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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 10Onsite File North Woods Unit 4 Block 16 Lot 10 #051-064-22 The 1985 field is to be abandoned under the 2021 permit due to it encroaching in groundwater. Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number:.OSP211315 PID Number: 051-064-22 Dwelling: 0 Single Family (SF) El with ADU El Duplex (D) R Two Single Family Project: El New Z Upgrade Name AMANDA & BRIAN BURTON ABSORPTION FIELD - ADVANTEX R Deep Trench N Wide Trench F1 Bed R Mound Site Address 21721 SHELTERING SPRUCE, CHUGIAK El Other Phone Number of Bedrooms Soil Rating depth from original grade 1 4 1.0 GPD/SF JTotal 5.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 2.5 Ft. Subdivision Block Lot NORTH WOODS UNIT #4 16 10 Fill added above original grade VARIES 0.9-1.73 Ft. Gravel length 80 Ft. Township Range Section Gravel width 5 FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 625 Ft' 1 -- Ft. Well -1. 200+ -,2,00+,- -1 25'+ TANK El Septic 0 S.T­E.'P.EJ H61diiig- Z'Other 'ADVANTEX Manufacturer ORENCO / GREER Capacity 1500 Gal. Surface Water 50'+ 50'+ Material HDPE Number of compartments 2 Lot Line 5'+ 5'+ NA Foundation 10'+ 10'+ [LIFT STATION IManufacturer ORENCO Capacity 68 Gal. Remarks Alarm location LIVING ROOM Electrical installed by DRS ELECTRIC PIPE MATERIAL House to tank 3034 Tank to 3034 Installer JRS drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdates:ection 1 2 9/29/21 �d 9/29/2021 Location and description 3'd10/1/21 4" 10/1/21 BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL or— Conditional Approval: Date dW . .. ......... .. ... .......... Curtis Huffman Septic System Approved - &Jv4 CE 128991 Date 1/ 12/202;. - Amp, OPROF�Ssokw AVD1 Note: this approval does not include well permit requirements. kmev UD/UZ/ 1?5) PID: 051-064-22 PERMIT: OSP211315 N90 00'00"E �20023'OT 9 KEYBOX TH21-1 BURRIED APPROX. LOC. PERC-2021 DEBRIS WATERLINE I 0 I G 0 z O H 24.0' O O PAVED 2 B F O O In D/W N 21.8' N of CD 20.0' W 2'x26' co o LOT 10 CANT � 0 __D o BLK 16 3 x = N BM POD 00 w z 16.0' FCO E �0 O O O , PUMP C D MH BASIN DECOMMISSIONED z EXISTING O Y 1.3'x10' SYSTEM & BW CANT INSTALLED 4BR ADVANTEX 28.0' SYSTEM W/ 1500 -GAL HDPE FP CANT Lo PUMP VAULT 80.0' TANK & AX20 POD. N90 00'00"E 200.59' A -C=12.8' B -C=50.8' FCO MT MT A - D =16 6'MH AX20 POD MH 99.07 MH 98.50 FINAL GRADE 99.33 97.60 B -D=52.2' ORIGINAL GRADE A -E=22 2 INSULATION 95.12 FILTER FABRIC 15 ORG/OL B -E=53 9 6.50 6.39 95.10 95.10 A - F = 7 9.4' 94.54 1500 -GAL SEWER ROCK SM B - F = 4 7 1' PUMP HDPE TANK BASIN GROUND WATER AT 9' B -G=35 6' 92.60 92.60 6/25/2021 TH21-1 H -G=16.1' 14' SEPTIC SECTION 83.60 BOH SCALEi NTS NORTH WOODS UNIT 4, BLOCK 16, LOT 10 SUPPORT @ SERVICES: PREPARED FOR: C. 5 F Idw � ���`S�' OF A.L ���,11 AMANDA & BRIAN BURTON 21721 SHELTERING SPRUCE LOOP CHUGIAK, AK 99567 S.W. * 9 TI 1111111" 0 I, rtis Huffman / FIRST WATER CONSULTING DATE: 1/12/2022 SURVEY: JLS 021 1 rJ, CE w 13030 SUES WAY ANCHORAGE, AK 99516 DRAWN FWCS 2/22 I A /12/22 v~ w 907-350-9566 FirstWoterAK@gmail.com SCALE: 1" = 30' ftpvssloo -AV *%k 0 • CON FjfS1 Wder S U L T 1 N G r' G t 4 i 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK(aDgmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: NORTH WOODS #4 B16 L10 DEPTH FEET OG SOILS ORG/OL 1 2 3 SM 4 BOH — PERC 6 BENCH 7 8 9 10 11 12 13 14 15 16 17 18 19 20 -49 TH • • Curtis Huffman CE 128991�� PERFORMED FOR: AMANDA & BRIAN BURTON TESTHOLE # PERC DATE PERFORMED: 9/28/2021 GROUND WATER ENCOUNTERED: NA IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: NA DATE: 9/28/21 SEE SITE PLAN FOR -SLOPE & LOCATION COMMENTS: PERCOLATION TEST AT TIME OF CONSTRUCTION Reading Date Gross Net Time Time Depth to Water Net Drop 9/28/21 30 min 6" 10/16" 30 min 6" 9/16" 30 min 6" 9/16" PERCOLATION RATE 53 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6" PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9/28/21 t LOT 9 25' N90'00'00"E 200.23' KEYBOX s IL' Z O 0 O 24.0 SEPTIC ® O O PAVED o 21.8' VENT 6 —1 M O/W (typ) CCf W r o O U Nryin - ry U) ci 0 20.0' Z 2'x26' b Z 41 ! L1 W 0 CANT J co o J a LOT 10 U w= NAuer cn LJ O BLK 16 0 1s.o C o ttb U O i� O x x o Y 1.3'x10' o BW CANT 28.0• io FP CANT Lqo 80.0' N90°00'00"E 200.59' LOT 11 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS-BUILT OF: NORTH WOODS SUBDIVISION UNIT IV OO = FND 5/8" REBAR LOT 10 BLOCK 16 PLAT 53-333 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted av physical survey of this property as shown on this drawing and that the � ' O Pi ' .A�� AL LAhrD S �� improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should: ' 49'j'x any information on this drawing be used for construction offences, ®t' structures, improvements, or for establishing boundary lines. '' EXCLUSION NOTES: It is the owners res onsibili to determine the existence of any easements, covenants, or restrictions which '.JOIN L. SCHULLER. do not appear on the recorded subdivision plat. LS-1040$ WORK ORDER NUMBER: DAIS: SCAM-E_MNU ^Q C3 AW 1831 Talkeetna Street a� d OCT 25, 2021 1"=30' aehuller0oAnchorage, Alaska 99508k.net �>� A t� 21-155 DRAM BY: CHECKED BY GRU NUMBER: BOOx ACE �®r°fessionp� � ° (907) 227-1455 office dLs NWt46o 270357 �1_®`• (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211315 Work Type: Septic Upgrade Tax Code Number: 05106422000 Site Legal Address: NORTH WOODS UNIT 4 BLK 16 LT 10 G:1460 Site Mailing Address: 21721 SHELTERING SPRUCE LOOP, Chugiak Owner: BURTON AMANDA & BRIAN Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: ent 0 \�- Dopa rt III e]It 8/4/2021 8/4/2022 27055 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing t_ Special Provisions: The water service line'shall be located and shown on the record drawings to confirm a minimum 10 ft separation to the septic system. CO -4C I &AV'�ea �e�riS �v.n �eS c`�c ,n G►IGt�1G1��,t . 4 Proceed 6' Yaur own rii. k dK� -Fo �e2 tes f s C.bM ifkk . /nG� q�z��zl Received By: Date:Issued By: Cmw Date: 'Ry ao21 Id 11111111111I� ;; t i P :.� a_. 3s• © Development Services Department f On -Site Water &Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-064-22 Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) AMANDA & BRIAN BURTON Day phone Mailing address 21721 SHELTERING SPRUCE LOOP, CHUGIAK, AK 99567 Site address 21721 SHELTERING SPRUCE LOOP, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS UNIT 4, BLOCK 16, LOT 10 Legal description (Township, Range & Section) Lot Size 27,055 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field 0 Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank El Upgrade El Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ignature of property owner or authorized agent) Permit/Rush Fees: 6SgS Waiver Fees: Date of Payment: %/ZCt/Z I Date of Payment: Receipt Number: X9'265 Receipt Number: Permit No. OSPZI� 315 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13021 Montego Circle, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com July 26, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: NORTH WOODS UNIT 4, BLOCK 16, LOT 10 The septic field has been found failed and encroaching groundwater and we request a septic permit to upgrade the system on the above referenced lot. We propose to install two shallow trenches with an Advantex system and pump vault to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on June 18, 2021. The slopes are flat at the proposed upgrade location. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211315, Rebecca Carroll, 08/04/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211315, Rebecca Carroll, 08/04/21 C. 0 -"A I Uuite Wat 1..� Onsite WaG. REVIEVVED FOR G DESIGN DETAILS: OSP217315, Rebem INSTALL NEW 1500—GAL HDPE SEPTIC TANK W/ AX20 POD & PUMP VAULT. MAINTAIN 10'+ FROM FOUNDATION, 200' TO WELLS, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION, INSTALL 2 401 x 5'W x 2.5'ED TRENCHES —5' FROM GRADE w/ 3'+ OF COVER MAINTAINING 200' TO WELLS / SURFACE WATER, 10' TO LOT LINE,.... INSTALL PER AMC 15.65, 15.55, & MASS... TANK BEDDING, SEPARATIONS, MATERIALS,... N90°00`00"W 0 0. 23 � / o FLAT DSR► S,� t , ! L, KENNEL I I Ft -ATT i� z 4- �, z O -� o MT O 24.n'�"A? S`7r I ASPHALT 21 a' I 20.0, zPUMP r /EX�IING v; ! I n T 1 r) 11 ' L:-_ DLit 10 k �' 6.0 - _ 1 di! ' .o EXISTING Lu SYSTEM & t INSTALL 48R LOCATE WATERLINE ADVANTEX '^ vy Jtra w / t�•V• - PRIOR To GUNSI. j yI DI!!Jp VAISI T TANK & AX20 PC)D.I N90�00 UU W 200.591 NORTH WOOUS UNIT 4, BLOCK 16, LOT 10 PREPARED FOR: AMANDA & BRIAN BURTON n. 3'r-1 ' ,r,-r,�n,G 3ti t„ ,tee- , L I / G I Jf"IGL I GrCIIVh .]rRlJl..t Lut-)r- -��• 1A�� _- • a ^ mrr •T p UHUGIAK, AK 990b/ — `-1(� A l A T r- r-% /'1 !\ A l r% 1 1 1 'T" I A 1 r� I ( (� > `JN V `•'• w•® ,rimcni i MAI r- GuiNiout lI Iivv I UHIt: 'Tp,' qua eta aalA11111Aaa. F. � 1 a znZ.n rI I� c tn/n v SURVEY: DMSCE 128991 � - _ _ _ _,• _ _ _ _ I ii�;wJiv: r+rvi;� 1907-350-9566 SCALL: 1 = �,Sp FirstWoterAK@gmail.com PAGE: 1 OF 2 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: NORTH WOODS #4 B16, L10 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/25/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 SM 5 6 7 8 9 10 11 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/25/21 30 min 6” 8/16” 30 min 6” 9/16” 30 min 6” 8/16” PERCOLATION RATE 60 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: YES IF YES, AT WHAT DEPTH: 12’ DEPTH TO WATER AT MONITORING: 9’ DATE: 6/25/21 TESTHOLE # 21-1 DATE PERFORMED: 6/18/2021 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: AMANDA & BRIAN BURTON 6/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211315, Rebecca Carroll, 08/04/21 MU"MCIP,A-LITY OF ANCHORACE ADVANCED WASTF-NV2',TFR'1*1�,IkT,lEiN'T SYSTEINIT IMAINTENANICE -A-ND REPAIR kGREEAMENT THIS 1MRAINTENANCE ANDRUADE, AGREEMEXL herein the "AGREEMENT' maid -c and t'itte'red Wito as e.) this Da -v of v of*')02/Jhvand betwe-m herein the "0 W N' E P, and the M un i c i pal i ty of An-choragt`,, hciT, thz "MUNICIPALII'Y", itl nw-rd,'tTwe widi Anchor---.'gt�%Mur icipwl Code (AMC) `-,65. 65_ in considl�ra7ionof the mutual covenants --on herein, tJ- ti I P tb s ,-knreement, ag�,e as lbliows; I Advanced Wastewater Tregtmp�q Svstlems. Thic, Nl4uni -pality g =,ts pe ission to the Cl - M21 OIN-ner to utilin �tnd opi�ralc -m Advanced Treatment '.,ystem fAW�k7S)- described as ANADVANTEX SYSTEM lo'catted at (le;' NORTH WOODS UNIT 4, BI 6, Ll 0 2. Maintenance, Regaimgpd Ajterafions. (0,Amer is required to read- under„,,t;m4j and initi�J-, each section) iTItQ 4 T-Viw agreement 'with wi AWWTS service amdr M.2iTl',rCTlaJlCC provider approved by the 1,vlunkipatin, or die t�inufreCs represuntati naatjve. The A8V'W*Tl5 shall be niLaintained in -a sat; s-fiazto-pr' ;Conditio-n capable o1perfor-min-g as dc-sipned andprodticing- trvaled septic efl-fluent :n a,c4cordsince with the cqLdpirient'sapprov�fl i- z- operation in the Municip, t I jji y. It sisal I be, flie res pon-sibslit y 01-thc 0xvner dtip t Lhe term of this Avxe--m,--,nt to xy f I 11 p repair v(s), adjustmenta's)- replacement costs, and inspection cos-QN- This includes an annual malmenwice fiec (iypicaUy $400 to $600), h Lh�! 3NIt c pah v 0�%Mer a, U-Ces that on -b, maintenance and rcpeJr pt�r-sonnel approved- '.. y mi i t or the it am rep�,�,ciatjtjvc vvill jj-lsllect and make any necessary niaintenatits, T-epairs, or pe =zittotCrations '10 the sy. t -n. s eT Ovnne r actin ow- I ed.,ges, that replar maimcnancc o f an A Wli-VTS mdu ws flit potential flailurc of the syste m which could include,-,,ewag-e back-up and costly repair3 or draiatield replacement. i -w;7 rj';flqP)rllR) Pt�.T- I r%F1 Owner ack-mnvIedoes that the rcqacsst records ofTnaiutcTiance and TCPiirS L—CiMI the, nmmjfacturer's represent awtive, or maintenance Provider - Owner aclknowledg'es tf-rat the f me I r faid to Mairi�;tiTl aP'd;rCpaiT -&-I may o idn- A�ITIX�"'f'S ybe r. I assessed in accordance writh ANIC 14-60.0.30- Owner kerees to grant the rin'sonable, access ti) test and hiTea the A)7k,"WTS. T� %vill give at !,east 24-hour notice. a4 reel thatt any cal; or mITIsf-�.F of tit.LC of 5h pToperiy will not occur without a new Cc:rtifi,ate ofCita 7Sitc SNstcms -Approval. i T' I I U."'mer agaces that the A)VIN" -S, insu-311ation Mrd nnaintenwice requirements, a -q provi(k(l h,v the AWWTS by thc,Nfunicipality are Gic g -ming I - �ovc - guidelines for the construction, ma-hlTefta-,X.Gind -4epair ofthe (),miers AW;v-TS, Ov;ner agrees TO I'll ail'YeatiTi i-c-motc in-onitoeme, of the AV,7VTS as required by the .ATV-VV7S approval. Term.v, i shall begin on the daw of app, u il by the MUMCI'-DZditV 10 QPCTaIQ 1111 instJ11e, sys-la.-an, or upon trarisfer of title- --nd slial I cont:vwt� I e -s- w h I I e LI I e A W W-1 -S :1s L) peneai ixl al or u, 't:I 1 ti tI i s tr, ns fc=,-d. 4. N o n w a iv c r. The )--a:L I urc, of the Nil: Ti c i p al I ty at =Y, time to enfTrK e a pro v is; (m of this A ree -Tlel i t sinal it: n a vi=al:- C ostat ulc a v,,aiver of dk p7ovisions, -nor in any � va, ,affect the validity of the Agi, ccmcnt or any part hereof or the right os the NRIun cipJa it%, thereafter to MR)rc.c every provision liertzof. Amendment. This Agreerneent shall only b� aTnended by auffionzed representativcs of the 0�vricr and Mwlicipalit' . Any attienipt to amend Ll -ds aggreement by either an unauthorize-d representati-,re or umauthori7ed means shall bee void. 6. Jurisdiction: Choice of _Law. Any civil aefion arising from this Agroement shall be I- brounhT in t1le Sup-erior Cour, year tI)e 71tird Judicial Dis-trict, of z State ofjAla'ska at AnchoTage, The lav °s of the State of.Alaska shall govern the rights and oblations of the. parties under this Agreeme.,mi. 7. Seve-rabffitv. ArrN,, Provisions of this Agne-ement decreed invalid a court of conapetent juxisdiction shall not invalidate the reT'M-rI-IIiTII provisions of the Agreement. si znature) a 7- - THIRDRUIDICIAL DISTRICT 'TA ALA-SKA �'•`�'4� � i��7'r�l KaI'z :5��i�'S c1 ���� �f'�rn �.�\ �' <, Mkt• Bv: _ (s �riut . - atc. 8 y ,2va 1 _ � it 2 P CC— ,PL sr€ t name Title:  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONIVIENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE [] UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION LOCATION ! NO. OF BEDROOMS I Well Absorptio~a Dwelling PERMIT NO. DISTANCE TO: ~::~D I.j¢. I- 2 Manufacturer o. ~ No. of compartments Liq.l~ gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ ~ ~ DISTANCE TO; Well ~ /~ Dwelling PERMIT NO. ~ ~ Manufacturer/ Material Liquid capacity in gallons E Well Foundation ) Nearest lot li.~ PERM~~ ~ DISTANCE TO: ~1~ ~]~ No. of lines Length oLeach,line Total leng~f lilnes ~17 Trench wid~ Distance betw~/~es ~'. ~ I r/~ ~/~ inches Top of tiJe~¢ finish grade j ~ Material beneath tile Total effective absorBtion area Length Width Depth PERMIT NO. ~ ~ Tgpe of crib Crib diameter opth Total effectiue absorption area ~ m DISTANCE TO: ~ell ~6ildin~ foundation ~earest lot line ~ ~ ~~ ~ ~pth ~%~ ~ Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING REMARKS ~ ~ ~0FE55~'~ APPROVED ~, ~,. .S~ 1~--';"-: DATE / LEG~ 72~013 (Rev. 3/7R) ...... ~'~ ..... F'ERM I T NC:): DATE l S,:~UED: DEPARTMENT GF H~ALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 APPL I CANT: ADDRESS: CONTACT PHONE: GIBBS EXt. % S&S ENGINEERING EAGLE RIVER~ AK 99577 694--2979 LEGAL DE,:~C'RIF': SUBDIVISION,.' NORTNWOOD ~4, LOT: 10 SECTION: 3 TOWNSHIP: 15N RANGE~ 1W LOT SIZE: ~7(J~ (SQ. FT. OR A[~RES) MAX BEDROOMS: 4 BLOCK. 16 I..is'Led below a~e t. he options available to you in designing your, septic system. Choose the option that. best [its your site. DEPTH 'TO PIPE BOTTOM (FT.) GRAVEL. DEPTH- (FT.) 'T'OTAL DEF:'TN (FT.) GRAVEL WIIYTH (F'T.) GRAVEl_ LENGTH (FT.) GRAVEL. VOLUME (CU. YDS,, ) TANK SIZE (GALS) SOIL RATING (SQ.FT. /BR) 4.0' 4.0 4.0 6. () 0.5 5 ,, 5 10.0 4.5 7.5 2.'5 27.0 5.0 90.0 .~ 54.0 116.0 +~. 54.2 54.0 86.0 1,~Z50..O :~. 1~250.0 ** 1.~25().0 ** GRAVEL LENGTH > :75 F'T. REQUIRES MULTIPLE RUNS (NOT E:XCEEDING '75 FT. EACH) TANK MUST HAVE AT L. EAST TWO COMF'ARTMENTS I cer'tify that: 1,, I am f'amillap with the r'equirement, s for on-site sewers and wells as set [orth by the Municipality oF Anchorage (MOA) and the State oF Alaska. ~?,,, I will install the system in accordance with all MOA codes and pegulat, ions, and in comp].iance with the des:[gn triter'ia o~ th-is permit.. 3. I will adhere 'l'.,o all MOA and State of Alaska requirements fop the set back dist. ances [Pom any ex:[st:i, ng well, wastewateP disposal system of public sewerage system on this or any adjacent of nearby lot. 4 bedrooms and 4, I under'stand 'Lh&at this permit is valid fop a max:tmum o£ ariy enIapgement will r'equlipe an addit, ional permit. IF: A I_IF'[' STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES.~ THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WIL. L. NOT 'BE APPROVED WITHOUT AN .ELECTRICAL INSF'ECTION REPORT; AND (5) THE: ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRI[;IAN. S I GNED ~' ~ ' ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~ t ~Z~t;Z~ LEGAL DESCRIPTION: L..,~,?-- 'i~) 1 2 3 4 5 6 7 8 9 10 11 12 13 16, 17 18 19 20, COMMENTS DATE PERFORMED: Township, Range, Section: '-~'~;-¥._.~ I ~"'~' ~;~ "~ SLOPE SITE PLAN ~ WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Deplh to Water After Moniloring? Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~-"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~:~ FT PERFORMED BY: ~[~ 1,,g,~ ~,~7~' CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) �g 5ell • 6.)!' Municipality of Anchorage • On-Site Water and Wastewater Program a AU,.] • Ii (907) 343-7904 �6 t n►L. t�� �� Certificate of On-Site Systems Approval °1 6 3 L ' Parcel I.D. 051-064-22 Expiration Date: J 1~ JO 17 1. GENERAL INFORMATION Complete legal description North Woods #4 Block 16 Lot 10 Location (site address) 21721 Sheltering Spruce Loop Current Property owner(s) Ponto, Jeatonne Day phone Mailing address 21721 Sheltering Spruce Loop Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: I] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class A Well Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: t AL . VI Date: //Q// COSA to be released to the engineer, unless otherwise re ested by the engineer. COSA Fee $ 2<0 Waiver Fee $ Date of Payment Date of Payment Receipt Number OB6Af Receipt Number COSA# O5C11 t \1 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 instajlation. In conducting anaiibgdacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines'aricregulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 7/5/2017 ofALgskiip *• V410;•. ..* 6. DSD SIGNATURE • i• , \ ( '•System #1 Approved for f bedrooms . 1.even'1 .'15ar r ne : —_ r System #2 Approved for bedrooms 4 9s, CE-8149 'e� Disapproved k>� 'RoFESSON�` Conditional approval for _ bedrooms, with the following stipulations: P c 5 23 030Q4 ON-SITE= VAND WA3VATERTEVVA( L-h' PROGRAPtA �c Original Certificate Date: p-1O -/ 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 COSA blue sheet_f - If more than 1 septic system is on the lot: COSA Checklist# 1 of Structure served by this system ' Certificate of On-Site Systems Approval Checklist Legal Description. North Woods #4 Block 16 Lot 10 Parcel ID 051-064-22 A. WELL DATA Well type A If A, B, or C provide PWSID# 213001 Well Log (Y/N) Date completed Sanitary seal (Y/N) 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 Tank Type/Material Septic/Steel Date installed 8/30/1985 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping coil 1 12 Pumper 311\i-1714,1 PL&J11ptrLs C. ABSORPTION FIELD DATA Date installed 8/30/1985 Soil rating (g.p.d./ftz or ft2/bdrm) 268 SF/BORN System type TRENCH Length 72 ft. Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth 1 ft Eff. absorption area 1080 ft` Monitoring tube Y Depression over field N Date of adequacy test 5/31/2017 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 40 in. Water added 610 gal. New depth 54'5 in. Elapsed Time: 1440 min. Final fluid depth 40 in. Absorption rate >= 600+ g p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "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: 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 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 1 00+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION OF A Ni I certify that t have determined through field inspections and A review of Municipal records that the above systems are in 0* ' c-tIC 1 f� -II -.4.. .0" conformance with MOA COSA guidelines in effect on this date. • Steven Pannone �, Engineer's Printed Name - -'r• 2 5{even , annone • 7/5/2017 6 CE-8149 Date4,s' �k�1` 4'.6-ESSICkP COSA canary sheet_2-6-15.doc 19 G5- • EA.S-T 200 23 t • t:14101‘4"G cg q• .., ` • .-pm f . f L. a• Z/8 a tx. 1 • Q\ `a • 41��D SiiJ/GG.E—F.A.97it V iv tba .v�s.Q�.x.Y-r N20 ti i\ °I \_'\ IIkli k ��� A 1tOF At IN /// %St" ..:1>4.1f...4 s y/49TN � . ir:447-4.144;6:: /: .• Duane Mark Sewarda r ��- e7 648/93 AS-BUILT'No corners set this date ASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE ' I hereby certify that I have performed a Mortagee'a in- ECORDED PLAT ARE NOT SHOWN HEREON. spection of the following described property: North Woods Subd. Unit IV. Lot JQ, Elk 16 'ie information hereon is for the use of lending Anchorage Recording Precinct,Alaska,and that the improve- ments situated thereon are within the property lines and do showing relationship existing not overlap or encroach on the property lying adjacent there- tructures and platted easements and lot lines. to, that no improvements on property lying adjacent thereto t is not to be used for positioning additional encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on tructures or fencelines. said property except as indicated hereon. Dated ikt Anchorage,Ala a). $9 Alla). 4,w4,--; 0,-.4.9,--...-:-0,-.4.9,--...-:- this day nt 19 .2-./9-c99 688-4566 [a7c1P.' 15--../7 c'4'4' r/kV/4‹:570 SEWARD & ASSOCIATES LAND SURVEYING 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 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# Location (site address or directions) Sh~It~rin,q Spruce Loop Property owner Mik~ and ¢onni~ WZs~ Day phone 688-5339 Mailing address HC80 Box 212 Chugiak, AK 99567 Lending agency Mailing address Day phone Agent Eva Lok~n / REMAX EAGLE RIVER Day phone 694-4200 Address. 16600 C~nt~rfi~ld Driv~ Eagle River, AK'99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX 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 NOTE: XXX Public sewer Il 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 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. Name of Firm ................. , -~ Phone Engineer's signature ,//~ Date o DHHS SIGNATURE /~ Approved for ! Disapproved. Conditional approval for ~-- bedrooms. bedrooms, with the following stipulations: Additional Comments 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. 72~25(Rev. 1/91) Back MOA#21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descril~tion: ~,-t" \c) ~z~¢_\ L~ t~,o .~v~,~, c, ¢ ~ Parcel I.D. A. WELL DATA Well type t1~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A B, or C, attach ADEC letter. ADEC water system number Date of test Static water leve~ u mP'~'~p level Date corn plated Driller Cased to Casing height Wires pro~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '7~'z> C~ g.p.m. ; On adjacent lots Absorption field on lot ~ ~ ; On adjacent lots sewer mum Public sewer manh~ Public Sewer service line Petr~k WATER SAMPLE RESU~ Coliform ~ Nitrate Other bacteria D~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~' ~ -t~.. ~'5' Tank size \'Z-~-% Compartments Cleanouts~Y.~N) ~ Foundation cleanoutl~N) ~ Depression (Y~J.)~ High water alarm (Y~j~ ~ Alarm tested (Y/N)' '' Date of pumping {'¢- c3 ~ Pumper ,. To property line. Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot "~z::> c> ~J¢~ On adjacent Io~.~ ~[.~ Absorption field "7~o ~ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE i C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pum~ High water alarm level ~J~e~E~sted Meets MOA electrical codes (Y/N) SEPARATION ~TION TO: Wel~on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ' ~, -' '~ ~ ~- Length '"~ '7.~ Width '~-~. Total absorption area ~,'c> Depression over field (Y~ Results~fail) Peroxide treatment (past 12 months) (Y~) Soil rating 'Z-L~'~ ~/~-~. Gravel thickness "~ ,~- I Cleanouts present (~YN) Date of adequacy test for ~ ~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type Total depth bedrooms On adjacent lots ~ (/~ Property line To building foundation '7~' [ + ~ To existing or abandoned system on lot On adjacent lots 'z'~ c~ ~ ~- t'[( Cutbank /~ Water main/service line Surface water \ c~ ~ ~ ~ Driveway, parking/vehicle storage area Curtain drain ~l ,~. Well on lot '~"~ ~ t J~ ~ ~ \ Jr- E. ENGINEER'S CERTIFICATION I certify that I havo~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~'~"~.~.~'""~ _ ~ Engineer's ~¢~34 Eagle River L~p R~d No. 2~ ~Eagle River, AI~a 9~77 . Date ~///5~ ~ HAAFee$ / "~ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 June 15, 1993 Mr. Ray Shafer S & S Engineering SUBJECT: Lot 10, Block 16 (21721 Sheltering Spruce Loop); Northwoods Sub. #4 Class "A" Public Water System, PWSID #213001 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on May 11, 1993. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on April 21, 1992. This does meet the provisions of 18 AAC 80.200(a). The last Radioactive Contaminants Sample results were submitted to the Department on April 11, 1993. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 2, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This .does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A/B" Public Water System is in compliance with other provisions of the State Drinking Regulations. Unless otherwise noted, this letter is valid for 30 days and is for the specified legal description noted above only. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. III STATE OF' ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION ~t, Block & Subdivision or U.S. Su~ey LOt 10, Block 16 *(21721 Sheltering Spruce Loop) Northwoods Subdivision No.4 PWSID #213001 [ Ce r t '"c a; ;'~;( ~ f--'°rDA~i~;~.~ 1 13 J This approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. ~ WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. Name Ti~n~ironmental Datejune 11,'93 Eng. Asst. II WASTEWATER DISPOSAL The domestic wastewater sys~,em was: [] inspected by the Departmen't of Environmental Conservatio~ applicable requirements of 72; found to be in compliance with [] inspected by a Professional En, eer who certifie.. quirements of 18 AAC 72; the system complies with applicable re- [] installed by a Certified Installer wh( of 18 AAC 72; or system complies with applicable requirements [] tested by a Professional Engineer and that the system complies wi ~s that the performance of the system is satisfactory um separation distances specified in 18 AAC 72. This approval is valid fora [] !y [] -family unit with atotalof bedrooms. Name Date 18-0404 (Rev. 8/85) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICANT; PINK--DEPARTMENT Parcel I.D. #  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 WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed Prior to submittal) (a) Legal Description (include i0t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner (~--)~~ Tl-c~,~ r~'elephone: (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and A gent~//~ ¢-3~ ~? ~-~t~" :~ ' ¢ -' ' · ' '~/ ' ¢ ¢~ Telephone (e) Mail the HAA to the following address: (or check here~ if hold for pick List contact person and day phone number below: S & $ ENGINEERING Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family,~ Number of bedrooms WATER SUPPLY Individual Well [] Community [] Public,[~ Note: If community well system,: must have written confirmation from the State .Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-Site J~ Public [] Community [] Holding Tank [] Note; If oommuni.ty 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 I 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. Telephone ~ ~'/-~ ~:;~ ~ 17034 Eagle River Loop Road No. 204 Name of Firm Address Date 6. DHHS APPROVAL Approved for ,z~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date 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 for errors or omissions in the professional engineer's work. 72~025 (Rev, 7/88)Back Page 2 of 2 k~uNICIP^Li OF ANCHORAGE f. NViL, ONMENT/~L srr'~ViCES DIViSiON FEB t959 WELL DATA Well Classification Well Log Present (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~, X/~,~. \~,, If A, B, C, D.E.C. Approved~N)'/~ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On AdjOining Lots '~ -'~'c~'x'' ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date SEPTIC/HOLDING TANK DATA Date Installed E~-'5o-'a~J Size ~"Z-~o Standpipes~'/N) '~ Air-tight Capsd_~N Depression over Tank (Y/~j:) ~-~ Pumping/Maintenance Contact on File (Y/N) ~ Holding Tank High-Water Alarm (Y/N) ~//~./ No. of Compartments '-[ FoUndation Cleanout ~i~/N) '7/ Date Last Pumped _'-/_. ~..~.. - / ; for -- / Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Wel '~--,~c~ t ..~ To Building Foundation To Property Line ~.,~:~ A-- To Disposal Field To Water Main/Service Line To Stream, Pond, Lal~e or Major Drainage Course Comments "~-~-~ ~.-~----~ L.-- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption-Strata Date Installed ~:~- '**~ ~ ,I Width of Field Square Feet of Absortion Area Depression over Field (Y/~' Results of Last Adequacy Test Type of System Design Length of Field ~'~ Depth of Field Gravel Bed Thickness '~ Statndpipes Present Date of Last Adequacy Test V SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ?~<:~c:~l+ To Property Line TO Building Foundat~nt ~-~; / ~ Lot /A- ; On Adjoining Lots To Water Main/Service Line I ~ ~ '~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~/~, To Driveway, Parking Area, or Vehicle Storage Area ~::~ ~ Comments To Existing or Abandoned System on Dimensions / D. LIFT STATION ~//~ D~,e~nstalled Size in '~a~s High Water Alarm Level at ~~ Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) inspectiOn. Signed Company Date **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this S & S ENGINEERING ~.7_n34 E~gle River Loop Eoaa Eagle River, Alaska 99577 Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMF~NTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 316 / ANCHORAGE, ALdkS KA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: January 26, 1989 PWSID: 213001 To Whom It May Concern: According to the records on UTILITIES/NORTHWOODS Water file in this office, the CHUGIAK System is in compliance with the .! State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental Field officer. Drinking Water Program ; 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 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~ , ApplicantName~ .'~_'~elephone: Home b~;;~o¢'-¢2.~-/ Business ..,~u~-~¢'6..6.~ Applicant Address ~(~l::~- /~q}5'~ '~ ~ '~ ,~ ~' ~__~/.~_..2 t/~.~? .~'~,._{-.~ Applicant is (check one): Lending Institution []; Owner/builder,l~; Buyer []; Other [] (explain); (d) (e) Lending Institution~~/~ ;./~.~. Telephone Address __ Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ¢i¢ Multi-Family [] Other Number of Bedrooms ~ ~ _ WATER SUPPLY Individual Well [] Community,J~' 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 community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) I ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and a~ 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 Telephone Address _ ,>¢.~-;;-¥ *.r;,r?,? Date ~t~ ~?~'/~ ~ ~'~" Approved for.~'~/.~- ' bedrooms by Approved .~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNJCIPALi~'Y OF ANCHORAG,2 DEPT. OF HEALTH & ENVIRONMENTAL "~'~'; £~' ,O,,l Legal Desc.rJl~ion: ~[~. ~, I O R ~/~1/-~ DJ ~. Well Classification Well LoG Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Td Septic/I-~;4~ti~,g"Tank on Lot :~ To Nearest Edge of Absorption Field on ,Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected Dy Water Sample Test Results Comments ~'~ k~J, '~. t ~>, A If A. B, C, D.E.C. Approve~) Date Completed Yield Cased to ,~l~e~'th of Grouting ir~- /Pump Set At ~ ' Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/I~ TANK DATA Date Installed 1~,-~ ~ Standpipes ~:~N) Air-tight Caps ~;~N) Depression over Tank Pumping/Maintenance Contract on File IY/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Plc~dt~ank: To Water-Supply Well "~"-r;~"-~ ~ To Property Line 10 To Water Main/Service Lin~ Course Size ~ No. of Compartments ~ Foundation Cleanout~i~N) ~ ~e Last Pumped 1~.~ ~ ; for Temporary Holdi'n g Tank Permit (Y/N) To Building Foundation ~ ' To Disposal Field ~ ~ To Stream. Pond. Lake, or Major Drainage Comments Page 1 of 2 72-026~11/84, C. ABSORPTION FIELD DATA Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Soils Rating in Absorption Strata ~..,~ ~t~ Type of System Design Date Installed ~:~ "~::~ - ~' Length of Field ~'~-' Width of Field '!5 ~) Depth of Field Gravel Bed Thickness ~"1 ~;~' [ ~ ~1:~ Standpipes Present Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Su pply Well '")"""~"c~ ~ To Building Foundation. ~ ~ Lot ~ / ~ To W~ter Main/Service Line L ~ t ~ To Strearrf/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~ ~ \'"~ To Existing or Abandoned System on ; On Adjoining Lots '~ Jo' To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles dunng Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments Receipt No. Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S gned ~ & ,~, ,~G~E=~I~ Date Compa~ ,;~t.~ ~V~ A~S~;~ ¢99~ MOA No. 72-026 111/84~ I i DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL .~I£FFIELD, GOVERNOR Telephone: (907) : ,~ddress: 274-2533 TO Whom it May Concern: According to records on file in this office the ~4Y'~~ Water Regulations Water System is in compliance with the St~ai:e Drinking I' Sincerely,