HomeMy WebLinkAboutSYLEA LT 15AOnsite File
#015-732-40
Was North Woods Unit 3 B12 L15.
Municipality of Anchorage °` :'••
;
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw Sl.
P.O. Box 196650 Anchorage, AK 99519-6650 Page / of 3•
www ci.anchorage ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number- u�0S-017-0 PID Number.
N.me
Wastewater System: J9 New ❑ Upgrade
addraa-3 O P S EUra C SPR'f t. -
ABSORPTION FIELD
Peons C NugDar q lt.* p a
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esp Tr.nM 13 SMllow Trance t] eh [3 M.,4 I] OIMr
LEGAL DESCRIPTION
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sl� Lot
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Gravy deme Immam ppa
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pl6'
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TANK
GPM
FI.
FI
SEPARATION DISTANCES
❑ Septic ❑ HoldingT.E.P. ❑ Other.
pf
To
Septic
Absorption
Lit
Holding
hrJ
ubPnvate
wMaa✓.rI
G�Uty
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Sewer Line
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Inspections performed b : iCi y
P P Y Dates: 1 S 4S
o x9L
.... .....
Development Services Department Approval
Reviewed and approved by: W � Date:`' %' D
PE 62
�e <"q'••. •'��v'
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
15' T & E Easement
DESIGN NOTES:
1. Total Depth of Trench is 6'.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Public Water System.
1500 Gallon STEP Tank
Remove Did Lift Station & Tank
Bdrm House Pressure Force Main
1.25' Schedule 40 PVC Force Main
or Equal
\ r%O—OUILI MtHJUKtMtNIJ
A g
Tank C.O. 1 31.6 27.5
Tank Manhole 35.5 33
5 % Slope Foundation C.O. 54
C D
Monitor Tube 1 101.6 79
Monitor Tube 2 95 64
/M.T.1 M.T.21
Absorption Trench
4' Effective Depth
1' = 40'
OF
NOR THRIM #yP' N❑RTHW❑DDS #3
ENGINEERING •. AS—BUILT
17237 E09te Rivera, Alaska ar W 99577 a -aa. •: • j --------LAYOUT
907.694.7028 L ❑ T 15, BLOCK 12 Date - --
6/29/05 2of 3
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05/19/2036 09:30 9076961815 GREEN GENERA„ INC PAGE 01/01
WAMOMM
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PAwr 696l3G1 cd / 227dM3
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7o: Green General Contracting
PO Box 672125
Chugiak, AK 99567
Date :8-10-05
Ref :23108 Glenn View
Peter Creek AK
PcMait :
poet -It" brand fax transminai memo 7071 It •f r•9•• •
This is to certify that on site sewer lift station at above mentioned
property has been wired in accordance with the standards of the National
Electrical Code and manufactures specification.
Systems were checked and performed as specified in the systems
manual.
Clint Walker
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jun 14, 2005
Expiration Date: Jun 14, 2006
Permit Number: SWO50170 Parcel ID: 051-732-08
Legal Description: NORTH WOODS UNIT 3 BLK 12 LT 15
Design Engineer: 0838 North Rim Engineering Site Address: 023108 SHELTERING SPRUCE AVE
Owner Name: STEVE & TRACY PIFER Lot Size: 23093 SO. FT.
Owner Address: 23108 SHELTERING SPRUCE AVENUE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK . AK 99567-5438
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
a.) Maximum depth of absorption field shall not exceed 6 feet below original grade.
Received
Issued By:
Date: 16, J^
MUMNIT 0_2
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 40-57 - 73�-02 Permit Number SW
Property owner(s) -r4 IF45/L Day phone Xf- 577-r
Mailing addressSe& 7'a/.v6' Vert Zip ode
Site address Yic/%%G
Zip Code
Legal description (Lot, Block & Sub'd.) N&d
is oo _f B(2 L tS
Legal description (Section, Township & Range)
Lot Size x3093 Acres
' /
Number of Bedrooms '7l-
THIS APPLICATION IS FOR:
Sewer Only 1
Well Only
❑
Sewer and Well /❑
Water Storage
❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑
Jacuzzi
❑
Swimming Pool ❑
Water Softening Unit
❑
Therapy Pool ❑
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.
of property owner
Permit/Rush Fees:
Date of Payment:
agent)
Waiver Fees:
Date of Payment:
Receipt Number. Receipt Number.
