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HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 14 LT 6Onsite File x v. North Woods #3 Block 14 Lot 6 #051-732-34 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131283 Tax Code Number: 05173234000 Work Type: Septic Permit Effective Dates: August 28, 2013 to August 28, 2014 Design Engineer: ARC TERRA CONSULTING INC Subdivision: NORTH WOODS UNIT 3 Site Legal Address: NORTH WOODS UNIT 3 BLK 14 LT 6 GA459 Owner/Address: CONLEY THOMAS E & CAROLYN E 22918 GREEN GARDEN DRIVE CHUGIAK AK 995675438 Site Mailing Address: 22918 GREEN GARDEN DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 34924 Total Bedrooms: 3 N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By By: K Date: Date: MUNICIPALITY OF ANCHORAGE nAlspj Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-732-34 Property owner(s) THOMAS & CAROLYN CONLEY Day phone Mailing address 22918 GREEN GARDEN DR., CHUGIAK, AK 99567 Site address 22918 GREEN GARDEN DR., CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTHWOODS UNIT 3 BLOCK 14, LOT 6 Legal description (Township, Range & Section) Lot Size 34924 Sa. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family [% Absorption Field ❑ Initial ❑ (SF) Septic Tank Upgrade (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. owner or authorized agent) Permit/Rush Fees: ` 4;?06 , 4? Date of Payment: Lao//3 Receipt Number: Q Permit No. aspl,'oiB3 V Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. Q►RCTER"q g a k K na515'�j0 August 16, 2013 ARCTER1ZA CONSULTING, INC 212 E. 51" Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit — Northwoods Unit 3 B14, L6 The owner has requested we proceed forward to obtain a septic permit to upgrade the failed septic tank on the subject lot. The proposed upgrade will serve the existing 3 -bedroom house. The adjacent lots are served by public water as noted on the design. There is no surface water within 100' of the proposed tank. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 868-3792/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth Duffu P. Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE NORTH WOODS UNIT 3 BLOCK 14, LOT 6 2 PLAN 21.4 N N 4 �fy N 62.92 146.50 5 >9 4 om 0 ISO.nn 146.50 3.5654'W 1317.95 (79-245) i'59'03'W 131845 (83-68) SUBDIVISION & ADJACENT SUBDIVISIONS SERVED BY PUBLIC WATER NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. Scalel 1'= 60' PAGE 1 OF 2 DESIGN DETAILS DECOMMISSION EXISTING SEPTIC TANK PER CODE INSTALL NEW 1000—GALLON SEPTIC TANK CONNECT TO EXISTING SYSTEMS VIA EXISTING POST TANK CLEANOUTS AND DIVERTER NOTES1 1. INSULATE TANK IF (4' COVER. 2. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS & SEPTICS. PREPARED FOR; THOMAS & CAROLYN CONLEY 22918 GREEN GARDEN DRIVE CHUGIAK, AK 99567 FIELD BOOKS W'"BARY� BOUNC 5TiV°N0' STAKIN ASeIALr: REJ DMR FIC ADA" F -F` FILE COMPUTek DRAWN' BMW C0'm KMD DATE 8/15/1 GR& NW1459 JOB NO'' 13-130 3 m a � L x i FmyaVSOLTING 1 s� R Ak. 99571- WASTEWATER DISP❑SAL SYSTEM DETAILS NORTH WOODS UNIT 3 BLOCK 14, LOT 6 NOTE1 1. CONTRACTOR MAY REMOVE EX. TANK AND REPLACE WITH NEW TANK. OF A POEEPNN:ETH 9TH 0 OS I1 �bFEsstoN�' i FLAG ALL WELL RADII, EASEMENTS & LOT LINES PRIOR TO CONSTRUCTION PREPARED FOR; THOMAS & CAROLYN CONLEY 22918 GREEN GARDEN DRIVE CHUGIAK, AK 99567 FIELD BOOKS BOUNDAS" BOON[ STMNG: STAKII ASBUL" REJ DW rxa: ACRD RF'FILE ooYPuTmk mAm: BMW cHEa - KMD DAVE: 8/15/1 aam NW1459 JOB I: 13-130 Scalel 1 30' PAGE 2 OF 2 oti �CTERRy �, �n 4 i r Fc?v oy NG . W5e R' AK. 99577— Municipality of Anchorage Page 1 of 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S W 15005 I PID Number: 051'7 3Z)3y 91) MOA 25 Name. BILLy �ATRILIA ` --r— LCR Wastewater S System: El New R Upgrade Address: kms- (X90x 10'71 38'7 , uGIAK Ak. C6567 ABSORPTION FIELD Phone: SS No. of Bedrooms: 75 P .Deep Trench )<Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: �'y e; GPD/S . Ft. (1 Lot: Block:I Subdivision: 43 Depth to pipe bottom from original grade: Gravel depth beneath pipe W0IZTFlwoo0S . S Ft. '� 5 Ft. Township: Range: IS Fill added above original grade: Gravel length: /-8 Ft. �[ 10S/ �a�� / , Ft. WELL: �(,4 ❑ New ❑ Upgra Gravel width: Number of lines: Distance between lines: 1 5 Ft. 0- / S Ft. Classification (Private, A,B,C): Total the Cased To: Total absorption area: Pipe material: After ASTM u do H V IT Ft. Ft. /,coo SO. Ft. i7 3p3 / F 10 Driller: Date Drilled: Static Water Level: Installer: $ea'DC+Tw+ Date installed: Ft. _A-)-�AN COWST, y-06-95, Yield: Pump Set at: Casing Height Above Ground: (�_ L TANK GPM Ft. Ft. x 13TI "6 SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines WeiF IOo 14 aoo 4 Material: Number of Compartments: Surface Water 1 Ott 064, -- LIFT STATION Lot LILT 1 1441 --- Size in gallons: Manufacturer: Line Foundation I®I a c) _-- ____._ "Pump on" level at: "P " level at: High water alarm at: Curtain Drain A'A /rP , ,t w-Yt' ' t tt leTr� NA- Pump Make el Electrical Inspections performed by: Remarks: :Low 'b IVa- 0J'_,-tALLEb BENCH MARK E(c 8 sib A'9-At`JIDo>,1E10 g�cN Location and Description: 1k12-21 To o D � a� ECK T1W41' it 'HA "$E -,_)S -CO —F)4t FvTuelE, $Y SLIOINC- GL,ASS'DooJk Assumed Elevation: 100 Ft E . eese•eee <� > _/ \ r �, ro �tt � Is, Pa°&irer Loop Road No. 204 17 02, g Inspections performed b%,,ii 1P@arer. Alaska 99577 Dates: 1st ep,:k 2nd ROBERT C. COWAN Department of Health and Human Services approval CE-aso1w,� Reviewed and approved by: Date:., .. . 91) MOA 25 Permit No. SW950051 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: NORTH WOODS UNIT 3, BLK 14, LT 6 PID No.: 05173234 CO3 95.5' H 91.3'' 1000 GAL SEPTIC N.r,s. ' TANK FINAL GRADE 88.2' ( GRADE C09_ MT ♦ 75. NO WATER FOUND " v X - S MAY BE G ^� TbM S' ..................................T.{?P..OF..A.ECX................� ............ ! /.. ........... ........... A .. / COi FLAW GO / EXISTING F GAL TANK O DIVERTER EXCAVATED,D. MOND IO CO o CO BE IN GOOD CONDITION. /4-5-95 - DBL ....,..,,........, (45) CM2 ZABEL Z-200 CO _ f / FLOW DIVIDQR = ` MTI C07 I SCALE 1" = 40' -013A(1/93)* CO1 10' 58' CO2 € 11' 62' CO3 17' 64' DVRT.... ..... 19. .... ...... �65' C04 20' 66' C05 21' 66' ZAHL ', 30' 64' C06 35' 72' C07 86' 80' MT1 83' 78' C08 34' 54' C09 88' 70' MT2 f 84' 65' .v, Gj.�• e.