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Home My WebLink AboutNORTH WOODS PHASE 2 BLK 3 LT 1 Municipality of Anchorage Department of Health and Human Services Rick Mystrom. 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 30, 1996 Gary E Sherman ' Vicki L Sherman PO Box 671222 Chugiak, Alaska 99567 1222 Subject: Lot 1 Block 3 North Woods Phase II Subdivision Permit #SW950277, PID #051-821-05 The subject permit, issued September 14, 1995 by this office for a single family wel~ and/or on-site wastewater system, has expired as of September 14, 1996. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration da~e. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. jSim~e s~e lY' //~ Program Manager On-site Services eric: Copy of Permit cc: Eagle River Engineering Services 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:SW950277 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:SHERMAN GARY E & VICKI L OWNER ADDRESS:23245 NORTHWOODS DR DATE ISSUED: 9/14/95 EXPIRATION DATE: 9/14/96 PARCEL ID:05182105 LEGAL DESCRIPTION: NORTH WOODS PHASE II BLK 3 LT 1 LOT SIZE: 27035 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~~~ Louis Butera, P.E. Registered Civil Engineer August 23, 1994 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods//2 Lot 1, Block 3 Narrative & Upgrade Application Dear Mr. Cross: The upgrade will have very limited impact on adjacent properties for the following reasons: 1. The subdivision is served by public water. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to lot size. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \G:\WPDOCS\1995\95-077A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 · Fax (907) 694-3297 1 1/4" PVC ~ TH2 LATERALS FILTER FA 1/8" HOLES~ i o 0 o 4.6' OC~ 0o W/ORIFICE , SHIELDS j ~1 0'~ LAT/R*L (TY~) ~ .... ~ ~!~ ~ ~ PRESSURE PIPE CLEANDUT 2" PVC MANIFOLD ~ ~ gED DETAIL ~ I ~ 2" IDRIVE / HOUb ~ OLD BED SYSTEM TANK W/L~ T ~~ o m 158,~1 NORTHWOODS DR. -- ~ - TEST HOLE · - ~ONITOR TUBE NOTES: o - SEWER CLEANOUT NO SURFACE WATER ~ - KEYBOX NO KNOWN CURTAIN DRAINS ~SEMENT COMMUNITY WELL SYSTEM SEPTIC SiTE PLAN LEGAL: NORTHWOODS ~2 LOT 1 SLK 5 ~L~ ...... .7C~.- ' ' _ OWNER: SHERMAN ff~ C~T~~ ..~,~ CONTRACTOR: N/A REVISED , 1" ~'~ JOg~ 95-077~IDAIE: 09/0~/951 SCALE = 40' EAGLE RIVER ENGINE:RING SERVICES P.O. Bom 773294 ~0~ RIVEN, A~. 99577 (907) 694-5195 FAX: (907) 694-3297 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694-5195 JOB SHEET NO. CALCULATED BY CHECKED BY SCALE OF. NorthwOods #2 Lot 1, Block 3 - REVISED 09/06/95 Single Family 3 BedrOom Dwelling AREA CALCULATION 3BR = 450gpd Soilrating = 0.3 gpd/ft2 450 +!0:3"~ li500required'area Area -~ 1,500 ft2 + 20' width = 75' length PRESSURIZED SYSTEM SIZINC~ FloW rate from lift station = 25 gpm Assumes 5"'head ax orifice 0~42 gpm per...1/8!!~ orifice 25 gpm. + 0.~2gpm = 59 orifices Spacing = 276' + 59 orifices = 4.6' spacing \G:\WPDOCS\1995\95-077B ,CAL EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 95-077 Calculated By: LB Date: 8/18/95 Legal: NORTHWOODS #2 LOT 1 BLK 3 Single Family 3 Bedroom Dwelling TEST HOLES l- 2 Bed Subsu[face Wastewater Disposal Field Water use at 150 gallons per bedroom = 450 gallons Percolation rate = 60,7.3 minutes per inch Wastewater application rate = 0.4 gallons per day per square foot Required absorption area = 1125 square feet Bed width(W)= 15 feet Gravel depth (D) = 1 feet Required length = Required absorption area / Bed width Required length = 1125 / 15 Required length = 75 feet Total Excavation Depth = 2.5 feet NOTE: Sand layer used to level bottom of bed. Two test holes dug and the two app. rates were averaged. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: /~fT'~ ~,/4~'~/'~' -~r,,~, J. / ~' ~' Township, Range, Section: 6 7 8 9 10 11 12 13 14 15 16 17. 18- 19- 20~ COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? ~/~ S DEPTH? p E Depth to Water Alter Monitoring? ~ · Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop / s"-i~.,/~- 2.'~'.~" 3~.'~ ~1 ~ el/~ __ PERCOLATION RATE ~'4:7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND ~*' FT PERFORMED BY: ,~_.~,,"~, z~ .5". I ~- CERTIFY THAT THIS TEST WAS PERFORMED tN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~- .~.~3 - ,~J'- 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: /~/'7'//~/~'~¢~'J' -¢r,~.., J. / ~' .~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15- 16 17, 18- 19- 20- COMMENTS SLOPE I ~,'1~7 ~ ~,'r~ WAS GROUND WATER ENCOUNTERED? SITE PLAN S IFYES, ATWHAT {,b~ /.~d.,,(' p DEPTH? E Depth Lo Water Alter ' a'"-,r~,"lP"'*'--.e-- Monitoring? ~ ~'' .Oate: Gross Net Depth to Net Reading Date Time Time Water Drop · , /~[,~- .~ ,~ ,..,/~ .r,~ ...... -'-'---" I r-u-~- ~-l,'z~- ~,,~ ~ ~ I ~ ~ PERCOLATION RATE 0' ~ (minutes/incl,) PERC HOLE DIAMETER ~" TEST RUN BETWEEN 2,..r FT AND '~, 5'-' FT PERFORMED BY: ('"~ 't"~ J' i ~'~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: LEGAL: Ao Bo SPECIFICATIONS FOR ON-SITE SEPTIC SYSTE[~ E C Northwoods//2 Lot 1, Block 3 REVISED 09/06/95 i. The septic plan is for a single family residence only. EIVED SEP 8 1995 Municipality of Anchorage Dept, Health & Human 8ervioee 2. 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 requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the · contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommende~ that a surveyor locate the nearest lot line position and the location of any easements. SEPTIC TANK/LIFT STATION 1. Septic tank and lift station shall be 1,250 gallon Orenco/Anchorage Tank model OSI 05-20-HHF. Effluent pipe from tank to field shall be 1-1/4" HDPE SDR-17 or equivalent. 2. Receipt from ~egified electrician stating the lift station was wired to applicable codes to be supplied to Engineer. The existing septic tank shall be pumped and properly abandoned. BED 1. o RE ME D ~ ~: BOTTOM OF GRAVEL LAYER = See profile drawing GRAVEL DEPTH = 6" under distribution pipe, 2"over pipe BED LENGTH = 75' BED WIDTH = 20' SOIL RATING = 0.3 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,250 gallons with lift LEACHFIELD LATERALS = 1-1/4" PVC Schedule 40 with 1/8" holes, 4.6' OC, holes facing up with orifice shields. ~: , Twenty-four (24) hours notice required for all inspections. The bed shall be excavated to the absorbing soil located immediately below topsoil layer identified as GM-SM subject to engineer approval. This excavation will not be level. A. level surface for the septic gravel shall be created utilizing imported coarse leveling sand, plus or minus 1.5". The sand leveling material shall be a sandy pit run material < 5 % fines or a MOA approved filte? sand with receipt of purchase provided to the engineer. The bed gravel is to be covered with typar fabric material. A combination of soil and extruded board insulation to a depth of Y or equivalent is to be placed over the leachfield, 2' soil minimum with 3:1 side slopes. The area over the bed is to be finish graded to prevent ponding of surface water runoff. /~UN1CIPALII'Y OF ANCHORA®~ ENVIRONI~ENTAL SERVICES DIVISION RECEIVED G:\WPDOCS\1995\95-077B.SPC ~ 11-% MUNICIPALITY OF ANCHORAGE fe--~ ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I{k~ ~. ~lJ ENVIRONMENTAL ENGINEERING DIVISION yL~i~ L~i~// 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE ~WAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ' , PHONE . ~ UPGRADE MAILING AD~, ~ C~ ,~z ' LOCATION NO. O~E DROOMS D I STANCE TO: ~ Ma~ No, of co. me nt~ ~ ~ Man ufactu~~.1~ I Abs°rpti°~ea/ D~d Hn~ ~ / PER M~ ~ ~ 7 ~ Liq~b in 9all°ns IF HO.EMADE: Indde ,en,th Width Liquid depth ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Baterial Liquid capaciW in gallon~ a Well Foundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: ~ ~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines ~ inches ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Q inches Depth ' ~ PERM ~ Length~ ~ Width ~ [ ~ ~ ~/~/ ff~ ~ ~ Typeofcrib Crib diameter ?~ ~ Crib depth / ~'Total effective absor 'on are Well Building ti~n Nearest lot line DISTANCE TO: ~, Driller ~ ~ Class Depth Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER :"'I.'I.',,, .". .., APPR~ DATE LEGAL t 72-013 (Rev. 3/78) I'IUI'-,I ! F: ! PAL f T"r" OF ANCHORAGE DEP RTMENT HEALTH-AND ENVIRONMENTAL C.:OTECTION 825 STREET., ANCHORAGE, RK. 9..,,¢_'~& 264-4720 - O1'4--S I ti SIPPER PERM PERMIT NO. ( 820?9? ) APPLICANT SKAGGS CONST PO BOX D CHUGIRK 9956? LOCATION LEGAL Ll B~ NORTHWOODS PHASE II LOT SIZE TYPE OF SOIL ABSORPTION SYSTEM IS: ~ ~ 688-28~1 999999 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= 190 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [~EPTH= ~ LE~4GTH= 13RA'./EI [~I='PT: :' ' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THE TRE~4CH L4 I B. TH IS FFET_ THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE,~IJ I RE[~ SEPT I C TA~k-'. S I ZE= iO80 GALl ,, O~4S 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. TI40 (2) I ~4SP~C:TI Cm~4S ARE REQLIIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R 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 ?5 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. P~R~I I T E:=<F' I RES B, EC:E~IBER ----<l.. l~q8~- I CERTIFY THAT iL: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. ~,. , c c,,c '' I :, .P. IT; ~, ~. I HILL.~N~TALL THE .~T_,TEM IN ACCO RB AN _.E WITH THE CODE_. 'A ~: I LIN[:,E~TRND THRZ THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE F~ESIDENCE,,S REMOD~E[~I IN,_:LU['E" MORE THAN3 BEDROOMS. I GNED / RPPL I CRNT ~S ~ O & E ENC.,NEERING & DEVELG, 'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688~2280 Russell Oyster 694-2774 SOIL LOG Earl Ellis 688-2280 Performed for: Name: Mailing Address: Legal Description: Depth (feet) Soil Characteristics 8__ 9__ PLOT PLAN 11__ 12__ 13__ 15__ 16__ Ground Water Encountered: Yes ////' No If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: PERC. TEST 7/ Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. E~ox 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ['~),~z-~t_ 0_/,~\ _ ~'~)~ NAA# 1. GENERAL INFORMATION Complete legal description Lot I; Bloc~ 3; Northwoods Subdivision #2 Location (site address or directions) Property owner Mailing address Klm LoF~sRarden - Day phone Lending agency Mailing address Gv, AC Day phone Agent Address Sharon Minsch - RE/MAX OF EAGLE RIVER 16600 Ce. nt2~field Drive., Su~'.t2. 