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HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 2 LT 2Northwoods
#i
Block 2
Lot 2
#051-741-31
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number OSP151335 PID Number: 051-741-31
Dwelling: [' Single Family (SF) [' Duplex(D) ❑ Multiple(SF and/or D) Project: Q New ❑■ Upgrade
Name:
John West ABSORPTION FIELD Existing
Address
❑ Deep Trench El Shallow Trench CI Bed [' Mound
22245 Whispering Birch Dr. Chugiak, AK 99567 ❑■ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
301-4277 Three GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
North Woods #2 2 2 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line Ft2 Ft.
Well >100' NA >100' N/A >25' TANK ❑Septic ©S.T.E.P. 0 Holding 0 Other
Manufacturer Capacity
Surface Water >100' NA >100' N/A Anchorage Tank 1,250 Gal.
Material Number of compartments
Lot Line >5' NA >5' N/A Steel Two
- , NA
Foundation >5' NA >5' N/A LIFT STATION
Manufacturer Capacity
Curtain Drain None Noted Anchorage Tank/Orenco 1,250 Gal.
Pump on level at Pump off level at High water alarm at
Remarks
Existing STEP Tank Decommissioned
in Accordance with Municipal Code. 42 in. 38 in. 44 in.
Pump make and model Electrical Inspections performed by
OSH P2005-11 Power, Lighting & Cont.
PIPE MATERIAL House to tank D3034 Tank to D3034
Installer drainfield
Royce Martin Drainfield CO/MT D3034
Inspector W. Roberts BENCH MARK (Assumed elevation) 100.0 ft
Inspeec s 1st 7/21/16 2w7/21/16 Location and description
dataro Orn Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date Z,N'' •' \i'_##
� *' 49TH t .
10 ,'„.MICHAEL E. ANDERSON :',.. ,,,w•
i Jr.. CE-4381 /4-,atet,
I,f�',.!D--9-/7 •.eyv-
41.
Approved ccuuta Date 10/t)0/ 17 �44IPROFESSIO�+���
Inspection Report_9-1-12.doc
Municipality of Anchorage Page 2 of 3
Permit Number: OSP151335 DEVEOPMENT SERVICES DEPARTMENT
/ 4700 Elmore Road Anchorage, AK. 99519-6655-343-7904
PID No. 051-741-31
r
NORTH WOODS NO. 2
t' r BLOCK 2, LOT 2
29,354 S.F.
'....N
NOTE:
Existing STEP Tank Decommissioned
I//:iI
in Accordance with Municipal Code.
/ Tank Only Replaced Under This
�wZ / ,��. \ v\Qr DO Permit.
PV2
r•••• • / 4.,-
Bio \
//
Bedroom \
Home \
FCO
A B \
Nic
-� ` S1 S1 19.8' 25.3'
% MH MH 25.8' 30.6' /
/ ��
1/ ..., --..„.
----, � �� 44.1
. 0
/ Existing Absorption /
Bed Remains in
`S 63. Service. /
'.+000 `MIii. 232 00
,� P.E .•
•• 34• / ,^. .)
Jeff 14 ' 49Th "� `• s = LEGEND
7 E4 i MT — Monitor Tube
MICHAEL E. ANDERSON ?[ i 1 1 1 1 Y 1 1 BUILT ECO — Foundation Clean Out
1,5
••irk,• No. CE-4381 ':tib`. = TH — Test Hole
CO Clean Out
• /0•p/7...." 4, SCALE 1' 40' MH — Mon Hole
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP151335 PID No. 051-741-31
99 5
in
U �Finished
Existing ■IIiie
1.250 Gallon
STEP Tank
94.7
NOTE: Tank Only Replaced Under This Permit.
Existing Absorption Bed Remains in Service.
lowswiiiiitlisi
•t_ OF 4/4
� 49th •r
/"J t
•, MICHAEL E. ANDERSON ; t
PROFILE AS-BUILT •
•.•Kph:.. No. I-4�1 : ``-
No Scale t„ , P� 4p'
Mike Anderson
From: Aaron <plc.chambers@gmail.com>
Sent: Monday, October 9, 2017 2:32 PM
To: andengr@gci.net
Subject: 22245 Whispering Birch Drive
The Orenco system installation at 22245 Whispering Birch Drive has been successfully completed and function tested.