(Rev. 09104)
r
� FEN�INEERIr 1 1
NorlhRim Engineering
17237 Bear Paw Circle
Eagle River, AK 99577
907.694-7028
June 7, 2005
MOA On -Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Septic System Replacement; Northwood, # 3 S/D, Block 12, Lot 15
A septic system replacement design is submitted for your review. The existing lift station
is not working properly and the entire system will be replaced. Public water serves the
subdivision; no well conflicts will take place. Nearby lots also have private residential
systems.
The drainage slopes from back of lot towards front of lot. An elevated bench is located on
the back portion of the lot. The bench contains excellent soil, with no groundwater
present. The sandy soil was not dense, which is unusually good for this vicinity.
Please review the wastewater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
Steve Eng, PE, PH
Design Enclosures
Y�T
�INEERI�
1N Northwoods # 3, Block 12, Lot 15
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 4 -bedroom, single family home. The existing
lift station is leaking and the entire system will be replaced. The best placement for an absorption
trench is upslope, which will require a S.T.E.P. tank (lift station). An excellent site exists on an
elevated bench to the rear of the property; the test hole was dry and no groundwater was
encountered. This requires a 1500 gallon S.T.E.P. tank, manufactured by Anchorage Tank &
Welding per Orenco Systems specifications. This lot is about 0.5 acres in size and the owner also
owns adjoining property to the west. No adverse impacts are expected from development,
neighboring lots range similarly in size. The entire subdivision is served by a public water system
and the neighboring septic systems are located per sheet 2. No conflicts to the other lots will take
place by this septic system replacement. A 15' utility easement on the front property line will not
be encroached upon. Soil tests found superior soil for this area; sandy soil, not dense, and with no
groundwater. The system utilized a 5' wide trench with allowable reduction factor. An application
rate of 1.2 GPD/Fr2 with 0.5 reduction factor for utilizing a 5' wide trench.
Specification Requirements: All components and work must comply with the Municipality of
Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater
Regulations.
• Two compartment, 1500 gallon S.T.E.P. tank, conforming to Anchorage Tank & Welding/Orenco
Systems Specifications.
• Watertight couplings on inlet & outlet
• 5 foot minimum between the tank and bed. 10 foot to property lines.
• 3 feet of cover is required for trench or insulate.
• Tank & solid pipe must be set on well compacted, stable soil
• 4 inch diameter elcanouts with airtight caps are required I to 4 feet from foundation wall, prior to any
90 degree bend in 4 inch line.
• All eleanouts must extend to at least ground level
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron
• Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock
• Drain rock to be % inch to 2 % inch screened. Drain rock to be distributed uniformly throughout the
trench.
• Distribution pipe shall be 1.25" Schedule 40 PVC w/ I/8" orifices t@ 27" on center w/ Flushing Valve
Box at end of pipe on both ends.
• Force main shall be 1.25" Schedule 40 PVC, conforming to Anchorage Tank & Wclding/Orenco
Systems specifications. Force main burial to be 4' minimum.
• Silt barrier (filter fabric) to be installed above the drain rock
• Smeared trench sides must be raked or scarified before drain rock placement
• Ball over drain rock must not be less than 24" & I" insulation.
• The finish grade must be mounded to promote drainage over the bed
• Insulation must be placed over any pipe installed under driveways or parking areas
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM
D2661, PVC Schedule 40.
• Sewer Service Line is minimum 2% slope
• Septic Tank to be pumped every two years or when required
• Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam Iil or equal
• The existing septic system will be abandoned; the septic tank will be pumped, croshcd, and filled with
sand/gravcl or removed and properly disposed of.
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
x
0
15' T & E Easement
DESIGN NOTES:
1. Total Depth of Trench is 7.5'.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Public Water System.
1500 Gallon STEP Tank
Remove Old Lift Station & Tank
Bdrm House IPressure Force Main
1.25' Schedule 40 PVC Force Main
�—�or Equal
5 % Slope Absorption Trench
rf— 4' Effective Depth
1' = 40'
r t6.OF A %h
NORTHRIM fy�� ' •d:t,'•.,
N❑RTHW❑❑DS #3
ENGINEERING ` :'s
LOT
17?37 Boor Pew Circ,o p
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LAYOUT
£opl. Rher, Alaska 99677 •
.=
907.694.7028 '
LOT 15, BLOCK 12
6/7/05 1 of 4
Septic System Construction
Does Not Preclude Adjoining
Lots From Sanitation
Improvements.
