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Home My WebLink AboutNORTH WOODS UNIT 4 BLK 16 LT 18 . ~ ~ MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Ire°NE MAILING ADDREss~'~ j'~ ~ ~;~' ~ ~'0 J~"] ' ~"' "'/-'J'~" L2/'~ "~'/~ '~/ I~g-~l LEGAL DESCRIPTION LOCATION LO~ /~ ~LO~_~ /~ ~O~'~ J~D~ '~ ~ %~ ~ F~~ NO. Of BEDROOMS Well Absorption area Dwelling PERMIT NO. ~ ~ DISTANCE TO: ~¢~.~y / ~ I lO I fl~ ~_ITTE~ ~ ~ Manufacturer Material No. of compartments~ Liq. capacity in gallons / ~ ~ ~ I F HOMEMA DE: Inside length Width ,. Liquid depth ~ ~ DISTANCE TO: Well Dwelling ~o~ PERMIT NO, O Z ~ Manufacturer Matedal Liquid capacity in gallons Q Well ~ DISTANCE TO: ~O~I'T~ IFoundation Nearest IotHne PER~IT ~ ~ Length line Total length of fines Trench width Distance between lines ~ ~ Top of tile to finish grade Q ~ / Material beneath tile Total effective absorption area ~ Length Width Depth ~ inches / ~ OO ~¢ o PERMIT ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well DISTANCE TO: Building foundation Nearest lot line ~ Class Depth Driller ~ Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS ~()~ SOIL TEST RATING INSTALLER .... REMARKS ~'ocM~ r/cd I ~ED DATE ~ ~- - ~ ' 72-013 (Rev. 3/78) '[ t~~ ~;~~~ ~ ~ [ ~ DEI"--'FtRTMENT L.. HERLTH RND EN',,,'t RONMENTFIL .... :OTECT I ON , - ,:,,..:.._ L"' STREET., FtNCH"Ii~'R SE., nK q,:,~l._..l.;L-. ' ' 264-47L::.'0 ' RNCHOF::RGE E;D4-2:Zi.':'i : EFIGLE F.: I VEF.: PERMIT NL-J. 8]:ii0~: FIPPL I CFINT: %I'.'.':I:~GGS CONh%TR PHONE: ':' ="~' - RE)DRESS:,-,r;' P_,,.., D LEGF'IL DESC:RI-F'TION SUE:DIVISION: NORTHt.400DS #4 ~;- LOT: ~" - TI-t '-- .... -- I-' LOT _IZE ¢1:51_.]!. FT. , _HNz, HIF': RFINGE: - -',E_.TION: - F1F,,.%IH]I-1 NUME:ER OF E:E[,Rnl]M'~ = c~ SOIL RRTING = c,~],-, .=,~..c .$,-,-, ._.. .... ~...,,:, ~-.._., -F:,o (~'-] FT. ,."'E:R) LISTED BELOH BRE THE OP]'IONS FP/RILFiBLE TO '¢OU IN DESIGNING'OUR' _,EFTIL.'= ' -' =,~-",TE~t. CHOO'SE THE OPTII]N THRT ~EST FITS '¢OUR SITE. · .......................... : ....... ............... ; .............. HIDTH = 2.~,= FT. LENGTH = :L3:4. 0 I:::'T. ' NOTE ' -'-~.-q I ....'- · - ..., .- FT. REQUIRE'=' THO TREN_t~E_-',, TFITFiL ,.,=FTH = u,. 0 FT. .~ NOTE ' .... REQUIRES IN::ULIITIUN- ~ - GRFI',,,'EL DEPTH = 3:. 0 FT. ! NOTE ~ .... MFI"r' REQUIRE LIFT STFtTION -~mm,~Z.L ',,,'OLUME = 43:. 4 CU. TI=INK SIZE = i., 080. 0 GI::tLLON:'-J (TglO COMPFIR"FMENT TFINt<) 1.,.I I [:'TH = 24. 0 FT. LENGTH = 48. 0 FT. .~c- ~ 0 FT. TOTFIL [:,.:~FTH = GRFI'.,,'EL [')EF'TH = El.._,':": FT. GRFI'v'EL ',,,""Il_ _ MF_ = 42. ~::; CL [." ::,.- TFtNI< SIZE = ±., 000. L'] GFILLONS (THO COMF:'FiRTMENT TFINK) IL..~ ]." [:,lEE IE:.lf:;.~F~ ~ ~-4t IFc ]:. E'~L_E]:~ llZ~ ~".~; ][ HI[:,TH = .=- 0 FT LENGTH = .~..=..'*'~'~' 0 FT..~ N.]TE ...,-'~'~, FT. REL:).UIF..'E~. _ THO TRENCHES. TOTRL DEPTH = 6. 0 FT. GRF'I',,,'EL [)EF'TH = =.'-' 0 FT. GRFIVEL ',,,'OLUME = .... ~t~ ]~: 0t_t. ' 'T [., ;, ."- TFtNK SIZE = :L., 000. 0 GFILLONS ('TktO COMPFtRTMENT TFINK) I CERT I F"r' THFIT' ' ................................................. : :.1... I RM FFtMILTFtR WITH THE REQUIREi'~ENr::,' ' - "'- FOR ON-SITE SEHERS FIN[:, ktEL. L':"; FIS SET FOF.:TH B"r' THE I"~UNIEIPFtLIT'.¢ OF F:INCHORFtGE FIND THE STRTE nF FILF~SKFI. =. I HILL INSTFILL THE ':';'¢S'I'EM IN FIC:L-:OF.'tE:,I:.".INCE HITH. THE C:ODES FIN[:, HFI'v'E F.'.'.E_.EI,,E[¢',' C' ' R F't]'" ' ~.Lr' OF THE 'CODE SUMi'IFIF:W laND DII'~GRFfM FITTRCHMENTS WHICH .IS PFIRT OF THIS FEI'.I~IT. 3:. I UI'-,~[:,ERSTRND THFfF THE ~ .... : ....... -,- JN .:,ITE _EHER S'¢STEM MFt'¢ REL..!UIF4'E ENLHF:.