HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 13North Woods
Phase 2
Block 1
Lot 13
#051-801-06
r MUNICIPALITY OF ANCHORAGE
DEI TMENT OF HEALTH AND HUMAN SEM :S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
,/fr' roc/tic &.✓Y
Wer/ to
Address
P t9• / c) ) 4' c7.0 A e,/Giorc�
Phone(s) Permit No.
S6/ -5Uo-
4.-k- 95 J/0
No. of Bedrooms
4
WELL
DISTANCES
SEPTIC
TANK
ABSORPTION
FIELD
WELL
LEGAL DESCRIPTION
Lot Block Subdivision
/.3/ �/art�ra/oo/�S �'
LOT LINE
3a
Township, Range, Section
773-/v /c / 44/ Sec-. 4
FOUNDATION
/3-
Q.4
TANKS
4 SEPTIC 6-00 54/ ❑ HOLDING
Manufacturer
Gree r
Material
TOO t; 4 1 .
❑ TRENCH
Capacity in gallons
No. of Compartments
TYPE OF SYSTEM
E BED "� W. DRAIN ❑ OTHER
Depth to pipe bottom from
original grade
Fill added above original grade
Gravel length
Total absorption area
Number of lines
% S FT
(T
,�2 v
FT
FT
/ 75- SQ FT
Soil rating
/ 7S SQ FT
Installer
Cil N ck /.'' r'
❑ PRIVATE
Classification (A,B,C)
Installei
Total depth from original grade
Gravel depth beneath pipe
Gravel width
Distance between lines
Pipe material
7`s -A-7 3o 3g
Date Installed
Spm/' // — /56 7
WELLS
SBFT
3 7� FT
S FT
/V FT
y bio
I* OTHER (Identify)
Total Depth
Date Installed
FT
Cased to
FT
REMARKS:
/ .cJ y , ae. E'x .rf --
�efart / eue l7p�rse&
AS -BUILT DIAGRAM (Show location of well. septic system, prope ty tines, foundation,
driveway, water bodies etc.) /`/T.S.
lit
I
/4
56
gc
r0
Aide j 7;461/K
751
1
Scale:
Inspealcom49prferigwOriitg,;Services
r 0. Box 773294
Plop River, AK 99577
Date:
094-5195
certify that this inspection was perlormed according to all
,;;;;';;;,,,,)‹zr
Municipal and Stale guidelines in effect on this date:
Health Department Approval: �[
Date
72-013 (3/85)
,� r�
MUNICiPA} ITY OF ANC/.ORAGL
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 .....4720
�
^ `�
|
'~ 5w
ON-SITE SEWER & SEPTIC TANK PERMIT
Permit Number: 870233 Upgrade
Date Issued: 08/31/87 Engineer Designed ^ �
.
Owner Name: E EQUITABLRELOCATION MANAGEMENT, CO Day Phone:
.��
Owner Address: 20 NORTH WACKER DR.
CHICGO, IL 60606
279~7611
Parcel 1d: 5
Lot 'Dlot.k'vf '
Sectibn 4 15N Range;.: IW
Lot Size 1.25 A (sq,{t. or acres)
Max Bedrooms: This PermiL: 1 Total Capacity: 4
Q,I.� /
r~l
i^=;
• SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. EaL|/ ��ptic
tank must have at least 2 compartments, Depth to top of septic tank(s) < 4"0
feet requires insulation over tank(s).
INSTALL PER ENGINEERS DESIGN: WIDE DRAIN FElLD 19' X o/ X 3,5/
�00•GALLON SEPTIC TANK TO BE ADDED IN-LINE WITH EXISTING TANK.
CONTACT OHMS PRIOR TO 1ST AND 2ND INSPEC[TONS AT 343~4/44"
l CERTIFY THAT:
I. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage• (MOA) and the State of Alaska.
^ I will install the mystem in accordance with all MOA codes and regulations,
and in compliancc• with the design criteria of this permit"
I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
seweragesystem on this or any adjacent or nearby lot"
. I understand that this permit is valid for a maximum of 1 bedrooms. I
also understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an additional permit.
Signed:
(Owner) EQUITABLE RELOCATION MAWIPEMENT, CORP,
issued 8y;
DATE:
?//d7
DATE:
.41,b~~___~~^^
LOT 13
BLOCK 1
WATER LINE (APPR
EASEMENT - - - - - -
EXISTING LEACH FIELD 44,0844--
NEW
4H HI -
NEW LEACH FIELD •msµ
CLEANtIUT -•
SCALD 1' = 50'
WELL AND SEPTIC SITE PLAN
LEGAL: LOT 13, BLOCK 1, N❑RTHW❑❑DS II
AGENT: PETIE STRANG
CONTRACTOR: CHARLES BARR CONTRACTING
EAGLE RIVER ENGINEERING SERVICES
P❑ BX 773294
EAGLE RIVER, AK. 99577
694-5195
tt-5C00• 0LQ 0e�
•Fr?‘g Louis A. Butera
CE -6736 a�
rp
�•
`fie %•'°ROFESS\0NP4
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: /42y/1/4/4 rr
,E //-
LEGAL
/
LEGAL DESCRIPTION: L 01' 13 / !� /J(
3-
10
'd•4
O �
To olu /i O/E'64 4c
WG // 5..-4 *Le rt
GYa ve / - -ss
t
•
o
S 6 -rel
S;/� Sti.ds
IA/ G„4 v-1
/ 75
11 -
12-
13-
14-
15-
16-
17-
18-
19-
20 -
OF d 4314
"'[�✓°°" \) .
