HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 2North Woods #i Block 1 Lot 2 #051-741-21 Municipality of Anchorage Page Of -7:7-- DEPARTMENT 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 S42 910.322 PID Number. Name � /w WaStPWatPr Cvetcm• m hi..... 9 Atltlress: .. -_____ _.._.. ..t.y�..alc 2299/ u w /)k � yglr ABSORPTION FIELD Phone: No. of Bedrooms: •' Deep Trench O Shallow Trench ❑ Bed ❑ 'round ❑ Other LEGAL DESCRIPTION Soil Rating: /y/� Dr Total Depth t, origins' de. Lot: Block: / Subdivision: lf.ItLQ •'/ �J I •� GPD/Sq. Ft. Depth to pipe bottom from original grade: Gravel depth beneath pipe if/o n L✓DD 3. 'IV Ft.9 Township: Range: Section: Fill added above original grade: Gravel length: Ft. Z . 'y L Ft. S 9? Ft. WELL: ❑ New ❑ U ade Gravel width: Numberof lines: Distance between lines: Classification (Private, A,B,C): al Depth: Cased To: Ft. Total absorption area: Ft. Pipe material: D.30.3 y Driller: Ft. Ft. Date Drilled: Static Water Level: SQ. Ft. Installer. c.(fC F S /D Date installed: 9$ Ft. D 11 Yield: Pump Set at: Casing Height Above Ground: GPM Ft. Ft. TANK SEPARATION DISTANCES septic ❑Holding 0S.T.E.P. TO From Septic Tank Absorption Field Litt Station Holding Tank ubliGPrivate Sewer Lints MBnU}aOtUr r: / N4 Gf Qapacity in gallons: D �� Well, 2� 0'-I- ,_ Material: Number of Compartments: Surface Water -y- — —. — LIFT STATION Lot Line �/-F' r /0 �. Size in gallons: Manufacturer: EDrain /0, /0, — .'Pump on" level at: p off" level at: High water alarm at: t /0 4' f ' /rid % --- — Pump M oriel Electrical Inspections performed by: Remarks: Gv e— o i a e BENCH MARK � u� Location and Description: Aile Govnli a11( f-65 10 r \ Assumed Elevation: / 194> Ft • InA �, /I ENGINEER'S SEAL 7 j OF At %I *AL:- ••• */O s"" '••'•••••• = Inspections performed by: i4e r Dates: 1s // 2nd • •••• ••�•.• A•�j o• w •••• •.... 4d Kenneth Department -6 /b�/5✓198 if'F9;••.�� of Health and Human Services ro a 1 L76 ••�a��e Reviewed �� �pAoss P®•� and approved by: Date: _L� ®sewv+® 72-0t3 lBev 4r5n nenr. va 9 AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW980322 N❑RTHWOODS S/D, PHASEII, BLOCK 1, LOT 2 PID#051-741-21 J SEPTIC 0+1� oh 0 LOT 2 FS TH # PRIMARY � SEPTIC T I A -C=15.4' BRUCE & JOANN THACKER B -C=14.9' DRIVE CHUGIAK, AK 99567 A -D=21.1' (907)688-5675 B -D=9.7' FIELD BOOKS COMPUTED: A -E=35.3' o KMD B -E=20.8' KMD laoa GA A -F=26.2' o 4 SEPTIC TANK B -F=52.2' RESERVE YSTEM GAL�gM .99,26 FINISHED GRADE FILLER FABRIC\ 94,70 SEWER ROCK 14 88.80 58 - PREPARED FDR BRUCE & JOANN THACKER 22991 NORTHWOODS DRIVE CHUGIAK, AK 99567 (907)688-5675 FIELD BOOKS COMPUTED: BOUNDARY: JOHNSON DRAWN: KMD STAKING: JOHNSON CHECKED: KMD ASBUILT: JOHNSON DATE 10/2 DWG. FILE: - GRIV NW115 ACAD FILE: 98103.DWG I JOB N°' 98103 SCALE NTS 81.61 ROK LCLAI LJ ENGINEERING 20441 PTARMIGAN' BLVD. EAGLE RIVER, AK 99577-8736 1 r_ rJ,..1,?! -'., "" ms n �v 1.115 11 DEPARTMENT AHEALTH &HRVICES UMAN � MUNIC%PL/TYOF;4`IVCHORAGE � �, � ., ;� j2n Site Services T�r„a�ngsml 13uhee .