~EI'IENT IF THE F. ESIE,EN'E ..... IS F.:EMOE:,E]_E[:, TO INCLLIE:,E MOF..'.E THRN 3: EEDF..UUi'I_..:' ' - - F'ERMIT FIPPLICF~NT I".IFI% THE RESF'ONSIBILIT~' TO INFOF::M PERSONNEL DURING THE -.I.~,~_:-,TPILL. H]" ..... I~ d'.,t£ IN_,FE..,' - '= ' ..'-'~'IL, N;:,-, - OF ¢lN"r' HELLS ¢IC'JRCEhIT TO THIS 'F'ROPERT%" RN[:' THE NUMEER CF RE:'7, tE:'ENCES THI~T THE HELL I.,.IIbL. SERVE. IF R L..IFT STFrTION IS INST?fLLE£:,., FIN ELE_.TI.IuRL= 'P - - FEE:HIT.' ~" FIND INSPEF:TION IIUST DE EE~FIINE[:,. FI2;-F_ . ILYS CRNNOT DE RF'F'F:'-'¢ED_ HITHOUT FIN ELECTF.:ICFiL IN.=.FE_.TIUN'- ' P -..EFJF..T. THE ELECTRICRL HORK MUST E;E DONE 8'¢ FI LICENSED ELE_.TRI_.I~' 'P -' -N. F:; I GNED - :tPPL I CRN-r' - [ :SSI...IEB, E:'¢: tE:;KFtGGS CFH"ISTR ~.~M~UNICIPALIT¥ OF ANCHORAG£~ Departmenti" ~ Health and Environmenta' -Trotection 825 ~ Street, Anchorage, AK. ~9501 - '< - ' 264-4720 Permit # ~ /f O5 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT Applicant: ~~,.,~t ~ ,.~,.~__ ~ ~' Mailing Address: ,~ Location: ~O..~~. , Phone Nu~er ~ ~ Legal Description:~'C,~,~~~~~_. Lot Size: Type of Soil ~sorpt~tem Is: Trench: __ Drainfield: / Seepage Bed: Holding Tank: Maximum N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is:' EPTH ' ENGTH /O / GR VE EPTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance betwsen 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 = 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 p~blic well. Minimum distance from a private well to a private sewer line is 25 feet and to a com~aunity sewer line is 75 feet. Well logs are required ~nd must be returned to this department within 30 days Of the well completion. Dther'requirements may apply. Specifications and construction diagrams are ~vailable to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 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 residenc~ is remodeled to include more that 3 bedrooms. ApPliCant- ' Date: [ 0--~--~ SW?/024(1/81) ~ ~ ,VIUNICIPALITY 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: DA E PERFO D: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE 9 lO 11 12 13 14 - N~ SITE PLAN ,1. /7' ../. , . 16 17 18 - 19. 20 COMMENTS Reading H~.O / Gross Net Time Time -- /. -./~ /,~-/ ,~,~/ Depth to Water PERCOLATION RATE ~ ~' ~}~' (minutes/inch) TF.~T RUN BETWEEN ~'~ FT AND -~ FT Net Drop PERFORMED BY: //~.t/r)~F/~// j~) ~.~ . CERTIFIED BY: ALASKA e Ull OnlllellTAL COF1TROL SeRUICeS, January 13, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Robbie Robinson MUNICIPALITY OF ANCHORAGE DEPT. OF t'~ALTH ENVIRONMFNTAL PROTeCTIoN' Dear Robbie: On December 1, 1983 our. company inspected the sewer system located on Lot 18, Block 16, Northwoods Subdivision Phase IV. Ail the standpipes were above ground and capped. The well is located over 200' from the system. The lot is served by a Public well and is approved by Alaska Department of Environmental Protection. Sincerely, Approved by: Tod Sherman Structural Engineer 1200 LUest 33rJ Aoenue, Suite 13 · Anchoro§e, Alaska 99503 · (907) 276-1361 . '. ~'.; .~ APPRQ~.V_AL FOR A SINGLE FAMILYDWELLING ......... L ":SComp[ete I~al' description ' .... Lot 18,;:- Block 1'6T 'Na~. ~oo~ Sub~u~Zo~ ~4 .... '. 5. "': STATEMENT" iINEER, :,.~<,~ .