p„t " o 0
a °•• (�
*_4 •
00
.•
�0,
0 �� ° Louis A. Butara �
v, -6 ',• CE -6736 4d
4BF4,PROFESSOV.:40°
COMMENTS
�Cs,S.J 4 6/4p-caf
DATE PERFORMED: /4t4-5 / // P7
-V- G•doceit i:t
SLOPE
(
T/Si✓ i(' / Gd s c 4/
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? NO
0
P
// E
IF YES, AT WHAT /y10N fer�4
as �2 e5 cd
DEPTH?
k-
TF
1 -10 -
o/
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Cdff'r
F�.�
7,47
/
/ N
/s/
'
PERCOLATION RATE
TEST RUN BETWEEN
14 N (minutes/inch) / % S .4S y d%
FT AND •' FT
PERFORMED BY:
72-008 (6/79)
Eagle River Engineering Services
P. 0 Box 773294 CERTIFIED BY:
Eagle River, AK 99577
694-5195
DATE: �/�'r/�"?
aQ
LUF
N
• Liq. cap ie gallons
atenalr� / No. of cpgipartments
IF HOMEMADE:
Inside length
Width
Liquid depth
-UZ
SZF
DISTANCE TO:
Manufacturer
Well
Dwelling
PERMIT NO.
DISTANCE TO:
No. of lines
"'Clomp?
Foundationa/
Material
Nearest lot ire
Length p)egrbJine
Top of tile to finish grade ��
w
QF
as
w
Length
Type of crib
Width
Total le inesq
Material beneath tile
Trenol3wie,,
inches
inchcs
Depth
Liquid capacity in gallons
PERM,..g /7
Distanw/e/e ween line
7eeff c i
ve
Totalorption areaWrio
PERMIT NO.
Crib diameter
Crib depth
Total effective absorption area
J
-J
w
DISTANCE TO:
Class
Well
Building foundation
Nearest lot line
Depth
Driller
Distance to lot -line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption weals)
OTHER
PIPE MATERIALS
SOIL TEST RATIjVG�
�t 4
INSTALLER
REMARKS
i
SFO
/1
APPROVED
,:z.(\..1C1
72-013 (Rev. 8)
DATE LEGAL
/12/
• /....") MUNICIPALITY OF ANCHORAGE (As\
•- 7r DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO' ECTION
t c I ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
--l�l}}JJ-- ""//�� //,+�/n7Q
) L , c sg aotifii
PHONE NEW
6ge 3/ UPGRADE
MAILIN�ADDRE'
LEGI---DESCRIPTION
ATe/T !! Q n/ e / /0 ®o /. C
LOCATION
NO;QF BEDROOMS
U Y
N Z
DISTANCE TO:
Manufart. !roe /'
WelC6p1s1 m
r,1
Absorptignarea� i
��
Dwelling /� /
PERJWy N ). 71)
(QJXX'' ``
aQ
LUF
N
• Liq. cap ie gallons
atenalr� / No. of cpgipartments
IF HOMEMADE:
Inside length
Width
Liquid depth
-UZ
SZF
DISTANCE TO:
Manufacturer
Well
Dwelling
PERMIT NO.
DISTANCE TO:
No. of lines
"'Clomp?
Foundationa/
Material
Nearest lot ire
Length p)egrbJine
Top of tile to finish grade ��
w
QF
as
w
Length
Type of crib
Width
Total le inesq
Material beneath tile
Trenol3wie,,
inches
inchcs
Depth
Liquid capacity in gallons
PERM,..g /7
Distanw/e/e ween line
7eeff c i
ve
Totalorption areaWrio
PERMIT NO.