��`At �Asv �ak4`'Ywi"s�' 6Y TO; fCeh Dv7Fvs LEGAL L 2 /31 /YoleT14w6a The attached paperwork has been reviewed and is being retu ned dor the following 'reason(s) : F _u� Discrepancy in legal description and/or owner name. Discrepancy in number of bedrooms. Signature and/or stamp missing on - Show measured distances to sewers/wells, curtain drains' and streams within 200 feet of proposed system. Replacement disposal site not shown and/or tested. Calculation error in design. Show locations of all soils, percolation or water table tests. Proposed system too deep for soil test submitted. Topographic information missing or inadequate. Narrative missing or inadequate. Additional soil/perc test needed. Sand filter requirements not satisfied. Water monitoring results missing or inadequate because Incomplete; missing Well log required. Water sample unacceptable because _ X Other&r2 c -f h a;. ti c �iL %o �io o.ri o 7rs7- //o 4 on ly3.� ��7%va l�•1 5. 9 � %rr�v�( o�e..�/� or. 5� LtJ;./> ,� _f_ / _✓' /� — Please supply the necessary information and re -submit your request. Your cooperation is appreciated. Reviewer t7;i - Date _/ �-13 — q 9 MUNICIPALITY OF ANCHORAGE -- Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade t�). �u®r~, `&Ln q - [ i-`1'� Date Issued: Aug 25, 1998 Expiration Date: Aug 25, 1999 Permit Number: SW980322 Parcel ID: 051-741-21 Legal Description: NORTH WOODS PHASE II BLK 1 LT 3 Design Engineer: 0070 KND EngineeringSite Address: 022991 NORTHWOODS DR Owner Name: Bruce Thacker Lot Size: 53750 SQ. FT. Owner Address: 22991 Northwoods Drive Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak , AK 99567-5463 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date:. 825j • RA V ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-87 11/FAX (907)696-8111 August 14, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit — Northwoods #2 S/D, Block 1 Lot 2 Gentlemen: At the request of the owners, on August 12, 1998, we excavated one testhole for the subject property to upgrade the existing system which was identified by the owner as in failure. Although we installed a monitoring tube a previous testhole was dug this year by another engineering firm with monitoring tube. We therefore used water monitoring from the previous testholes to establish water monitoring. The results of these tests and water monitoring are attached. We propose to install a 5' wide shallow trench. The existing testhole had registered water at 2" from BOH upon monitoring. There was also no water monitored in the second testhole (98-1) on August 17th. We do not anticipate additional fill being needed over the system. This lot slopes break at where the house is located and slopes away from the house to the northwest and to the southeast at approximately 2-7%, which is away from the proposed system. There are no public or private wells within 100' of our proposed system location except as noted. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, Engineering enneth M. Duffin attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Tests WASTEWATER DISPOSAL NORTHWOODS S/D, NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM, NO PRIVATE WELLS WITHIN 200' Or PROPOSED SYSTEM EXCEPT AS NOTED, NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. SYSTEM DETAILS/SITE PLAN PHASEII, BLOCK 1, LOT 2 / 0 L P SE LOT 4A (B3 -ll LOT 3A IN. PROPOSED U RA SEPTIC LOT 1 ALL PROPERTIES SERVED BY COMMUNITY WATER. Agr of ALS 1 * 4 TH* r I _EENNETH M. DU ,, CE -7116 WC / 'ftnSSIoNN' .V \ 'I 1 SEPTIC ��✓S ch 0 �s Afi S.T. N LOT 1 LOT DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/0,8 GPD PER SQ, FT. (7.4 MIN/INJ= 5625 SO. FT (562.5/5'(W)) X .50 (RF) (4.0' GRAVEL) = 56.25' FT. TRENCH USE 1 TRENCH - 57' (L) X 5' (W) X 4'(D) Total depth of system is 7.5' from original grade. Total depth of gravel below distribution pipe is 4.0' NOTES; 1. USE 1000 GALLON SEPTIC TANK,IF REQUIRED. INSULATE TANK IF (4' COVER. 