N90000,00,11
SPRUCE
---t•
-----r-----
Utu Eer
Vacant
5% Slope
New Leach
Field
Septic
Area
10
DESIGN NOTES:
1. Total Depth of Trench is 7.5'.
2. Sewer Service Line minimum 2% slope.
3. Trench is Minimum 10' from Lot Line.
4. Lots Served by Public Water System.
Avenue
Septic
Area
14
1/Septic
Area
15• Utit Esml
ib� 20 35.26 120.00
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N❑RTHW❑❑DS #3
ENGINEERING • *
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LAYOUT
Eavo INW.7'6928 99577 ., a-ws ,:
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SOILS LOG - PERCOLATI❑N TEST
THRIM Date Performed: 5/19/05
INEERING
Performed For: Steve & Tracy Pifer
Legal Description: Northwoods #3, Block 12, Lot 15
T.H. Location: See Attached Design
Elevated Bench In Rear of Property
Groundwater?lei_
Depth --
Water Depth
After Monitorino.None Dates 5/?7/05
#
DEPTH
Gross Time
Net Time
(FEET)
Net Drop
1
5/24
Organic
--
3'
--
2
2 -
::.: ...
2 Min
3
0.5'
3
5/24
35
--
4
--
4
5/24
37
2 minj
5
0.5'
5
5/24
70
Sand
3'
--
6
5/24
:,
w/ Silt
7 -
0.5'
8
10
11
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
T.H. Location: See Attached Design
Elevated Bench In Rear of Property
Groundwater?lei_
Depth --
Water Depth
After Monitorino.None Dates 5/?7/05
#
Date
Gross Time
Net Time
Depth
Net Drop
1
5/24
0
--
3'
--
2
5/24
2
2 Min
3.5'
0.5'
3
5/24
35
--
3'
--
4
5/24
37
2 minj
3.5'
0.5'
5
5/24
70
--
3'
--
6
5/24
72
2 min
3.5'
0.5'
21 - Percolation Rate 4 min,/Inch Perc Hole Diameter >'
Test Run Between 4' and 5'
Comments: Dry. cnnd14 call Pncy Pxrnvnttn8.
Performed By NorthRim Fng, I CERTIFY THAT THIS TEST WAS
Performed In Accordance with All State/Municipal Guidelines in Effect
ON THIS DATE. DATE: 6/1/05
NORTHRIM a�" •+:
TESTH❑LE LOG
ENGINEERING17237 y9 ' '
T. H. 1
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EdVo Rlw.A/oskoW 995773i� a-Wa✓!
r
907.694.7028•''•••••• -
GE❑TECHNICAL
DOW
6/1/05 1 of 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
8 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
C. DISTANCES
Address TO SEPTIC ABSORPTION
FROM TANK FIELD WELL
WELL
Phone(s) Permit No. No. of Bedr oms W-A�y oo
LEGAL DESCRIPTION ai LOT LINE
Lot . Block Subdivisio v 10
1 1
Township, Range, Section
T1 �,i FOUNDATION g a +
ac AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
TA KS
driveway, water bodies, etc.)
d fA
SEPTIC ❑ HOLDING �• •`
' n
Manufacturer• Capacity in gallons
TYPE OF SYSTEM
❑ TRENCH D< BED
❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
Total depth from original grade
original gradera
I FT
31
FT
Fill added above origin grade
Gravel depth beneath pipe
_ FTFT
•Q
Gravel length a
Gravel width
,
S-C� FT
ICJ
FT
Total absorption area
Distance between lines
SQ FT
If
FT
Number of lines Soil rating
Pipe material
3 ;?0(:)' SQ FTb3caf
InstallerDate
Installed
t
ELLS
❑ PRIVATE
54 OTHER (Identifv)
Classification (A,B,C)
Total Depth
Cased to
ASS A
FT
pT
REMARKS: /I
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'175034 Eagle 111Municipal audaglIGIRf4ir, XIl
Health Department Approval:
72-013 (3/85)
dour a 1 e ,;
Scale: N • -T
Inspe orrmed by:N
�
AW
Date: Ip — V j_a"'
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71
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MUNlCIPALITY OF
ANCHORAGE
Department of Health & Human
Services
825 L Street, Anchorageq Alaska
99501 343
ON-SITE SEWER
PERMIT
Permit Number:
890087 Upgrade
Date Issued:
06/01/89 Engineer Designed
Owner Name:
if) ,H"F.C,
Day PhoDe:
Owner Addr��s�
520 E" 34 AVE"
6q4 2979
ANCH�RAGE, AK 99503
Parl Id:
051 08
Lot Legal:
Gubdivision: NDRTH WOUDS #3 Lot:
15 Block:
12
Section: 4 Townshipx 15N Range:
1W
Lot Size
23093 (sq,ft" or acres)
Max Bedrooms:
This Permit: 3 Total Capacity:
3
SEPTIC TANKx Minimum total septic tank capacity: 1,000 gallons, Each septic
tank must have at least 2 compartment$, Depth to tank(s) < 4.0
Feet requires insulation over tank(s),
INSTALL PER E�K INEERG DESIGN" LIFT STATION AND HI8H WATER ALARM
TO BE TESTED" TAIS PERMIT IS ISSUED FOR THE EXIGTING 3 BDRM.,
DWELLING ONLYPINT) EXPIRES ON 12/31/89.