Direct buried wire was used going out to the vault,the pump and floats were connected in the jbox using the water proof
wire nuts provided.
The remote alarm was installed in the laundry room and tested.We reused the existing circuit for powering the
controller and lift pump. If there are any questions please call.
EADE 1831
Aaron M.Chambers
Power, Lighting &Control LLC
13841 Savage Drive
Eagle River,AK 99577
plc.chambers@gmail.com
(907) 242-5211
1
On -Site Water and/or Wastewater System
Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151335
Tax Code Number: 05174131000
Work Type: SepticTank Upgrade
Permit Effective Dates: September 30, 2015 to September 29, 2016
Design Engineer: ANDERSON ENGINEERING
Subdivision: NORTH WOODS PHASE 2
Site Legal Address: NORTH WOODS PHASE 2 BILK 2 LT 2 G:1559
Owner/Address: WEST JOHN H &
PATRICIA JANE PERROZZI 22245 WHISPERING BIRCH DR CHUGIAKAK 995675450
Site Mailing Address: 22245 WHISPERING BIRCH DR, Chugiak Lot Size in Sq Ft: 29354
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
MUNICIPALITY OF
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
/r
V '
ON-SITE SEWERIWELL PEW
Parcell.D. 051-741-31
Property owner(s) John West & Patricia Perrozzi Day phone 301-4277
Mailing address 22245 Whispering Birch Drive Chugiak, AK 99567
Site address Same
Legal description (Sub'd., Block & Lot) North Woods Phase 2, Block 2, Lot 2
Legal description (Township, Range & Section)
Lot Size 29,354 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(M all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank 19Upgrade FXDuplex
(D)
❑
Holding Tank ElRenewal F-1
Multiple Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 3W. ap— Waiver Fees: _
Date of Payment: ql w,45 Date of Payment:
Receipt Number: jF34g4 Receipt Number:
Permit No. 19&0j5Lj&5 Waiver No.
Permit App__- :
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 FAX
September 11, 2015
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2, Block 2, North Woods Subdivision No. 2
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The 1,250 Gallon STEP Tank on Lot 2, Block 2, North Woods Subdivision No. 2 has
failed and must be replaced. We are proposing to replace the tank and lift station with
a new 1,250 -gallon STEP tank to serve the three-bedroom home on the lot. We are
therefore requesting a permit be issued for the construction of a new tank to serve the
home. The attached Site Plan and backup documentation identify the location and
configuration of the existing septic system and the location of the new STEP tank. Also
identified on the plans is the existing water service on the lot. The subdivision is served
by the AWWU water system. No conflicts exist between the water service and septic
system on this lot and those on adjacent lots. The existing tank will disposed in
accordance with Municipal Code. The drainage patterns on the property will be
maintained after construction.
The ground surface on the lot is basically fiat in the area of the new tank. The tank will
be placed near the same location as the existing tank at nearly the same elevation. It
will then be tied in to the existing service line. The tank will be constructed in
conformance with Municipal requirements.
If the tank is constructed in accordance with our design the following statements apply:
The tank, if constructed as designed, will have no adverse impact on the wells in
the area or those to be constructed in the future.
2. The tank, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lot 2, Block 2, North Woods No. 2
September 11, 2015
Page 2 of 2
3. The tank, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The tank, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, RE
Attachments
49th
MICHAEL E. ANDERSON
111
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Municipality of Anchorage Page I or '2 -
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: 5w9wOno PID Number: 06"17 Lf 131
Name:
astewater System: ❑ New O -Upgrade
Jo A. e SUSAN .SK/�uNtrz
Address:
ABSORPTION FIELD
rO
22,245 I.t1rfISPaRWF tRct+ Da.
,phone;
No. of Bedrooms:
Deep Trench ❑ Shallow Trench ❑ Bed 5� Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
O.1' GPD/Sq. . Ft.
/' Z
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
2 Z ORTt{ WOOPS PffASF L
4 - S Ft.
• 5- Ft.
Township:
Range:
Section:
Fill added above original grade:
12--Ft./00
Gravel length:
Ft.
Gravel width:
Number oflines:
Distance between line:
• ❑New ❑Upgrade
WELL •
/ Ft.
3
+5 Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Commy,017-YFt.
Ft.
4 ,500 SO. Ft.
q 7,W D3034 P. Y. C.
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft.