+11 J "F°. e gay ROBERT C. COWAN ��' ce �,��A u® o d :e 12;�A/ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE ( Q DEPARTMENT OF HEALTH AND HUMAN SERVICES 4A -Q�� -9S' P.O. BOX 196650, 825 "L" STREET, ROOM 502 S�S ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT Lii`�G(S PERMIT NUMBER:SW950051 DATE ISSUED: 4/18/95 C)L) DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 4/18/96 OWNER NAME:TYLER BILLY D & OWNER ADDRESS:P.O. BOX 671387 DR to"b " CHUGIAK, AK 99567 ,LI a) ( � PARCEL ID:05173234 LEGAL DESCRIPTION: NORTH WOODS UNIT III BLK 14 LT 6 LOT SIZE: 34924 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR RECEIVED B ISSUED BY: DATE:- DATE: ATE:DATE: G A Apnit 14, 1995 ROBERT SHAFER, P. E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE 1lepantment o6 Heatth and Human SeAvices P.O. Bax 196650 Anchorage, AK 99519 SEWER & WATER MAIN EXTENSIONS REFERENCE: Lot 6; Btock 14; North woods Subdivision #3 Request you dasuey`,a peami,,t� to! upgrade the septic system waving the SEWER I WATER tkee bedkoom on MLC, /Le{e/Cenced ptopetty. INSPECTION GLL�I A test hole was excavated and a pencotation test pet6onmed in the an.ea o6 the proposed upgrade. The approximate tocation o6 the test hole is ENGINEERING STUDIES .located on the attached site plan. At the time o6 excavation no water. AND REPORTS was encounteaed and a6ten seven day ground wateA monitoring the monitoring tube was bound to be dr.y. Attached is the proposed upgrade design. WELL INSPECTION & FLOW TEST This property is served by a Community water System. There ane no pr.otecti.ve weP2 radii which encroach upon the paopeaty. SITE PLANS 16 you require additional in6onmation please contact us. S.inc/eAe2y, ROADDESIGN 0/4-z Robert C. Cowan RCC/gk SOIL TEST ENCLOSURE PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP SUITE 204 EAGLE RIVER, ALASKA 99577 F x d M U mo C z a 3 w ox 7 �i en Z w a a a ✓i `. 1 r i 1 W U U 0x ( r; f1f W H g 11d > O 1- V=O Z O � OmFO W Q m 0 I Uoa3 7 C U OZ �I �i II�M wW0_-1ZE- g 11d 3:0HGO Q� r � Z �7W \ \ ZOWw HZ 7 NQYF- zi a o O v w z o o O U x Z a K \ aN on, 00 �vwia_ j w m Q N \ \ 2N ANO Q Mww Y [if V) -i of � wwr NO \ St ml ~NZ� w \ \ vlj�?�z�CL �\ \ w-V)L awn w Dozm w}LJ UL zi F�Z� h --i O'O' => V)>�z W \� F HO \` 31yos ,05 = :,4 F4 r= z 0 Ow U3w m0V) z) - p N W > U www V)Uw >N CY W of O aw_ rr o F o `"� O d U OZ �I WOcaxl II�M wW0_-1ZE- g 11d 3:0HGO cO M to O a W Q m 0 I a ° w a F p M 31yos ,05 = :,4 F4 r= z 0 Ow U3w m0V) z) - p N W > U www V)Uw >N CY W of O aw_ rr o F o `"� O ORG sn� St�Tr .S,, o,, GMU122- `V /6'XR51ovn-1- 5&wn L&,seg 6RlL- L2-C6lAlnJb WAS GROU _ ENCOUNTE 8•d- H. IF YES, AT DEPTH? Depth to Water A Monitoring? _ Reading Date-_, Gross Time 5AL) 3i �T'b� & C:)/ n .r'^•3'; Municipality of Anchorage LEGAL DESCRIPTION: DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 r/"G SOILS LOG — PERCOLATION TEST G✓ DEPTH PERFORMED FOR:1ILi Ret-7(t?1ClFt l '�Lts/L DATE PERFORMED+ ORG sn� St�Tr .S,, o,, GMU122- `V /6'XR51ovn-1- 5&wn L&,seg 6RlL- L2-C6lAlnJb WAS GROU _ ENCOUNTE 8•d- H. IF YES, AT DEPTH? Depth to Water A Monitoring? _ Reading Date-_, Gross Time Li 3i �T'b� & Net Drop q S LEGAL DESCRIPTION: IrK41660,S wte /fwnship Range Section DEPTH SLOPE SITE PLAN ORG sn� St�Tr .S,, o,, GMU122- `V /6'XR51ovn-1- 5&wn L&,seg 6RlL- L2-C6lAlnJb WAS GROU _ ENCOUNTE 8•d- H. IF YES, AT DEPTH? Depth to Water A Monitoring? _ Reading Date-_, Gross Time Net Time Depth to Water Net Drop q S 7 wte 319 yp 3/jj PERCOLATION RATE 46 (minutes/inch) PERC HOLE DIAMETER _I/ L j�TEST RUN /BETWEEN � FT AND � FT COMMENTS T, H t EXi�tHIA-?f0 t V PZ74t0 LtYvSil� B1 9AA UF6040E Ti4NK Up2/PIEO oN 44� PERFORMED BY: fV I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WI H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE / • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I( ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW C T—L E 6 _ 3 ❑ UPGRADE MAILING ADDRESS ® 6.OK 99ff_6 LEGAL DESCRIPTION T �� L F6 LOCATION NO. OF BEDROOMS L 3 v Y DISTANCE TO: Well ClyalM��l Absorption area E Dwelling PERMIT NO. r— • s '�" F_ 2 F Manufacturer Materia _TC No. of compartments w '�" L— w Liq. capacity in gallons IF HOMEMADE; Inside length Width Liquid depth 0 Y X72 DISTANCE TO: Well Dwelling PERMIT NO. J = Z F Manufacturer Material Liquid capacity in gallons -�= w DISTANCE TO: Well Foundation !Q fLu Nearest lot lin I PERMIT NO. 60"16 tlz�- .j u.2 w;icc No. of lines 2 Length of each line Total length of lines Trench width Distance between lines' H Z 2 inches I.- Top of tile to finish grade Material beneath tile Total effective absorption area .. S C inches _z Lu Length -Width Depth PERMIT NO. C7 F i wLUa Type of crib Crib diameter Crib depth Total effective absorption area to DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER •� L. A PIPE MATERIALS SOIL TEST RATING . ,w INSTALLER REMARKS b�- Me SP & s �4 13 O ©A 5T 9Z 16 V41 L I TNWl a �, f APPROVED DATE LEGAL MUNICIPALITY Of ANCHORAGE Department,,=,f, Health and Environments) --\protection 825 Street, Anchorage, AK. )501 264-4720 Permit„ # # # HANDWRITTEN PERMIT # # # r-rwawR ON-SITE SEWER PERMIT Applicant: Mailing Address: Po•�c.D CL4; Location: Pone Number: Legal Description: fi Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 11.21L_ The Required Size of the Soil Absorption System Is: DEPTH yl��/ GRAVEL DEPTH WIDTH _ v1:� LENGTH p �e The length dimension is the length(in feet) of the Nt rldh 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(W+ L-�) 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(Z) 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 enlar ement if the residence is remodeled to include more tha 3 b roo Signed: , Wdy Issued by: _ Applic t Date: SWP/024(1/81) SOI LS LOG { MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: �h DATE PERFORMED: Jiukj Z%tP LEGAL DESCRIPTION:_ /) blpd� 11A Lot ©L SLOPE SITE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17- 18• 19• 20 COMMENTS (If" � / Q Jf �� (y �� f �i WAS GROUND WATER S ENCOUNTERED? L Depth to Water 0 P IF YES, AT WHAT E DEPTH? Y11=� — 6z " Reading Date Gross Time Net Time Depth to Water Net Drop ,5 d 7ro27 AI::v7 a �8 ly�'57 t35 S q'57 >60 l0 5,'07 p .36 C 5`:(J7 .60 �7 5:/7 '5o d 5;'77 lU 13S '/5 oo,, PERCOLATION RATE /•� (minutes/inch) 19 TEST RUN BETWEEN 2 FT AND 131 5 FT PERFORMED BY: � _ PS a CERTIFIED BY: mon s-�- B -3 -coy 72-008 (6/79) a am MM .r .S`Fj 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 an h k c orage.a .us (907) 343-7904 ERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING "Parcel I.D. 051-732-34 GENERAL INFORMATION Complete legal descriptipn Lot 6; B Location (site address or directions) 22 pGE BG a � $A ETY HAA # O Ik 0 3146 Expiration Date: �z - V-2- - n NortWoods Subdivi 0 Current Property owne4,(s)Robart Brennan & Catherine r hone P . -�lailingaddress Lending agency Mailing address Day phone Real Estate Agent Kathy Geraci Day phone 694-9125 Mailing Address 11411 Old Glenn Hwy. Eagle River AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. y7 7/2 -X,�p 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site