HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 11No th Woods lock 12 Lot 11 051 - 73 2 -2O On-Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 EImore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111166 Tax Code Number: 05173220000 Work Type: Septic Upgrade Permit Effective Dates: July 27, 2011 to Design Engineer: ANDERSON ENGINEERING Subdivision: NORTH WOODS UNIT 3 Site Legal Address: NORTH WOODS UNIT 3 BLK 12 LT 11 G:1459 Owner/Address: Site Mailing Address: July 26, 2012 BOHN KEVIN W & BARBARA L 23121 GREEN GARDEN DRIVE CHUGIAK AK 995675435 23121 GREEN GARDEN DR, Chugiak Lot Size in Sq Ft: 23107 Total Bedrooms: 4 This permit is for the construction of: Y 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. tB. Covered, sealed, and heated to prevent freezing. Provisions: Prior to construction; the ground water elevation shall b_e.,..¢~ m of the proposed sewer roc_k.p. Jeva~~ (2) additional 'trench portions of the not within 30~./ s do~ith .the permitte¢ nd percolation test results shall be submitted with the ~ . Date: Date: '-~2//~ ?-/// M UNICIPALITY OF ANCHORAGE Community Development Department ~'~' Phone: 907-343-7904 Development Services Division ...... Fax: 907-343-7997 On-Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. O~i-'717_-zO Property owner(s). J~z~/,tJ .,.. '~.&lz.~,~n..~ Mailing address ~iZi ~~ ~~~ Site address ~ Legal description (Sub'd., Block & Lot) ~'0~o0~5 Legal description (Township, Range & Section) Lot Size Z.'~, l O'~ Sq. Ft. Day phone Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: ([] all that apply) Absorption Field ~ Initial [] Septic Tank ~ Upgrade Holding Tank [] Renewal [] Privy [] Private Well [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) fRush Fees:~:* Payment: Receipt Number: Permit No, ~'1¢ Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) co:/. ANDERSON :ENGINEERING P,O. BOX 240173 ANCHORAGE, AK 99524 522-7773 677-7766 (F~) July 19, 2011 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 11, Block 12, Northwoods Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing 1,250 Gallon Septic Tank will be decommissioned in accordance with Municipal Code. A new 1,250 gallon tank will then be placed. The existing absorption bed will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing absorption systems on this and adjacent lots. The subdivision is served by a community water system. No conflicts exist between the proposed septic system and the water services on this or adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot in the past indicated well graded gravel underlain by wellT~ graded sand (GW/SW). The visual absorption rate was determined to be 85 square feet per bedroom. We have designed the new trench to be within the 30' radius of the existing test hole with an application rate of 1.2 gallons per date per square foot. We are proposing to place a 50' !ong trench by 5' wide with a ,4' effective depth. The total// depth of the system will be 5 with the distribution line at I below the existing surface./ The test hole was placed to a depth of 14' with no groundwater encountered. Records~ indicate however that groundwater did appear at 9' below the surface during the monitoring period. Additional percolation tests will be completed during construction to verify the consistency of the soils in the area. Test results will be submitted with the/ certified as built for the project. e Lot 11, Block 12, Northwoods No. 3 July 19, 2011 Page Two The ground surface on the lot slopes to the north in the area of the proposed absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: o The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. The system, 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, P.E. Attachments LOT 1 5 LOT 1 0 Existing Absorption Bed I No Slopes >25% Within 50' of the Septic System. Ground Surface Slopes to the North in the Area of the Absorption Trench. No Surface Water Within 100' of Septic System. LOT 1 4 N 90"O0'O0"E 120.00' LOT 1 1 25,107 S.F. 56' Long x 5' Wide 't x 7' Effective Depth i~ Absorption Trench ~ MT cot, - ~-~co Decommission Existing Septic Tank in Accordance with Municipal Code. Place New 1,250 Gallon Septic Tank. THA f TH Four Bedroom Home Existing Absorption Bed ,: DRIYEWA¥ 15' Utility Easement 0 0 0 0 N 90'O0'O0"E 120.00' LOT 1 ,.5 Existing Absorption r~ Trench LOT 1 2 ,,.