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Home My WebLink AboutNORTH WOODS PHASE 2 BLK 1 LT 3A Municipality of Anchorage Page I o! _~- 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: ~,.) OqO ilo PID Number: C~.~ I,-?tTI- ~ Name:~/t~ ~b~ Wastewater System: D New ~uPgrade Address:l ~~ /=~ ~'~- Te~c ~. ABSORPTION FIELD Phone:~ No. of Bedrooms: ~ ~ Deep Trench ~hallow Trench D Bed ~ Mound D Other LEGAL DESCRIPTION Soil Rating~ Total Depth ,r~;~inal grade: Lot: ~ ~ Block: ! ~O~~Subdivisi°n: ~ Depth to pipe ~b°tt°m Irom original grade: Ft. Gravel depth/~n~th pipe Ft. ~ I Section: Fill added abo~ original grade: Gravel le~th~ Township: / 5~ Range: / ~ I 5~ ~ 6 ~ ~ ~ Ft. Gravel width: Number of lines: WELL: D New D Upgra~ Ft. / ~A. I Classification (Private. A,B.C):. · ~P~ ~ ~~Ft. Cased To: Ft. Total absorption~area:~o~O SQ. Ft. Pipeful_material: Date installed: Driller: [~ Date Drilled: Static Water Level: Installer: · ." I ' SEPARATION DISTANCES ~tic o Holding D S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity In gallons: From Tank Field Station Tank Sewer Lines ~h~ '5 5 ~P I~T~:'~ I/ ~ Material: Number of Oom~tments: s.,~ ' LIFT STATI ON Water ~¢Of ~¢¢~ Line g~ / /q ' L~ / Sizein gallons: Manufacturer: Foundation ~ '': ~ 3' a ' "Pump on" level ,,: High water alarm ,,: CUDrainrtain +~O ' ~ + ~O ~ ~0' p~~Ctrical Inspections performed by: ~ t~o/)c ,~,J~,~ BENCH MARK Remarks:' Location and Description: I Assumed Elevation: / .... ~I ~ ~ Ft_ . Inspections performed by: ~H ~5 ~0~ DateS:2nd 5//7/o~1st ~/,5/oV !~~Ji~/~' Department of Health and Human S~vices approval ~.. ..... CE:10~7 Reviewed and approved by:~Date: ~ 72-013 (Rev. 9/91) MOA 25 Permit No. SW040110 Page 2 of. 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: ,:343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: NORTHWOODS #2, BLK 1 LT 5A PID No.: 051-74-1-58 SWING T1ES A B C $ 8.0 46.0' D 110.0' 84.0' E 124.0' 100.0' TR - TRENCH ~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEAN OUT 4- - WELL NEW [.EACH REID 60' E · DR~Nfl[LD U FLOW O EXISTING LEACH FIELD SCALE 1:50 EXIStiNG 3BR HOUSE 15' UTII.JTY Nm~t ELEVATIDNS (NBT TEl SCALE) NAIL IN TREr FAST ~ TR-t ASSUMEO El. iV ~I~' ~ ~IGIN~ /LEVEL / TR! ~6~ TEST 94.0' GV.T. eLO' 5/20/04- ENGINEER'S SEAL ~< ~r ~L 3~- %%2". c[-~o3a~ ..-;~ ~.... ...-'X~ l~lAY-24-21a84(l~iON) 10:58 EAGt. E RIVER ENBINEERiNG (FAX)807 694' 8297 · P. 1~01/(~1~1 FAX TRANS/V TTAL Eagle River Engineering Services Chrlsto~,l~er 1~. Wood, P.E. 10~21 VFW Rd. ~te 201 (90~ 69~-5195 EaSe ~:, ~ 995~ (90~ 694-3297 ~.eagle~vervng~ee~g.com To: Number of Pages: Legal Description f~xBLA.,NK, do¢ 1 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O, Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 10, 2004 Expiration Date: May 10, 2005 Permit Number: SW040110 Legal Description:[NORTHWOODS Design Engineer: 0848 Eagle River Engineering Services Owner Name: Michelle Fields Owner Address: 23005 NORTHWOODS DRIVE CHUGIAK, AK 99567-5463 Parcel ID: 051-741-38 Site Address: 023005 NORTHWOODS DR Lot Size: 55295 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: r~ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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: ' ~'~.,c:~..~-~~ /~' ~(}~-<-~~ __ Date: 0ct-14-03 12:57P Permit Counter 907 343 8250 P.O1 Municipality of Anchorage Development Services Department 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 (907) 343-7904 ON-SITE SEWER./VVE[.I PEI~.M!T APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. C)b"'~ =,F/--/.-f-~ 3" Permit Number SW E~) Z./z D,/. / O Property owner(s) /-~'/~'z~- Mailing address (1) / ~ ~',~.~.. Mailing address (2) ..