WEED 'EXC-RVAT/N(r
1 $'"27-94
Yield:
Pump Set at:
Casing Height Above Ground:
f�
TANK
GPM
Ft.
- Ft.
SEPARATION
DISTANCES
❑ Sep ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity In gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Material:
r of Compartments:
Well,
2001+
2001 i-
2001 t,
f
25 4 -
Surface
Surface
'
a
LIFT STATION
Water
100 f -F-
100 +
f
100Lot
Size in gallons:
Manufacturer:
I
Line58a
/Q
S�
---
125Q
cHoiZAGc hN
"Pump on" level at:
"Pump off' level at:
High water alarm at:
Foundation
/3
�y a
p /
yZ as
3z as
yN"
Curtain
1
-73, 1
/ _,
*38.
Pump Make & Model
Electrical Inspections performed by:
Drain
3y
al Qb-N//
evs
Remarks+ �11 Ir -1 lam ty
BENCHMARK
Location and Description:
7'0P OF MAN 01-6'
Assumed Elevation:
/00-00
ENGINEER'S SEAL
sly P ,r,
/ 6'9
17034 Eagle River Loop Road, No. 204'
w w
Inspections performed by: Eagile River,Alaska 99577 Dates: lst s-27
2nd s -27 -9ti
m, wQv
A.Wia+51t'gA N rtt....
Department of Heal and H n eryices approval
Reviewed and approved
72-013 (Rev. 9/91) MOA 25
Permit No. SW9401 10 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 e Anchorage, Alaska 99519-6650 *Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
NORTHWOODS SUBDIVISION #2,
Legal DescriptiorpLOCK 2, LOT 2 PID No.: 05174131
1 4
CO2
r MH
1250 GAL
S.VET.
4'
MT1 99.5
If INSULATION
GRADE--.
IMPERMEABBIER FILTER FABRIC_
.......... .......................
1.2' SAND FILTEJ
W -
I SCALE 1" = 40'
3A (1/93) -
C01 26.5 19.0
CO2 30.0 23.5
M.H. 31.0 25.0
MT 52.5. 72.0 -
MT2 49.Q 70.5 -
MT3 52.$ 30.0 -
MT4 56.5 35.0 -
r NEW 1250 GAL. S.T
.5'
BARRIER I
ENGINEER'S SEAL
4"
U,
W
&
14SY-9
VALDEZ, ALASKA 99606
WORK ORDER
�O'J'j ela'ic' inc,
CONTRACTING
3138 COMMERCIAL DR.& JIM No. 4303
ANCHORAGE, AK. 99501
PHONE 212-4591
Quantity
DESCRIPTION
Price
Amount
q
H S N v
I
rt
-12
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW940110 DATE ISSUED: 5/03/94
DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 5/03/95
OWNER NAME:SKINNER JOE A & SUSAN
OWNER ADDRESS:22245 WHISPERING BIRCH DR
CHUGIAK, AK 99567
PARCEL ID:05174131
LEGAL DESCRIPTION: NORTH WOODS PHASE II BLK 2 L
T 2
LOT SIZE: 29354 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
F�7mIoo�-11m 101MCO 00Nl Ps
RECEIVED
ISSUED BY:
BY: e DATE:
DATE:
April 28, 1994
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 'L' Street
P.O. Box 196650
SEWER &WATER
Anchorage, Alaska 99519-6650
MAIN EXTENSIONS
REFERENCE: Northwoods Subdivision; Lot 2; Block 2
SEWER &WATER
INSPECTION
Request you expedite issuance of a permit to upgrade the septic system
serving the three bedroom house on the referenced property. THE
ENGINEERING STUDIES
AND REPORTS
EXISTING SYSTEM IS IN A STATE OF FAILURE AND CAUSING UNSANITARY
CONDITIONS.
During an inspection of the existing septic system, effluent was found
WELL INSPECTION
to be surfacing in the area of the leachfield, therefore we request
&FLOW TEST
that you expedite issuance of this permit.
A test hole was excavated and a percolation test performed in the area
of the proposed upgrade. The approximate location of the test hole is
SITE PLANS
located on the attached site plan. At the time of excavation water was
encountered at 6 feet and after seven day ground water monitoring water
was found at 4 feet. Attached is the proposed upgrade design.
ROAD DESIGN
This property is served by a Community Water System. There are no
protective well radii which encroach upon the property. We do not
anticipate any adverse effects on neighboring properties by the
installation of the proposed septic system.
SOILTEST
If you have any questions, or require additional information for your
review, pl se contact us.
PERCOLATION
Sin rely,
TEST
STRUCTURAL& t A. Shafer, P.E.
MECHANICAL
INSPECTIONS 6SZLSU/jk
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
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ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
R1?R'p32F.NCE: Northwoods Subdivision; Lot 2; Block 2
GENERAL:
1. The scope of this project includes the installation of a 1250 gallon
septic tank effluent pumping (S.T.E.P.) system and two five foot wide
pressurized distribution drainfields to serve the existing three bedroom
residence on the referenced property. The existing 1000 gallon septic
tank is to be excavated, pumped, crushed, and abandoned in place. Also
the existing leachfield trench is to be abandoned in place.
2. Construction shall be in accordance with the approved site plan and
design drawings, Municipal permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater Disposal
Regulations.
3. The contractor shall be responsible for obtaining any necessary
underground utility locates.
4. Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling. On all leachfield mound systems, the property owner shall be
responsible for ensuring a satisfactory vegetation growth over the
mounded area.
5. Contractors installing wastewater disposal systems must be certified by
the Municipal Health Department for system installations. Owners
installing their own systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
2. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
4. Septic tanks installed with less than 4' of cover shall be insulated.
Page Two
Northwoods Subdivision; Lot 2; Block 2
April 28, 1994
5. A foundation cleanout shall be installed one to four feet from the
building foundation. In the line between the tank and the leachfield
there shall be two adjacent cleanouts (unless an effluent pumping system
exists within the septic tank). These cleanouts shall be located on
undisturbed soil not more than 10' from the tank. The first cleanout,
in line, shall be to clean toward the leachfield. The second cleanout
shall be to clean toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope
exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the
sidewalls of the excavation become smeared, they must be raked or
scratched (roughed -up) before gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to be installed
level with the perforations faced downward. Gravel is then to be placed
over the distribution pipe to provide a minimum of 2 inches of cover
over the pipe.
3. A silt barrier must be installed between the final gravel layer and the
native soil backfill. Ensure the silt barrier covers the entire gravel
surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter and installed
approximately in the locations shown on the design. The portion of the
monitoring tube extending through the gravel shall be perforated from
the bottom of the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as noted on the
design.
5. Backfill over the final gravel layer must not be less than twenty-four
(24) inches. Insulation must be installed when the backfill depth is
less than thirty-six (36) inches. The finish grade over the trench must
be mounded to prevent the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation must be constructed by a
Municipally approved septic tank manufacturer.
Page Three
Northwoods Subdivision; Lot 2; Block 2
April 28, 1994
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Type of Pipe
Perforated
Solid
Cast Iron
Yes
Yes
ASTM D3034 (PVC)
Yes
Yes
ASTM F810 (HDPE)
Yes
No
ASTM D2662 (ABS)
Yes
Yes
Use of a type of pipe other than listed above must be approved by the
inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal)
must be installed between the final leachfield gravel layer and the
native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel
with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C. requirements.
Typically there will be a minimum of three (3) inspections required during the
installation of the wastewater disposal system. These inspections will occur as
follows:
1. The first inspection must be conducted after the excavation of ditches,
pits, trenches, or beds and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled before this
inspection.
2. The second inspection must be conducted after the placement of the silt
barrier, gravel, distribution lines, standpipes, cleanouts, and
insulation, but before the placement of any other backfill.
Page Four
McCabe Subdivision West: Lot 5
April 26, 1994
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution
systems, etc. Thus, the inspecting engineer is to be contacted at least 24
hours prior to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in
these specifications and plans and in accordance with the attached M.O.A.
permit. There will be no contractual arrangement existing between the
contractor and S & S Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to document the
contractor's activities. Final acceptance of the contractor's work rests with
the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or
omissions of the contractor or any other persons performing work on this project
or the failure of the contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer will not be
responsible for the construction means, methods, techniques, sequence,
procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
(ENGINEER'S SEAL)
4 Y
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST r
PERFORMED FOR: �Oi-- Sl�lo�aS-�- DATE PERF
LEGAL DESCRIPTION:,�-f g2' / o9z Jorz. YO Township, Range, Section:
SLOPE SITE PLAN
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS TI
&A/l — R--Uou)N MOtb7 511-7Y
rz'�o.
5,C,7 y BAJO
iv Src.7,
t 1 WAS GROUND WATER—
T ENCOUNTERED?
S
IF YES, AT WHAT L
O
DEPTH? P
E
Depth to Water After �1 ( I y
Monitoring? —! Date:
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
�! 9
75 t/L
1/4,i
)�1
1
PERCOLATION RATE 3'� (minutes/inch) PERC HOLE DIAMETER 6 „
TEST RUN BETWEEN 3 FTA --Lj— FT
V034 Eagle River Loop Road NO - ;9
PERFORMED B
Emla a River, Alaska 9"77
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI
72-008 (Rev. 4/85)
/ E IFY THAT THIS TEST WAS PERFORMED IN
IN EFI CT ON THIS DATE. DATE:
_1\ .
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME / /� /
/�. f��L G /
PHONE GNEW
Ci%�Zf J
❑ UPGRADE
MAILING ADDRES /
//2 Qe °7
LEGAL DESCRIPTION
LOCATION /
0ec Al
NO. OF BEDROOMS
/
U y
DISTANCE TO:
WellN
le:Z_A � j'
Ab on area
J
Dwelling
/(�
PER T (�
w Q
Manufacturer G�— ��. l /, h
iv
p� %
/
No, of compart ents
HF
Liq. capacity gallons
�JGJ 'i.J
IF HOMEMADE:
Inside length
Width
Liquid depth
Y
J0Z
DISTANCE TO:
Well _
Dwell i
PERMIT NO.
_ F
Manufacturer
Material
Liquid capacity in gallons
W
DISTANCE TO:
IN�jI, �� n
(9 [� /'7
Foun
Neares I;line�
Ci/ T
PEIT 2
•.J
J LL
No. of lines /
Length ofpoel} ling
Total le .oi lines
Trench 'dfq !i
Distance be ee lir}6l:
Q
Coo
CJ
CJ inches
/7
To of vile to finish rade
%✓t-�
Werial bend tll.etile //
Total effec 've absorption area
517
p
/� 4 7^� G1
Z -ZX .�� � inches
Length
Width
Depth
PERMIT NO.
W
0
a a
W
Type of crib
Crib diameter
Crib depth
Total effective absorption area
LU
DISTANCE TO:
Well
Building foundation `
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
s
PIPE MATERIALS
SOIL TEST RAVNG
INSTALLS F3,
s
y-
ze X ,
REMARKS
h.
l� �1����✓�te 70 �� re, .NIA
.a.�attll
.. CIF Al
INS
A
�OFESSI.
'°
t7
_ v
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APPROVED �„> q�g I �� Ilii DATE EGAL "
72-013 (Rev. 3/78) S 7 x — / / 7-
r_TAA
r-1 uwa l r x F--i 41 x -r te IDP
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L_STREET., ANCHORAGE, AK 99,501
264-4720
rte,r4— ; _ -r F= -_sEt4r=F;z F::,-F Fri _ -r
PERMIT NO: 840305 ENGINEERED DESIGN
CRATE ISSUED: 05r'07/84
AFPLIdANT: LIFESTYLE IND
ADDRESS: SRA 1452T
ANCHORAGE, AFS; 99507
LEGAL DESCR I P : - SUBDIVISION: NORTHWOODS #2 LOT 2 BLOCK 2
SECTION: 3 TOWNSHIP: 15N RANGE: :1J
LOTSIZE: 2954 (SQ, FT. OR ACRES)
I 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.
2. I WILL INSTALL THE 'SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. 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
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT CSR NEARBY LOT.
i
IF A LIFT `NATION IS IN_wTALLED IN AN AREA COWERED BY MOA BUILDING CODES,
THEN <1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BU.ILTS
WILL, NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT: AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED �s�d-5 � DATE
APPLICANT: LIFE'S ,•'LE ND
i
ISSUED BY GATE :
--------------
--
Ga ail3. d
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
` 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
w
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
V
z' =jjh7
PHONE
NEW
❑UPGRADE
MAILING ADD ESS
LEGAV 617—TI �.