Crib diameter
Crib depth
Total effective absorption area
J
-J
w
DISTANCE TO:
Class
Well
Building foundation
Nearest lot line
Depth
Driller
Distance to lot -line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption weals)
OTHER
PIPE MATERIALS
SOIL TEST RATIjVG�
�t 4
INSTALLER
REMARKS
i
SFO
/1
APPROVED
,:z.(\..1C1
72-013 (Rev. 8)
DATE LEGAL
/12/
PERMIT pa
mur4IcIF-ni_II-v pit -Jr:
DEPARTMENT ):IE HEALTH AND ENVIRONMENTALAOTECTION
825 ' STREET, ANCHORAGE, AK. 9 ji
264-4720
F"EF:MIT
(821174)
APPLICANT STEVEN L SKAGGS CONST PO BnX D CHUGIAK AK q99A7
LOCATION
LEGAL Li3B1 NORTHWOODS II
688 -2831
LOT SIZE •4'74qqc4q SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFLELD
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 280
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
--
IDIEZIF•TH= 4 t_..E.EWOTI-1= (3F:FIVE-EL
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
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
TI -ME TIFZIEEF-40/-1 WIEOTH2.3*.O. 01010 FI-EZEET_
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
IREOUIR:EEN T1RF-.IJ< Eci== iLlemaio ciint_A_Gircs
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- TWO <2>
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 15
10 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATICIt
>41F*IP:JES.7 DICIaMELlaIR
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 THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TCI INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:__
APPL I CANSTEV 4
ISSUED BY
GGS CONST
DATE--
39
6 (c
Russell Oyster
694-2774
Performed for:
0 & E ENS. NEERING & DEVELG MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Name- 37.EV,E/V /</% CWS
Mailing Address: /49` 69 e 2° X 1) Cl'/1C) /A/<.,
Legal Description. 'L r /3 /5)66' it/ /27-r>i /ii'
Earl Ellis
688-2280
Tel. No Lfg
x , 9,1"c 7
ra `S'7 //>1J'E
Depth (feet)
0
1 ✓YIL S/LT / P `aoa.,
Soil Characteristics
.-2
3
4
5
6
7
8
—9
10
11
12
13 8:07-7-C, A-1
14
15
16
19Eg C'.. / EST
5M A -7-Y 0,,1 f1 EL L c /-/</E-
5 vto R Nsc
,2 (C?a 4/8,
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by:
PLOT PLAN
Aft) SC4LI
PERC. TEST
gAt "z "1ST D ,- f.C/
_200 /0/6, ,.2
Date'
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 13, BLOCK 1 , NORTHWOODS II
A. GENERAL
1:. The well and septic plan are for a single family residence only.
The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of
Health and State Department Of Environmental Conservation require-~
ments.
4. All soil tests are advisory to the design and are to be verified or
modified in the field by the engineer-.
All excavations and depths are advisory and are to be verified or
modified 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.
S.. It is always recommended that a surveyor locate the nearest lot line
position and the location of any easements.
3
DRAINFIELD
1. The drainfield is to follow the natural land contour to main tai.n
uviform total depth of the trench bottom.
2. The bottom of the drainfield shall be level, plus or minus .1..".
3. The total depth of the drainfield excavation not to exceed 6' at
any point.
G, The sewer :1.i.ne is to invert off of the existing sewer line that leads
to the existing trench, to overflow into the additional leaohfield.
5 The drainfield gravel is to be covered with typar or fabric material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the drainfield.
7 The area over the drainfield is to be finish graded to prevent ponding
of surface .water runoff.
8. The septic tank and leachfield must not be closer than 100' to any
existing private well, 150' to any Class "0" well, or 200 feet to any
community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH = 6' GRAVEL DEPTH = 3,5'
DRAINFIELD LENGTH = 19' DRAINFIELD WIDTH 7 5'
Soil Rating = 175
Bedroom Capacity = 1 additional
Septic Tank Size z 500 additional
** NOTE: THIS IS A ONE (1) BEDROOM UPGRADE.
f f'l fH- < ,314,300'0,
�'z �.��1
5 "UO(3 r�¢�o DD YSO OOOo® �p
Cr. 61'46
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-801-06
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
Expiration Date: S
2
N\Wr
NORTH WOODS '; BLOCK 1, LOT 13
22540 WHISPERING BIRCH CIRCLE, CHUGIAK, AK, 99567
SCOTT GRIFFITH Day phone 688-0420
22540 WHISPERING BIRCH CIRCLE, CHUGIAK, AK, 99567
CHRISTINA CARLSON W/ HERRINGTON & CO Day phone 433-9935
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
W aiverNariance request for:
N/A
■
TTI
L)CI 0 9 2014
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
•
n
Distance:
Received by: f .
COSA to be releas to the enginebr, Weiss otherwise requested by the engineer.
Date: i°49/1
COSA Fee $ 526
Date of Payment Eo�a IN cr.
Receipt Number 2)g -X)
COSA # osC ALN t 5201
awY.e.L
Waiver Fee $
Date of Payment
Receipt Number
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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations The reported results described the performance of the
system under the conditions encountered at the time of the fest, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal fight whatsoever
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
/
r•
•
• -ch .. ,%I C 953
i
d.
Date 9 i tt/r`9-
r
0.
ill n 14grH14rW .�
bedrooms, with the following stipulations
K\y OF
q r`
0N -SITE sot
WATER AND t_
hlaSTWA ER
Eo'
"FRO
OR PRDC'Ra
.V ``1411 (F`
By:
Original Certificate Date: / D
The Wheal lfalify or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
rgcv 1nprwm
Nitrate Advisory
Arsenic Advisory I [#
Other Xd ErV/ Pt_
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: NORTH WOODS S/D #2; BLOCK 1, LOT 13 Parcel ID: 051-801-06
A. WELL DATA PUBLIC WATER
Well type If A, B, or C provide PWSID# _ Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N
Total depth ft. Cased to ft Casing height (abo - •round) in.
FROM WELL LOG AT I CTION
Date of test
Static water level ft. ft.
Well production g p m g.p.m.
WATER SAMPLE RES
Coliform colonies/100 ml. Nitrate mg./L. Collected by
enic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA
*INSIDE HOUSE. SEE ATTACHED.