~'_ .,4~,~' Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) .,~'~ ~/f,/ D',~::: ~. ~ ~-/.~-../c~ Lot Size ,/. ~ ~ A~'~'/~Sq. Ft. Number of Bedrooms Day phone Zip Code . ~'~".-,<~,,~'~ THIS APPLICATION IS FOR: Sewer Only I--~ Well Only I--i Sewer and Well r-I Water Storage Sewer Upgrade THIS PROPERTY CONTAINS; Hot Tub [] Jacuzzi [] Swimming Pool [] Water Softening Unit [] Therapy Pool ["1 I cedify that the above information is correct. I fudher certify that this application is being made for a Single Fan31~ Dwelling aj3d, is in ac/::ordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Eagle River Engineer g Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax May 7, 2004 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods//2, L3A, B1 Narrative & Septic Permit Application Dear Mr. Cross: Eagle River Engineering Services (ERES) was contracted to perform a Health Authority Approval at the above referenced property, and found the septic system in a state of failure, and in need of upgrade. The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 2. 3. 4. The surrounding lots are all connected to city water, allowing sufficient room for septic sites. Immediate neighboring septic systems are all +30' distance, and no private wells within 200'. This permit is for replacement of the leachfield system. Tank integrity will be checked, and old leachfield kept on-line with use of a bull-mn diverter valve. Drainage will not be affected and is not a major consideration in our design. The existing leachfield will be abandoned in place, but kept on-line by way of a Bull Run diverter valve. We are requesting that the lower leaehfield be allowed to be 35' from the edge of the steep +35-percent slope. The slope is heavily vegetated, with a 1-foot layer of peaty topsoil, underlain by two feet of orange to tan silty clay. The GM accepting soil layer starts at 3 feet. We believe that no effluent will daylight on the surface of this slope due to the nature of the soil deposit. This work will not affect the reserve septic areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, ICES Christopher R. Wood, P:ES. ~ Principal ~.003\04-023 SEPTICNARRATIVE.DOC N48'OO'OO"W 182.98' I WELL .t- 200' WELL + 200' SEPTIC +30 SX6o THI DIVERTER VALVE EXISTING 1,000 GAL TANK FLOW SPUT£R 0 TEMPORARY ABANDONED LE. ACH~ELD DOUBL.~ CLEANOUT CHECK EXISTING TANK INTEGRITY, REPLACE IF NECESSARY WELL + 200' SEPTIC +50 -' EXISTING HOUSE 15' UTIUTY EASMENT NORTHWOOD DRIVE ~x~ - WATER KEYBOX ~,~ - OIVERTER VALVE I~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEAN OUT + - WELL EASEMENT :- ............ PROPOSED LEACH FIELD ~- EXISTING LEACH FIELD ~ - DRIVEWAY WELL/SEPTIC SITE PLAN LEGAL: LOT 3A, BLOCK 1 NORTHWOODS SUB. PHASE II OWNER: UNKNOWN CONTRACTOR: CCC CONSTRUCTION JOB#04-022 I DATE: 05/6/04 I SCALE 1"=50' A EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW Rd. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM UPGRADE LEGAL: Northwoods #2Lot 3A Block 1 May 7, 2004 A. GENERAL 1. The septic system upgrade plan is for a 3 bedroom single family residence only. 2. The drawing and or site plan shall be a part ofthis specification. 3. All materials and wor 'kmanship 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 in the field by the contractor to meet Municipality 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 wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test hole excavations shall be filled and monitor tube removed. B. SEPTIC TANK 1. Existing Septic Tank shall be checked for integrity, and replaced with a new 1,000 tank if required. C. DRAINFIELD 1. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5", and shall be located at 6' below top of ground surface as measured on the downhill edge of excavation. 