201, Day phone 69,4-4200" Eagle Rive. r, Alaska 99577 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwme requested, HAA will be held for pickup. NOTE: Individual well Community well ×XX Public.waTer If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/911 :font VIOA #2" 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 verihj that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 17034 Eagle RiYer Lc>or) Road No. 284 Eagle River, Alaska 9957/ Phone Date DHHS, SIGNATURE for ~¢¢//,~/'¢ bedrooms. Approved DisApproved. Conditional apl~roval for bedrooms, with the following stipulations: Additional' Comments Date ,f: JIl OJ¢ 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. 72425 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.~-c ~ ~t_,~ ~¢.1'~&~c,~,~, ~ Parcel I.D. A. WELL DATA Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~ ~ Absorption field on lot ?..Oc~' ~' Public sewer main Sewer service line g.p.n~ "~(~z~ > WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~/."~o.-E~ 'Z- Tank size ~C, oO Compartments Cleanouts~)'N) ~ Foundation cleanout (Y~ ~ Depression (Y/~ High water alarm (Y/i~ ~ Aia~m tested (y/N) ~"J/J~ Date of pumping , ~,-"/,.,,~'~, Pumper ;~.~. Well(s) on lot To property line ~, o~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ?..o~:> ' ~' On adjacent lots AbsorPtion field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA e~ Manufacturer Manhole/Access ~ "Pump on" level at ~.----'""~"~"Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~. c-/o - '8,?.- Length ~'c~' Width '?-"~' Total absorption area I0oo ~ Depression OVer field (y~L~ ~' Results ~ail) l~& Peroxide treatment (past 12 months) (Y/~ Soil rating Gravel thickness o. ~' ' Cleanouts present.N) Date of adequacy test for "~"H~,F-.E (39 ~o~ ~~ If yes, give date System type [5~ Total depth 3 ' &-zz -'ti bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ¢o~ '"' To building foundation On adjacent lots ~'~ Surface water /oo Curtain drain /'//,4 On adjacent lots 'J//~ Property line I ~3 ' 4- To existing or abandoned system on lot Cutbank "J'/,~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION / certify that I have checked, verified, or conformed to al~ MOA and HAA guidelines in effect on the date of this inspection, S & $ ENGINEERING Signature Eagle River, Alaska 99577 Engineer's Name Date ¢:~- ~7- ~ / HAA Fees //¢O, OD . Date of Payment ~/~ ~///~'~ / Receipt Number ~'~5-'_('/'---~.~ ~/~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 June 5,1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering Ray PWSID 213001 My review of the records on file in this office reveals that the Chugiak Utilities, Northwood Subdivision Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer ~:~ printed or~ rec¥ck;d paper b y C.I~ APPLIr"-~N'I:?FILLS ouT UPPER HAI"~'ONLY Property Owner .L~/L~ L r'j(~ E~) ~t ~j5 ~-/~ Phone Buyer I .... ~t ' ' ' Address Zip Code Institution [~ ,- Realty Co. & Agent ~ ' j ~ ' ' '' Phone Address Zip Code Legal Description LOT I g~cK 3 /'/~fez",F ~ooDS' .~,3D, Street Location C~"~)~e?/~ L qT~;'~ ~ ~ Type of Residence , Single Family Multiple Family No. of Bedrooms [] Other Water Supply [] Individual ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. '~ Community For wells drilled prior to that date, give well depth (attach Icg if available). Public Utility Sewer Disposal Year Individual Installed: Individual 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 Field Notes: MUNICiPALiTY OF ANCHORAGE D?T C": ; '~ ' LT: t ,~. ENVIR-h ~;, :t :, A .... O ,', L C 2 0 1982 RECEIVED ( ~ ) APPROVED BEDROOMS *OONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) OONDITIONAL APPROVAL* DATE f ~ ,~,,__ Jji ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (3182)