3, CONTRACTORLATE WILL WILLS ENSURE MAXIMUM 2L SLOPE INTO SEPTIC TANK, 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED, 5. CONTRACTOR TO VERIFY INTEGRITY OF TANK AND REPLACE IF REQUIRED. 6. CONTRACTOR TO INSTALL 2 POST TANK "CLEANOUTS & DIVERTER VALVE, PREPARED FOR; BRUCE & JOANN HATCHER 22991 NORTHWOODS DRIVE CHUGIAK, AK 99567 (907)688-5675 FIELD BOOKS COMPUTED: BOUNDARY: JOHNSON DR^WN: KMD STAKING: JOHNSON CHECKED: KMD AsemLT: JOHNSON DATE' 8/14 DWG. FILE: GRID: NW15E ACAD PILE 98103.DWG I JOB No.: 98103 Scale; 1"= 100' PAGE 1 OF 2 Z9S�S\I EJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 81 I I WASTEWATER DISPOSAL SYSTEM DETAILS NORTHWOODS S/D, PHASEII, BLOCK 1, LOT 2 0 TALL_ DIVERTER C ED UPCR�KE TIS #98 EXISTIN EXRISTING 10 0 AL -I-7 CL--. OF AZA -:I,��'� ( PREPARED FOR, ��. BRUCE & JEANN HATCHER 22991 NORTHWOODS DRIVE / Z'�j�/ *,CHUGIAK, AK 99567 I (907)666-5675 KENNETH M. / FIELD BOOKS COMPUTED: I1f CE 7116 WC / BOUNDARY: JOHNSON DRAWN: $c�/ KMD 1 \ �7�0 �' STAKING: JOHNSON CHECKED: KMD p"�'CF'ESSIDXAy / AsewEr: JOHNSON DAM:8/14/ <, DWG. FILE: GRID: NW155. AGAD RLE: 98103.DWG JOB No.: 98103 Scale 1°= 20' PAGE 2 OF 3 Z�V�7 � ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 AX (907)696-81 KH F,NGINI?ERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ti • k 49-M � M. SOILS LOG - PERCOLATION TEST V V Performed for: Date Performed:��Z' 'o- ESS10t'i Legal Description: �1�1%� �`2 ���Z TEST HOLE # tlr %arena Y- 1 GP ead f les euro 2- 3- @! 5- / 6 GJ/�/Q✓e/�//� 8- 1s-� 13oe-t f 14- Pro �oeC! 15- 16- 17- 18- 19- 20- I, Kenneth M. DUffUS, certify that this test was performed in accordance with all State effect on this date: and Municipal guidelines in s� SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered?_ O What depth? /% qqQQ Depth to water after monitoring? _-De Date B'/' -/,l Reading Date Gross Net Depth to Net Time Time Water Dro s /l••Ilo — " w 3�mrr ,2 iG ire •�E wa�e ad Percolation Rate %/ (min/in) Pere Hole Diameter_(," Test Run BCtWeen _ feet and _.�_ feet I, Kenneth M. DUffUS, certify that this test was performed in accordance with all State effect on this date: and Municipal guidelines in s� 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 _. ..,........„... .,�.:,.,. , , NAMEw PHONE }2rNEW ❑ UPGRADE MAILING ADDRES P. LEGAL DESCRIPTION LOCATION NO. OF BE ROOMS DISTANCE TO: Well dkf Absorption areaD I lin P MIT N U YM I An 1 w2Q Manufacture��� Materi No. of compartment V ~ Liq. cape it i ons Inside length IF HOMEMADE: g Width Liquid depth J 2z z DISTANCE TO: Well Dwelling PERMIT NO. SAH Manufacturer Material Liquid capacity in gallons TL) DISTANCE TO: W I Foundati n Nearest lot line . y P MIT NO J LL 2W No. of lines Length of each line D� Total lengt f I" s Trench widt Distance between lines of tile to finish grade I ✓ Material beneath rile inches ✓ Total effective absorption aria Len thd 9 Width Depth inches w PERMI NO. (� i H w ° Type of crib Crib diameter Crib depth Total effective absorption area rn DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot Zine PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATER LS SOIL TEST RATING +a INSTALLER i✓ REMARKSQjI 3 p. 6 �S LEGAL I ly APPROVED DATE 3 f i 72-013 (Rev_ 3/781 - MUNICIPALITY OF ANCHORAGE Fiµ of Departmentro"f Health and Environmenta"'�Protect n 825 L Street, Anchorage, AK. 