3. The existing leachfield shall be abandoned in place, but connected to new system ~vith a Bull Run diverter valve. 4. The drainfield gravel shall be covered with typar fabric material. 5. A minimum of 3' of fill, or a combination of soil and 2" extruded board insulation to an equivalent soil depth of 2', is to be placed over the leachfield. 6. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff. Care shall be taken to ensure that 3' min. of native fill, or equivalent, is placed over the entire drainfield. 7. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 6' GRAVEL DEPTH = 3' under pipe, 2" over pipe DRAINFIELD LENGTH = 120' (2 ~ 60') DRAINFIELD WIDTH = 5' SOIL iRATING = 0.45 GPD/ft2 BEDROOM CAPACITY = 3 total SEPTIC TANK = 1,000 gallons min. Twenty-four (24) hours notice required for all inspections. \~Eres~DOCS\WPDOCSL2004\04-023 drainfield- spec.doc EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 04-022 Calculated By: CW Date: 05~05/2004 Legal: Northwoods Sub Phase 2 L13A B1 Single Family 3 Bedroom Dwelling TEST HOLE 2 Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 40 minutes perinch Wastewater application rate = 0.45 gallons per day per square foot Required absorption area = 1000 square feet Trench width (W) = 5 feet Gravel depth (D) = 3 feet Required length = Shallow trench factor * Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.58 Total Excavation Depth = 6.0 feet Required length = 117 feet 04-022_drainfieldCalc.xls 5:38 PM05/05/2004 Performed For. Legal Description: 3- 4-. 10--- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ., www.d.a nchoraqe.ak,us (907) 343-7904 Soils Log - Percolation Test Township, Range. Section: 7',,~'",~/ ,,,~',/,~4x' Site Plan WAS GROUND WATER ENCOUNTERED? IF ~ES. AT WtV~T DEPTH? Depth to Water After Monitoring? L 0 Date:, Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE [minutes&~:h) PERC HOLE DIAMETER TEST RUN BETWEEN F'r AND Fi' COMMENTS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPA~G'UIDELINES IN EFFECT ON THIS DATE. DATE: Pea'on'ned For:. Municipality of Anchorage Development Services Department Bu~ing Safely Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box lg6650 Anchorage, AK 99519-6650 .,. www,ci.anchoraqe.ak,us Soils Log - Percolation Test Depth (Feet) Slope ,,~ ~,'~ ~ / Township. Range. Section: ,,,7',/~'"'/fj~ /~//~/ ,~/..E"./~/ :~'.~/--,-~- ~ Site Plan Ill &~.~ [ I I~1/I I ~ III I1~,~-~*11 I fl I I I 2- 3- 4- 5- 6- 7- 8- WAS C.OU.D WATER 9- ENCOUNTERED? L 10- IF ~E$. AT WHAT OEFTH? ~//~-- O Depth to Water After p 11 - Monlto~ng? f/// E 12- Date: Reading Date Gross Time Net Time Depth to Water Net Drop Y ~ '~ ~ ~o' ~'~ ~" ~" 13- 14- 15- 16- 17- 18- 19- 20- PERCOLATION RATE. ,~ ~ (minutes/'mch) PERC HOLE DIAMETER ~" TEST RUN BETWEEN ..~ FT AND ~' FT COMMENTS t' ~,: ,,,,'/ ,,, ~ / PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL""GUIDELINES IN EI~FECT ON THIS DATE. DATE: : '~ MUNICIPALITY OF ANCHORAGE t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION · ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMe- ~'~ J~HON E ~NEW MAI L. Jj~G ADDR ESS DESCRIPTION LOCATION NO. OF,~EDROOMS _v DISTANCE TO: IWel.''~(~O/~ Absorptio~,~ , Dwelling "7 ' PERM~,~ ~ ~ Ma n u fact u rer~-~-~ r'~-.*, ~ ~ Mat er£al ~(~ -'~--,~:2~ ~.~.~ No. of c~mp. artments Liq. c~j~_~ n gallons IF HOMEMADE: inside length Width Liquid depth I~ ~ v DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest lot line PERMIT NO, ~ -r DISTANCE TO: j~ ;T', ~ No. of lines Length of each line Total length of lines Trench width Distance between lines Z L~ inches ~ ~- Top of tile to finish grade Material beneath Total Q~ inches Length .