SEPTIC/STEEL
Tank Type/Material SEPTIC/STEEL Date installed
1000 2
Tank size 500 gal Number of Compartments 1 Cleanouts (Y/N) YES
Foundation cleanout ( /N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
a� ry
Date of pumping 2 B / Pumper SANITARY PUMPERS
12/15/1982
9/1987
C. ABSORPTION FIELD DATA
12/15/1982
Date installed 9/1987
'BELOW EXISTING GRADE
280
Soil rating (g.p.d./ft2orbdrm 175
System type TRENCH/TRENCH
Length 75/20 ft Width 3/5 ft. Gravel below pipe 7/3.5 ft.
*10.4 1008
Total depth "5.9 ft. Eff. absorption area 175 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **8/22/2014 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 62 in. Water added 670 gal.
For 4 bedrooms
New depth 74 in.
Elapsed Time: 120 min. Final fluid depth66 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
**TESTED 1982 TRENCH ONLY. 1987 TRENCH WAS DRY UPON INSPECTION. NOTE: SUMP FOR 1982 TRENCH
ONLY EXTENDS 59" INTO 84" EFFECTIVE. TOTAL DEPTH AND LIQUID LEVELS ARE CALCULATED ABSOLUTE
LEVELS BASED UPON THE INVERT OF THE DRAINPIPE. SOIL COVER OVER INVERT IS APPROXIMATELY 3.42'.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at . wa er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATER
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
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation *5' APPROXIMATE Property line 5'+ Absorption field 51+
Water main
10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 101+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*EXACT DISTANCE UNKNOWN. ST1 TO FOUNDATION IS T 2". SEE ATTACHED LETTER.
NOTE: SEPTIC TANKS ( INSTALLED IN 1982 & 1987) ARE LIKELY APPROACHING THE END OF THEIR USABLE LIFE.
G. ENGINEER'S CERTIFICATION
1 certify that f have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
(Rev. 10)12/12)
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
August 25, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
REFERENCE: North Woods S/D #2; Block 1, Lot 13: Advisory on Tank Configuration.
To whom it may concern,
The septic system on the aforementioned lot consists of a two septic tanks and two separate drainfields.
The 1982 septic tank, which is closest to the foundation, appears to be very close to the 5' required
separation to the foundation. According to our field measurements, the closest cleanout standpipe is 7' 2"
from the edge of pipe to the siding over the foundation. It is impossible to confirm the exact distance from
the tank to the foundation without excavation.
GEG Advisory: The tank in question is, at this time, 32 years old. It is likely that the next homeowner will
be responsible for replacing the tank in the next 5-10 years. Due to the close proximity to the foundation,
the buyer of this property should be advised that:
• The abandoning of this existing tank and the installation of a new tank may require special
construction measures to protect the integrity of the foundation and the safety of the workers
performing the installation.
• The new tank will need to be moved far enough away from the foundation such that it meets MOA
code and provides for ease of access and repair in the future.
If you have any questions, please contact us at 337-6179.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
14
7'
' o
12
UNDER NO CIRCUMSTANCES S*ULD AN M-BuligT E uSED
THE SURVEYOR TAKES FIF-SPONSIDLYN FOR THg iNittAL, TRAtusAcTioN
UnID OISTNICES PREVAIL OVER SCALING,
LOT SURVEY SUR Y TWE
enuNbArroPi As-slav
ANAL 311TUG11IRE AS—BUILT
TQF4AWY
FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY CR FENCE USES.
ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR WE COST OF THE SURVEY
REPRODUCI1ON MAY CAUSE ERRORS IN SCALE,
PLOT PLANS & CofsuRvEyg
IT tS 71 -IE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION* TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICIIONS
WHICH DO NOT APPEAR ON THE RECORDED SUROogSION PLAT.
SURVEY EERTWICATION
PLOT PLAN
umgdfugogja AnnIsYs114YemiRtn.,T11
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or !ham so ine pren atone 610 Nat my
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ONLY THOSE tMPROVSMENTS AReare OROUND AND VISIBLE WILL De
sMoVAi. FENCE, WELLS, SEPTIC SLEANCHITE, SIDWALKS DRIvEWATS.
EEO* ARE SHOWN IN THER APPROXIMATE LosA-noN. ONLY, SNOW
MAY PREVENT SOME zMAROVENIENTS FROM BEING BEEN AND 10CA1ZO.
ALL DISTANCES DFAg ROPtC/ UNLESS oll-1EPwisB NOTED
Prepared • y
Robert E. Johns, Jr. & Assoc.
PU0'16351011E11 Land Surveyors
1700 kink OrIvr*
AND'S:RACE, ALASKA 99004
Scale
Data altmly19451
Data DEAVE14
Legal a
1" = 50'
08/15/14
08/15/14
Rea Lot S.F.
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14-380
Lot 13 Block 1
NORTH WOODS PHASE 2
Municipality of Anchorage
P.O Box 196550 4700 Elmore Road
Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997
httn://www.muni.oraionsite
Planning and Development Services Department
On -Site Water and Wastewater Program
On -Site Sewer/Well Submittal Comment Sheet
Engineer: GARNESS ENGINEERING GROUP LTD
_egal Description: NORTH WOODS PHASE 2 BLK 1 LT 13
10/14/2014
'ermit: OSC141537 Septic Completed By: J.Poet
2eport Type: COSA
-he attached paperwork has been reviewed and is being returned for the following reasons:
Sanitary Pumpers Invoice states: Dirt and Rocks in Tank Holes in Tank.