I�X Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 S & S Engineeri Address 17034 N. Eagle River Phone 694-2979 Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert c Govan Date 7 / ;i l'0 `f. 5. DSD SIGNATURE -- Approved -for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By; Original Certificate Date: 7_ v2.. - 0 (Rev. 01/02) Mun Develop apartment �r ro�ram s^f k� �b``L If A, B, or C" rovicfeFG1751t ed Sanjtary seal (Y/N) Wires properly ected (Y/N) Cased to ft. g. Cesin ight (above ground) in. _. INSPEC7i25N"°.,.' "`" leve ft. ion S" k Hies/100 m1. Nitrate' m'' �"-"'� ?)cher bacteria �� colonies/i00`rrih " _ mg./I. Date of sample: Collected by: aeSr�� ( w Date installed �/12.Le,3 _gal Number of Compartments "2 CIeanqutsO/N) yt�S eingpt N) S epression over tank (YO - High water alarm (Y/ID MO _D,. Mg, Z..0 Pumper 1>-. Z6 S Soil rating or ftZ/bdrmQo yS �a ��orJ pp ( System type rY�ncS t! ft Width ft. Gravel be .. e' _ s ft. 5 ft Eff: absorption area 's"ft` Monitoring tube l��? w, Depression over field �o Results(Pass/Fatl) acytest ZZ 6� �aSS For bedrooms �q x.':a x „�», ,a..--, a sorp ion a ore test m' t l� Water added? 59ga1: New depth' in. �5mrn Final fluid depth 6 in. Absorption rate >_ (5� d .. ..., on trea men pas mo. ype'h�. Khv(tJi� If ves. give date records that the above systems are ina��y�,/ J 70A HAA guidelines in effect on this date. aoer:ar es �. d c= ea�2 l- n y ZAP r E. lS "Sfl Waiver Fee $ !y'p� Date of Payment �po Receipt Number FkUM :Great Land Realty FAX NU. :6943093 Jul 97/21/2004 15:57 9072422091 FRED WALATO 8 ASSO 21 2004 03:59PM PI/1 PAGE 02 r�.0F • a * .4 9 Ta -Fred WGIAa NO. 37UA SGa/e /" =90 i.°4drrear„ra� Y hereby awft iW 1 hu" podormad a Martegee'a ht- wMen K the loltaeWN decenbed ptopa'!9: L n f di 16/0cA /it, 1✓0rihhr00ds 5Mhbd. and an roaaWKYNton up" ar other visible eaeemeMe on sdd _ t Atyutte zp, Ailed heraan. Dated a WLA 0* dsw /9u9uf la B3 BASEMENTS OF REOORO, OTHER THAN THOSE SHOWN ON THE RMOORDOD MM WALATKA & ASSOt:lATAS PLAT ARE NOT SHOWN HXRMON. f• 5 8 3 -I p 47 dyll Englaeere and Surveyors Parcel I.D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-732-34 HAA # VA � 'nn n n 1. GENERAL INFORMATION Complete legal description Lot 6, Block 14, North Woods #3 Location (site address or directions) 22918 Green Garden Drive, Chugiak, Ak 99567 Property owner Darrell & Carol Volkert Day phone 688-1450 Mailing address 22918 Green Garden Drive, Chugiak, AK 99567 Lending agency Day phone Mailing address Agent Aurora Properties/Linda Harter Day phone 688-9014 Address PO Box 671923, Chugiak, AK 99567 Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) FrOM MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & 5 ENGINEERING � �.,' � _ � r � 9Name of Firm 17n34 E^91a River Loop Read No. 394 Phone Address Eagle river, Alaska 099577 Engineer's signature 6. DHHS SIGNATURE (/ Approved for 71H /? E F- bedrooms. Disapproved. Conditional approval for Additional Comments 0 CAUTION Date S- / / cl !`) c� bedrooms, with the following stipulations: Date 5 = ;?- I ' 1� 9 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 x21 ROHRT C. COWAN r i g ff�@ CE - 8801 bedrooms, with the following stipulations: Date 5 = ;?- I ' 1� 9 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 x21 RECEIVED Municipality of Anchorage MAY 19 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES i Environmental Services Division MUNICIPALITY OF ANC TAS SERVICE 825 L Street, Room 502 • Anchorage, Alaska 99501 • (901MM- Health Authority Approval Checklist f Legal Description: ���-4T G> ! ' / �� j� % ���� /'� Parcel Y 2 3Z --:34 A. WELL DATA Well type _I1f "!L1 " j��/i` IyA', B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform of sample: Date completed Cased to Casing,height (above ground) r Wires properly protected (Y/N) i FROM WELL LOG r=' AT INSPECTION B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: Other bacteria Date installed c- A � Tank sized e G Number of Compartments Cleanouts (Y/N) Foundation cleanout C(.Y//N) Depression (YC) ' r� High water alarm (Y/N) Date of Pumping s h -7 `� `I Pumper C. ABSORPTION FIELD DATA Date installed ��= C r Soil rating p:d /ft? or ft2/bdrm) f1! L��✓ System typeG%�?,� Length &5 Width 5- Gravel thickness below pipe 3, < Total depth Effective absorption area C/f g p ) �� Monitoring Tube resent Y/N Depression over field (4j Date of adequacy test % Results (Pass/Fail) Rqa5 For 5 bedrooms Fluid depth in absorption field before test (in.); I 3 Immediately after`i5' gal. water added (in.): ' 3 ��- Fluid depth '/i ,(ins) Minutes later: 3 Absorption rate = �i d f g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)" D. LIFT STATION Date installed— /V I�- Size in gal Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES evel at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic/holding tank on lot Zc On adjacent lots Absorption field on lot Public sewer main Sewer /septie�rtiv�line On adjacent "Pump off" level at* ublic sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: 441 ��. Foundation /o Property line Absorption field Water main/service line Surface water/drainage Wells on adjacent lots 47 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 Building foundation ' Water main/service line f i / �. Surface water ��'� Driveway, parking/vehicle storage area Curtain drain 1�if. Ale- kAf`�s esu Wells on adjacent lots F. ENGINEER'S CERTIFICATION /certify that I have determined thru field inspections and review of Municipal recorA*`ailhe abo e'sys e s are in conformance with MOA HAA guidelines in effect on this date. 1,7 MkjA Signature zs •�� Engineer's Name �i" 0, "zv� % C Gs .�`w i. ROBERT C. COWAN CE - 8801 Date S` JI6 1F�CrE3'S1�"'?�`�" �• HAA Fee $ Date of Payment / Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number. 72-M (Rev. 1/91) Front MOA e21 3i 77 STATEMENT, OF.INSPECTION +. e it '*evk^^ty=.+•^'i+ -^ ...-,,-,--Ascertified b}emyseaitaffixehere x rs, a a Investigation of this Health uthor� and/or wastewater:iisposaf`system :s and type of.structure indicated here the Municipality of Anchorage fifes supply and/or wastewater disposal 'ordinances,, -'and regulations in elle �SSENti1N1 Name of Firm "=e f '+�Y k',s;•*-�,.✓v^e_i.�v vl#.,.3 . 72-M (Aft, 1/81) Beck MOA e21 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �- 6 T � 1 Nu Parcel I.D. © S-1 - -7 3:1 3y .9ocs 3 A. Well Data Well type If A. B, or C> attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMA RESULTS: % 3 � � n g.p.m. g.p.ny."�) '^ y Public sewer manhole/cleanout Petroleum tank Other bacteria Date of sample: Collected by: B. SEPTIC/HGLDING TANK DATA Date installed 9 - 12 - S 3 Tank size � opo Compartments 2- CleanoutADN) J Foundation cleanout 1N) ./ Depression (YO) .J High water alarm (Y.S � Alarm tested (Y/N) '� lA Date of pumping q / Pumper -rA N ) T4,- y pu M.4 f'^- I SEPARATION DISTANCES FROM SEPTIC/HGEB4NG TANK TO: Well(s) on lot /� On adjacent lots Foundation I O ` To property line �'� i Absorption field S k4- Water main/service line Io Surface water/drainage _ 1 e b 72-026(srss)•Front CONTINUED ON BACK PAGE ter+ ® o n n p < D n n On adjacent lots oS D On adjacent lots f Public sewer manhole/cleanout Petroleum tank Other bacteria Date of sample: Collected by: B. SEPTIC/HGLDING TANK DATA Date installed 9 - 12 - S 3 Tank size � opo Compartments 2- CleanoutADN) J Foundation cleanout 1N) ./ Depression (YO) .J High water alarm (Y.S � Alarm tested (Y/N) '� lA Date of pumping q / Pumper -rA N ) T4,- y pu M.4 f'^- I SEPARATION DISTANCES FROM SEPTIC/HGEB4NG TANK TO: Well(s) on lot /� On adjacent lots Foundation I O ` To property line �'� i Absorption field S k4- Water main/service line Io Surface water/drainage _ 1 e b 72-026(srss)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION LIFT STATION TO: on lot On adjacent lots D. ABSORPTION FIELD DATA tested at Surface water Date installed 4-Z t- -`j S Soil rating (GPD/Ft2) D.'/S System type - P-dAs-en kl Length /0 6 Width - / Gravel thickness 3.5Total depth 6 � Total absorption area /000 f Cleanout present OY N) _Depression over field (Y)19P--,-J— Date of adequacy test 'f1.4 Afw/ Results (pass/fail) ^l for 3 Bedrooms Water level in absorption field before test 't / After test ' L Peroxide treatment (past 12 months) (Y& If yes, give date '114 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ^�l� On adjacent lots To building foundation On adjacent lots 3014.- Zoa f� Property line /Z/( To existing or abandoned system on lot _ Cutbank `tI4 Water main/service line Surface water /66 ' 4- Driveway, parking/vehicle storage area Curtain drain <<-Aia^) E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect �✓'�- - Signature -,al Engineers Name iia 0 �-A- % C Co w /I Date S / a- / 01 S- HAA Fee $ 1)�y c Z,0 Date of Payment 57- Receipt Number /�Ls 7 72-026 (353)' Back Waiver Fee $ Sb ? f- Date of Payment Receipt Number of this inspection. ROP.@RT C. COWAN i C G .. ,�J,�!, Time APPLI1 NT FILLS OUT UPPER HA 'ONLY .Property Owner` C:c \A -t c� ): i A\ C e(-- Phone 'Mailing Address ,;E: ur,. -:� (" ---.,. AV-) Zip Code y Buyer Date Inspector Address Zip Code Lending Institution. Inspector Field Notes: Phone Address - Zip Code MUNICIPALITY OF ANCHORAGE Realty Co. & Agent Fl -'PT Qf 119/1TH L-. Phone Address ENVRaC s,V1LNTAL PROTECTION Zip Code Legal Description , Street Location J - 'CONDITIONS OF APPROVAL Type of Residence ( ) DISAPPROVED L -Single Family ( ) CONDITIONAL APPROVAL' DATE I I. — 1 45. (4r\\S BY: ❑ Multiple Family No. of Bedrooms Date Sewer Installed ❑ Other Well Log Received Septic Tank Size pc> Water Supply ❑ Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. 2' -Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal �-- �7 L;- 1ndividual Year Individual Installed: l ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE Fl -'PT Qf 119/1TH L-. ENVRaC s,V1LNTAL PROTECTION HOW RECEIVED, ("3 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE I I. — 1 45. (4r\\S BY: Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size pc> 72023 (3182)