~ ~. Width Depth · Crib diam~eter Crib de~pth _ Total affect,va absorpt oz]arg6 Well Buildin~ ~j~u~dation Nearest lot line //0 [ DISTANCE TO: ,~4..._.1~] If~ . Class Depth Driller ! Distance to lot line PERMIT NO. ~: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS SOl L TEST RATING' ~, I'NSTALLER REMARKS' ~ q ~ '~ ~ .,~l~',k .~,~ '.,ti ~,.~,':. APPR~ DATE LEGAL 72-013 t 3/78) PERMIT N0. I3N S I TE APPLICANT LOCATION LEGAL LIFESTYLE IND L~Bi NORTHWOODS PHRSE II L ITS' m3F Ar~CH~-~RAGE ~IIJ~'~ICI~EALTH AND . ENVIRONMENTAL JTECTION DEPARTMENT 825 'L' STREET, ANCHORAGE, AK. 9950t 264-4?20 SE~ER PE~I IT SRA ±452-T 99502 LOT SIZE TYPE OF SOIL ABSORPTION SYSTEM IS: 999999 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS ==.? SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 2c LENGTH= ~]R~'EL [)EPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE '~ EET >. ~ ~ GROUND AND THE E:DTTOM OF THE EXCAYATION (IN F THE TREr-~C:H P-! I E:.TH I S FEET. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AN[:, THE BOTTOM OF THE EXCAVATION <IN FEET>. RE~a. IJ I RED SEPT I C TA~-4P.C S I ZE= iOE-IO GALLCID4S PERMIT APPLICANT HAS THE E.E~PON_IBILITY TO INFORM THIS DEPARTMENT DLRINU THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE TI..-ICm < 2 -'-, ! I'-iSPEC:T IONS AE:E E:EC4Lm IRE[:, BA_.KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PRO:.ECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t00 FEET FOR A PRIVATE WELL OR i50 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERP11 T E>::P I RES DECED1BER _~'..:q . i,, 982 I CERTIFY THAT t: 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 THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. SIGNED: ......... APPLICANT LIFESTYLE IND ISSUED B~-- - = ~ATE ....... V4. 0 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 8LOPE DATE PERFORMED: S~/'' 2~'//; /~'Z. SITE PLAN hi,)g.TH t,~)o )~ Ot£ l'Z. 10 11 12 13 14 15- 16- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? O P ! E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop i ~tW~ q:~ '- ' '-'° x, PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN Z- FT AND ~ FT CERTIFIED B/~.~~/~''~ DATE: 72-008 (6/79) • s • r 1 Municipality ofMunicipalio. - On-Site Water and Wastewater Program 1:1_11 (907) 343-7904 s, P (T Y Certificate of On-Site Systems Approval (�] Parcel I.D. 051-741-38 Expiration Date: 67-5--` 9 1. GENERAL INFORMATION Complete legal description Northwoods #2, Block 1 , Lot 3A Location- a' 23005 Northwoods Drive Current Property:own`er(s) Darwin & Nadine Hanson Day phone 907-440-6880 Mailing address. Same Real Estate Agent FSBO Day phone t • 2:-...TYPE OF DWELLJNG: ❑ Single; amily (w/wo ADU) ❑ Duplex 9 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Distance: • 17 Received by: � 15" Date: 1191 COSA may be released to the engineer or property owners. COSA Fee $ 5,4 Waiver Fee $ Date of Payment - Date of Payment Receipt Number a q4, Receipt Number COSA# 0 C-i `e' Waiver# 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, based on procedures outlined in the Certificate of On-Site Systems 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 Crewdson Engineering, LLC Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 5/3/2017 Note: as engineer of record, the information I have provided on this form satisfies MOA Qafft �` its Systems Approval requirements only, and does not include any statements or guaranta'rig2. g Cli life and serviceability of the subject systems. .-:0,..... ,Si"f 1 • may• .1, I/ 6. DSD SIGNATURE %*:••4 v f' * /� System #1 Approved for 3 bedrooms 7 , err:.. System#2 Approved for bedrooms • /�+ ' t A. Crewdson Y pp c '• /) C1 527 .0 Disapproved 114;? C?31 � \50%.....