Also stated: There no Depression over the Tank.
Was tank level normal at time of adequacy test?
ti vOt 1>l,,ri,l t'S t
SANITARY PUMPERS
20627 UPPER BOWERY LANE
CHUGIAK, AK 99567
907-688-4602
CUSTOMER'S ORDER NO.
PHONE(j
DATk / la // y.
1 j
NAME
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RECEIVED SY
TOTAL
1406.6
All claims and returned goods
MUST be accompanied b t
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09/04/2014 03:12 FAX 19072762631
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ONE STOP SERVICES
7654 Old Harbor Ave
Anchorage, AK 99504-1930
Off907-338-5563
Fax 907-338-5564
v re'
degg-
Scott Griffith
22540 Whispering Birch Cir
Chugiak, AK 99567
Invoice
Date
Invoice #
8/26/2014
13194
P.O. No.
Terms
Item
Quantity
Description
Rate
Amount
Camera
1
Camera sewer line from house clean out in utility closet to verify
good sewer access to tank. Video to verify direct access 11.5 feet
from clean out. Functional as foundation clean out.
300.00
300.00
Thank you for your business.
Total $300.00
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I D # 051-801-06
1. GENERAL INFORMATION
Complete legal description
HAA# s// f,36l73
Northwoods #2, Lot 13, Block 1
Location (site address or directions)
22540 Whispering Birch Circle, Chugiak
Property owner Lawrence & Theresa Caroselli Day phone 688-1022
Mailing address 217 Whispering Birch Circle, Chugiak, AK 99567
Lending agency Lynn/City Mortgage Day phone 696-0701
Mailing address 11401 Old Glenn Hwy.. Eagle River. AK 99577
Agent N/`a' Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
x
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
x
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 Eagle River Engineering Services Phone 694-5195
Address
P.O:. Box 773294, Eagle River, AK 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for bedrooms.
( Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By
Date
.e4::•/:,.
::/ OF
A.
nit
R .n rr •.1
bfJ. ^
e _ n
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gggr* 9 q � ! ( +,+,ck ms's$ �.
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® J,.®CE-15736 ��'
Q T " .'46 4
Q�PROFESS\0• '9 `dam
®R0^a'4aa0,01'.
Additional Comments
Date
CAUTION 'k 99;.
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 St ..e 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) Beck MOA 921
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /1/v47.814)00,05 2. A21'3 084.-/ Parcel I D D5/- VOI -0(.
A. WELL DATA
Well type /wBL/e--*
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG AT I = ECTION
SEPARATION DISTANCES FROM WELL T
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
9P
O a
g,
n oT
w
; Onadjacent lots
On adjacent lots
Z
Public sewer manhole/cleanout
Petroleum tank
WATER SAM E RESULTS:
Coliforr• Nitrate Other bacteria
D. e of sample: Collected by
B. SEPTIC/NO4DING TANK DATA 500//000
Date installed /9ri/ / 9t2 Tank size 500 // 000 Compartments
we Ref. ,, //
Cleanouts (Y/N) YeS Foundation cleanout (Y/N) Al ...,41...4/V
Depression (Y/N) O
High water alarm (Y/N) N/4 Alarm tested (Y/N) /t//A
/2 -
Date
Date of pumping 0 9/0 %/ 3 Pumper J/Z
SEPARATION DISTANCES FROM SEPTIC/H6tDtNG TANK TO:
Well(s) on lot A/11/ On adjacent lots 2-00Foundation
5/
To property line
P10'
i
Absorption field ' O Water main/service line f�D /
Surface water/drainage /1/40
72-026 (Rev. 7/91) Front
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons Man/Access (Y/N)
Vent (Y/N) "Pump o "level at f "Pump off" level at
High water alarm level �.� Cycles tested
Manufactur-
1
Meets MOA electrical codea..(N)
SEPARATION D+S`7ANCE FROM LIFT STATION TO:
Well orr (ot On adjacent lots
D. ABSORPTION FIELD DATA /6,e / 3 e<
Surface water
Date installed /Yi/1 / /9 �Z Soil rating /75 97 Z go g' System type j�,eNFU_/7 Ne#
g / / 3 /�, p ,/ c) ,
Length ZU % 5 Width 5� Gravel thickness 5Total depth 5
Total absorption area X75 37t/ mD8 y6:5 / y6.5
Cleanouts present (Y/N)
Depression over field (Y/N) NO Date of adequacy test G79/O0_5
Results (pass/fail) P4S 5 for 4
Peroxide treatment (past 12 months) (Y/N)
N/A
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /-//i4 On adjacent lots f 2v0
To building foundation 7L yt2 v
i
On adjacent lots t 30 Cutbank
Surface water N/A
Curtain drain NNt ARA le /j
E. ENGINEER'S CERTIFICATION
If yes, give date
bedrooms
Property line f /0 /
To existing or abandoned system on lot /4/ /
/1/4 Water main/service line 71/0
/
Driveway, parking/vehicle storage area / /U
1 certify that I have checked, verified, or conformed to all MOA and
Signature—��"`�`'
Engineer's Name
Date y/��5 7
HAA guidelines in e.,ff,�,a n,t ,date of this inspection.
F ,4 ,1&1
a tr*�,aT;..
