~ ~_1 ~-'~--~ ....... ~ .... Z~2 ..... ~ ......... ,~ 'rES. ^'r DEPTH? Tirr~ Time Water J~'~o 4-23-8; 3:30 PH 20 Nih. 15 I 3/4 4-23-81 3:40 PM 30 Min. 16 l 4-23-81 3:50 PM 40 Min. 17 1 4-23-81 4:60 PM 50 Mtn. 17 3/4 3/4 4-23-81 4:10 PM 60 Min. 18 1/2 3/4" PERCOLATION R~,TE *15 TE~T RUN BETWEEN PERFO,~M£DB¥: Howard Grey & Assoc., Inc. .C~RTmFmEDa t ~ 'J MUNICIPALITY OF ANCHORAGE :  OF HEALTH & ENVIRONMENTAL PROTECTION DEPARTMENT ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~-- PHONE I ~"N E W MAI LING ADDR~S~ ' LEGAL DESCRIPTION ~ ~' ~d¢ ~ d/}~ LQCATION NO. QF BEDROOMS ~ ~ Manufacturer ~ ~ ~SC~, Materia~¢~ C No. of com~tments Liq, capacity in gallons ~ Inside length Width /~O IF HOMEMADE: ....... Liquid dept~ ~ ~ DISTANCE TO: Well J DwelNng PERMIT NO. O ~ ~ Manufacturer I ~ -- ~ Material Liquid capacity in gallons ~ WelI~ · ~ Foundation Nearest lot li~2~ ~ ~*~ No. of lines Length of each line ~ Total length of lines Trench width ~ Distance betweentimes ~% Top of tile to finish grade Material beneath tile /¢' / ~ ~ { Tot~ffeffectwe Length Width Depth ~ PERMIT NO. ~ ~ Type of crib CNb diameter Crib depth Total effective absorption area ~ ¢ ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Cla~. , ~ Depth .. Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line ~ Septic tank ~ Absorption area(s)~ PIPE MATERIALS OTHER ~ INSTAELER ~ ~ , REMARKS APPROVED ~/TE LEGAL 72-013 (Rev. 3/78) ~ ............................ ?~: '::'"" "i ~, :¢r"~ .-~ .................. L ,::..~:: (Jr ~ P'][:. '~: ".: ]~ L F~:,'::n~,p""r TFq[':' [:'~.~ "~'~" , ............. !'-~ [:,Z~"'":'~'""~ "~""' F'~4'~"~ ':'ZN ~'""'~ ....... ....... ~ .... .-[:..- I ~ F'[:' '~"l,4F'"r~ ......... 'T'NF' F:,F:'F, TF. 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"'" "2'"' ').2.: ......... ¢ F'O[;: i:::i F:'?. :.: '?'P¢ I'E: i,t[:' (J~: "t~:: 'i .... ::::,~::[., FEF'T F:'~?r'd','~ F4 "', ................. '- ' , ....... [-' ,..~:,~ i; ["' ),~F::' "~F:' z'E:'~'-. ~'" '" ~ r'" OTNF'~? '"' ........ .... ! ..,.j r,,, .., . .... i' T (j~,,~ !'h ' ' """" "" '"' i ............... ;i: '-'~¢:'7'"i:u~ TF.r::'T' FO?TH B'¢ "!U'., "":T?:il T'r~; IjF ~:'~.-'i'"'i:,~: '" :' ' ................ ,..h.,:,., FIND ON"--S: ~[ 'T'~' ':;~: ,!~:'~, '::~,~':'""F~?~ i',IF¢? r;,[:' "~ -' r ,~' ::' .. i ~ ~::, "i~;'~,.i¢::'~ '~.. i' ~:' -'r, .-. FES]:t':,Fi'.,! 1'~." r,: ~""~:'i:' FFiFff',i ;3: 57 / / [] SOILS LOG PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? COMMENTS SLOPE P IF YES, ATWHAT DEPTH? PERFORMED BY: 72-008 (6/79) PERCOLATION TEST DATE PERFORMED: ¢~t SITE PLAN PERCOLATION RATE FT Gross Net Depth to Net Reading Date Time Time Water Drop I '7 /z s , ,z~,o ,, lo:~/.',. " 'd- fl - C) 0) CD Cn M M 9 1 LU 0 M41.1 U LL a_ z LL o�I a ti O ® � � U U) L a Ucu L A lJ N O N LO N a) cu n c 0 cu a- x X W CD CD 0 I 0 d' I r M I r LO O D a) L u�u N 0-) d' J Q M co Y O7 J � En 0 U O O O I LLJ �— m O O o o N Q N U U 0 a) a) ca � m J CO W COw 06 0 ry CLLJ /) v / W W LL C//) I..I� i J Q LL W D LL Q) U Q) Q. 0 Q- C) U iii C: 0 Q W O _0 0 O a) M L UC Q C 0 0 > "O 0 0 CL Q ca N 0 C > o U) Q Q ca a) � (n C = o O Q) C H U X of U I O o O ,LJ ice+ ++ C C � � C N N O O t E ~ O ~ W U L O O a _ -O 0 TW Q. a) U ca A Ecn vi 0 yr O C L '3 a� 0- > O _� O 0 Q Q. E d N v v _ cC >, C Ccu >+ � •fes+ .Q = � Qi N N E a . 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LL ¢^ � (a Q) o O O V ' ^ CL L 0) ai ° N LU LUN �.� o f �� CO Q a a) N M .4 L6CC cu QL Wm > 0 ITl a) a) LL a) 0 a c� a 0 m 0 m co LL U) O 0 (1) co 0 N N N 0 U .a a Q a 0 U North Woods Block 3 Lot 42 051-731-40 Property is served by community well. 9/26/23* *Sanitary Pumpers N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 WOOD FEY EAST 80.89 NORTHWOODS DRIVE • SEWER PIPE ESM'T. 49 TH* AaK f/1 ooO °N SHANE A. HOLT..",d G OQ� P LS -6914 �` O 4�plo fessionak �Qo AS BU/LT SURVEY PI =301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT42 BLOCK3NORTHWOODSSUB. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD ,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT %EXIST OTHER THAN NOTED. ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DATED AT ANCHORAGE,ALASKA THIS 28 TH DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. MARCH , 2024 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN HEREON HOL TLAND SURVEYING THESURVEYDATA ON THIS DRAWING IS PREPARED FOR THE OWNER OFRECORD ONL Y. 9309 GRO VER DRIVE ANYCOPYING, OR UTILIZING THE DATA HEREON IS PROHIBITED UNDER COPYRIGHT LAW ANCHORAGE,AK 99507 16019 236-14 223-8615 Orn N O 4-0c n n t O N N M M i � LL O O CD X fO O O 61 LL O O 4' N U �L— p � p C V U p N U-) N U O p U 4 p J W 0 N E .ate00 -+ Ln N O t Q •� N O M Q O y m v O N ®G N >, it v O cB p J N Q O —_ v O L m H 4A � O > M � Z o N O m N a>UJ v N E QJ N p L ON N U � L a 'N Ul N bZ a� w c41a >, N O O N Y .0 L. co p v L 4J w 41 U v ap-+ cite, j L O 4-- � U N > +_ w o ++ GO E O Z (3) N (D H `�° own `0 O 4� i L O v O 4- co nLn � 0 E U N U _0 f9 > N 3 L N (p ++ N n O 3 U cn H Ou C: H 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. # LO ~ i CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 42; Block 3; North Woods Subdivision Location (site address or directions) :R~roperty owner Jarn~s Fue9 · Mailing address "'~'°' Bo× 670236 Lending agency Mailing address Agent, Address 21707 Northwoods Drive Day phone Chugiak, AK 99567 24R-4Oq7 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: 3 \' Individual well Community well xxx Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system.. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72A)25 (Rev. 1/91) Fron[ MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal.system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 170~e Eagle ~iver Loop Raa& No. 20.4 Address Eagle River, Alaska 99577 Engineer's signature /2~C~ ~ .. ~¢-~ Ph'one Date '? //;;;;z//q-/ St DHHS SIGNATURE 'b'~Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1/91) ~ack MOAt21 Legal Description: MuNiCIPALiTY Municipality of Anchorage gNVIRON~ENTAL SEP, VICE$ Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501. (907) Health Authority Approval Checklist A. WELL DATA Well type L(~/~l~lol/d~_?'r~' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level .Well production WATER SAMPLE RE,SM Coliform ~ Nitrate /~~ample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 6-~/' ~-// Tank size Foundation cloanout~)N) Date of ,bmping ~/(//'ecO Pumper C. ABsoRpTION FIELD DATA' Date installed ~ ~/' ~') :'¢". Soil rating (g.p.d./fF or fF/bdrm) Length "~' Width : Date completed e~ Cased to _ Casing height (abov Wires prop~te~ (Y/N) T FROM WELL LOG AT/INSPECTION g.p.m, g.p.m. Other bacteria Number of Compartments ,~ Ceanout~N). 4/*~ Depression ('~ ./E~ High water alarm (Y/._I~ r~¢-> Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) (~, z_/ System type Gravel thickness below pipe Total depth Monitoring Tube present(~l) ~-5 Depression over field (Y~)~ Results (Pass/Fail) ..... For '~' Immediately after -%gal. water added (in.): Absorption rate =__ ~ g.p.d. If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in.g~qJJ~s~~---~ evel at* "Pump off" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main S.e~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' '~/' Property line /O/'/' Absorption field nt Iots~'~ t lots Public sewer manhole/cleanout Water main/service line Surface wateddrainage /00 ~'~' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation lO ~ ~ Water main/service line /© Driveway, parking/vehicle storage area ~L'"dJ ~'~,d,~ Wells on adjacent lots )~t~(~ ENGINEER'S CERTIFICATION ~' · - "*" I certify that I have determined thru field inspections and review of Municipal reco ~l~ms are in conformance with MOA HAA guidelines in effect on this date. ~gna~ure ~//~f -. ~¢~ HAA Fee $ ~-4~ , 4'~ Payment '~-~--C ~' 3!h Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska 995'19-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# /'~\ _-'~.