-- Conditional ` approval for bedrooms, with the following stipI1��►'�'� �. ACLC 1 (A79.9 •,� C; ANC, ,a,;SCF Gc'‘'N.. N P NI• NA s,, CP r.,... ;t`, 4' ' `�. BY: tn--r� Cf Original Certificate Date: 6"--- I -/7 The Municipality of Anchorage Development Services Department (DSD) issues a Certificate of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r '., c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Northwoods#2, Block 1, Lot 3A Parcel ID: 051-741-38 A. WELL DATA Well type Public Water If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft, Cased to ft_ Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/plastic 5-17-2004 Date installed Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) '' Foundation cleanout . D-:re'ssiol*avef - • . r_`_ - • • : - - arm N _ Date of pumping .) Pumper A J asu . ��Ski% PQV' C C. ABSORPTION FIELD DATA 6 Date installed 5-17-2004. Soil rating (g.p.d./ft2) 0.45 System type Shallow Trench Length 2 x 60= 120 ft__ Width 5 ft. Gravel below pipe 3 ft. Total depth 6.5 ft. Pt absorption area 1000 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5-2-17 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field Oefore test 2 in. Water added 450+ gal. New Depth 8 in., Elapsed Time: 120 ripe. Final fluid depth 2 in. Absorption Rate >= 450+ g.p.d. Any rejuvenation treatrrent (past 12 mo ) (Y/N &type) N If yes. give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+' Property line 5+' Absorption field 5+' Water main 10+' Water service line 10+' Surface water 100+' Wells on adjacent lots 100+' * ABSORPTION FIELD ON LOT TO: Property line 10+' Building foundation 10+' Water main 10+' Water Service Iine10+' Surface water 100+' Driveway, parking/vehicle storage 10+' Curtain drain None Known Wells on adjacent lots 100+' F. COMMENTS G. ENGINEER'S CERTIFICATION .7- - pF 0 F A " . 1l . ! certify that I have determined through field inspections and AV,�P•' �� •. � �1 review of Municipal records that the above systems are in i aj conformance with MOA COSA guidelines in effect on this date. 4 it 49 ry ,'#, /� ji �_,- ,� �. . . . . . Engineer's Printed Name -�LLW 9S l,l^�W - CM • • • • ' ' ' ' ' ' T'es A.Crewdson Date .3 - r-* la . r.K 011527 • r Note: as the engineer of record, I have provided information on + ''•.. .. ••'' A�, this form intended to satisfy MOA COSA requirements only, and q% PROFESS\� it does not include any statements or guarantee regarding the �� ALC c future life and serviceability of the subject systems. I "' �� COSA canary sheet_2-6-15_CE.pdf Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program .- 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Bate: .~r-_ ~/~.. O,~ Day phone Day phone Parcel I.D. C) ~'! - '7 ¥ ! - · 1..,I~ENERAL INFORM~TION · -:.- C0m I~gal descnptmn :..\ ,-.. . ~,, ~: "' Lo~ation (si~address o~'directions) '"'.~Current PropeAy ownef(s) · ' LMailing address:"' I~ Lending age'hcy Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD.for pickup. NUMBER OF BEDROOMS: ~ .3. TYPE OF WATER SUPPLY: ' · -IndividualWell ..................... lq- -- Individual Water Storage [] Community Class ~ Well Public Water System 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 Authod[7 Approval Guidelines for this application, showSthat 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 Address_ I o~2.1 VI--~,J Engineer's Printed Name DSD SIGNATURE ~ Approved for '."~ Disapproved. . bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HA,& Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate'Date: ,.~_-- ~. ~ -0 ZTz (Rev. 01/0"2) .