~ As certified by ~y seal affixed hereto and as of the validation da~e sh0Wnb~low; Iverify that my,~- investigati0~' 8~ thiS' Heaith"~UthOrity ApP~ovai' application shows th~{the On-site water supply and/or wastewater~disposa!'system !s safe, functional and.adequa,te for the number of bedrooms and type of structure indicated herein. I further verify that based onthe information obtained from the Municipality of Anchorage files and from my inves_ti, gation and inspec,tion, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State, codes, ordinances, and r.egulat!Ons in, effect on the date of this inspection. ..... , :.., _ Name of Fi ..... rm 2:,$:& s ENGINEERING ~tu~ ~.aSi~ ~i~.r ~ ~.a.... -=-- . Th~'~unicipaliW 0f An&komge Depament of Health and Human Se~ c~r~'~'~S)i~uesHealth Authofi~; , : :Ap~val Ce~ifi~t~s"~bas~ o~lY upon the repr~en~tions given in pamgmph~5 above 'by an indePendent':':~' t: ,~' '" .:::'?'P¢sf~ional e~i'~r"~iste¢~ inthe State of Al~ka. The DHHS d~s'this as a c0~'~s~ i~ purCh~em of ho~:~ST~;~:~:-' '* and their lending institutions in orderto ~tis~ ~ain f~eml and state r~uimmen~. Employes of DHHS do not "~ .,_.conduct nsp~t ons ~r~.~nalyze data before a ce~ifi~te is i~u~, The Municipali~ of Anchorage is not ,:...:: ~ponslble for e~om:~::;:~.m~lons m the pm ~ o al eng~n~Fs o... r ,~: :.. :,:., '~ L ......... .... :: ':: - . .. _. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~[c)o,>5 Parcel I.D. Legal Description: ~-~T~ I~ T~_~t/~, /~ ~f--'F~ ~L_~ A. Well Data Well type /~ Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ Driller Total depth Cased to Casing height Sanitary seal (Y/N) Date of test Static water level Well flow ~ Wires properly protected (Y/N) FROM W~ .g.p.m. g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Z.-~. ~ ~ Absorption field on lot ~ ~ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform .~'~' Nitrate Dat~e ~ Collected by: ; On adjacent lots ; On adjacent lots Public sewer manhol~ Petroleum ~ Other bacteria B. SEPTIC/HOL-I~I TANK DATA Date Installed: .. ~ !~,~ ~.~c;:>-~: !~.7~Tank sIze l~c> c, Compartments Cleanouts~i" :' ~ ...... :: i?':,:. Foundation cleanout..~) V Depression (Y/.~. High water alarm'(Y~::) . '~' }}, Alarm tested (Y/N) ~ IA Date of pumping L, ~ !~j,,-q~" Pumper ~--~--, P~f,~L5 SEPARA~ ON plSTANcEs FROMi~SEPTIC/I-i~)L-t~N~ TANK TO: Well(s) on' On adjacent lots ~.~,~ t & Foundation To property line i ~ ~ ¥ Absorption field t ~ ~ Water main/service line Surface water/drainage \ ~ c> ~¥ 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) ~ s~TATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) Sudace water D. ABSORPTION FIELD DATA Date inStalled ~, ~ ~ '~ ~ Length ~'c>' .Width Total absorption area /?~o Date of adequacy test /~ ~ / Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ Soil rating (GPD/Ft~) 7...~ ~f'/.~ System type ~.~ ~ Gravel thickness o, 5" Total depth ~'"" Cleanout present (;~N) ~ Depression over field (Yl~i) Results ~fail) ~,~,~ ~ for ~ Bedrooms ~,.C" After test "?- ~- /,.~/~_ i~o,.~.~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: / Well on lot [,'* To building foundation On adjacent lots Surface water Curtain drain [o I On adjacent lots ~'~° o ' ~ Property line // To existing or abandoned system on lot Cutbank ~J ~/,~ water main/service line /-/- Driveway, parking/vehicle storage area &~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o_~e of this inspection. Signature Engineer's Name - Date H~ Fee Date of Paymem & ~-/~ ~5 Date of Paymem aecei¢ Numar 7'?