OF
a o aa0 gs
a
rQ c� ?nq� .p�
.deet>(� � �, ;74e
rig
go. ea oe i as aesoeir.
A ., , Loafs A. f.)utera . tc6$
Q® �� aaa Cr: -6736 a Ga40
t01®®�v0FESS 4
HAA Fee $ / 70 ' (DO
Date of Payment
Receipt Number 2 / ?O ( 7 7.7%)
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee' $
Date of Payment
Receipt Number
1.
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(
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
LOT 13, BLOCK 1, NORTHWOODS #2, T15N, R1W, SECTION 4
Location (address or directions)
P± 1't RS CREEK, WHISPERING BIRCH CIRCLE
(b) Applicant Name PETIE STRANG
h!l'i-rfl Il
(PILL' Wing )
am( ,cam lc/ 8r1
Telephone: Home NA Business
Applicant Address 501 W. NORTHERN LIGHTS, ANCHORAGE AK 99503
279-7611
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer 0 ; Other OK (explain);
REALTOR
(d) Lending Institution AK. PACIFIC BANK
Telephone 561-5002 ATTN: LORIE HOLTE
Address P.O. BOX 100420, ANCHORAGE, AK 99710 ATPN: MORTGAGE DEPARTMENT
(e) Real Estate Company and Agent DYNAMTC REALTY
(f)
Address 501 W. NORTHERN T,TGHTS, ANCHORAGE AK 99503
Telephone 279-7611 ATVN: PF"PTR STRANG
Mail the HAA to the following address:
HOT,T) FOR PICKUP EY RAGT,R RIVER ENGTNRRRTNG SERVICE
2. TYPE OF RESIDENCE
Single-FamilyU Multi -Family 0 Other
Number of Bedrooms 4
3. WATER SUPPLY
Individual Well O. Communitygi Public 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ✓`p' ` e' 4-6" ";"- /ic,- /n re -H i SA" 2.
4. SEWAGE DISPOSAL
Onsite a Public 0 Community 0
Holding Tank 0
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
5. ENGINEERING FIRM PROVIDIN( .SPECTIONS, TESTS, FILE SEARCH, DA\ND 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. *• FOR THE (1) ONE BEDROOM UPGRADE. REFERENCE PRIOR, HEALTH APPROVAL
ISSUED AUGUST 19R8'7� FOR EXISTING SEPTIC SYSTEM INSPECTED BY TOBBEN SPURKLAND, ENGINEER.
Name of Firm RAGT, . TVER RNGINFFRTNG SRRVTCES Telephone 94-5195
Address P.O ROX 773294, FAGT R RTVRR, AK 99577
Date
J 8'
6. DHEP APPROVAL
Approved for bedrooms by
Approved Disapproved
Terms of Conditional Approval
.e°°oy
go Ci..,P
10.A. e m esease m..2�
p , "��-• . 00 *see above note
�.-...." 4' d Engineer's Seal
f �Y Louis A. Butera %� 04
0� J, °.o CE -6736 ��®
4����•& ES 3P4
Date
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues 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 DH EP 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
DEPT. OF HEALTH &
ENVIRONMENTAL PROTEITION
SEP 31987
RECEIVED
A. WELL DATA AA
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
n
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description k� 1
)-jsn)
aa. 1 , kbo44iBods z
W 1 s EG -no ki
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Cased to Depth of Grouting
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA rdG 5 ' " Hf
Date Installed /96.
Size -6 eo j4f, No of Compartments
Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N)
Date Last Pumped Nek/
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Ala (Y/N)
N,
Alarm
Y/N
;for
Temporary Holding Tank Permit (Y/N) �'�
Separation Distances from Septic/Holding Tank:
To Water -Supply Well �d To Building Foundation /
To Property Line f w / To Disposal Field "
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course /'1.
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata %S ��� Type of System Design 6 /G''
Date Installed /5,F-7 Length of Field '6 /
Width of Field Depth of Field S
Square Feet of Absorption Area
Gravel Bed Thickness
Depression over Field (Y/N)
Results of Last Adequacy Test
Standpipes Present (Y/N) i
Date of Last Adequacy Test /Ye''
Separation Distance from Absorption Field:
4cUD
To Water -Supply Well
To Building Foundation
Lot /9
tie '
To Property Line 7S
To Existing or Abandoned System on
• On Adjoining Lots 1.- 7,7
To Water Main/Service Line fr/e)
To Stream/Pond/Lake/or Major Drainage Course 1.1XX5
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutbank (if present) "f4
7L/o/
D. LIFT STATION fig
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
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 Date
Company � MOA No .S%
Receipt No.
I C- X7
Date of Payment
Amount: $ is c2 cr — -
P L INP6'J i3v id g 10- a
PV (OAS d J q 7
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
p�f olo(a
kl2-i-LCLi/I
Application Date
1. -GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
LoT /3, 13k) Noerki ce.)1) #/ 2
Location (address or directions)
.21"7 LV-" P[riw� `�3ire 4 eire-le
Property Owner l-retuJLes o Telephone: Home
7u Dy in :2 e.c lF
Mailing Address
Lending Institution
Business
K-ey ?A4;,c_
Mailing Address 10 .1A
Real Estate Company and Agent
Address
Telephone
Telephone
P
D.