-T.%...°..E .....,~ ~?,,. ~/ 49~ch ~1~ %zl-'~ GREEN GARDEN DRIVE;;_~;, i'~', '~......................_ ~nou, SZTE PLAN sv wn, ~.~% ~o,' CE-43et Z~ FCO - Founddtion Clednout ~,;~...~..";¢~ T. - T~st .o~e ~ ~" ............ %;~ %~- MT - Monitor Tube q~ FDV - Flow Dive,er VQIve CO:l. LOT 11, BLOCK 12, NORTHWOODS SUBDIVISION, UNIT NO. 3 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House Deep Trench System Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 7' Drainfield Rock 4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area 500 SF/14 SF = 35.7 LF Trench Length THEREFORE: Construct an Absorption Trench 36' Long x 3' Wide x 7' Effective Depth. Flow Line Elevation in Trench to be 1' Below Original Ground Surface. Total Depth to be 8' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Revegetate Outer 6" Backfill 6" Geotextile Fabric C) 4" Perforated PVC (Holes Down) -- Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) .~,~,~,¢r<. ?..... NOTE: Grade Area Over Trench to Drain Away. _~. M n ' ' · mum 6 Separabon From Bedrock. _~.......-. ......................... ~.....:....~ Minimum 4' Separation From Groundwater. ~ ~ Minimum 200' Separation From We Is n the Area. ~'~t:'"~;~'~;;,"~ Minimum 100 Separation From Surface Water or Streams: ~j~':. No cs~l Minimum 10' Separat on From Water Services in the Area · '*i~'~': ....... 4700 DEPTH (feet) 1 2 3 4 5 6 7 8 9 11 20 MUNICIPALITY OF ANCHORAGE DEVELOPI"IENT SERVICES DEPARTMENT BRAGAW STREET ANCHORAGE, AK 99519-6050 SOILS LOG - PERCOLATION TEST LOT II, BLOCK 12, NORTHWOODS SUB. NO..13 LEGAL DESCRIPTION: PERFORMED FOR: DATE: 8/8/2011 PARCEL ID#: BARB AND KEVIN BOHN PROJECT No.: TECHNICIAN: TEST HOLE B OB/OG SILTY GRAVEL WITH SAND GM/SM POCKETS OF BLACK SAND DRY WAS GROUND WATER ENCOUNTERED? __ IF YES ~ WHAT DEPTH?__ DEPTH OF WATER AFTER MONITORING: BOH @ 12' S. GILBERT SLOPE NO NONE DATE OF MONITORING: 8/19/2011 E SITE PLAN SEE SITE PLAN SEE SITE PLAN DEPTH TO DATE READING GROSS TIME NET TIME WATER NET DROF (MINUTES) (MINUTES) (INCHES) (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 8/8 1 3:38/3:48 10 12"/18" 6" 2 3:49/3:59 10 12"/18" 6" 3 3:38/3:48 10 12"/17" 5" 4 3:49/3:59 10 12"/17" 5" 5 3:38/3:48 10 12"/17" 5" 6 3:49/3:59 10 12"/17" 5" PERCOLATION RATE: 2 .(MIN/INCH) PERC. HOLE DIA. 6" fINCHES) TEST RUN BETWEEN: 3.0 FT. and 4.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 8/19/2011 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST 1 2 3 4 5 6 7 8 g WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 1o 11 12 13 14 15 16 17 18 19. 20 Reading Date Gross ~. N et ~_~ ~o~ Net Time PERCOLATION RATE (minutes/inch TEST RUN BETWEEN FT AND ~ FT PERFORMED BY: q~C~ ~r~M~r{~~ ~W~ CERTIFIED BY: ~ d ~r~'~ DATE;~ ~ ~3 -ool 6T 8~ 72-008 (6/79) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 11, BLOCK 12, NORTHWOODS SUBDIVISION, UNIT NO. 3 GENERAL: The scope of this project includes the decommissioning of the existing 1,250 gallon septic tank in accordance with Municipal Code. Work also includes the procurement and placement of a new 1,250 gallon septic tank at the location shown and the construction of a new 50' long X 5' wide X 4' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 1' below the existing ground surface. Total depth of the trench will be 5' below the existing ground surface. The new absorption trench must be placed a minimum of 200' from all Class A Wells and 100' from any surface water in the area and 10' from the water service line on the lot. A minimum of 3' of cover is required over the absorption trench. A flow diverter valve must be placed and the existing absorption system tied in for future use. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division On Site Water and Wastewater Program for system installations. Owners installing their own systems must receive prior approval from the On Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250-gallon septic tank must be procured from an approved source and installed at the location shown. Lot 11, Block 12, Northwoods No. 3 July 19, 2011 Page 2 of 3 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation unless one is currently in place. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below the distribution line must be perforated. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. Lot 11, Block 12, Northwoods No. 3 July 19, 2011 Page 3 of 3 A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as-built of the completed system.  ) ?"~x~ 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 PHONE J ~NEW . 'or I MAI LING ~REss LEGAL DESCRIPTION ~ ' ' ' LOCATION NO. OF BEDROOMS ,j~ ~1 Absorption area~ I I PERMIT NO. ~ Liq.Manufacturer'ca~aclty in gallons' ~n Materia~ No. of compartments ~ HOME~: side length Width Liquid depth ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~z ~ DISTANCE TO: We,~ Foundationl~' Nearest lot line lo ' P~R~ITNO. No. of lines ~. Length of e~h~n~ Total ~n~h~f ~ ~ ~ ~ ~ width ~ I i~. Distance between lines ~/ ~ Q~ Top of tile to finish grade ~ ~t Material beneath tileX~ inches T°ta2f~ea~i~n area' Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth ~ Total effective absorption area m DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER , SOIL TEST RATING INSTAELER ~ ~ REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) Permit Applicant: MUNICIPALITY OF ANCHORAGE'A~. Department~ Heat,th and Environmenta_ Frotection 825 ~ Street, Anchorage, AK. 99501 264-4720 ~--~ ~, * * * HANDWRITTEN PERMIT * * * (~0/]~ C0/~]6'-'~ .Mailing Address: Lg,C,~,t~.~pn: Phone Number: Legal~ Description: .~ ~'"',, [~/~A/.~ ~//~.~.0.~ _.~"~T .0 t S i Z e: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: M~6~=~t%m Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~- The Required Size of the Soil Absorption System Is: DEPTH LENGTH . _ GRAVEL DEPTH 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). /~O * * REQUIRED SE TIC(~,~=~'::~) TANK SIZE ~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * Two(2) INSPECTIONS ARE REQUIRED * * * 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. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 19 8.3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes.' ; (3) I understand that the on-site sewer system may require enlargement if the ~idence ~s r~deled to include more that/~ bedrooms.///-~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13- 14 15 16 17 18 19 2O WAS GROUND WATER ,,~ S ENCOUNTERED? f~;> ~ P E IF YES, AT WHAT DEPTH? Reading Date Gross :~ Net ~'~.~ ~ ,~l~.to Net Time ~¢~ 0~- ~JV~/~j. Drop ~ Lawr*nce I PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT 72-008 (6/79) Municipality of Anchorage • On-Site Water and Wastewater Program ` `' !It; (907) 343-7904 ; CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-732-20 Expiration Date: 47—q—( S 1. GENERAL INFORMATION Complete legal description North Woods Unit 3 Block 12 Lot 11 Location (site address) 23121 Green Garden Drive,Chugiak,AK Current Property owner(s) Arntz (7 In r) Day phone 406-4878 Mailing address same // Real Estate Agent Cindy Bell, Jack White Realty Day phone 406-4878 �'�61 8. 