~/ (YSq) Rece ~ Numar 72-026 (3/93)' Back 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 Parcel I.D. # ("~,\ -~lnLI --~ \ 1. GENERAL INFORMATION Complete legal description HAA# Lot 18; Block 16; Nort~oods Phase 4 Location (site address or directions) 21448 Snowflower Loop Property owner Mailing address Karen Robinson) ~=~ ~. ~"~-Day I~hone wk:564-5884 -h~: 688--~3 Lending agency Mailing address Agent CENTURY 21/COLONIAL Dave & L~s Bailey Address Business Blvd. Eagle River, Day phone Day phone 696-8600 Alaska 99577 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. ~ [ ~ ~NGINE£RING 17034 Eagle River Loop Road Name of Firm Address Engineer's signature bedrooms. Phone 6. DHHS SIGNATURE ~! _/~ Approved for ~ Disapproved. Conditional approval for 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 Description: A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE FNVIBC)NMENTAL SERVICES DIVISION 1992 IVE D SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ; 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~/N) High water alarm (Y/(~ Date of pumping Tank size ) ~,c~ c~ Compartments Foundation cleanout ~N) ~/ Depression (Y~) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line 1D Surface water/drainage On adjacent lots ~3 I~. Foundation Absorption field I'~ ' Water main/service line 72-026 Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer "Pump on" level at High water alarm level ~ested Meets MOA electrical codes (Y/~)-~ SE~ROM LIFT STATION TO: W~II on lot On adjacent lots Manhole/Access (Y/N) ~ Surface water D. ABSORPTION FIELD DATA Date installed ~\~ ~c,---f~ '~ Length ~'O ' Width Total absorption area Depression over field (Y~) Results~fail) Peroxide treatment (past 12 months)(Y~ Soil rating Gravel thickness Cleanouts present I~N) Date of adequacy test for If yes, give date System type ~d~-.p Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~ Surface water ~oo Curtain drain On adjacent lots ~'/A. Property line To existing or abandoned system on lot Cutbank ~"~ [,~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect S & S ENGINEERING Signatu re , . Eagle River, Alaska ~9577 Engineer s Name Date '~ ~"'~'~ HAA Fee $ _ //~'~ ~ Date of Payment ~,..3~., <~.jL~ Receipt Number ~o ~7 72-026 (Rev. 3/91) Back MOA 21 "ect oD the date of this inspection. Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 349-7755 July 14, 1992 Mr. Roger Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, AK 99577 SUBJECT: Public Water System ID# 213001 Dear Mr. Shafer: A review of the records on file in this office indicates that the Chugiak Utilities Class "A" Public Water System serving Northwood Subdivision is currently in compliance with the routine coliform bacteria sampling requirements listed in Table C and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Project Engineer ML/pf MUNICIPALITY OF ANCHORAGE Department of Health & Human ServJces DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submitta ) (a) Legal Descri pt)on (include Iot~ block,subdivision, sect on, township, range) Northwoods #4 Lot 18 Blk 16 T15N R1W Sec. 3 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Location (address or directions) NHN Snowf lower (b) Property owner Terry Walker Telephone : (home) 688-9737Business Mailing Address "HC :Box i'~-13 Chugiak, AK 99567 (c) Lending Institution Mailing Address 11421 Old (d) Real Estate Company and Agent Address Northland Morga~e Glenn Hwy. Telephone 694-7872 Eagle River, AK 99577 N/A Telephone (e) Mail the HAA to the following address: Ior check here ~, if hold for pick up.) List contact person and day phone number below: enqineer 2. TYPE OF RESIDENCE Single-Family [~ Number of bedrooms 3 3, WATER SUPPLY Individual Well [] Community E;~ Public [] Note:,!f corem,unity well system,: must have.wr ~tten confirmat on from the Staie Department of Environmental 4. SEWAGE DISPOSAL .... ~ NoI~;,!