I CERTIFY THAT:
1^ I am Namiliar with the requirements {�P onmsite zewers and wells as get
forth by the Municipality of Anchorage (MOA) and the State o{ Al�ska.
2, I PA 11 install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o{ this permit.
3" I will adherC,,� to all MOA and State of Alaska requirements f,or the set back
distances from any existing well, wastewater disposal system or public
sewepage system on this or any adjacent or nearby lot"
4" I understand that this permit is valid for a maximum of 3 bedrooms. I
also understand that the capacity of the total system is :3 bedroom; and
any enlargement will require an additional permit.
Signed: DATE:
�t____.... ....
...
...
_1.� _~_..... ..... .... .... ... ..... ����..... ~
�
Issued ByxDATE:
L
CV
C.0
I ryaG, i VCICI
Ivry
LP 0
t-t'C>P�7-rp Woops
m
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: L-��I�%�- 3_ `7L— T �{[,,,�.�-,-lrnG�, DA
LEGAL DESCRIPTION: L' iS r./ ISL- 1'1C)V" Township, Range, Section
pT �� SLOPE SITE
_Iw �- r -,--r T
2
r
3
4
12-
13-
14-
15-
16-
17
2 1314151617
81920 18-
19-
20
COMMENTS
v, 4 Eagle River Lo
PERFORMED BY: a nt
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72-008 (Rev. 4/85)
41
WAS GROUND WATER \I I/�
ENCOUNTERED? �%
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water After
Monitoring? —7 Dater
Reading
Date Gross
Time
Net
Time
6
�r
1
7
_p
G � Y
~y�
r
1_' 4r
8-
7-`•4:;-�
9-
91011
10-
11
f `/
o
io
lv
12-
13-
14-
15-
16-
17
2 1314151617
81920 18-
19-
20
COMMENTS
v, 4 Eagle River Lo
PERFORMED BY: a nt
ACCORDANCE WITH ALL STATE AND MUNICIPAL
72-008 (Rev. 4/85)
41
WAS GROUND WATER \I I/�
ENCOUNTERED? �%
S
IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water After
Monitoring? —7 Dater
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
S -tom -tet 2.to--
'2—
1_' 4r
7-`•4:;-�
o
io
lv
u
PERCOLATION RATE 67 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 3 FT AND FT
CERTIFY THAT T/HII TESTPASCPPERFORMED IN
EFFECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE b�O is Sa ¢a
• 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 W
J z� PHONE
tsM 2 UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
U DISTANCE TO: Comm
Y
IL Q Manufacturer
LU C---Iree^
W Liq. capacity in ggallons
I e.f,'I IF HOMEMAnF•
NO. OF BEDROOMS
)tion area DwellingQQ PERMIT�N9O.
`5 U keuxfjytii +e,1
Material No. of compartments
L
length Width Liquid depth
G Y
J t=Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= Z F
Manufacturer
Material
Liquid capacity m gallons
DISTANCE TO:
Well « r
Foundation
Nearest lot line
I
PER, aTi'i
F Z w
No. of lines
Length of each a
Total length of i�ne
Trench width
-A1
flWr" ^
Distance between lines
f
D
Top of the to finish ,grade rr
Material beneath the
2
Total effective absor ioniarea
Length
9
Width
Depth
10
inches
4 1 6 u
w
PERMIT NO.
C7
Q F
LU a
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w
w
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
3:
STANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
`
PIPE MATERIALS
(�
I VC
SOILTESTRATING
IZCa IJtA
_5
INSTALLER
S
REMARKS
M
d
K
it
APPROVED
DATEL�E.gGAL
p to r 11A WOO
p
72-013 (Rev_ 3/78)
Inswt-cAed bqt�o--"y % Rol -k
MUNICIPALITY OF ANCHORAGE
Department,- f Health and Environmental-,Trotection
825 Street, Anchorage, AK. _9501
0 264-4720
Permit #,F - # # HANDWRITTEN PERMIT # # #
NBA ON-SITE SEWER PERMIT
Applicant: Mailing Address:
; *U
Location: L P one Number:
Legal Description: �d 7-16- Q%Jklet Lot Size:
Type of Soil Absorption System Is:
Trench: Dra.infield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: _ Soil Rating (sq. ft/br) /Ao
The Required Size of the Soil Absorption System Is:
DEPTH y _LENGTHr GRAVEL DEPTH WIDTH JAS
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).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = Ja d b 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, 1 9 3 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 e rge ent if
the residence is remodeled to include more tha 3 edro
Signed: 01 Issued by:
Ap icant Y(-1 /_-�
Date:
SWP/024(1/81)
94— SOI LS LOG
MUNICIPALITY OF ANCHORAGE
' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
a .