'A501 N� 264-4720 Permit # # # # HANDWRITTEN PERMIT # # # ON-SITE SEWER PERMIT /� Applicant: Mailing Address: r `C%A.dr D / Location: Phone Number: Legal Description: �o % ,2 �K ", , Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: _ _ Seepage Bed: X_ Holding Tank: Maximum Number of Bedrooms: ,�_ Soil Rating(sq.ft/br) .2/0 yU3 E.yuwa The Required Size of the Soil Absorption System Is: q , i DEPTH 3' LENGTH 7 �' _ GRAVEL DEPTH `�� /�'H WIDTH 3 ll The length dimension is the length(in feet) of e trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(hl@tBiiVG) TANK SIZE = lodo 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(Z) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee 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 3 3 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 thWIT, dence is remodeled to include more that 3 bedrooms Signed: `S CA Issued by: Applicant\ �� V Date: •� - / --� SWP/024(1/81) O & E ENGAEERING & DEVELO TIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: %s`� ^��� tee- ���(� �f-iwaTn,J' Tel. N0.41P'B-Z'027�' Mailing Address:—"" "' < Legal Description x 4 S t A.I�, •• ' 4 S�.- Depth (feet) Sol] Characteristics 0 2 4 V\1 4 — �- 5 7 10 11 _ 12 13 — a 14 _ 15 — 16 Ground Water Encountered: Yes No "� If yes, what depth Proposed Installation: Seepage Pit_ Drain Field k�- Performed by: PLOT PLAN /J PERC. TEST OF Akh, `�^f aa,B4 cCQ nSf Date: r3Lc G Y� ., i2FJ l Lc- .� s 1 U PLOT PLAN /J PERC. TEST OF Akh, `�^f aa,B4 cCQ nSf Date: r3Lc G Municipality of Anchorage ppGE eGi • Development Services Department . Building Safety Division _ On -Site Water and Wastewater Program s`pE r. G 4700 South Bragaw St, P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. S-1— 74/— o / HAA # D!A 03--11 $ #1, 11. Expiration Date: (9— ©� 1 Ggil!ERAL INFORMATION Coriiplete legal description NO 0063 �� 340 C(C Z_ G12 Location (ite'address or directions) oz %� / �1QR%/fW c70t5S e/V� Current Property owr Madmg address; Lending agency Mailing address SCa T c r/! L/c�r2 Day phone asgq� AV,' r ctct-q Day phone _.-- Mailing Address f�4K' o F E%f 6Lc l l 4f� Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ER TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm &Q(6 � '!5A)a46f4e4&J6 Address /7-237 B96£ t�fI ,t C aeOltsE Engineer's Printed Name 45M 5. DSD SIGNATURE t/ Approved for bedrooms. Disapproved. Phone 690-70a Date a Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: z Original Certificate Date: (Rev. 01/02) inunic l Developmei Bu nnGn> W -a Ca+� ..*r a � a **r�" '� :§�.;�'`�e* � ,5"u'Pas�d,+M.a, ^w �a�+5''%rai�caur^u��` ° .