~ ~ommd'.i.?'~v~ll system; must' l~e':written confirmation from the stateDepartment;"""" ....... of Env ronmenta, Conservation attesting to the legailty a~d.statbs.- ......... .... ~'-'" 72-4)25 fRev. 7/88) Page 1 of 2- ,- 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION · va dation date shown below, verif{/*{h~t my investigation of this Ascertfedb my seal affixed neret° and aS°fthe .... _. · · ~": s sa s stem.is safe Y ...... , - water su~PPolfY and/or wastewate.r,, d, p~ Y . Health Authority Approval .shows th. at th.e,_._o~n__si_te~ ~..~ functional.and adequate for the number of oeu[uu,,,o ,~,,,~ ,z~,, structure indicate;:l h&r~in!~t~further verify that based on the information-obtained from the Municipality of Anchorage files and from my inyestigation and inspection, the on-site water supply and/or wastewater disposal system is in complian~ With all Municipal and State codes, ordinances, and regulations in' effect on the aate of this inspection. "!. '::" 694 -5195 Name of Firm E~gl~ ]~v~=r ET~g'i n~=~'~O Telephone P.O. Box 7732-94 Eagle River, AK 99577 ~ Address Date '~/~'¢2 6. DHHSAPPROVAL ~ ' , - /~ x3 ~ Appr.°.,ve.~I(~rj ~.~/~/ :drO0msby APproved ~ ' -~: u~sapproved . Cond~bonal Terms of Conditional Approval 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 cert ficate is ssued. The Municipality of Anchorage is not responsible for errors or omissions in the professional eng'neer s work. 72-025 (Rev, 7/88)B~ck Page 2 of 2 ¸%: I ,; j MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) MU NlCl PAt~I~LCII'~ -AC~E I~ R U A R Y 1984 VI.ONMENTAL SE,ViCES ~]~4 ~UG2~ ]g~ Legal Description: WE,, DATA R E C E iV E D Well Classification ~r'>~-~xv~c~i ~tJ ~IOS5 Well Log Present (Y/N) __ Date Completed lotal Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Depth of Grouting If A. B. C, D.E.C. Approved (Y/N) __ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Pum ping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPTIC/HOLDING TANK DATA Date Installed ,/,~,~'~ Size *"'~"~_~',~/"No. of Compartments '-~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) /~' Foundation Cleanout (Y/N) Depression over Tank (Y/N) /,,/ Date Last Pumped /~L/'~,P /v'/.,i. ; for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~,-)~ w To Building Foundati0n:_/~-2 "~/~ / To Disposal Field ':' To Property Line To Water Main/Service Line Y To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~o" .~ Width of Field "'2- ~ ~' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~-~'~'~'~'~'~'~'~'~'~ ' To Building Foundation /'¢" L o t To Water Main/Service Line "~ To Stream, Pond, Lake, or Major Drainage Course /~'/"~' To Driveway, .~.rking Area, or Vehicle Storage Area Comments /~-~'~ ~ ~"~; ~ z~,,,,~ ~-~ / To Property Line To Existing or Abandoned System on ; On Adjoining Lots /- '~" To Cutback (if present) D. LIFT STATION //M//~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guideline,s.;,i.n;;effect,ta,~ the date of this inspection. Signed Eagle River Engineering Se~ices Company P. 0. ~0x/73294 ~ ~o~ ......... ~,',' E~gm~er s Seal Eagle River, AK 99577 Date ~ ~ ~ 0 6~5195 MOA No. , .... ~ ~ · ...... Receipt No. ~/ ~ Receipt No. Date of Payment ~ L/-- ~ Waiver Fee: $ Amount: $ ~ /~- ~ Date of Payment ~-0~ (.ay. ~/..) B.c~ Page 2 of 2 