G i�
&o C( 6
LOCATION
NO. OFgEDROOMS
U Y
DISTANCE TO:
Wel
Absorption area
Dwelling
!0
PEf�Nf�.I N0
�"" 70
a ZQ
W F
Manufacturer
Pi
No. of co artments
y
Liq. caps y' allons
!` CC����==``
IF HOMEMADE:
Inside length
Width
Liquid depth
p Y
Jaz
DISTANCE TO:
Well
Dwelling
PERMIT NO.
C) Z C
2—F
Manufacturer
Material
Liquid capacity in gallons
p
w=
DISTANCE 07W
Well
-
Foundation
Nearest lot line
PERMIT NO.
J LL Z
P Z W
No. of lines
Length of each line
Total length of lines
Trench width
inches
Distance between lines
F
p
Top of tile to finish grade
Material beneath tile
inches
Total effective absorption area
W
Length
Width
Depth
PERM N
[�-�'
aType
W
of crib
Crib diann to
Crib depth
Total effective absorption
area
y
DISTANCE TO:
Well Q�
Buildingation
s u
Nearest lot line
O
J i
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE M RIALS
p /
SOIL T R/ATI G/n'�
INSTALL_ 9 0 / o
REMARKS
l
1�
1
t
r
trl
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APPROV
DATE LEGAL
72-013 (Rely Z/78) r f 1
A
PERMIT NO.
PlUr-4 10 11"1 1 -r'-e OF=- F=lr-40,"7F;;?F=113F=
DEPARTMENT i. tpHEALTH AND ENVIRONMENTAL _,OTECTION
825 'L' STREET, ANCHORAGE, AK. 99501 n, -AA.,,)
264-4720
0 r-4 -!F. I "T F= !F. F=t4 FE F;;,' F=* f� FZ Ul I '-F
< 821026 )
APPLICANT LIFESTYLE IND SRA 1452-T 99502 345-3891
LOCATION
LEGAL L2B2 NORTHWOODS PHASE II LOT SIZE 999999 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SY$,TEM IS:
x(g -- F= F=m -r lc_
r_)l F= F=" 7r F= -r FZ C3 1=1 %-* C -
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F -"F= C-4- 11 1 F? EE 01 ==. F= F=" -r 11 �-F n r -J F< !:-; 17.x= -1 C_;t 10 &0 1:3 F4 L_ C-1
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
-rWID < IZ� -r I RD n F? FE - C4 U I R-0 E-
- - - FRI= Er -w
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F='F=FZM I -r F=XF=" I FREE:F. 0mE=0F=ME$F=Fes' -1 !F-4:0 fz�
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 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 TO INCLUDE MORE THAN 3 BEDROOMS. It 8J
SIGNED:---------------------------------------- i .>C� 1 �
APPL I CANT
IGNED:----------------------------------------
APPLICANT LIFESTYLE IND
ISSUED BY(f) TL)-- - �a
-A ------------ L- L4 A,TE---
F
' � wr .' . . .rte .. �' �'� � - � g'�_�'` -• ��
;
`z t
1
r iy it,: isR
yAk �, SOILS LOG
MUNICIPALITY OF ANCHORAGE
y" DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
II TEST
- 825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: l --I — S TV r� C /N -}. DATE PERFORMED:
LEGAL DESCRIPTION: LU7 r:C ,.(Slk r / t"O�%l� ��%000� U ����s`G ..La•-•
D - T SLOPE SITE PLAN
E ) QYyO.(A% i L So I I S -- - ---
1
v
"�iL• SAw01 (jrftui L �%ILc,W SIF
2
S /. O N b L-3) L i c�� l S; (t '£ t \t
6 L
10
11 wns cR
NCOUNTERED?
12
13 X
14
as
15 a ®F .p L.S9��9
16 m� 1 .. /�L�
17
III dA' :• Itoiert A. Shu ,r <<
';� . No. 1457-E
19
20
COMME
PERFORMED BY`. wiaw.� 4•4
IF YES, AT WHAT
DEPTH?