+,•+•ia.. �d"�y,*` "r tt.... . imp e e andary' seal Itesprop'erly protected (l�/N) ft Casetl to ft. •Casing height (above grou d) ' in. � �` ROM WELL: L`OG AT INSPECTION` s Nater le el Iwo' 'otion_ g g.p.m. 4 SAMPLE'RESOLTS: I colonies/100 ml Nit to mg:/I. 0 er bacteriacolonies/100 mi. �k-s7URRism a am Date installed Depression over tank (Y'�N) ,� High water alarm (YJN)" AA _ Pumper' cS4�liTi/y /�Ul�Iir�FPS Soil rating (g:p.d)ft2 orft2/bdrm)�Q—.P _. System type" 75?AZC_6fi ft Width_ ft Gravel belovvplpe S, % ft. Eff a6sorpU6 ares WS ft2 Monitoring tube Depression over field Al .c: t� tt t •� x. Mv*; 'Us, .;:.fie �y Results (Pass /Fall) For - bedrooms tion fie efore Les In Water addedw—S-0gal New depth45m k2i''4,"''MS snx's'�-w lq •a.Y'k .au/ �a"' `4✓er:"ve. k P a cr c F, h d ,: sa i '"".'<,.-a<' s a,[%., s,°r .. „ nln Final fluid+s;depth t = In. Absorption rate >= S ® f g p. d. If vAq vivo r'Int a ,.. in. line Pump off' I el at _ in,h water alarm level at in. ;ycles t ted Meets alarm & circuit require tints? On adjacent I On adjacent Jots Public sewer manh a/cleanout Holding tank OLDIHG`TAKlk ON LOT TO: .. e^�.*kWx � v a^^ nms x.WN�43�w,F _] m:'.ur� tv7-. ro^'.99F. ✓rct^ :'�`N.+.4.. .+YS. -4' .. � emk r.. � RT^ Property line Absorption field--45-- Water ieldJ`—Water service line /CJ Surface water r Building foundation Surface water Driveway, parking/vehicle storage ave detetmined through `field inspections and"" " %; br* ,ipal records that the above systems are in ,49 ith MOA HAA guidelines in effect on this date. _ ci -A/0 Waiver Fee $ Date of Payment _ Receipt Number aLLSy�{AY& Ven W, ng PE 6256. ter%\ U Jae 4e` 71 o �V Frramx. „ ) M1' �j� d J irk,,irk,,/ L F a t 9`.�... t J Y r e <� J c; 2�HeO e4 L / AS -BUILT I hereby certify that I have "surveyed the following described' property: L o 2. e I' l✓Orfav µ.-ort ct s D r t v --w- 1�' Anchorage Recording Precinct, Alaska, and that the improve- ' ments situated thereon are within the Property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach x / on the remises in' h trail P 1, -question and t at there are no roadways, J , Y' Y smtsston tees or other visible easements on said property except as indicated hereon i Dated at E,�gle River, Alaska % this? �:'�J'7Y'L_day of A. L-1 1 ' n ROBERT C. JOT-INSON SCALE: Registered Land Surveyor No.`880-LS Boz 7,"•-0456, Eagle River, Alaska 99577 fr. Phone (9M 694.2543 Municipality of Anchorage + Development Services Department 1 Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. " P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us 343- 9e.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel Parcel I.D. 051.741.21 HAA # EY��� �S b Expiration Date: ;.7 - O -2- 1. GENERAL INFORMATION ,v Complete legal description '1i1b"r�h"V 6-6o Ii Slock 1. Lot 2 Location (site addressor directions), 22991 Northwoods Drive Current Property owner(§) Bruce Thacker Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 688-5675 "- 22991 Northwoods Dr Chuqiak AK 99567.5463 Day phone Barbara Crittenden Day phone 689-1802 Prudential Vista Real Estate 16635 Centerfield Dr Eagle River AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND Engineering Phone 696.6111 Address 20441 Ptarmigan Blvd Eagle River AK 99577 Engineer's Printed Name Kenneth M. Duffus Date 08/27/2001 •-_c OF AC .��. 5. DSD SIGNATURE fo - CE 7116 Approved for bedrooms. ,t1iFOpROFESStoNP�+�+ Disapproved. ,������•� Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory WATER AND : r' PR-�:: - Maintenance Agreements Supplemental Engineer's Report Other By: Q 'Z Z Ctl- Original Certificate Date: S — � " (Rev. 12/00) Municipality of Anchorage y .F Development'$e c,es Department' Building Safety Division b On -Site Water & Wastbwater Program � � r: ,7(0 South Brayaw St. bnchor ge:, AK `"9�3519`6�50 �c anchorage ak.us DIITLJ!'S�iT1%'Ammm^%/AI f' i ir^Izi anr. `xvasr WWI— r Ser'a«...moWIF 's/100 ml. Nltr""ate mg.A. Other bacteria ' colornes/100mI Collected by- .. .,.:� .,. i �� � 'k::' ,� a, '3;�' �.