825 L. Street, Anchorage,. Alaska 99501 264-4720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: �"7'`=(f��� L. K�lel�, 4n) ,,;T DATE PERFORMED: OjP_ eIa-
LEGAL DESCRIPTION: `L7i' �� ���= d1oi ` lue,jeyr '4 /, fl-.-
DEPTH
(FEET)
1
rr� L f 1 T f fIPS.C9tL
2
3
4
6,eA d e," 5 A fJw wu rryl
to 16hsacs 12O Sr)
5-
6-
7-
8-1
67$ SN! S i wry 6,mae y
9-
10-
11
1011 WAS GROUND WATERS
ENCOUNTERED? JU O L
O
12 P
®® IF YES, AT WHAT E
13 �-r-rvm OF'/� DEPTH?
14-
15-
A6
OF
16 4w , oOeeouaeB
o X e
17 Pm4°H
1$
�®mm _ aom aeq gee omo
� oua e® on o
f° t" *Russell L. Oyaten
4%
19 1� 00 No. 4286.E
�meg,po
PLAN
Reading
Date
Gross
Time
Net
Time
Depth to-'-
Water
Net
Drop -
t®
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND--V
FT
COMMENTS �-
COMMENTS LoQ�! tb -d.�r ]( SC-�t7r ^' �%'�r� •> �' "7-1�r5 f-- q- —/V,p FJEi%I�A(C 7d C0/0046NEC�
n _
PERFORMED BY: Sem r ST�iB CERTIFIED BY:
72-008 (6/79)
DATE:_ L 19$' j
En A WS
MUNICIPALITY OF ANCHORAGE
` i
Development Services Department ` Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 051-732-08 Expiration Date: d _ZCiZ
1. GENERAL INFORMATION
Complete legal description North Woods Unit 3 Block 12 Lot 15
Location (site address) 23108 Sheltering Spruce Ave
Current property owner(s) Troy Davis Homes, Inc. Day phone 357-9394
Mailing address 1689 S. Knik Goose Bay Road, #400, Wasilla, AK 99654
Real estate agent Day phone
2. TYPE OF DWELLING:
J Single Family (w/wo ADU)
E Duplex
E Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well 0 Private Septic [�
Water Storage l—I Holding Tank
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance.
Received by: Date:
COSA to be released to the engineer.unless otherwise requested by the engineer.
COSA Fee $ 636 Waiver Fee $
Date of Payment .51881 1q Date of Payment
Receipt Number 6cc31 Qq D Receipt Number
COSA# 0.5C1(1118‘0 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 5/23/19
*: 49 i • *',
6. DSD SIGNATURE ► • ••
System #1 Approved for J bedrooms •
r/ . Benja•
, hiller
1259
System #2 Approved for bedrooms F9F,C5123/19?.` ��
Disapproved ill °PRoFEssIoA�
Conditional approval for bedrooms, with the following stipulations:
By: — Original Certificate Date: C3,
The Municipality of Anchorage Development 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
COSH Cbecc s:bice sneer
COSA Checklist
Legal Description: North Woods Unit 3 B12 L15 Parcel ID: 051-732-08
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached) Well production at time of test gpm
Date drilled Water storage tank volume gallons
Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No
Cased to ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) in. Collected by
Date of flow test for COSA Date of Sample
Static water level at beginning of test ft.