9 10 77 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ice% ❑ Duplex E APR o9 Z018 ❑ Multiple Dwellings (Single Family and/or Duplex) ts.44 ti h 3. NUMBER OF BEDROOMS: !z �i 6 8 L°' 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community El Public Water System ® Public Sewer ❑ Received by: Date: 9/2/ /e/2 COSA to be released to the engineer,unles otherwise requested by the engineer. I COSA Fee $ J,P-c r Date: Date of Payment L—f HI Date of Payment Receipt Number O3106 . Receipt Number COSA# o3C-1 bV.)b 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 4/9/2018 �va'esrsi* 4 • ' 1, 6. DSD SIGNATURE 1 ..a System #1 Approved for "1 bedrooms. •�iG��.,,:• -‘1" System #2 Approved for bedrooms. Disapproved. '-I y Conditional approval for bedrooms, with the following stipulatoh's SJ SAT-SITE AND m m WASTE1/4/ATCR PROORAm o ^ By: J-}„ Original Certificate Date: L - C(-le The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc 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: /Vo(tA to cxst 3 (Jit, 73 ,12 4 // Parcel ID:6S/ 732 2c3 A. WELL DATA PU&1 e- w47- Well type If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA pp.. Tank Type/Material SE �t L/ , 7---'. E.L. Date installed U/a c/f t Tank size /Z5-0 gal. Number of Compartments 2- Cleanouts(YIN) Y Foundation cleanout(Y/N) Depression over tank(Y/N) AlAigh water alarm (Y/N) AV Date of pumping 47�7/ 7 /Pumper S A A/17jgte f,c_)41?5-72_,S C. ABSORPTION FIELD DATA z 6 e e� Date installed F-ke/I/ Soil rating (g.p.d./ft or ft2/bdrm) / 2 System type T,rP„4 Length 3 C ft. Width 3 ft. Gravel below pipe 7 ft. Total depth /3 ft. Eff. absorption area t5O1(ft2 Monitoring tube / Depression over field Al' Date of adequacy test 4/0e Results (Pass/Fail) ID For V bedrooms Fluid depth in absorption field before test 5517 in. Water added COO gal. New depth 66 in. Elapsed Time: ,6(� min. Final fluid depth Sil in.A/0 / Absorption rate >= AGO 1- g.p.d. A Any rejuvenation treatment(past 12 mo.) (YIN &type) d If yes, give date D. LIFT STATION ciA Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: AlA Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout • Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation l Q �1- Property line 1 V r' Absorption field /c 1f- water main /G Ct. Water service line /6 "'t' Surface water /D,c7 `-1- Wells -tWells on adjacent lots Z Co 4- ABSORPTION FIELD ON LOT TO:• Property line JO t Building foundation / C ^F Water main / O Water Service line /C r' Surface water / O 6 �'� Driveway, parking/vehicle storage J Q -rc Curtain drain J 6 Wells on adjacent lots Z O a {'E" F. COMMENTS G. ENGINEER'S CERTIFICATION �„,- 1'Notetk OF `hq'e �p7p7``��'' I certify that I have determined through field inspections and �'"W , 00e.""'4 - review of Municipal records that the above systems are in frrj ,,,,,44::..:5.'t:,14) conformance with MOA COSA guidelines in effect on this date. B yr 4iE.tE ";' ,j Engineer's Printed N me_ s7-6_u _EE,J 6 >� -�- e Date y'/ //1 / V/V4ck,0***c)..,`,-*- COSA yellow sheet_2-6-15.doc LOT 15 LOT 14 LOT 13 N 90'00'00"E 120.00' SEPTIC CLEANOUTS LOT 11 23,107 S.F. "' LOT 12 LOT 10 — rn IC Lo v.) o N O O r• o x —N W 10'x16' DECK o + 00 \ ' Z O O SEPTIC CLEANOUiS o 1111111111 0 28.6' ' CHAIN-LINK FENCE-- Z 48.2 ,,, 2-STORY rn a' RESIDENCE i.) 2.3'x4.7' CANT ` 42.0 16.2'x16.2' SHED 48.2 E. w IIIIIIR 2' CANT ASPHALT _ DECK CRIVENAY N 15' UTILITY EASEMENT KEY BOX—\\:\I / — — _ • N 90'00'00"E 120.00' 0 0 ori N q. GREEN GARDEN DRIVE PLOT PLAN AS BUILT _X SCALE 1" = 40' GRID NW 1459 Project No. 18-124/R1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone oovOp�� (907) 522-4625 Fax o Q Professional Land Surveyors kenOlangsurvey.com o �F AC,9��d JonathanOlangsurvey.com SOP . S �O I herebycertif that I have surveyed the followin described roe • ' �\ LOT 11, BLOCK 12, NORTH WOODS SUBDIVISION UNIT 3 (PLAT No. 83-68) 49TH •i� •*�A Anchorage Recording District, Alaska, and that the improvements situated thereon are ve.x.......z VA VA within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed KENNETHLA,fes Q premises and that there are no roadways, transmission lines or other visible o . `' 0 0 easements on said property except as indicated hereon. QO '. 4 ' t " ° ki VP ''•.LS-5202.'••gJp� Dated this the – Day of — , L___>1.1__'-) , at Anchorage, Alaska u4�'ORO�SSIONAI 0.3-\ '=''' It is the responsibility of the owner to determine the existence of any easements, 4��44p�o�� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE ~^ DEPARTMENT OF HEALTH & HUMAN SERVICES~ Division of Environmental Services LITY OF ^N~-~U~ On-Site Services Section E~ENTAL SERVIcEs DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 OCT 0 7 ]997 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~"/')\ --"),'~-;~", HAA# ~,~ ~-~C:~'"~ 1. GENERAL INFORMATION Complete legal description Lot 11; Block 12; North Woods ¢3' Lqcation (site address or directions) /Rr0perty owner Y~landa & Donald Novak /!.~Mail[~.g add ress -- .... ~627 ,March St. Edwards, '~' i~hd ng agency 'tJVlailing address 23121 Green Garden Chuqiak, AK Day phone CA 93523 Day phone Ageq,t. ' Linda Ha.fret - AQrora Address Properties Day phone 688-9014 o Unless otherwise requested, HAA will be held for pickups.. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public 'water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 (Rev. 1/91) Front MOA#21 o 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. $ & s ENGINEERING Phone Name of Firm ]7034 Eagle River Loop Road No. 204 Eagle River, Alask, a 99577, Address Engineer's signature , .... _.~ , Date /,2 /-~ /'ff ? DHHS SIGNATURE ,,// Approved for Disapproved. Conditional approval for bedrooms. bedroo~,-with the fol'10wing stipulations: Additional Comments By: Date I~-Zl '~7 '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. 72-025 (Rev. 1/91) Back MOA Legal Descr pt on ~.ll WELL DATA Log present ( Total depth Sanitary seal (Y/NI Date of test Municipality of Anchorage MUNI¢IPAUT~ OF ANCO.- DEPARTMENT oF HEALTH & HUM/~ SERVICE~NIP-ONMENTAI, SI~I~V'C~ ' Erivir°nmental Services'Division ~,1' n ~ ~9~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343~414 v. Health Authority Approval Checklist RECEIVED ~1~ ~o~H~5~ ~ Parcel I.D.: FROM WELL;LOG I A, B, or C,' attach ADEC letter. ADEC water system number · Date comp eted Cased to Casing height (above ground). Wires properly protected (Y/N) AT INSPECTION Static water level Well production WATER SAMPLE RESULTS: Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed g.p.m. ~ g.p,m. Nitrate Other bacteria ~///~/~-~~ Tank size 1~7~ O~'O Number of Compartments ~ Cleanouts / gh water alarm Date ~ c. AaSORI~T~0N FIELD DATA Date:}i~i~il~d ~- {~'~ ~'~ :~ Soil rating (g.p.d./ff~orff~/bdrm) ~LS~System~pe ~ Lengih~ ':,5~ ~ ~'Width' ' ;1 ~ Gravel thickness be ow pipe O { ~ / Total depth Effectiv~bs0~pt~~ ~ on area' ~ver field Date of adequaCy test io~q~ Results 72-026 (Rev. 3/96)* Date installed '! Size in gallons Manhole/Acce. ss ~/N) High water a arm level at*. Cycles tested SEPARATIOI' Sept c/ho d ng tank FROM WELL ON LOT TO: :: On adjacent lots "Pump off" level at* Absorption field On adjacent lots Public sewer main e/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM.SEPTIC/HOLDING TANK-ON LOTTO: Foundation io ~ 'P ' 'l' Property ine' !o Absorptionfield Water main/service line i.O' ¥ Surfacewater/drainage ~(~o~ ~' Wells on adjacent lots SEPARAT ON DISTANCE FROM ABSORPTION FIELD ON LOTTO: Fropeny line ~'. '2 BUilding [0undati0n f~d- Water main/service line Driveway, parking/vehicle siorage area Surface water I0o' ~ .,'_ Curtain drain ~O~E" K.