[ Lb'gal De{cription: WELL1 DATA f W, ,ell type IP~t,,z'~_,/~.z"P,J If A, B, Or C pro~,ide PWSID # Date completed ~ Sanitary seal (Y/N). T6taldepth ;. ft. Casedt0 ft. Stabc ,water level W~ell I~roductl?n Coliform Itlt~l~T'~ols,5 # ;~. LOT 3,,4: I~LO~I¢ ~ Municipality of Anchorage DeVelopment Services Department Building Safety Division .... On-Site Water & Wastewater Program 4700 South Bragaw St. · P.O. Box i960§0 Anch6rage, AK 905'1 www~ci.anchorage.ak.us (907) 343-7904 -- HEALTH AUTHORITY APPROVAL CHECKEIS" . )om, Nitrate __ mg./I. Date o~[ sample: t 00 mi. · ,, B; SEPTICI~ TANK DATA t Well Eog (Y/N) Wires ProPerly Casing height ( AT IN,~ o5'/~ 7/-//- ~ ¢ Other bact~ri'~ Collected by;I..,. , CleanoutsK~)N) '; High water alarm colonies/100 mi. ABSORPTION FIELD DATA !:;',:.'.' I~' · ' I' I .i .~ ....... !, ,' ,' , - ,: . . ...... I~ t :" " ,il I ; ,r_ ,~ . ; ,'~ ;:~.." , i ' ' ': ii ;' ,~ ' Da~e in?tail,ed ~. '. :'§0il rating (g.p:d../ff2 or '¢t?:¢1~I~) ¢,z./,¢ Systerh t~;i~e bl~-.~'~ Len, gth ~X ~0- I~O ft:;. .'; ~.: .[~ Width ,- 5 ft. · "Gravel.belowp~pe · '~ ' ft. · . i,: .,: ~ .. , , ,, · . . , , T6t~lde~pt~ht~.~ ,t. -~,Eff.'at~s0rpfi0narea~[t~ Monitoring tube' ~ I~pr~ssionoverfeld ~ , .! I , · , 4 .... ; , .. ,-[, , ofiadequ~cytest ,AJ~/~. ,I ' : ~esults(Pass/Fail) ~/C~¢ ; !': For ._-,'~ bedrooms d(~pth in ~bsorption ~eld b~foro/ test/¢O ~'n.~? . i~ ! 'i :'. :: i' I! ..::~' !; - . Wateradded ~//,4_al.g i', i: New depth /714 'in. ?edtT!me:!~/A min.,: ' i,Fin~lfuidde~3th '~/4: in. ' Absorptionm)~e,>~' ' ld.~'O g.p:d. , I ; f , :,,. . ;,,:/~..: ' t: ~' ': :I!: II;~ .' ni r. ejuvenation treatment (past !2 mo.) (Y/N ~& type)': ' A ilf ~ye ~s,:give date LIFT STATION Date installed "Pump on" level at in. Datum ~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LoT TO:: Size in gallons 'Manhole/Access (Y/N)~ ___----- ''Pump off level at ~__.~~g-h-~ater alarm level at Meets alarm & circuit requirements? in, Building foundation ~ :~; Propertyline ?--9 I Water main ¢) ,5' ~' Wate~:'serVice line ' ~/ i Wells on adjacent lots '¢'/¢o - .., SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT ~'O:": Property line J /-/! . Building foundation '~ .'~ ~ Water Service line / 20 f~ ~ -Surface water 't'/f,-"¢ /' Curtain drain :/' ¢'C) ~ ,,{. ' Wells on adjacent lots ~/0¢ ~' ! Absorption field '~ ~ Surface water '/-/r_..'~ Water maii~ .. '/'/DE)" Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'scE~RTIFICATION ' ' '"' I certify that I ~'ave determined tlirough field inSPecti'on.s and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect ori this date. Engineer's Printed Name Date' '~ ' ~'/~ '~O ?: HAA Fee $ 'H Date of Payment · Receipt ~.umber <Rev. 12,01) ",. ~ee $ Date of Payment Receipt Number " .', '"' .''", or~'adiacenilots ' "' " ' ..,~-----~~ septic tank/lift stati~)n on lot Absorption field on lot ¢, On a.d'aj.~.p~~ . ~ ' Public sewer manhole/clean0ut . -' Public sewer main :. 'twit Sewe,~~ - - Holding tank ' ' ASBUILT I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: TH,~, ,,u ~.~u/~[jHMENTS~ EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE'OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 694-0_~8 SCALE: / ;_xj_~, ' DATE.' GRID: FB: DRAWN~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I,D. # '~,~_/- 7~//-- ~7C'~ HAA # . ,/'/~ ~/~,Z~'~/,,) ~' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) LOT 3A; BLOCK I; NORTH WOODS #2 Subdivision, Location (addresS or directions) 23005 Nort~,)Oods Drive (b) Property owner H.U.D. #_~30239. Mailing Address Telephone: (home) Business (C) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Aaaoc,iate_d Baoke_~ A,f~tn.' Sandy Address 640 W~A,f 3gfh Au~_nu.~_ ~n~. ~1; A~ohn~ag~.: A~. 