A7?- 1t '1
(e) Mail the HAA to the following address: or: Check here
List contact person and day phone number below.
if hold for pick up.
,A7q - ayr.,
2. TYPE OF RESIDENCE
Single -Family
Number of Bedrooms
3
3. WATER SUPPLY
Individual Well Community 0 Public 0
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 0 Community 0 Holding Tank 0
No : If community 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 (Rev 8/861 Front
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 wit all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Address
Date
go 75
Telephone
/S—>46
g1R-39/
6. DHHS APPROVAL
>t 9 e-7
�'••• "° ,Engineer's Seal
0 • • ............
r,
•i'
Approved for 71-%" r `3) bedrooms by Date
Approved ' ` Disapproved Conditional
Terms of Conditional Approval
2�
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CAUTION
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
engineers work.
Page 2 of 2
72-025 (Rev 80361 Back
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: LOT / 3, ag.1,
No 2-Thfu oor, rt 2..
A. WELL DATA
Well Classification c/A9S A If A, B, C, D.E.C. Approved (Y/N)
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 Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date
Water Sample Test Results
Comments T.uf/S ! a*4 to 3a f
B. SEPTIC/HOLDING TANK DATA
Date Installed Rita to Size 1O No. of Compartments 7iWv
Standpipes (Y/N) T 11b0 Air -tight Caps (Y/N) ¥
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Date Last Pumped
;for
Holding Tank High -Water Alarm (Y/N) "44 Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
2vC)
To Water -Supply Well
To Property Line
]II
To Building Foundation
To Disposal Field
Iv/At
Tc, Water-Min/Service Line > / a To Stream, Pond, Lake, or Major Drainage
Course NO NE -
Comments EComments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata .28O Type of System Design / 'e'rr1 -frt
r
Date Installed 2 Z Length of Field 76
Width of Field 36 " Depth of Field
Gravel Bed Thickness 7
Square Feet of Absorption Area / 00 f3 Standpipes Present (Y/N) Orl/if
Depression over Field (Y/N) N Date of LLaast Adequacy Test 8/7/8 7
Results of Last Adequacy Test a__ 5 /( 7 �7 ►'V'
Separation Distance from Absorption Field:
To Water -Supply Well
To Building Foundation
To Property Line
>,b
To Existing or Abandoned System on
Lot A/O N C� ; On Adjoining Lots > =s 0
To Water Main/Service Line >/Q To Cutbank (if present) NO/V�
To Stream/Pond/Lake/or Major Drainage Course t%/0
To Driveway, Parking Area, or Vehicle Storage Area /J f
Comments
D. LIFT STATION No W
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that Ihave checked, verifieor conformed to all jv1O,A and HAA guidelines in effect on the date of this inspection.
Signed
Company
Date 1 -?l F7
MOA No
Receipt No. CO CO / --OC) / T
lQ a E OF Ai
Date of Payment ..,_�.•• .
Amount: $ /00
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
AUG 1 0 1987
RECEIVED
*: 44T --t , • .. iy
Engineer's Seal
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE: T"-/0-2-'
PWS I.D.# 2/36'`i
STEVE COWPER, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern:
According to records on file in this office the N oi-7hv'°-tr ,
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
TOI3L3gA LRL
CONSULTING ENGINEER
^`203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL: LOT 13, BLOCK 1, NORTHWOOD #2
LOCATION: 217 WHISPERING BIRCH CIRCLE
OWNER: TRAVELERS. RELOCATION
RESIDENCE: SINGLE FAMILY, THREE BEDROOMS
WELL: CLASS A, COMMUNITY SYSTEM
SEPTIC SYSTEM:
FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1000 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 1008 SQ. FT.
SOIL RATING: 280
INSTALLATION DATE: DECEMBER 1982
DATE OF PUMPING: AUGUST 6, 1987. JR'S CESSPOOL PUMPING
DATE OF TEST: AUGUST 7, 1987
TEST PROCEDURE: S L 'RCTFI A'• ANK WAS FOUND A
WITH LESS THAN ONE FOOT OF COVER. _AND WITH 49 /
INCHES OF LIQU . TREAD ON STANDPIPE. TOTAL DEPTH WAS 8
FEET. NO WATER IN SUMP. 600 GALLONS OF CLEAN WATER WAS ADDED TO
THE SUMP. NO RETAINAGE OF WATER WAS OBSERVED.
TEST RESULT:
THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
1
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 April 22, 1986
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 13; Block 1; Northwoods #2
Location (address or directions)
217 Whispering Birch
(b) Applicant Name J. A. Stanley, Jr. Telephone: Home 688-3083 Business 694-6670 (wife)
Applicant Address SR 3, Box 217, Chugiak, Alaska 99567
(c) Applicant is (check one): Lending Institution 0 ; Owner/builder I; Buyer 0 ; Other 0 (explain);
(d) Lending Institution City Mortgage Telephone
Address P.O. Box 2117, Eagle River, Alaska 99577
(e) Real Estate Company and Agent none/refinance
Address
TelephoneHH
age HAA to the following address:
S & S Engineering
(f)
SRB 196X
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family 01 Multi -Family 0 Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well 0 Community ® Public 0 Chugiak Community Water
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
OnsitefLI Public 0 Community 0 Holding Tank 0
Note: If community 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)
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 ti inspe n.
5 & S ENGINEERING Telephone
Name of Firm
SR 6 196X
Address SLE -RIVER, AK 995// APR 2 7 1986
Date
6. DHEP APPROVAL
Approved for bedrooms by
1117 "
Ste"
{TrF{b, F.
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e• IW. 7447-$ ��
Os!f�fkba`lfdFlRfda
fit • "."r;4
• ee n
: �.t/.,
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A AUF'''r,n w..
ate
Approved Disapproved Conditional 61
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues 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 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
A. WELL DATA
n
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Well Classification VLAS3 L- I G..
Legal Description'
l/3
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR 2 81986
RECEIVED
If A, 6, C, D.E.C. Approved 61/,141 -
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 Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
47
To Septic/Holding Tank on Lot Z °" t ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line To Nearest Public Sewer
I ` ; On Adjoining Lots
Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by ; Date
Water Sample Test Results
"P vv s 1D°'"
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed a"/J a Size /0 4,71/4- No. of Compartments Z'
Standpipesa'X - Air -tight Caps/,PI•)"' Foundation Cleanout
Depression over Tank era
Pumping/Maintenance Contract on File (Y/N)
Date Last Pumped ` 2' �G
;for
Holding Tank High -Water Alarm (Y/N) " Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well Zvi I r To Building Foundation 7/
To Property Line LO "" S' To Disposal Field %
To Water Main/.Eerriee Line , , .
Course
Comments
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
zga 91/3.
Type of System Design `/`�/ie•fc
Date Installed aZ -/5 0 Z Length of Field
Width of Field 36,1' Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area `ooh r6 Standpipes Presen
Depression over Field Kt//
Results of Last Adequacy Test
Separation Distance from Absorption Field:
7'
44)
Date of Last Adequacy Test
Si+ -7 iJ F' TZ)Z fs
'4/- z 7-4'4
To Water -Supply WelZG
l Z) To Property Line Go �°-
To Building Foundation 32- 1
Lot ; On Adjoining Lots
To Existing or Abandoned System on
To Water Main/Serviee Line v To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
go !V --
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for /17 Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) A
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certifglitihaveLLier d,rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signet a B 196X IVVGG Date
Oomph MOA No
r
Receipt No S‘ a3(.0
Date of Payment
Amount. $
Page 2 of 2
72-026 (11/84)
q-5-- c3
APR 2 71986
rs,,.6
sigma A. Shafer
% No. 1457.E ,••
•A ••
STELE Dr MIAVAY\
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE:
PWS I.D.# c7 /&
/9 7q '6
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern: n s
Accordiinng to records
Water Regulations
Water System is in compliance with the State Drinking
Sincerely,
Michael P. Lewis
Environmental Engineer
•
APPLIfNT FILLS OUT UPPER HAn ONLY
POwner -------
t---`
\ C.� -
,..,�
i - c_ 1 _ S
0.t f�� Zip CodeG1j "%
(
Phone
G-,�(k' ��o S
V
� Y"-
Mailing Address PCj c?-.0K. ` i 5;-,
Buyer 4/ y +
Address
t /
Zip Code
Lending Institution--
IC.. , wl L k" c..a L ..il >=
Address
'�.
Phone
- 7
C:61
(j 1� C:6S ! i
< F ___
Zip Code
Realty Co. & Agent ( ,._Phone
Address 20&-..,c--
Field Notes: MUNICIPALITY OF ANCHORACit
DFPT. or ;',__:..i.T1l R,
ENVIRJId1',`..zh,A_ I..O,ELTION
is ;:141982
RECEIVED
Phone
U4 4 z D
V- :
L.,.1,EL- A‘...,(
Zip Code 1 ��I(�%7
t
Legal Description 1 j �/-a' x y,,,�_t@ .^.��
Street Location 1 _ (( l�1 Tl/t (C (P4
..�
I t..
Date Sewer Installed
i —i, r— 8 L
Type of Residence
Mir Single Family
Multiple Family No.
E Other
of Bedrooms 3
Septic Tank Size e,f4--fit
Water Supply
❑Individual
sigCommunity
Public Utility
ATTACH WELL LOG. A well log Is required for all wells drilled since. June1975.
For wells drilled priorto that date, give well depth (attach log if available).
Sewe Disposal
'Individual 1lQQ 01LL-, / v.�-t I-12_o I p /a- i 4-1-q `.a
E Public Utility(
0 Holding Tank S n )T i) 7 LL
- 1
Year Individual Installed' 2
When Connected to Public Utility
NOTE: THE INSPECTION .FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
na-5\A•\Ar"0
Date
Date
Date
Date y� r�
\�-1.-C�c�.-9: 11. 4 o n
Inspector -
Inspector
Inspector
Inspector
21- .
Field Notes: MUNICIPALITY OF ANCHORACit
DFPT. or ;',__:..i.T1l R,
ENVIRJId1',`..zh,A_ I..O,ELTION
is ;:141982
RECEIVED
(_j ) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE (?--I �' 1-
'CONDITIONS OF APPROVAL
BY: 9.--4/
Soils Rating
Date Sewer Installed
i —i, r— 8 L
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size e,f4--fit
72-023 (3182)