`7"'.w�w•ra"s.r��'�^- Asn ;�,; a r'ia�o« horage Tank •Steel an�size 70 ' gal. Plumber of Compartments Z' [azton on tot ..P4�PYP114 Ww yy. _.,. on lot"On adjacent lots Public manhole/cleanout tin sewer "}{olding .rvice lirief tank 7777777777777777---. NSTANCES FRONT 8EPTIC'/H0LDING TANK ON LOT TO ... ' held 5+ tion 5'+ Property line 5'+ Absorpfwn a t �10'+ Water service line Surfacewafe�' 100'+"'"' t' e: r f ",200'+ nt lots. LOU k uurm 5 sa.e a ;^En 4#t7i§+.a xSLY 7C .' L * I, TfFICATi'O� determined fHrougii MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M 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 741 21 HAA # 99 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Btock 1 • Nonthwoods Subdivision 02 Location (address or directions) (b) Property'owner Nance Telephone: (home) 688-4024 Business Mailing Address (c) -Lending Institution NotihZand Montgaae Telephone Mailing Address. Ea.ate •Vve2. Ataska (d) Real Estate Company and Agent HERITAGE REAL ESTATE/Suzanne Coot Address 18550 Eagte Riven Road EagLe Riven.. Ata4ka 99577 Telephone (e) Mail the HAA to the following address: (or check here,% if hold for pick up.) List contact person and day phone number below: 17034 Eaote Riven Loop Road Suite 204 Eagte R.iveh, Ataska 99577 2. TYPE OF RESIDENCE o4dened by Suzanne Coot Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Well ❑ Community 01 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 -sited Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the Iegailty and status. 72-029 (Rev. nas) Page 1 of 2 Z;o Z abed Noze leen n88) szo-u -liom s,aaau!6ua !euo!sseloid a41 ul suo!ss!wo jo saoiae ao; apsuodsei lou s! a6saogouV;o lel led!o!un W 441 •panssi s, aleo!;!1jao a ajolaq elep az Cleue,)o suopadsui lonpuoo11ou op SHH(];osee (o!dw3 •sluewaa!nbei alels pue!ejapa; u!elaao jsi�us olaapio u! suo!;nl!lsw 6u!pual a!94; pue sawo4 ;o siesupind of Rsaljnoo a se SM SBOP SHH(] a4l Te se!V ;o 91eIS 441 ui PaJalslbaa jaau!6ua !euo!ssa;oid luepuadepui ue Aq anoge g ydej6eied u! 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'mo!aq umo49a;ep uo!lep!!eA a4l;o se pue olaJ94 pax!lle leas Rw Cq pallpeo ev NOIlVWNOdNI ONV V.LVO `H0dV3S 311d'S1S31'SNO11O3dSNl ONIOIAOdd WHId DNIH3311 NI`JN3'9 MUNICIPALITY OF ANCHORAGE (MOA) • '� Health Authority Approval (HAA) UNICIPALIlegIf fffGg:E6RUARY1984 VIRONMENTAL SERVICES bigg6pgq ' SEP 1 21988 Legal Description: -L— A. A. WELL DATA RECEIVED _ Well Classification A. If A, B, C, D.E.C. Approv6ddpN) _ Well Log Present (Y/N) Date Completed 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 Wring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL`. To Septic/Holding Tank on Lot ?moo I 1 ; On Adjoining Lots To Nearest Edge of Absorption. Field on Lot �� I� ; 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 B. SEPTIC/H0L0frfG TANK DATA Date Installed 45'1-(015"5 Size��22 No. of Compartments 2- Standpipes((S N) _Air -tight Caps(3:Yl) _Foundation Cleanout(VN) Depression over Tank (Y6 Date Last