Comments PUBLIC WATER
B. TANK DATA C. LIFT STATION
Age of tank(s) 14 years ❑ Required maintenance completed
Tank type/material Septic/Steel Age of lift station 14 years
Measured operating fluid level in septic tank 49" Lift station material Steel
❑■ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 6 3d `17
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 8/5/05 Adequacy test date 5/22/19
❑ ALL standpipes present per record drawing Results Q✓ Pass For 3 bedrooms
Total measured depth from grade ,.lC ft (max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade ft(min) Water added 600 gal
• N/A—pressurized field New depth 0 in
❑� Monitor tubes go to bottom of effective. If not, state 0
depth into effective Elapsed time min
❑■ Code-required soil cover over field Final fluid depth 0 in
Absorption rate 450+ gpd
❑ System presoaked NA
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced NA gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout> 100'
✓❑Yes if No ft 0✓ Yes if No ft
Neighboring Tank > 100' ✓0 Yes if No ft Private Sewer/Septic Line > 25' ✓l Yes if No ft
Absorption Field on Lot > 100' ✓❑Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft
❑✓ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes if No ft —0✓ Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ✓0 Yes if No ft Surface Water> 100' ❑✓ Yes if No ft
Property Line > 5' p Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' ✓0 Yes if No ft
Water Main > 10' ✓0 Yes if No ft Community Wells > 200' [' Yes if No ft
Water Service Line > 10' 0✓ Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' p✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ✓0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10' p Yes if No ft Community Wells > 200' 0 Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION �t���"\‘
_, of AC4lkI
I certify that I have determined through field inspections and review ,r Q'•
of Municipal records that the above systems are in conformance with j 413 i �• .. 0,A
MOA COSA guidelines in effect on this date. / *• TH i"Ik • * y
% VP- . ‘%.". . . . . /
Benja chiller . • .
�# (�c•.. CE12592 ��
�� '...5/28/19 ,•��v��
COSA Checklist yellow sheet 1kV'PROFESS10NP4.�
SHELTERING SPRUCE AVENUE
o • o 1\
N 90'00In .( '00•E 120.00'
2.0'x10.3' CANT
.ic..-- Q MANHOLE
• _c. u,
SEPTIC \_.15' UTILITY EASEMENT
'°Q> PIPES
GRAVEL Qo 6.1'x7 8'
ENCLOSERETAINING WALL
• ENTRY 2.0'x 18.3'
CHAIN—LINK FENCE CANT
1.5' CANT so.2 49.8'
10.3'x 12.3' SHED 7 STORY RESIDENCE. 1
1 1.9'x8.2' N w/ DAYLIGHT BSMT, d 2.0'x4.5' '
GREENHOUSE MAd50.2' B • N CANT N
a
•
liff".141111— a)
WOODEN
�,a
o
Tract B1 FENCE o Lot 14
• w 1.3'x3.6' CANT —` o
0o , o
o Lot 15 DECKS
o
•
°
23,093 s.f. cn
o
0
Z RETAINING WALL p��i4
IWIRE FENCE
WIRE FENCE
• SEPTIC
PIPES
7.9'x8.2' PLAYHOUSE•
.`• •`
\ N 90'00'00"W 120.00' •
\
\
\
Lot 9 \\ Lot 10 Lot 1 1
\ I
PLOT PLAN AS BUILT X SCALE 1• = 40' GRID NW 1459 Project No. 17-497/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang (Sc Associates , inc . (907) 522-6476 Phone d000Op T
(907)an2surve comFax c OF / O�p
Professional Land Surveyors g y. d ..... ..1. p
jonathanOlangsurvey.com �oPS QO
I hereby certify that I have surveyed the following described property: QOM '
LOT 15, BLOCK 12, NORTH WOODS SUBDIVISION — UNIT #3 (PLAT No. 83-68) p * 49TH •��.D0
Anchorage Recording District, Alaska, and that the improvements situated thereon are o 0
o
within the property lines and do not encroach onto the property adjacent thereto, that 0 r
no improvements on the property lying adjacent thereto encroach on the surveyed 0"-L KENNETH LAN
premises and that there are no roadways, transmission lines or other visible 0�c^„, OD
easements on said property except as Indicated hereon. '
PSP c'tY P O���P�'�LS�20g ••.gjp�0
Dated this the \'J Day of �' ,: , �' I , , at Anchorage, Alaska a O o
I p40QRG SSIGNAL-'Q'
It is the responsibility of the owner to determine the existence of any easements, �OpppOo�
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
KEY BOX AND SERVICE LINE LOCATION BY SKETCH - opro
INDICATE
NORTH
STREETLWIW
/c"-4/' 4,7 A
lk c
N
1 S -
0 6 -"o
-
fi
k)
o
le
a
n
1
,
31-058 (Rev. 10/97)* Back
MUNICIPALITY OF ANCHORAGE
Phone:Fax_
3<E3 �90�
Development Services Department Fax 07••313 7997
On-Site Water & Wastewater Section
Lift Station/Pump Vault
}' `� Maintenance Log
Leel Desc.__ -'--
P�.one --- -
c.ptic Tank;
-SIu«ge Iev?! ,! !n:;hes -Pumping: requ -edt.L0 -Pumping completed ell .0 i
LJ1t atiQn: ID N1cLy rt
-Pump basket cleaned ,,,-.`: rac1 ifiuent filler cletaned ,Q
-Control floats cleaned COR -Prrtip•ff ilc;�t settings confirmed ro
-Operation satisfactory o
Alarm System;
-Dedicated electrical alarm circuit 0 no -Audible and visual alarm inside dwelling xE+x.09
s t��f X14044- 1
-Alarm �.yystern operation atict4• tom. u acto.�C
iVtarillR15.t
-Ground water intrusion at riser to tank connectior ygaal
-Grottnd water intrusion around pipe penetralior?. v,^;
00 •tiAk±en hole functional VF!c no
InsulatedProperly Secured r
-Manhole lid: Functionalo
-All manufacturer required inspections and maintenance completed
Technician L- .c c-vE'-T r.. --- Date of maintenance_.