~.~ 1. GENERAL INFORMATION Complete legal description HAA # ~ ~c~('~ Lt Lot 42~ Block 3; North'Woods Subdivision Location (site address or directions) Corner of Oberg and Northwoods Property owner Mailing address Day phone ~22-4556 (Nancy) Lending agency Mailing address Day phone 561-2488 Agent Bob Jett/AREA COLDWELL BANKER Day phone Address 4105 Tudor Centre Drive, Anchorage, Alaska 99508 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ '~ TYPE OF WATER SUPPLY: individual well Community well Class A 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 ×XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirrnation 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. Name of Firm Address Engineer's signature SIGNATURE Approved for ~_~ Disapproved. Conditional approval for 17034 Eagle River Loop Road No. 204 Eagle River, Al,~=k. 99577 Phone Date bedrooms, bedrooms, with the following stipulations: Additional Comments By: 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. 72-025 (Rev. 1/91) Back MOA#21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~-~;~ ~"/,-- ¢"/~,~-~ ~2¢.-~ A, WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. Date completed Cased to FROM WELL LOG ADEC water system number Driller Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B, SEPTIC/HOLDING TANK DATA Date installed -~., Cleanouts ~/N) \] High water alarm Date of pumping Tank size ~ Z;;E:~ O Compartments Foundation cleanout (Y~..) ~ Depression (Y~ f,-/ Alarm tested (Y/N) Pumper ~"'~-'". ~'~r~-& ¢'°Ob' SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN~< TO: Well(s) on lot On adjacent lots To property line Absorption field Surface water/drainage /~ Foundation Water main/service line 72-020 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical~. SEPAR~NCE FROM LIFT STATION TO: ~ lot On adjacent lots ManufactUrer Manhole/Access (Y/N) "Pump on" level a~ ~ off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed I c~ Length ~.o ~ Width Total absorption area Depression over field Results (~fail) Soil rating 7'7 7~/~ System type /'~ Gravel thickness ~,~' z Total depth Cleanouts present~'/N) Date of adequacy test *'~" ~- 7-92-, for -~ ~.~ ¢./c',.~ ~ bedrooms If yes, give date P,~.e.e~oxide treatment (past 12 months) (Y~J~ P~'~"~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot % o ¢ ~ ~ On adjacent lots Property line To building foundation On adjacent lots Surface water Curtain drain To existing or abandoned system on lot '~ Cutbank ~ l~ .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 ~ S & S ENGINEERING Signature ~' ..........~, R~ad No. 204 Eagle River, Alaska 99577 Engineer's Name Date HAA Fee $ Dateof Payment --~_ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 ' ¢ffect Qn..tbe date of this inspection. Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 349-7755 July 14, 1992 Mr. Roger Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, AK 99577 SUBJECT: Public Water System ID# 213001 Dear Mr. Shafer: A review of the records on fife in this office indicates that the Chugiak Utilities Class "A" Public Water System serving Northwood Subdivision is currently in compliance with the routine coliform bacteria sampling requirements listed in Table C and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, el ku, E.I.T. Project Engineer ML/pf 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 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 42; block 3; North Wood Subdivision ~qL~ ~ Location (address or directions) 21707 Northwoods Drive (b) Property owner Mailing Address (c) Lending Institution Mailing Address Telephone:(home) ~hn~ga; A£a~a q9~1 Telephone (d) Real Estate Company and Agent Associated Brokers ATTN: Sand~ Address 640 West 36th Avenue, Telephone 563-3333 Business Suite #1; Anchorage, Ak. 99503 (e) Mail the HAA to the following address: (or check here,(]~ if hold for pick up.) List contact person and day phone number below: S & 5 ENGINEERING EagJe River, AlasEa 9~577 2. TYPE OF RESIDENCE Number of bedrooms Single-Family)D~ 3. WATER SUPPLY Individual Well [] ~ '"4 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 ~XX Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty 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, 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. Telephone ~ ~'('¢' '~ ~ ~'~ 7 ~' Name of Firm Address Date ~ & S ~.NGINF..F. R1NG 17034 F_agie River Loop ~aqie River, Alaska 995~'7,, 6. DHHS APPROVAL Approved for ~' bedrooms by Approved /-~k...~ Disapproved Terms of Conditional Approval Date Conditional The MunicipalityofAnchorage Department of Health 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 DHHSdonotconduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageis not responsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev 7/88) Back Page 2 of 2 OF ANCHORAGE (MOA) ~:~/t ~i~ ~i~/~p roval (HAA) ON~~ ~UARY 1984 343-4744 ~0 Legal D~ption: ~ A. WELL DATA Well Classification Well Log Present (Y/N) __ A Date Completed If A, B, C, D.E.C. Approved~C;~N) ¥ Yield Total Depth_ Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To ,~eptic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ I'F i On Adjoining Lots To Nearest Public seWer Cleanout/Manhole Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDINGTANK DATA Date Installed /t Size Standpipes (~TN) Depression over Tank (Y/d~ Pumping/Maintenance Contact on File (Y/N) Air-tight Caps~N) No. of Compartments Holding Tank High-Water Alarm (Y/N) ,.I/,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water, Supply Well ..~ I.¢. To Building Foundation To Property Line ! o Lc- To Disposal Field To Water Main/Service Line / ~ ~ ~ To Stream, Pond, Lak~e or Major Drainage Course / ~ /~ '-/ Foundation Cleanout~3~ Date Last Pumped ~- ¢ ! - '~' ~ ,,4/~ ; for ~ Temporary Holding Tank Permit (Y/N) '~//f Comments ~"?~ -~ ~-'~ $ ~'~ ~--' )~h-1 f~//~/~' . 72-026 (Rev. 7/88) Fron! Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field / Depth of Field "~ /)?/~) Gravel Bed Thickness Square Feet of Absortion Area ./_~L/~ ~ Statndpipes Present~:~/N) '~' Depression over Field (Y/~I~ ~ Date of Last Adequacy Test Results of Last Adequacy Test ~/;5,d~ ~)~-/,,.-¢_~f------~a.~ .--- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well "Z~cp 14- To Property Line To Building Foundation . (_~''2~'~ To Existing or Abandoned System on Lot r'J /,~ ; On Adjoining Lots "~ -I-o Water Main/Service Line I c> To Cutback (if present) / -I-o Stream, Pond, Lake, or Major Drainage Course ,] L~ D -I'o Driveway, Parking Area, or Vehicle Storage Area 7...~, t Comments L-~-yd'c---',q 'Era ~L-cb ~ ~ ¢:~,~_~ ,~ ¢t5. i_..1 ~--¢m.~,~-% D. LIFT STATION Date, n stalled.........~ Dimensions Size in Gallons ~ Manhole/Access (Y/N) "Pump On"Leve tPa~ ~ "Pump Off" Level at -~7-'- ~ ----- Vent YIN High Water/Al'arm Level at ' - ~( ) - Tested/ ""Pu~ ~C~ycles during Adequacy Test. MeetfMOA Electrical Codes (Y/N) '~~ Co m kc~e.~t.s ~.. { **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 Company Date MOA No. Receipt No. Date of Payment Amount: $ 72-028 (Rev. 7188) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 o December 8, 1989 STEVE COWPER, GOVERNOR 563-6775 S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 PWSID: #213001 According to the records on file in this office, . the Chugiak Utilit.ies/Northwoods-Deerhorn · Subdivision Water System is in compliance with the State of.Alaska Drinking Water Regulations. Sincerely, ~v~r~m~n~'Field ~~icer VEC:bas MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264~4720 Application Date ~7// GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Z.