Pumped �l — 1t::>- F�e2 Pumping/Maintenance Contact on File. (Y/N) for Holding Tank High Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Su l Well . �1+ f Supply To Building Foundation To Property Line t To Disposal Field oci To Water'Mai`n/Service Line t-4 To Stream, POnd,`take or Major Drainage Course t E>:� 14- f ;- , , „ 72-026 (Rev. 7i8e) Front Page 1 of 2,; C. ABSORPTION FIELD DATA / ^ Soils Rating in Absorption Strata '�1 O �'� Type of System Design, Date Installed �� '0-b Length of Field �} — Width of Field 3 (I Depth of Field Gravel Bed Thickness n Square Feet of Absortion Area St*dpipes Present67N) Depression over Field (Y(5) / r -S Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line To Building Foundatiofr To ExistiI g or Abandoned System on Lot N'� ; On Adjoining Lots �a- To Water Main/Service Line I I � To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course IA - To ©� To Driveway, Parking Area, or Vehicle Storage Area Comments _. D. LIFT STATION Date Size in Gallons — "Pump On" Level at — High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) . "Pump Off" Level at Vent(Y/N) _ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection.d S & S ENGINEERING Road No 2�6 ��p Signed 17034 E091e RI ar Loon Company Faule River, Alaska 99577 r Date .. , MOA No. Receipt No. —, / �-%o ii //S —�G�� Receipt No. Date of Payment (?// Z/? Waiver Fee: $ Amount: $ 7® OZ) Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 orL4be.4WJe of this ..,. bort & Ybege No. 14571 :, ,. . STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 h DATE: Sentember 9, 1.988 PWSID: 213001 j� To Whom It May Concern: According to the records on file in this office, the CHUGIAKi� UTILITIES/NORTHWOODS/MEADOWRIDGE Water System is in compliance & with the'State of Alaska Drinking Water Regulations. �: x Sincerely, ' Steven W. $g, PF, District Engineer ( ::. CWFenitlr e 1 {{ d ' 1 4 � , yG ik d 4 4i' Y i Time APPLIC�JT FILLS OUT UPPER HALNLY Property Owner .. a .... s. .a S.�.MM u ur.e vut ws r nl>n .. .in ✓'-mrnu+iFF d:'eA, x... Date try- Phone .; Mailing Address ?(y ., cn (i /im P>sJXr; ^7 ! .� 1 Zip Code 17f <? f Buyer Inspector Inspector Address Zip Code Lending Institution Phone Address 2IP Code Realty Co. & Agent. Phone Address Zip Code Legal Description �- L' (;4�j.s S[reet Location I " ( APPROVED BEDROOMS `CONDITIONS OF APPROVALS ( ) DISAPPROVED Typ,,_e,, of�fe'Residence Family ( I COp1D'ITION(A APP OVAL' RRY mgle ❑ Multiple Faml)y No. of Bb&ooms .,, DATE (�� Cl Other .. .... ... Water Supply Soils Rating ❑ Individual ` oCommunYty ,, ° ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Public Utility Septic Tank Size For wells drilled prior to that date, give well depth (attach Tog if available). Sewer isposal Individual Well to Tank (''�i /^ UZ_ aY EX� ❑ Public Utility Year Individual Installed. A6 S i aS7, ❑ Holding Tank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.. Time Time Tim Time Date Date Date Datei�� �� Inspector Inspector Inspector Inspector Field Notes: JUN i01983 "MUntclpatity of Anchorage" "Dept. of Health & I " ( APPROVED BEDROOMS `CONDITIONS OF APPROVALS ( ) DISAPPROVED ( I COp1D'ITION(A APP OVAL' DATE (�� BY. Soils Rating Date Sewer Installed Well To Absorption Area Well Log Receivetl Septic Tank Size S_ 6 3 Well to Tank 72023131821