99503 Telephone 565-3333 (e) Mail the HAA to the following address: (or check here IZ~if hold for pick up.) r, List contact person and day phone number below: 17034 Eagle Eider Loop Road No. 204[ 2. TYPE OF RESIDENCE Single-Family [~3X Number of bedrooms 3 3. WATER SUPPLY Individual Well [] Community Ji~ Public [] Note: If community well system,: must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. .r. 4. SEWAGE DISPOSAL On-site INX 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, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .end adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date 17034 Eagle River Loop Road No. 204 6. DHHS APPROVAL Approved for ~ bedrooms by Approved ~/~._ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage 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 DHHS do not conduct inspections or analyze data before a certificate is issued. The Mun ici pality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 .M~,~F~iI~'Y OF ANCHORAGE (MOA) ~ ~_~,~,~l~4~uihority Approval (HAA) CHECKLIST - FEBRUARy 1984 343-4744 Legal Description: ~ '~ ~--, ~ RECE}VED A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth__ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Depth of Grouting if A, B, C, D.E:C. Approved ~N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ~ t-Jr To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ; On Adjoining Lots ~ I-ir ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed t ,~/w_.~Z- Size I. <:::;L~_ r'~ Standpipes(~/N) ~ Ai r-tight Capstl~N) Depression Over Tank (¥/t~ Pumping/Maintenance Contact on File (Y/N) ri/ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCEs FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Building Foundation To Disposal Field t To Property' Line ~, c~['~' To Water Main/Service Icine To Stream, Pbnd, Lake or Major Drainage Course Comments No. of Compartments '~' Foundation Cleanout([~N) D~ate Last Pumped r'~//N' ; for - Temporary Holding Tank Permit (Y/N) r'~/ 72-026 (Rev. 7/88) Front 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 z3t-"~1 Depth of Field ~f'l Gravel Bed Thickness I~:~ ~ \"'~ ~:~t'~l=' Statndpipes Present (~:N) I~ Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Y~) 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 To Property Line To Existin~t or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. //~.. Dimensions LIFT' STATION ~.~ Date ~nstalled _ __ Size in G~,~ Manhole/Access (Y/N) "Purnp On" Level at ~'~,-~ "Pump Off" Level at High Water Alarm Level at ~, Vent (Y/N) Tested for Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to ail MOA and HAA guidelines in S & S ENGINEERING 17034 Eagle River Loop Road No. 204[ inspection. Signed eff,~:~.t~ ~ of this Company Date MOA No. Receipt No. c;~ / ,~ ~ ? Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 329- ANCHORAGE, ALASKA 99503 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 ~he records on file in this office, the Chugiak Utilities/Northwoods-Deerhorn · Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, ~nEv~roE~mCen~aI~ Field fk~icer VEC:bas : MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPR°VAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date GENERAL INFORMATION (a) Legal Description (include lot, block subdivision section, townsh p, range) Location (address or directi..~onst _.~ ~ ' (b) Applicant Name 0~', ;~'-0~..) [~.