ry() � -
O
P -
E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
r�
s`
PERCOLATION RATE I ! ( (minutes/inch)
TEST RUN BETWEEN FT AND FT
CERTIFIED B DATE:73
Municipality of Anchorage
-�1 Development Services Department,
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite I 0 /Z'7106
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
+FOR A SINGLE FAMILY DWELLING r�
Parcel I.D. ['Z51- C4 1- 3 1 COSA# 08037 —
1. GENERAL INFORMATION Expiration Date: - / 0 , �? S — !21
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
NORTHWOODS #!2 LOT 2 BLOCK 2
22245 WHISPERING BIRCH DRIVE ' CHUGIAK, AK 99567
DANIEL AND LISA DEAN Day phone C/O AGENT
22245 WHISPERING BIRCH DRIVE ' CHUGIAK, AK 99567
Day phone
ALEX MITCHENKOV w/REMAX PROPERITES Day phone 257-0427
16600 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class A Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (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 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 riles 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 Finn 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. Date to 17-3104a
Engineer's Comments:
In conducting this evaluation, GEG, LID. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines Q Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lost, 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 right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the flowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By:
(R.. I WS)
P�\iY OF G,ic.
ON-SITE •-��=
WATER AND ; rn=
t. WASTEWATER
PROGRAM
Original Certificate Date: / C9 - �)'5 - 0 O
� Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: NORTHWOODS #2 LOT 2, BLOCK 2 Parcel I0:
A. WELL DATA
Well type _A
Date completed
COMMUNITY WATER
If A, B, or C provide PWSID# 21
3001
Wires properly protected (YIN)
To�Ltlapt ft. Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production -9 -P.M.
WATER SAMPLE RESULTS:
Coliform colonies/100 mi. Nitrate mg./L.
Arsenic: Dale of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./STEEL
Tank size 1250 gal. Number of Compartments 2
i
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO
C.
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
colonies/100 ml.
Collected by:
Date installed 5/27/1994
Cleanouts (YIN) YES
High water alarm (YIN) YES
Date of pumping 10/4/08 Pumper JR'S PUMPING
ABSORPTION FIELD DATA BELOW EXISTING GRADE]
Date installed 5/27/1994 Soil rating (g.p.d./ft'o t /bd 0_3 System type BED
Length 100 ft, Width 15 ft. Gravel below pipe 0.5 ft.
Total deplh!2.91 —3,25ft. Eff. absorption area 1500 ft= Monitoring tube YES Depression over field NO
Date of adequacy test 8/28/2008 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test DRY in. Water added" 1840 gal. New depth DRY in.
Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date —
••HOUSE WAS VACANT FOR MORE THAN 30 DAYS PRIOR TO TESTING
D. LIFT STATION
Date installed _5/27/1994 Size in gallons 1250 Manhole/Access (Y/N) YES
"Pump on" level at 42 in. "Pump off" level at 32 in. High water alarm level at 44
Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WATE R
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic serves
On adjacent
Me,
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM 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 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain •73' Wells on adjacent lots 200'+
F. COMMENTS
*PER MOA INSPECTION REPORT 1994
G. ENGINEER'S CERTIFICATION
I certify that I 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 1o1z3/04a
COSA Fee
Date of Payment
Receipt Number-
(Rev.
umber (Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
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IU/09/2008 07:31 9073449821 JRS SEPTIC PAGE 01
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Plrone: "7.0444%
Fax so -W-W21
Invoice: 8046
Job Loat itm:
32245 WHISPERING BIRCH
CHUGtAKAK
$165.00
$125.00
$125.00
$150.00
c
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section cffs
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING,
Parcel I.D. # 051-741-31 HAA #
1. GENERAL INFORMATION
Complete legal description Lot 2, Block 21 Northwoods Phase 2
Location (site address or directions)222a_s [n, ;ing Birch
Property owner Joe & Susan skinner Day phone 688-3201
Mailing address
Lending agency Northland/Trish Kastner Day phone 257-0133
Mailing address 2605 Denali St, Suite 100 Anchorage, AK A950�
r Agent Remax Eagle River/ Brook Stiltner Day phone 694-4200
Address 16600 Centerfield Drive, Suite 201, Eagle River, AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water XXX
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 xxx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Re . "1) Front MOA 021
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 forthe 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.
S & S ENGINEERING
Name of Firm -moi-- 04-Ea$le River 1 cop Road No 904 Phone
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved for _ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
By:
UITIC
6 cl y—)L47 7q
Date 9/73'/g5,
OF 144
6P
� Itf 4%.