r
Company A p k .l_ 4 GL.0? $21C q
Signature:_ _
Date;S�1/
. - • " • -. ..- . • . . .fir ' .. ' -w'vW.r lurhp.Grq • I
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services�i
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell.D.# 051-732-08 HAA# HA890046
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 15 Block 12 North Woods Subdivision Phase III
Location (address or directions)
NHN Sheltering Spruce
(b) Property owner AHFC #56696 Telephone: (home)
Mailing Address 520 East 34th Avenue, Anchorage, Alaska.
(c) Lending Institution Northland Mortgage Telephone o Tammy
Mailing Address
Business
(d) Real Estate Company and Agent Lynda Banner % Jack White Company
Address 10928 Eagle River Road, Eagle River, Alaska 9.05577
Telephone 694-5500
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
S & S Engineer
17034 Eagle River Loop Road, Suite 204
Anchorage, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms three (3 )
3. WATER SUPPLY
Individual Well ❑ Community:9C Public ❑ P.W.S. ID#213001
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-sitell3c Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the Iegailty and status.
72-025 (Rev. 7/88) Page 1 of 2
� p
A
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
June 23, 1989
Mn. Dan Bones
Mun i.c l pat i.ty o6 Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L St&ee-t
Anchorage, A2a,6ka 99501
REFERENCE: Lot 15; Btock 12; Nonth Woods Subd.iviz ion 03
Dean. Dan,
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
On February 13, 1989 you .issued a eonditiona2 Hea.2.th Authority Approvat
(HAA) on the te4etenced property. The condition o4 this approval
required the ab,sorption bed to be monitored 6or water during the period
Brom May 1, 1988 to June 15, 1988. On May 11, 1989 groundwater
monito&ing resutted in a determination that the existing absorption bed
was .in non-compliance with the 4 boot separation required to the watem
table.
Subsequent to this determination, Municipae penm.i..t #890087 wa3 .i3,sued
4or the upgrade o5 the ab,6orption area. Attached .is an on -,site
in.speetion report az-buC2t 4or the upgnade pergormed under this permit.
Request you now .i3sue a 6inat HAA.
ptea3e c.ontaaZ t us.
33
. SHAFER, P.E.
16 we may be o6 burther zerv.iee,
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
JUN 2 61989
RECEIVED
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
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MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND "'ATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel 1.D.# 061 -1 -CA HAA#- i1Q9,"�CY2�LV_,n
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner HE #56696 Telephone: (home) Business
Mailing Address 59d F_ 34th, Anohaaago
(c) Lending Institution Nau.thfand Ma 'gage Telephone
Mailing Address Attn. Tammy
(d) Real Estate Company and Agent Jack White Co. / Lynda Bannek '
Address 10928 Eagte Riven Rd., Eag.2e Raven, Ak. 99577
Telephone 694-
(e) Mail the HAA to the following address: (or check here* -,if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Ea4le River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family>y(.l Number of bedrooms 3
3. WATER SUPPLY
Individual Well Community EX Public ❑ P.W.S. TV. #213001
Note: If community well. system, must. have written confirmation from the State Department of Environmental
Conservation attesting to th"legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .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 S & S Engineering Telephone
694-2979
Address 17034 Eagle River Loop Road, Suite 204 Eagle River 99577
Date
Engineer's Seal
6. DHHS APPROVAL
Approved fattree 3 droomsby �---Date June 27, 1989
Approved xxxxxxx Disapproved Conditional
Terms of Conditional Approval
The upgrade of the on—site wastewater disposal system has been
completed and as—builts turned into DHHS for review and approval.
The as—builts have been approved, see attached copy.
Therefore, this property is now fully approved as a three(3) bedroom
single family dwelling.
1uTIa
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in orderto 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.