// _Telephone: Home Applicant Address (c) Applicant is (check one): Lending Institution r"l; Owner/b~tder [~; Buyer I-I; Other [] (explain); . Business (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (f) TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community ~ Public J~ Note: if community well system, must have written confirmation from the State Department.of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [~[ Public [] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 72-025 (11/84} Page 1 of 2 ! *; -;' 5. ENGINEERING FIRM PROVIDING ,,,~SPECTIONS, TESTS, FILE SEARCH, DATA AND~INFORMATiON* * I:,' ' 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 ~f this inspection. F rm Name of Date Telephone Approved for ~{,~_, bedrooms by ~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval c~rtificates 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 of homes and their lending 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legit, Description: ,~_/~ I WELL DATA Well Classification ~¢/~ i4,~c,( J.~'~)f It A, B, C. D.E.C. Approved ~)N) Well Log Present (Y/N) //f"¢ Date Completed ~/~ Yield Total Depth ~! lfJ¢- Cased to /¢ ~;~ Static Water Level A,/~ Casing Height Above Ground II I¢~ Electrical Wiring in Conduit (Y/N) ~//~ Separation Distances from Well: Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depresmon Around Wellhead (Y/N) To Septic/Holding Tank on Lot fO,/' ~ ~2o ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~:~ ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results ; Date MUNICIPALITY O; ANCHORAGe, DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION Comments B. SEPTIC/HOLDING TANK DATA To Property Line To Water Main/Service Line Course / ~ 9';;~ Size Date Installed Standpipes (~N) Air-tight Caps ~N) Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; [or Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream. Pond, Lake. or Major Drainage Commems Page 1 of 2 72-026[11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed [ q~ ~ Width of Field -~' ~' Square Feet of Absorption Area Depression over Field .(Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Length of Field .z./7 ' Depth of Field Gravel Bed Thickness ~. ET. Standpipes Present,~'N) bate of Last Adequacy Test To Water Main/Service Line ~ To Str.eam/Pond/L_ake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design -24-- To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ (--) / ¢- - To Cutbank (if present) Comments 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 ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 8 & Date ~ ~, 6~ MOA No. Receipt ,o. ~--~ bate of Payment (~ ~1'~ %~ Amount: $ ~5 ~ Page 2 of 2 72-026 (11/84) /,o -/¢- Cj'-- APPLIC'-'NT FILLS OUT UPPER' HA['- ONLY Property Owner ~/F~.? ~'~.~-c~/~_, { ~/~. Phone Buyer ' ' ' ~ ' ' Address Zip Code RealtyCo,&A~nt '' ~ ' '' ~ ' Phone Address Zip Code Street Locat,~ ~r'~/ /~L)~)~D Type of Resi~nce 8ingle ~mily Multiple Family No. of 8edroo~ ~ Other Water Sup~ly ~ Individeal &~AOH WELL LOG. A w~l log Is required fo~ all wells drilled sinae dune For wells drilled prior to that ~ate, give well depth (attach log if available). Oommunity Public Utility Sewer Disposal ~ Individual Year Individual Installed: Ig~ Public 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 Date Inspector, Inspector Inspector Inspector Field Notes: MuNiCIPALiTY OF DFPT ('" ~-J~Vh~-~; ~I' :~ .? .... gECE V D (~) APPROVED BEDROOM8 *CONDITION8 OF APPROVAL ( ) o,s.. .owo Soils Rating Date ~wer Installed Well To Absorption Area Well Log Reoeived /~ ~ Well to Tank Septic T~k Size / 72-023 (31~) ' ii I I ix/ordq slc P'h sc, MUNICIPALITY OF ANCHORAGE Departme~ of Health & Environmenta~Protection ~nvironmental Health Divis Case Review Worksheet Case Numbe'r ~ Date ReceiVed ..... ~ Comme'nts Du~ By s-6690 I{ December 14, 1982 ti December 30, 1982 Subdivision or Project Title: Lots 3A, 4A Block 1 North Woods Subdivision Phase II ublic water available ( ) Public sewer available ~ Community water available Comments: