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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 13 Municipality of Anchorage On-Site Water and Wastewater Section•(907)343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 191048 PID Number: 051-064-25 Dwelling: L Single Family(SF) ❑ with ADU ❑ Duplex(D) ❑ Two Single Family Project: ❑ New ❑■ Upgrade Name Shattuck, Linda& Rex ABSORPTION FIELD Site Address ❑Q Deep Trench ❑Wide Trench 0 Bed 0 Mound 21665 Sheltering Spruce Loop 0 Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907.529.7480 3 0.8 GPD/SF 9.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.6 Ft. 6.2 Ft. North Woods Unit 4 Block 16 Lot 13 Fill added above original grade Gravel length Township Range Section 0.3 Ft. 48 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 2.5 Ft. Ft. To Septic Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist.between trenches From ; Tank Field Tank Line 576 Ft' 1 Ft. TANK ❑D Septic ❑S.T.E.P. ❑Holding 0 Other Well 1 NA NA I NA NA NA Manufacturer Capacity Surface Water >100' >100' NA NA MaterialAnchorageNumber Tank 1000Gal. of compartments Lot Line >10' 10' NA j NA NA steel two Foundation 1 15' 1 43' NA NA i LIFT STATION i Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Dean Construction Drainfield 03034 CO/MT D3034 Inspector Curtis Townsend, PE BENCH MARK(Assumed elevation) 100 ft Inspection 1N5/3/19 5/6/19 Location and description dates: 2° r 5/7/19 49' 5/23/19 top of rear deck ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date i.P�OF�ri,c,��) 1, S*'49 • h+ 1' *,6 # It._ lo . citrus �;' Septic S Ste r (i - •. No.CE11904•.•$ Approved 1 t.- Date 6-{ /.-_/? ��l\DP ',,,� ROfESS\0tt) Note: this approval does not include well permit requirements. `������ (Rev 05/02/18) L___1ri— I I DESIGN PARAMETERS j./� PRIMARY SEPTIC SYSTEM LOT 13 <. I NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000G PERC RATE: 6.7 MPI 'DECK M------ 7F-- SOIL RATING: 0.8 GPD/SF I AREA REQUIRED: 563 S.F. SYSTEM TYPE: DEEP TRENCH 48' X 30" X 6' EFFECTIVE DEPTH, 3 HO SOOM E 4' COVER. (V FC0 cV 1% SLOPE 1 1 DECK i 0 I DECK-1L _ BJ J N W 000 GAL SV1 J S PTI4 TANK SV2 DCO BM, TOP OF MARK A B DECK SV2 10'-4" 36'-2" O J o CO1 30'-3" 48'-2" I C01 MT 67'-3" 68'-4" I \ I 2% SLOPE CO2 68'-7" 69'-2" N@W 48' x '0" x 6' ED ss AISORPTIO" TENCH o'Rqs \s / FSHED I E SHED- I s CO L — L_ - _ y J_ — -- I _ � � I -- z z r O- F O r- r Z< 0 m Di, OAU YZQ Ya -Iz g CC 0 Q� O w Z w Z w Q ZZ r F-O i--U OJT O 7 o v O FILTER FABRIC 'c5§ v = ��� ••44 4 DIA PERFORATED DRAIN PIPE FINAL GRADE '8 "' �� � �/ / ORIGINAL GRADE ii M1•1111111•11110•••111 111, ORG a 1.000 G �.2 STEEL TANK ' 9 90.1 /2" INSULATION OVER TANK SEWER ROCK GU R6 7 .. SEPTIC SECT1Oty SCALE 1" = 10' NO GROUNDWATER 5/6/2019 80.5 As Built o' Septic System Prepared for ..'mss`„*,11 f Rex and Linda Shattuck •♦•��F''' •' A:'.•� 21665 Sheltering Spruce Loop, Chugiak Alaska 99567 �. �_ �• NORTH WOODS UNIT IV BLOCK 16 LOT 131" ../ OSP191048 : t;;4.1_____ • r , ^ : EKLUTNA ENGINEERING, LLC DATE: 6/13/2019 . CURTIS TOWNSEND;! • 19162 MOUNTAIN ROAD DRAWN: CLT ��j J`•• N f ,3 11904 �`� GHUGAK, ALASKA 99567 •• „ •• ♦♦• SCALE: 1" = 30' • �v ��� ;907) 355-9820 4�e E;�♦♦♦ PID: 051-064-25 SHEET 1 OF 1 N""a 'r MUNICIPALITY OF ANCHORAGE oent �, On-Site Water &Wastewater Program .off ..> •, s�e '. PO Box 196650 4700 Elmore Road d� E 3.,�- 0 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 ; ' A; http://www.muni.org/onsite cituoi ., 1,CHO n r.4E On-Site Wastewater Disposal System Permit Permit Number: OSP191048 Effective Date: 3/20/2019 Work Type: Septic Upgrade Expiration Date: 3/19/2020 Tax Code Number: 05106425000 Site Legal Address: NORTH WOODS UNIT 4 BLK 16 LT 13 G:1460 Site Mailing Address: 21665 SHELTERING SPRUCE LOOP, Chugiak Owner: SHATTUCK LINDA A & REXDENIS C Lot Size in Sq Ft: 26536 Design Engineer: EKLUTNA ENGINEERING, LLC* Total Bedrooms: 3 This permit is for the construction of: E1 Disposal Field E1 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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 Cif's- , - 1//2- (1/4 5 Received By: Date: / Issued By: /n6,1' � �-- Date: _31eD/M MUNICIPALITY OF ANCHORAGE •ir-- Development Services Department `(_ j Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 gunm!.TTAL ON-SITE SEPTIC/WELL PERMIT APPLICATION MAR 5 2019 Parcel I.D. 051-064-25 Bob Parker Property owner(s) Linda and Rex Shattuck Day phone 907.529.7480 Mailing address 21665 Sheltering Spruce Loop Chugiak AK 99567 Site address SAME Legal description (Sub'd., Block & Lot) North Woods Unit IV Block 16 Lot 13 Legal description (Township, Range & Section) Lot Size 26,536 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field n Initial Single Family (SF) X (w/wo ADU) Septic Tank x Upgrade Fx I Duplex (D) ❑ Holding Tank Renewal n Multiple Dwellings Privy I I (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 Mun( i I Codes. 3/ `-1/( tf. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: 3r 5;17 Date of Payment: Receipt Number: ;3 1451/f Receipt Number: Permit No. O$P /9 1 01-4 r Waiver No. 6(0/- 7914t7 G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Eklutna Engineering, LLC curtistownsend@gmail.com March 15, 2019 Subject: North Woods Unit IV Block 16 Lot 13 Upgrade Septic System Permit Request Narrative OSP 191048 This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed system will serve an existing three (3) bedroom house.The existing drain field is in failure. A diverter valve will be provided if grades allow, switched "on" to new drain field. The existing septic tank will be removed and disposed of.The system will utilize a replacement 1,000 gal septic tank and new deep trench. 1. Soils. One test hole was performed in the vicinity of this system by Eklutna Engineering in February 2019, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 16' below the surface in the test hole monitor tube in March of 2019. Bedrock was not encountered in the test hole to 16'. Based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 GPD/SF was used for a conventional wastewater system in the area of the test hole.4' of cover will be required over the length of the trench so as to ensure that the effective depth of the trench will not be in the organic layer. See sheet 2 of the design package. 2. Soil Absorption System Design. See Sheet 1 of the design package. 3. Wells. This lot and the surrounding lots are served by AWWU water.There are no wells within 200' of the proposed septic system. Please refer to the included AWWU water distribution system map NW1460. 4. Neighboring Wastewater systems. Immediate neighboring septic systems are all +30' distant. 5. Surface Water:There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 6. Topography:The house sits on a high spot on the property,with approximately 1%to 2%slope from the perimeter of the house to the edge of property line.The area where the new drain field will be placed is a flat area that allows for the effective depth of the trench to remain in the design absorption layer. There are no steep slopes within 50'of this system. The proposed drain field will maintain 50' separation from all steep slopes. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, F,gLq\�� Curtis L. Townsend, P.E. Agr,<p7,• ' 9•;f*1 Attachments *49 TM • 11 *0,� r� 7 19 • r.` Curtis .Towns ny•• Date �• i v ••• 4ck- 0 `%`fly Nb.CE 11904 .• • Ate '\ ��PROFESS10�44� SHELTERING SPRUCE LOOP LEGEND --w— EXISTING WATER LINES `�,1-,, —ss— PROPOSED SEPTIC j I \ FgSFMe�T T / / /LOT 13 o I � T \ , � � � I I � o M� REMOVE EXISTING `� 10' IDEC 1000 GAL TANK 0 NEW 1000 GAL r 3 BEDROOM ;- SEPTIC TANK HOUSE FCO i-- 1% SLOPE W SV1 a,' LI SV2 l�� I- _, DECK (Ni DCO: }� DECK I Q I- -- — - W DIVERTER '-__ J x ss -" -is:i >- OJ -i-t ,EXISTING 24'X38' � VALVE N � I '�_— __ � a O N I ABSORPTION BED ---.--17/257 titil ; , pi NEW 48 X30"X6 CO ����1, G EFFECTIVE DEPTH s THERE ARE NO STEEP ABSORPTION \ 16' SLOPES WITHIN 50' OF TRENCH i 2% SLOPE THE PROPOSED ss TRENCH. THIS PROPERTY IS SERVED BY AWWU AND RAMI _ THERE ARE NO WELLS MT LSHED� WITHIN 200' OF THE [SHED1 CO PROPOSED TRENCH. r — r — f SCOPE OF WORK r — — — r 1 r' r 1. E INTO EXISTING ABSORPTION BED SYSTEM IF RADES ALLOW AND REMOVE EXISTING SEPTIC DESIGN PARAMETERS TANK IN ACCORDANCE WITH ANCHORAGE MUNICIPAL CODE. PRIMARY SEPTIC SYSTEM 2. PLACE NEW 1,000 GALLON SEPTIC TANK AND NO. BEDROOM: 3 (450 gpd) NEW 48' LONG X 30" WIDE X 6' EFFECTIVE TANK SIZE: 1000G DEPTH ABSORPTION TRENCH. AT NO TIME SHALL PERC RATE: 6.7 MPI TOTAL DEPTH OF EXCAVATION EXCEED 10'. SOIL RATING: 0.8 GPD/SF 3. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH AREA REQUIRED: 563 S.F. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE SYSTEM TYPE: DEEP TRENCH MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. 48' X 30" X 6' EFFECTIVE DEPTH, 4' COVER. Septic Design Prepared for .'x""11, Rex and Linda Shattuck 44 OF OF 44•44.-:./644 21665 Sheltering Spruce Loop, Chugiak Alaska 99567 :`?�'� �• NORTH WOODS UNIT IV BLOCK 16 LOT 13 ; ; ?TN c d•_ � �0 OSP 191048 • i F-- :•• EKLUTNA ENGINEERING, LLC DATE: 3/15/2019 .. -:CURTIS TOWNSEND 19162 MOUNTAIN ROAD DRAWN: CLT �o.; .vols/t,� 4•'...-: 11;.= CHUGIAK, ALASKA 99567 SCALE: 1" = 30' •• lr ••�\ (907) 355-9820 �t11SS;, i• PID: 051-064-25 SHEET 1 OF 2 SOILS LOG – PERCOLATION TEST 1– OB ORGANICS _ — 3– 4 - LOT 13 I "I�, 5– S' 6– 7– 8 9= GM SILTY SANDY 10 GRAVEL r , \_1.._ �-----“--T 's 13– 14 – 15–I E .] L- — 16 BOH WAS GROUND WATER ENCOUNTERED? NO ` .— t DATE PERFORMED:2/25/2019 IF YES, AT WHAT DEPTH? II DEPTH TO WATER AFTER _. MONITORING? NONE DATE: 3/04/19 NET WATER NET NO. DATE CLOCK TIME TIME RLLEVEL DROP (M1 2/25/2019 16:39/17:01 30 6" – 1-1/2" 4-1/2" 2 2/25/2019 17:02/17:32 30 6" – 1-1/2" 4-1/2" 3 2/25/2019 17:32/18:02 30 6" – 1-1/2" 4-1/2" PERCOLATION RATE: 6.7 MIN / INCH PERC HOLE DIAMETER: 6" TEST RUN BETWEEN 4 FT AND 5 FEET. PERFORMED BY: CURTIS TOWNSEND. I CURTIS TOWNSEND CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2/25/19 Septic Design Prepared for ..'�,w`11II,11, Rex and Linda Shattuck �� .• . :9�gSx_... 21665 Sheltering Spruce Loop, Chugiak Alaska 99567 4,c-) `-'57 •, NORTH WOODS UNIT IV BLOCK 16 LOT 13 • • : 49I TI #O •OSP 191048 • • EKLUTNA ENGINEERING, LLC DATE: 3/15/2019 ;. : CURTIS TOWNSEND;i No. CE 11904 1 9162 MOUNTAIN ROAD DRAWN: CLT .♦kS`�••., . 1 f,. , • CHUGIAK, ALASKA 99567 ( r - SCALE: 1' = 50' ����� . ..'1C�4�� (907) 355 9820 ,6 ��14 PID: 051-064-25 SHEET 2 OF 2 SHELTERING SPRUCE LOOP r 1? (L=36.14') (N 90'00'00" NO (78.72') (R=50.00') NOTES: "- 1. () RECORD I 11 I (L=36.14') DIMENSIONS PER r`-, Gm I I (R=50.00') PLAT 83-333. LI 2. UTILITIES OTHER L ` 45.T', THAN THOSE NORTH WDODS 6 F-4 • SHOWN MAY EXIST. SUBDI VISION UNIT IV ASPHALT �q'r A 3. THIS SURVEY DOES PLAT 83-333 DRIVEWAY I I ' ` / -I- NOT TNOT CONSTITUTE A LOT 13 ) ) I I I BOUNDARY SURVEY BLOCK 16r /� y0' T&E AND IS SUBJECT TO f r' �f EASEMENT TANY HATINAACCURACIES 22.2' 51.5'1 SUBSEQUENT GRASS I 6 BOUNDARY SURVEY ( 1 o o3 MAY DISCLOSE. 1 GRASS UNDER NO �- CIRCUMSTANCES oo n 23.1 C., SHOULD ANY DATA o 2.0' 2-STORY 4 Z in SHOWN BE USED TON 45.1'�� 4 g� FRAME ``� ESTABLISH ANY 2 0'� oo HOUSE v N FENCE, STRUCTURE 'S 6 OR ANY OTHER . ti IMPROVEMENTS. w �S) 45.3' 0 O I - 1 co J 4. ALL VISIBLE ABOVE o (:§) DECK o DECK — —� O GROUND FEATURES o 0 OF THE EXISTING o L (S' SEPTIC SYSTEM v WERE LOCATED AT THE TIME OF SURVEY AND ARE LEGEND ;S; SHOWN HEREON. 0 FOUND 1/2' REBAR " co L y M B MAILBOX GRASS W LE J ELECTRIC PEDESTAL T TELEPHONE PEDESTAL r - 1 — -1 0 -0- GAS METER Lim J L —1 J (S) SEPTIC VENT G — — NATURAL GAS 34" , 146.56') Lor 24 0 co (S a1'16 W LOT 23 ASBUILT - NO CORNERS SET THIS DATE ;o LOT 22-NN-6' CHAIN-UNK I HEREBY CERTIFY THAT I HAVE PERFORMED n A SURVEY OF 1~``\���` LOT 13, BLOCK 16, NORTH WOODS o �,V��F �:4.0 1, SUBDIVISION UNIT IV, PLAT NO. 83-333, c ��4:r.•' ' • � �� PALMER RECORDING DISTRICT, ALASKA, Q •'� fi j �\ ••*r� AND THAT THE IMPROVEMENTS AS DEPICTED . ... . . . .. ..1 ... . 0 HEREON EXIST AS SHOWN IN RELATION TO NORTH J, • . • . • • • • , THE PROPERTY LINTHAN. EASEMENTS OF 1 RECORD OTHER THAN THOSE SHOWN ON 1 Dayna M.R •felt • / RECORDED PLAT No. 83-333 ARE NOT �l rOrli›.-. No.LS 133 ••� %, SHOWN HEREON UNLESS OTHERWISE NOTED. A\fN AVi:e,o,;•5 I'• ,��• s c- DATE: 3/15/2019 FB: 2018112019 SURVEY & MAPPING v- ofESSIONaL�,`+ GRID: NW 1460 DRAWN: DMR 2890 S. BARNYARD CIR., WASILU, AK 99654 \\���~~ DANA RUUFELT(907)301-5177 SCALE: 1" = 30' FILE: 19-004AB ':~'0-' ' MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION , \ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT [] UPGRADE MAILING ADDRESS?o LOCATION __ NO, OF BEDROOMS ~ell Absorption area Dwelling PERMIT ~ DISTANCE TO:ao~un ~TY /&.~/ /0~ ~N2~ Manufacturer ~n0~raa~_A -- Material~e~[ No. of compartments 2 [Liq ca~ac ty n ga ons ~ Inside length Width Liquid depth [ I~00 F Hu,v,EMADE: ~ ~ DISTANCE TO: Well Dwelllng PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons Q II Foundation Nearest lot dine PERMIT NO. ~ ~ ~ No, of lines ~ Length o~ine Total length of Hnes ~~nches Distance between lines ~1 ~ ~ ~ Top of tile to finish grade .~ Material beneath tile Total effective abs~-~n--ea ~' ~~ ~ inchos Length 'Width Depth PERMIT NO. ( ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: ~ C~ ,~ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE ~: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST ~ATING INSTALLER ,~ ~:'; % ~4a C~5::~J , j I ¢ , 21 or woo ' PERMIT NO: [:,ATE ISSUED,: t-~LIN I C I PF~L I T~' Etak l=tl'.tC HC, I;~:'t:tGE D, EPARTMENT OF HESLTH RND ENVIRONMENT8L PROTECTION 825 L STREET., RN~HORHGE., 8K mDN--S I TE __~E~ER PER~'I I T · 05/10,x84 APPLICANT: ADDRESS: CONTRCT PHONE: STEVEN L. SKRGGS CONSTRUCTION P 0 BOX 670~90 CHUGIRK, RK 9956? 688-28~1 LEJAL CESL. RIP: LOT SIZE: MAX BEDROUMS: SUBDIVISION: NORTHWOODS #4 SECTION: ~ TOWNSHIP: i5N 265~6 (SQ. FT. OR ACRES) LOT: RANGE: BLOCK: LISTED BELOW ARE THE F ' ~ JPTIUN~ AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OF'TION THAT BEST FITS YOUR SITE. DEPTH TO PIPE BOTTOM (FT.) GRRVEL DEPTH (FT. ) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS. ) TANK SIZE (GALS) SOIL RATING (SQ, FT, ?BR) 4.0 4.0 4.0 -~.0 0.5 7.8 4.5 7.8 2.5 2i. 0 5.0 9~. 0 ~* 42. 0 68. ~l. 4 ~2. 6 44: 000. 0 ** i, 000 0 ** i., 000. i~4 i~ i~4 *¢,', GRAVEL LEN,',TH } 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEE[ lNG ?5 FT. ~:~: TANK MUST HAVE AT LEH_,T TWO COMPARTMENTS EACH) I CERTIFY THAT: i. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS~ AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT· ~. I WILL RDHERE TO ALL MOA AND STATE OF ALASKR REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY E~ISTING WELL, 'WASTEWATER DISPOSAL S~S~EM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4, I UNDERSTRND THAT THIS PERMIT IS VALID FOR R M8%IMUM OF ~ BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ~DDITIONAL PERMIT. IF 8 LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, fHEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTRINED.~ (2> AS-BUILTS 4ILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT.~ AND (-?.) THE ELECTRICAL WORK MUST BE [>ONE BY A LICENSED ELECTRICIAN. ~PPL ICQNT: N BLUL. K: t6 LOT: ±~ RFINGE ...... SECT I FiN ..... MF:IXIMI.JM I",IUME:[]R OF DE[::ROOMS = 3 SOIL RRTING = 194 2[93:2[94 (SQ. FT. ,.."BR) L. ISTE[., BI;SL. OLI F~RE THE OF']"iONS FIVFIILRE:LE TO '/OI.J IN DESIGNING YOUR SEPTIC SYSTEM. ISI"IOOSE THE OPTION 'T'HRT DEST FITS '¢OUR SITE. WIDTH = 2 5 FT. LENGTH = :37. 0 F:"T. ' NOTE :::'75 FT. REL.]UIRES TktO 'TRENCHES TOTRL DEPTH = 7. 8 FT. GRFtMEL F..",~P"FI..1 = 3. 0 FT. GRR',,,'EL. ',,,'OLL1ME = 2:1. 4. CU. YDS. TRNI-'.'.' SIZE = i, 880. 0 GIqL. L.O,~,tS (TWO COMPRRTMENT TRNI<.':, WI[."TH = ;-21. 0 FT. LENGTH = 42. 0 F'T. ]"OTRL. DEPTH = .5. 0 FI". GRF'I'¢EL. [:'EF'TH = 8. 5 FT. GRFt',/EL VOLUME = 22. 6 CU. 'r'[:'S. 'TF;NK £;IZE = i., 80C~. 8 GALLONS ':.'TNO COMPARTMENT TRNK> 1.4iDTH = 5 0 FT. LENGTI'"i = 68. 0 FT. TOTFIL, DEPTH ~ 7'. 0 F'T. GRR',,,'EL. DEPTH = ]:. 0 F']". GRR',,,'EL. VOLUME = 44. 0 CU. "r'DS. TRNK SIZE = 1., 000. 0 GFtLLONS (TklO COI"IPFIF:'.'flIENT TRNK) I CERTIF'¢ TI'"IRT: :1... i FiM FF:IMILIFIR HITH THE r::.'EQUIREMENTS FOR ON-SITE SEWERS RI'.,ID ~,.IELLS FIE;., SET FORTH D'.r' THE MUNICIPRLI]"'.r: OF RNCHORRGE RND TI...IF STRTE OF: F~LRSKR. 2. I HiLL INSTRLL THE S"r'STEH IN RCCORDRNCE HITH THE CODES I::li'.,ID I--IR'CE RECEZ',,,'ED R COP'.," OF THE CODE SUI'iMRF::'.r' RND DIRGRRI'"I RT]"I"]CI';IMENTS .Ltl...tICH IS PRRT OF' TI-.IIS PERM I T. ]:. i UNDERS"r'RND TI-.IRT -FI...IE ON...-SITIZ SEI.4ER S'./STEM Mt::¢r' REL.]UIRE ENLRRGEMENT iF TNE RES I[:,ENCC' IS REHODEL. ED TO INCLUDE MORE Tt...tRN ]: DEDROOMS. PERi'tIT RF'PLICAIqT ~11'~:'5 THE RESPONSIBILZT'.r' TO Ii'4F'OR.M PERSONNEL [:,URI'NG TNE INSTf';LL. ATZON INSPEC:TION5 OF RN"r' PlELLL"."; FI[:,J'RCENT ]"0 THIS PROPERT"r' RN[:.' THE NUMBER OF RESIE:-'ENCE9 TI'"IFFF THE !.4ELL ~.4IL. L IF :1 L. IFT 5TFfTIC'ht tS INSTALLED., AN ELECTRICFfL F'ERMIT F~N[." INSPECTION MUST BE ODTRINED. F~5'""E',UILTS E::FtNNOT E:E RPPROVED WITHOUT RN EL. ECTRICFIL INSPECTION REF'ORT. THE ELECTRICRL t,.IORI< MUST BE DONE E:%" F:t LICENSED ELECTRICIFIN. ISSUED ;?'/: [:'FtTE ' -2.2,."::L2,."83: ,-~UNICIPALITY OF ANCHORAGE °6 "~ Departmenti ? Health and Environmenta?'~rotection 825 ~ Street, Anchorage, AK. ~9~501 264-4720 * * * HANDWRITTEN PERMIT * * * P. ermit ~,~.~/ oc~ ~ ON-SITE SEWER PERMIT APplicant: ~7-~U~'~A~) L. S/C~S - Mailing Address: L~ocation: Phone Number: Legal Description: Type of Soil Absorption syste~ Is: Trench: ~'"-~Drainfield: Seepage Bed.. Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating (sq. ft/br) The Required Size of the Soil Absorption System Is:' DEPTH 7 LENGTH ~7/~ GRAVEL DEPTH ~7Z' WIDTH 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 = /~d] 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 pubtic well. Minimum distance from a private well to a private sewer line is 2,5 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 g 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include morethat/~~m_s. Signe~: Applica~ Date: Issued by: ~~~__--~~,7//~7~ ~ SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 ~3 4 5 6 ~7 8- 10 12- 13 SLOPE DATE PERFORMED: WAS GROUND WATER ENCOUNTERED? IF YES~ ATWHAT DEPTH? SITE PLAN ~leading Date Gross Net Depth to Net L Time Time Water Drop "..'is ,o,.t z~ '~ ;s,~ - s~:.,4.4 - PERCOLATION RATE / //~z~ FT AND TEST RLJN BETWEEN ' // PERFORMED BY: ~. ~ CERTIFIED BY: (minutes/inch) ~ FT 72-008 ~,6/79) E PLRNS MUNICIPALITY OF ANCHORAGE i Development Services Department .„. 472 Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-064-25 Expiration Date: (c7- /'i -269 ? 1. GENERAL INFORMATION Complete legal description North Woods Unit 4 Block 16 Lot 13 Location (site address) 21665 Sheltering Spruce Loop Current property owner(s) Shattuck Linda & Rex Day phone 907.529.7480 Mailing address 21665 Sheltering Spruce Loop Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well LJ Private Septic U Water Storage n Holding Tank ❑ Community Well _ Community n Public Water System Public Sewer U Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ ai i V Waiver Fee $ Date of Payment 61(-1119 Date of Payment Receipt Number Ob—toi OD Receipt Number COSA# Q5C141aia 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 Eklutna Engineering, LLC Phone 907.355.9820 Address 19162 Mountain Road Chugiak AK Engineer's Printed Name Curtis Townsend, PE Date June 1 , 2019 `%of 4s�1 *' i\ 1 6. DSD SIGNATURE •••' t � 95 System #1 Approved for .3 bedrooms • • System #2 Approved for bedrooms +� F No.ct:11904...c: Disapproved Conditional approval for bedrooms, with the following stipulations: k1/4kLIY °FmkON-SIb��� WATER A WASTEWATETEND R z� 3c PROGRAM iii SER\11 �4)))»»))01 By: Original Certificate Date: l0— ! 7-17 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 Checklist blue sheet COSA Checklist Legal Description: North Woods Unit 4 Block 16 Lot 13 Parcel ID: 051-064-25 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 AWWU, public water B. TANK DATA C. LIFT STATION Age of tank(s) <1 years ❑ Required maintenance completed Tank type/material septic /steel Age of lift station years Measured operating fluid level in septic tank 50., Lift station material I Standpipes/foundation cleanout per record drawing Comments: Date of pumping new tank installed May 2019 D. ABSORPTION FIELD DATA Which system tested(date installed) "2019 Adequacy test date ©ALL standpipes present per record drawing Results ❑Pass For bedrooms Total measured depth from grade 10.1 ft(max) Fluid depth prior to test in Measured depth to pipe invert from grade 3.9 ft(min) Water added gal ❑ N/A—pressurized field New depth in ❑l Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective ❑■ Code-required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies:new system installed May 2019 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 ❑ Yes if No ft Neighboring Tank > 100' ❑Yes if No ft Private Sewer/Septic Line>25'❑Yes if No ft Absorption Field on Lot> 100' ❑Yes if No ft Holding Tank> 100' ❑Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main>75' CI Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ❑✓ Yes if No ft Surface Water> 100' ❑✓ Yes if No ft Property Line> 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells>100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells>200' Q Yes if No ft Water Service Line> 10' ❑✓ 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' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main> 10' CI Yes if No ft Private Wells> 100' ❑D Yes if No ft Water Service Line> 10' ❑✓ Yes if No ft Community Wells>200' ❑✓ Yes if No ft Surface Water> 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ENGINEER'S ,r"�P��OF;�gsif-t,� krtis � r.COSA Checklist yellow sheetl • .To j7 1,'. Date 4. 13 yh``j q ``CNo.0 11 ..`tr 4t19F-PROFESSlbha1► SHELTERING SPRUCE LOOP i i? ,� (L=36.14') NOTES: v (N 90'00'00" W) (78.72) ° (R=50.00') 1. () RECORD I I (L=36.14') DIMENSIONS PER YR- I I I (R=50.00') PLAT 83-333. LTs. 2. UTILITIES OTHER I �S.r THAN SHOWN MOSE AY EXIST. a NORTH WOODS 6 Fq � • SUBDIVISION UNIT IV p ASPHALT I FNT I 7\ 3. THIS SURVEY DOES ti PLAT 83-333 I DRIVEWAY I T L NOT CONSTITUTE A OJ LOT 13 JI I I I I �' —" BOUNDARY SURVEY BLOCK 16 J I �0' T&E AND IS SUBJECT TO ANY INACCURACIES J --..0I am _-I -I 5'.5't THAT A 0 +) 22.2' SUBSEQUENT GRASS I Y ib BOUNDARY SURVEY a o; MAY DISCLOSE. UNDER NO I GRASS .-. 1.CIRCUMSTANCES b 23.1' N N- SHOULD ANY DATA 2.0' 2-STORY 4 W in SHOWN BE USED TO o -�-45.1'1 ESTABLISH ANY 2.0' 4.8' FRAME W FENCE, STRUCTURE ' HOUSE a N u., OR ANY OTHER - 3 IMPROVEMENTS. w 45.3' = r 0 o �� DECK o p-CD DECK, -_ -- J o \ ,44CD Z 0 in up LEGEND 15 O 1/2' REBAR F M B MAILBOX c) n 7 ELECTRIC GRASS \- LEJ PEDESTAL A TELEPHONE LTA PEDESTAL GAS METER _ _1 — - LSHED J LSHED1 SEPTIC VENT NATURAL GAS q.) • 0 LOT 24 <o (S 81'16'34" W) (14 L O T 23 ' CHAIN-UNK ASBUILT - NO CORNERS SET THIS DATE ;o LOT 22 FENCE I HEREBY CERTIFY THAT I HAVE PERFORMED ii A SURVEY OF ,o 4~~``\\��� LOT 13, BLOCK 16, NORTH WOODS s Q .��• feta l SUBDIVISION UNIT IV, PLAT NO. 83-333, ��,`Q�. ,,,0,1,40- '` •��ef PALMER RECORDING DISTRICT, ALASKA, r AND THAT THE IMPROVEMENTS AS DEPICTED HEREON EXIST AS SHOWN IN RELATION TO THE PROPERTY LINES. EASEMENTS OF cl NORTH 1:). . G/L.`': .`. . • • i RECORD OTHER THAN THOSE SHOWN ON Dayna M. umfelt • % RECORDED PLAT No. 83-333 ARE NOT r • o/ SHOWN HEREON UNLESS OTHERWISE NOTED. VENDE -AT1iF�FO• N..j131NA1 3(2?, •i��� DATE: 6/3/2019 FB: 2018112019 GRID: NW 1460 DRAWN: DMR SURVEY & MAPPING 1�N�"``�� 2890 S. BARNYARD CiR., WASILLA AK 99654 kiP°FfSSI0 DAYNA RUMFELT(907)301-5177 SCALE: 1" = 30' FILE: 19-004ABpc Parcel I.D. # I I i 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 O~-/- GENERAL INFORMATION Complete legal description Location (site address or directions) ~-/~ 4, ~- Property owner I~~.~ Mailing address Lending agency Mailing address ~ ~;~-,-~ ~-'---~ Day phone Day phone Agent '-'~ ,,3 C~...~,= ~- Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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. ' Phone Name of Firm n,,v;.4 ~: n.../.,,. 20210 Donalar St. Address C ..... ~:~ ............ Engineer's signature ~ul~)~'- ~2'~~'~ Date DHHS SIGNATURE X Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ ~' ~ ,.Date g-:2-~'~ 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 p?ofessional engineer's work. 72-025(Rev. 1/91) Back MOA~21 I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. o~'/- If A, B, or C, attach ADEC letter, ADEC water system number Date comPleted Driller A. Well Data Well type Log present (Y/N) Total depth Cased to Casing height FROM WELL LOG Sanitary seal (Y/N) Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line .g.p.m. g.p.m. ?~ ~, ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ~" High water alarm (Y/N) Date of pumping Tank size ! o~_:> Compartments 'Z- Foundation cleanout (Y/N) ~ Depression (Y/N) '4~x/~" Alarm tested (Y/N) ~"/~/~'~ Pumper 5~t ,""~ ~ ~:~c, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field ~ Foundation //o Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump. off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/~ ¥ ~'~ Soil rating (GPD/Ft~) /~-L~ ~--~ System type Length :~ ~ Width ~z.-~ Gravel thickness g'~';"~'~ Total depth Total absorption area ~'/Z- Cleanout present (Y/N) Y' Depression over field (Y/N) Date of adequacy test ¢~,/f'¢ Results (pass/fail) ,~x~ for '.~ Bedrooms Water level in absorption field before test I ~/~ '~ After test /~ ~,..//_~,~ Peroxide treatment (past 12 months) (Y/N) /t~ If yes, give date Well on lot To building foundation On adjacent lots :~--~ Surface water Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots ~ Property line To existing or abandoned system on lot Cutbank /~//~/~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I ceftin/that I have checked, verified, or conformed to all MOA and HAA David R, Dayton P-E. 20210 Donalar St. Signature Engineer's Name ~.~/.~_ ~/-- ~-"~ Date =. of this inspection. Date of Payment ~/7-'"'~/'?/7Z' Rece ptNumber 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number 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 ~----1- '~C::>- ~,~' GENERAL INFORMATION (a) (b) (c) (d) Lending Institution Address (e) Real Estate Company and Agent Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~(.~'~/'"~,.-~-~ ~_..,~.o~-- Tele. phone: Home Business Applicant Addressg (~'1'7>-g~:... ~r'c,~.,c,~::~.~ -- ~:.~'/'~__.,4~ ~._~,_/~,~..-- Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other~'(explain); Address ~(~ '~ Tlglephone l_/.~cq[. L.~ (f) ~HAA to the following address: Telephone TYPE OF RESIDENCE Single-Family I[~'-Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] Public~. Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 SEWAGE DISPOSAL Onsite~J~. 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 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA',,-. 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. ~".e. ~ ¢=~,t~fa~.fR,m Telephone Name of Firm _ _,~ , . B 19~X . Address ~ ~...'.L~iLR' ~1~!i:{~_ ~,!/':,¢~,',~ Date ~'~"~" ~' .... ,- Approved for Approved ~/' Disapprov d~ ~/ Condition~ Terms of Con(Jitional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval c~rtificates 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal p~scription: ~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring m Conduit (Y/N) Separation Distances from Well: To Septic/l~a~+~ Tank on Lot A If A. B. C, D.E.C. Approved ~N) Date Complete? Yield Cased to .~3 ,~Depth of Grouting /~. Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorptio~ Field on Lot To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sam pie Test Results : On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC~ TANK DATA Date Installed Standpipes (l~/N) Air-tight Caps ~N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticJHc~d!ng Tank: To Water-Supply Well -'7_.~_~'-b ~ ~ To Property Line ~. c:~ ~"~ % ~,_.~..! _,~,L~ Size [~:::~z~:,c~ No. of Compartments ~ Foundation Cleanout ~'N) / Date Last Pumped 10-'7--'~'~-,~' ; for ~ Tern porary Holding Tank Permit IY/N) To Building Foundation To Disposal Field I '~'~ To Water Main/Servic~ll.~e t ~:::, -~ To Stream, Pond, Lake. or Major Drainage Course -- ~ Comments' //'~/'~/-,'~//~ ~ ~ ~~ ~~ ~' ~ 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed,, . Width of Field SC uare Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (~N) Date of Last Adequacy Test To Building Foundation Lot To Water Main/Service Line ~ c:)~J¢ To Stream/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 ~ l~Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adec uacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certity that I have checked, verified, or conformed to all MOA and HAA guidelines m effect on the date of this inspection. Signed ~''~ ~_ _E~i.I_~_E~[[~¢¢ Date Com~'~-~-~ ~ MOA No Receipt No. '~~ (~ ~ Date of Payment I O ~ ~ Amount: $ Page 2 of 2 I i DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNO~ Telephohe: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the Water Regulations Water System is in compliance with the St~e Drinking Sincerely, ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALI'W OF ANCHORA~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG ,'5 '1. 984 RECEIVED Well Classification ~m~ Well Log P~esent (Y/N) ~ Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) S~pa=ation Distances f~cm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absc~ption Field on Lot To Nearest Public Sewer Line C leanout/Manhole Water Sample Collected By Water Sample Test Besults C~t~t~nts Legal Description: If A, B, c= C, D.E.C. Approved.(Y/N)'~ ~te ~le~d Yi~d ~p~ of ~ting Pump Set At Sanitary Seal on Casing (Y/N) Deuression Around Wellhead (Y/N) ; On Adjoining Lots t On Adjoining Lots To Nearest Public Sewer To Nearest Sewer service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 2/ ~ /~ Size I000 NO. of Oht~a~tm~nts ~ Sta~i~s ~) ~ Ai~-tight ~ps ~) ~ Founda%io~ Clea~out ~) ~ession ~ Ta~ (Y~ ~]~ ~te ~st P~ ,~/~ ~f~ P~i. ng~aintenan~ ~n~a~ ~ File (~)~/~ ; f~ ' Holding TapR High-Water Ala~ (Y~) ~/~ %e~ra~y ~ldi~ Ta~k ~t (Y~) ~p~ation Distan~~ng Tank: To ~te=-Supply ~'i~~ ~ To ~ilding F~ndation ~' To ~o~rty ni~ ~ To Dis~sal Field /~. ~' To ~ter Main/~rvi~ Li~ ~O' To' S~e~, ~nd, ~e, ~ ~jor ~aina~ cou= + jOO ' Co~a~ents [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata / ~ ~/~/~7~ Date Installed ~Z ~ /~ Width of Field Square Feet of Absorption A~ea Depression over Field (Y~ Results of Last A~]equac~y Test Length of Field Date of Last A~l~quacy Test Separation Distanee~ie ld: To Water-Supply Well (' ~(~ -f- ~.3 To P~operty Line ~(~ ~ Depth of Field Gravel Bed Thickness Standpipes P~esent ~N) To Building Foundation ~ ! Lot~i' ~! N/~ ; On ~joining Lots To Water Main/Service Line ~O' To Cutbank(if To St~eam/Pond/Lake/c~ Major D~ainage Course To D~iveway, Parkinc3 A~ea, o~ Vehicle Stc~age A~ea To Existing o~ Abandoned System cn Date Installed Size in Gallons "Pt~.~ On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA C(~nts .~ ** Check Permitted Bed~cx:~ Rating Against HAA Request .I ~ertify that I have checked, verified, c~ conformed to all "!0~ the date of this inspection. Signed ~J~3~ ~ Date ~_~ ~ /~ Cc~oany ~_~fli~ ~ ' ~O~.~ MOA No. ~ ~-~S [Page 2 of 2] in effect 2-15-84 I DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTP~AL REGIONAL OFFICE 437 ~'E:' STREET, SUITE 200 ANCHORAGE, ALASKA 9950 RILL SHEFFIELD, GOVERNOR Telephone: (90,7) Address: 274-~533 DATE: To Whom It May Concern: .- .............. Water System is in compliance with the State Dri g l- Water Regulations. Sincerely,