72-026 (Rev. 7/88) Beck Page 2 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION '
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .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 3 & S ENGINEERING Telephone v �r� Z 71
17034 Eagle River Loop Road No. 204
AddressEagle Rivet,
Date 2 _11�
P �=" e• rte, taa<<.� o M�,�.
6. DHHS APPROVAL
Approved for •� bedrooms by *' � Date �
Appreved i J. •.-. • • •
Terms of Conditional Approval
70 �e¢74dPz
etdl fvY�X0:2 ��t� j
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a K g /`' a SS/IZ
CAUTION
11 C oLK U/S G� 6
� dam. G ��i/T (f � /YtOH/Tfjylbfey
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
7- '
MUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744 44
Legal Description: U-0< 14� 1�L �• 12--
Q� Q Lam`
A. WELL DTb n
Well Classification
(�
If A, B, C, D.E.C. Approved/N)_
Well Log Present (l%N) 7 Date Completed Yield
Total Depth Cased to Depth of Grouting
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot 7.0014" ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot '7,00t k ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by Date
Water Sample Test Results
Comments `i12
B. SEPTIC/HOLDING TANK DATA
Date Installed l01 -O3 SizeI Q(22_No. ofCompartments 'Z—
Standpipes&N) T—_Air-tight Caps ON) Sf_Foundation CleanoutCSDN)_
Depression over Tank (Yo D to Last Pumped
Pumping/Maintenance Contact on File (Y/N) rJ • for
Holding Tank High -Water Alarm (Y/N) I I -Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well ��� t� To Building Foundation
r
To Property Line
To Water Main/Service Line
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course \racy L
Comments 112 5 00'FJ t-1
t1
72-026 (Rev. 7/88) Front Page 1 of 2
'5,
/
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type Type of System Design
Date Installed Length of Field �� )
Width of Field 1 �� Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area l Statndpipes Present(fVTl)
Depression over Field (YJJ�T /A Date of Last Adequacy Test -z-
Results
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well
To Existing or Abandoned System on
On Adjoining Lots4-
To Cutback (if present) `� —
To Stream, Pond, Lake, or Major Drainage Course `�_
To Building Foundation
Lot (jam
�
To Water Main/Service Line J�_
I
To Property Line tb
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Si n Gallons
"Pump On" slit
High Water Alarm Level at — -
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N)
mping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request"
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection. e4
Signed
S & S ENGINEERING
17084 Eagle River .. _
Company
ever, /Ilaska 99577
0 ---,?
Date
MOA No.
,^Zil
r , C_Z
a e 9 &_0 ('6_;2A/
No. o_4;
Date of Payment
Amount: $
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
of this
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DEPT. OF ENVIRONMENTAL CONSERVATION/
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 316
ANCHORAGE,' ALASKA 99503
DATE: January 26, 1989
PWSTD: 213001
To Whom it may C,rncern:
Apcordin�g�;to the records on file in this
WTILITIE ZNORTHWOODS Water System is in
State of Alaska Drinking Water Regulations.
Sincerely,
STEVE COWPER, GOVERNOR
563-677
A
1j:
E
1.
ri
Sincerely,
STEVE COWPER, GOVERNOR
563-677
A
E
1.
Sincerely,
STEVE COWPER, GOVERNOR
563-677
A
Time
AP' FILLS OUT UPPER HA ONLY
Time
rPLI"1NT
Property Owner W11 M 07-1- f`�.�T �C.� j�� r�
FPhone
Address i
+-7 /l.
J /T
lf� C (`j /tJ% �3 f{ 5 l Zip Code/)
G}Mailing
3 �f ' /3:",3
Buyer
Date
Inspector
Address
Zip Code
Lending Institution
Field Notes:
6
Phone
Address
Zip Code
Realty Co. & Agent
Phone
Address
Zip Code
Legal Description L9 (' ,�
13eor K Z f'! CrU 's �✓
'
Street Location & A!
4 T c-'
T pe of Residence
,Single Family
"?
',J
71 Multiple Family
No. of Bedrooms
❑ Other
Date Sewer I
tailed
Water Supply
11 Individual
Well Log Received
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
X. Community
Well to Tank
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
Se
'Z �� 7 ,SK>4� C}
q`�
Cl)(`isi
p�
Year Individual Installed:
=�'l.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
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
6
JUN 101983
"Municipafity of Anchoraga,,
( APPROVEY BEDROOMS
'CONDITIONS OF APPROVAL epL. of Health &
f nvircnmental Protection''
( )DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE,
BY:
Soils Rating
Date Sewer I
tailed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72023 (3182)