~t'ow~ Wells on adjacent lots ' ' I F. ENGINEER'S CERTIFICATION I certify that I have determined thru field Signature Engineer's Name Date CE-8801 HAA Date of Receipt Number 72-026 (Rev, 3~96)* Receipt Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 20, 1997 Robert C. Cowan, P.E. S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 11 Block 12 North Woods #3 WaiVer Request #WR970063 , PID #051-732-20 Dear Mr. Cowan: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 8.5 feet. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-siCe, wastewater disposal system will require all separations be me.t er another approval from this department If there any further questions' or concerns regarding this waiver, please call our office at 343-4744. "' Sincerely, "" Donna Meats On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR970063 PID~ 051-732-20 HA~ Ha970469 Permit Date Received: October 6, 1997 Legal Description: Lot 11 Block 12 North Woods #3 Engineer: Robert C. Cowan, P.E., S & S Ehsineering 17034 Eagle River Loop Road, Suite 204, Eagle River, Ala~kR 995~7 Applicant: Yolanda & Donald Novak Waiver Requested: east property line. Lot line waiver of 8.5 feet from the leachf~eld to tho Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal SeparatIon TOTAL: Special Conditions: 3. Other: Waiver is Granted: v Waiver is NOT Granted: List Conditions or Reasons for above: ~~ h~ ~h~©~ Date: 10' 21'E7 Na~e of Reviewer 03327/3832 Amount: $ 115.00 Date Paid: Oct 7, 1997 ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL iNSPECTIONS ONSITE W/~,STEWATER DISPOSAL SYSTEM DESIGN October 6, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 11; Block 12; North Woods #3 MUNi~,.II-'ALIT¥ OF ENVIRONMENTAL SERVICES DIVISION OCT 0 7 1997 RECEIVED Request you issue a Health Authority Approval on the referenced property and grant a waiver for the horizontal separation distance between the leachfield and the east property line at 8.5 feet. We do not anticipate any adverse effect on the adjacent property. The property line is adjacent to a developed property. The separation distance of 8.5 feet is solely based on the as-bUilt completed on September 23, 1991 (attached). If you require additional information, please contact us. Sincerely, RCC/gk 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 o EAGLE RIVER, ALASKA 99577 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 APPROVA_ FOR A SINGLE FAMILY DWELLING 1o GENERAL INFORMATION Complete legal description Lot 11; Block 12; North Woods #3; Location (site address or di[ections) 23121 Green Garden Drive Property owner Hugh HJ2Y Mailing address Seth Caro~O~na Day phone Lending agency ¢)n. P~o~x~ (~J~y ~nstgag¢ Day phone Mailing address Old Glenn Highway Eagle River, A~ska Agent Roll M~on HERITAGE REAL ESTATE Dayphone Address ~n ~g~ P;,,o~ P~,~ ~?~ P/,,n~ ~x~, 00~77 Unless othorwise requested, MAA will be ~old for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: X× 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 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 Address S & $ ENGINEERING 17034 Eagle River Loop Road Ne. :204 Phone Eagle River, Alaska 99527 EngineeCs signature Date DHHS SIGNATURE ~'~"~ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of A~chorage Department of Healtl~ 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Em ployees 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) Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ ~[ ~4_ [Z.. ~o~.-r'~ '~c,c~.5/~ Parcel I.D. A. WELL DATA Well type ,Z~ If A, B, or C, attach ADEC letter. Log present (Y/NI Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG Date of test Static water level Well flow _,--'~g.p.m. Pump level / SEPARATION DISTAN CE~"~M WELL TO: Septic/holding tank~o~ Absorption fi.j.eld~on lot Public. er main ~ewer service line ADEC water system number Driller . Casing height ~ Wires properly protected (Y/N) ~ AT..JNS~CTION ~ N[UNICIPALITY OF ANCHORAGE r_~mONMENI'AL SERVICES DIVISION RECEIVED ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 'E,- 1"5 ~ G~ Cleanouts (~/N) ~ High water alarm (Y~ ,,.-( Date of pumping Tank size yT.~'-o Foundation cleanout ~/N) Compartments Depression ( Y/&~I~ Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots Absorption field Well(s) on lot ?--C,C~ To property line /o Surface water/drainage 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 elect~ ,S,~~STANCE FROM LIFT STATION TO: ~ on lot On adjacent lots : Manufacturer ' Manhole/~ "Pump on" leve.~.~ ~----~ ~ "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Length '~-~ t :: Width Total absorption area /~'~.~ (-~ DepresSion oVer field (Y/~) Results~fail) Peroxide treatment (past 12 months) (Y~_~ Soil rating ~ ?--~" ~//~¢'- System type Gravel thickness ~,~ ~ Total depth Cleanouts present ~N) Date of adequacy test ~ - 2. -~'--~) for ~/~) ~ ~ ~ bedrooms /~/0~¢ /z,,,/o~/J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Surface water Curtain drain Wellon lot To building foundation On adjacent lots On adjacent lots ~}~, Property line la ~ To existing or abandoned system on lot Cutbank /'Si/~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines Signature Engineer's Name Date · S & $ ENGINEERING ;703,;, Eagie ~i~,er Loop Road Ne. Eagle River, Alaska 99577 HAA Fee $ ,/~ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA in effect on the.date of this inspection. A ".~ ~ Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL cONSERVATiON ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 September 24, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering PWSID 213001 My review of the records on file in this office reveals that the Northwood Subdivision Class "A" Public Water System, is in compliance with the provisions of 18 AAC 80.200, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer 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 GENERAL INFORMATION (a) Application Date 10/7/85 LegalDescription(includelot, block, subdivision, section, township, range) Lot 11 Block 12, Northwoods Subdivision #3 Location(addressordirections) Green Garden Drive T15N R1W Sec.4 (b) Applicant Name Perle Strang Telephone: Home N/A Business 279-7611 Applicant Address 501 W Northern Lights, Anchorage AK, Dynamic Realty (c) Applicant is (check one): Lending Institution I-I; Owner/builder []; Buyer []; Other~] (explain); Rea~tor (d) Lending lnstitution United Bank of Alaska Telephone 276-1911 Address Pouch 7059 Anchorage AK. 99510 (e) Real Estate Company and Agent Dynamic Realty Petie Strang Address 501 W. Northern Lights Anchorage, AK 99503 Telephone 2 7 6-19 1 1 (f) Mail the HAA to the following address: Pickup by Realtor TYPE OF REsIDENcE Single-Family [~ Multi-Family [] Other Number of Bedrooms4 WATER SUPPLY Individual Well I"] Community ~] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) "-"~ 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 verity that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date EAGLE RIVER ENGINEERING SERVICES EAGLE ~iYt~, AK ~7 P.n RO~ 773294 694-5195 Telephone Engineer's Seal DHEP APPROVAL ('~/ Approved for .~ Lf_ ~_ bedrooms b "~'~ ~~"L~. Approved __._ ~ Disapprovc~lY//~-v, Conditional Terms of Condltional Approval Date CAUTION \ The Muncip~tlity 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 WELL DATA Well Classification "'""")MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (NAA) CHECKLIST- FEBRUARY 1984 '- 0 ? 1985 264-4720 Legal Description: ~-~/~_.~~/¢-2~- ~',K - If A, B, C, D.E.C. Approved (Y/N) Y Well Log Present (Y/N) Total Depth Cased to Static Water Leve~ Casing Height Above Ground Electrica~ Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Date,Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead IY/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date B. SEPTIC/HOLDING TANK DATA Date Installed ~2~'~/'g' ~ Standpipes (Y/N) ..,J/ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /"/,,'//,,4- Separation Distances from Septic/Holding Tank: To Water-Supply Well ~"'~ To Property Line /,--.