0M N UVWAN ''1 �Q-
CE - 8801r+`;
i 7
/
Il
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bedrooms, with the following stipulations:
Date�24��
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-M (Rev. 7191) Back MOA a21
D. LIFT STATION
Date installed Sq Size in gallons /,{ 6-0
Manhole/Access N) "Pump on" level at* 2 y "Pump off' level at*
High water alarm level at* `i7 *Datum _Ofk 130TToM
Cycles tested 3
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Seaver peptic service line
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I
Absorption field l o ' k
Znrr
_ Wells on adjacent lots c
Foundation
1 "�)
Property line
Ygi
Water main/service line 4n 14- Surface water/drainage 1Ck-:1 td-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
3Z "
i
Property line 101 Building foundation I Y Water main/service line /D
Surface water %too I� Driveway, parking/vehicle storage area
Curtain drain 73 Wells on adjacent lots oZz�o
F. ENGINEER'S CERTIFICATION
I certify that / have determined thru field inspections and review of Municipal
in conformance with MQ uiqlnes in effect on this date.
Signature [%
Engineer's Name a� 0,C f A -7" C. Ct of J
Date q11- -/if
HAA Fee $
Date of Payment'
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
OF
A R08ERT't CpwAN;e-•�Q•
..CE-8801���`��
are
M
APPLIC NIT FILLS OUT UPPER HAL )ONLY
Property Owner C %1'',. r✓ J -0,
Phone
Mailing Address
Zip Code
C
Buyer
Date
Address
Zip Code
Lending Institution b;?K f% /4f (f t`1`1�.
% �! �% tv 4 !"1r l �) t t
Phone
Address
Zip Code
—
Realty Co. & Agent
Phone
Address
Zip Code
Legal Description %.� �-^ "GCi is
�''}� ( �`
�' CifC J i Ery/ c)t).S (.af j , (-�`7" i -rr
Street Location
(.3 ) APPROVED BEDROOMS
Type of Residence
( ) DISAPPROVED
Single Family
edrooms
❑ Multiple Family No. of Bedrooms-
-
❑ Other
0
DATE 12 --
BY: Z—BY:
Water Supply
Individual
Soils Rating
ATTACH WELL LOG. A well log Is required for all wells drilled since .June 1975.
i�
JZ Community -
Well Log Received
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
'�.— �--'
Well to Tank
Sewer Disposal
Individual
f �}
Year Individual Installed: 198 Z
❑ Public Utility
When Connected to. Public Utility:
❑ Holding Tank
- NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
RAGE
Field Notes:
M
DFPT C' _:,ON
'tt) 82
P,FCEIVED
(.3 ) APPROVED BEDROOMS
*CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE 12 --
BY: Z—BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
'�.— �--'
Well to Tank
(z Uzi jam)
11
ADEQUACY TEST
WATER AND SEWER INSPECTION
WELL INSPECTIONS AND
FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
ON SITE WASTE WATER
DISPOSAL SYSTEM DESIGN
EXCAVATION WORK
Mr. chuck Tanner
Lifestyle Industries
SRA 1452 T
Anchorage, Alaska 99507
r
January 8, 1984
Dear Mr. Tanner,
Reference: Lot 2; Block 2; Northwood subdivision Phase II
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
At your request we made an on-site visit to examine the septic
system installed on the referenced property. The owner of the
house explained he was having considerable problems with the
system backing up into his home. A monitoring tube located in
the seepage bed in the back yard was full of water at the time
of the visit. The topography around the seepage bed causes all
surface water from the rear of the house to drain onto the bed
and could easily be the cause of the system's saturation. The
original soil test performed by us September 24, 1982 was taken
in an area now be in ron o e ouse. There is nn
„;4+-,rN., frim the Munici ality s recor s a a w soil test
n
inity of
bed which is
It is suggested that one of the following alternatives may correct
the existing problems:
A. Install a curtain drain at the base of the slope in the
back yard to eliminate surface water collected over the
system and haul in fill material to mound up the ground
over the system to assist all water to drain away from
the system.
B. Divert the water from the septic tank through a four inch
PVC pipe to the front of the house and construct a new
absorption system in the front yard. This will eliminate
the collection of surface water on the system and in
SRB 196X EAGLE RIVER, ALASKA 99577 ��
page two
Chuck Tanner
accordance with the original soil test may provide more
suitable soils for percolation.
If we may be of further service, please do not hesitate to call.
Sincerely,
R, P.E.
']jAS/ss