~-k ~-/a ,~'¢/~-,~', 3 ,dJo,-¢7,~.~oo~Zr 7-/3-f~//8~ Location (address or directions) (b) Applicant Name /d"~ ~'-", ,'- /(3%.~ Telephone: Home -~',oc"P~ P 7Z-*¢' Business Applicant Address ~d'~.'~ ~ Z~o~" ~5 "-/ o ~74,.,j.,~ ,/¢' ,,~ff$'-6-'~ (c) Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain); (d) Lending Institution -~/'~ ~ /~ ~ ,,,¢-7 Address I?/-), /~,~ ~ 7710 ~ ~ (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Number of Bedrooms '~ Other ,' I WATER SUPPLY Individual Well [] Community'~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite"[~ Public [] Community [] Holding Tank [] Note: If corem unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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 investigaticn of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. funotiona! 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 F~fw~ i:klnl~f~:l:t~l~l~ ~r:R~/IP, F.~ Telephone Address Date .~//. . 694-5!95 Engineer-s Seal DHEP APPROVAL ' Approved for ~:(~.~/bedrooms by "Approved X Disapproved Terms of Conditional Al~rJroval Conditional CAUTION The MunCip~lity of Anchorage Department of Health and Environmental Protection (DHEP) i~sues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers o¢ homes and their lendi~ institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct, inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGe: ~"~' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION , UL !6 RECEIVED WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ,~,. ~','~ ~r If A, B, C, D.E.C. Approved (Y/N) 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 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 7/~¢ ~ Size Standpipes (Y/N) )/ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) /~///~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~ ~- To Property Line /O y- To Water Main/Service Line /~ / Course No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped / ; for Temporary Holding Tank Permit (Y/N) To Building Foundation / -9' ~. / To Disposal Field ~ o / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _ Width of Field Square Feet of Absorption Area / / Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ¢'~)- / Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Z ~,~ ,z, Type of System Design Length of Field 2%0 / Depth of Field /?~ ' Gravel Bed Thickness ~ /' Standpipes Present (Y/N) Date of Last Adequacy Test Y To Property Line /~ /- To Existing or Abandoned System on ; On Adjoining Lots '-~ ~- To Cutbank (if present) /~o¢~.~_ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ~'T ~ ~- 6 s'- MOA No. Signed ~'""~-~ Date Company /~./(', ]Z, ~' · Receipt No. ~')~°t ~.-.'~ ~ Date of Payment '"~' ~.~' ~ Amount: $ A5 ,.O~ Page 2 of 2 72~026 (11/84) ' APPLIC,_ FILLS OUT UPPER ONLY Property Owner -"'~,~'/)'~"~'S ~ ~ ~ ~ ~ ~, /~.~ ~. Phone MailingAddre~ ~ ~, ~] ~ ~ * ~ ~ ZipC°de ~~ ~ ~~ Buyer ~ Address ~ Zip Code 5ddress d~,¢ ~ ~ ~, b ~ ~-<~ Zip Co . RealtyCo.&A~nt AP~-- ~ ~OUi~ ~C~O ~ - Phone Address Zip Code ~. Type o~esi~nce [ ~ingle Family ~ Multiple Family No. of Bedroo~ ~ ~ Other Water Supply ~ '~ividual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ ~Community~ For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal /~ ~ ~. '~_ [~..~.q Year Individual Installed: ndividual ublic Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSiNG CAN BE INITIATED. Time Time Time Time Date Date Date Dat~.~ Inspector Insp~tor Insp~tor Insp~to~ MUN ........ Field Notes: PFPT 0~ H~"LTH 'q' ENVI~ RECEIVED ~' ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) OISAPmOVED ( ) CONDITIONAL APPROVAL' DATE n ~' ~" ~ ~ Soils Rating Date ~wer Installed Well To Absorption Area Welt Log Received Well to ~nk Septic T~k Size 72.023 (3182)