~ / To Water Ma~n/Service Line ~'/~ Course Size /..2 ~----~ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped /~.,//~-/o~5''~ ; for r , Temporary Holding Tank Permit (Y/N) To Building Foundatior /6' / To Disposal Field ~<~/ To Stream. Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(1'1/84 ~ ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _ //¢oc ~ Width of Field foc~ / Square Feet of Absorption Area ~'~ Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well "~;~P ~ To Building Foundation .,/'42 / Lot TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Cam merits ~Jz:~z::~ Type of System Design Length of Field ~ / Depth of Field S ? ~ Gravel Bed Thickness ¢¢ ''''~ Standpipes Present (Y/N) Date of Last Adequacy Test' To Property Line ¢"~) To Existing or Abandoned System on ; On Adjoining Lots _~/c To Cutbank (if presentJ ,¢"7./~.l LIFT STATION ~¢~/'/,~ Date Installed Size in Gall OhS "Pump On" Level at _ High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Cam ments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have cbecke~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ' ¢' Date. Company .,¢~,¢(~'~/~_~' MOA No. ~ ~¢~ Rece, pt No, . 35.~ 3 ~ Date of Paymem /~/~/~ Amount: $ ~00 ~* Seal Page 2 of 2 ¢ 72-026 11/84 vER ENGi ING RI NEER · SERVICES Lou Butera P.E. P.O. Box 773294 Eagle Riyer, Alaska 99577 Telephone (907) 694-5195 GROUND WATBR MONITORING RBPoRT Legal: Lot 11 Block 12, Northwoods #3 Due.to concerns with. ground water table fluxuation the Municipal- ity of Anchorage ~as asked for a ground water monitoring of existk lng septic systems prior to Health, Authority Approval. A monitor. tube was placed at a: depth of 12' on the above referenced lot 10/23/85. A monitor of the water level on 10/30/85 shows a level of 9' below the land Surface. MeasuremenTs taken through the monitor tubes on the eXisting absorbtion bed show a total 'depth of 5' below land surface and a subsequent 4' separation between. absorbtion bed bottom and water -table as monitored 10/30/85. This is a report on the water table only and. not a soil log or evaluation. Eagle Rivelr Engineering is not responsible for any future £1uxuation in Water table:or possible contamination t~ this lot from other neighboring septic systems. The buyer should be aware that while this septic meets standards today any further rise in the water table will reqUire raising the septic Ieach field or installation of~ curtain ~ain~ge. DEPT, OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 PWS I.D.# C~/'~/ To Whom it May Concern: According to records on file in this office the ~ Water System is in compliance with the sta~e Drinking Water Regulations Sincerely, APPLIC-~I~ T FILLS OUT UPPER HAt'S'ONLY MailingAddre~ ~), ~0~ ~?/~ ~/[-[~//~ ~ ZipCode ~ '7 ~,~-~77~ Buyer Address Zip Code Lending Institution Phone Address , ~ Zip ~de Realty Co. & A~ent Phone Address Zip Code Street Locati~ Type o~ Resi~nce ingle Family ultiPie Family No. of Bedrooms ~ ~ Other Water Supply ~ Individual ATTACH WELL LOG. A wall Icg Is required for all wells drilled since June 1975. Comunity For welJ~ dril.[ed prior to that date, give well depth (attach Icg if available). Public Utility Sewer Disposal ~lndividual Year Individual Installed: /?~ ~ Public Utility When Connected to Public Utility: ~ Holding Tank . ~ ~ ; NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE I~ITIATED. Time Time Time Time Date Date Date Date inspector Inspector Inspector Inspector Field Notes: AUG 3 1 1983 "Municipality of Ancl~0raga" "Dept, of Health & Environmental Protection" ) APPROVED BEDROOMS ) DISAPPROVED ) CONDITIONAL APPR~y&~ DATE ~ _ &/5// *CONDITIONS OF APPROVAL Soils Rating 72.023 (3182) D at e,,Sewe r,4'n st ailed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size