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 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Northwoods #4 Lot 18 Block 16 T15N, R1W, Sec.3 Location (address or directions) NHN Snowflower Peters Creek (b) Property owner H.U.D. /Joe Bell Mailing Address 605 W. 4th Ave. (c) Lending Institution Mailing Address Telephone: (home) Business271-2792 Suite 086 Anchorage, AK 99501 Telephone (d) Real Estate Company and Agent The Realty Store Address 8040 Opal Circle Anchorage: AK 99502 279-1895 Telephone (e) Mail the HAA to the following address: (or check here i-I, if hold for pick up.) List contact person and day phone number below: P'Jck-~]? by Rng~n~ 2. TYPE OF RESIDENCE Single-Family I~ Number of.bedrooms 3 3. WATER SUPPLY Individual Well E~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 41 SEWAGE DISPOSAL On-site I~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72.025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ~' .... As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 FirmEaqle River Enqineerinq ServiT~9~phone 694-5195 Address P.O.B. 773294 Eagle River. Alaska 99577 Date 6. DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional 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 A. WELL DATA Well Classification ~'/~- MUNICIPALITY OF ANCHORAGE (MOA) Health Authority ApprOval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ~'/" If A, B, C, D.E.C. Approved (Y/N) ~ Well Log Present (Y/N) __ Total Depth__ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Date Completed YielC Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Clean out/Manhole ; Date SEPTIC/HOLDING TANK DATA Date Installed /~) '~ -~ Size Standpipes (Y/N) ~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Air-tight Caps (Y/N) No. of Compartments Y Foundation Cleanout (Y/N) Date Last Pumped ~¢. 17~'~' ; for ~.~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supp y We I 'Y'.~ ! To Property Line ~/e ~' To Water Main/Service Line ~'/~ ~' To Stream, Pond, Lake or Major Drainage Course To Building Foundatio TO Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed /~/~ ~ Width of Field ~ ~ / Type of System Design Length of Field Depth of Field /-/, Square Feet of Absortion Area Gravel Bed Thickness ~ '/ J~.~ ./Z~ ~ Statndpipes Present (Y/N) Depression over Field (Y/N) /1/ Date of Last Adequacy Test Results of Last Adequacy Test -~"~Y"~'f'~f"~.~ ,~Z.~,-,,.-&.-~,~ ~:~.,/~ ,'~,~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~','~ ~ To Property Line '~/'~ / To Building Foundation ~ / To Existing or Abandoned System on Lot ~1//~ ; On Adjoining Lots ~' ~g / To Water Main/Service Line ~o ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area '/'/~ / D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA gu deHn. es~ i~ effect on the date of this ~. Signed~'"'~'-'""'~ ~ '~'~'--- ¢' '" ..... "": '"'' '~ r..c,~,:' ....., ', ':, ':';~ngineer's Seal Eagle Rivcr Engineering Services Company P.o. Box 773294 ,,~/~c,/~, Eagle River, AK 99577 Date / MOA No. Receipt No, (/~ -~ '~.¢~) ~)V / Date of Payment Amount: $ 72-026 (Rev. 7/88) Back t-? o.o(') Waiver Fee: $ Date of Payment Page 2 of 2 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 Des. cription (include lot, block, subdivision, section, township, range) Location_s(address or directions) -- T~ ~ ~ ~ ~-- Applicant Name ~' ~~ Telephone: Home ~-~ ~ Business Applicant Address ~¢~ ~ ¢~~ ~. ~ Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer~; Other ~ (explain); (d) Lending Institution ~":~//~ 2~--~-' ,,~_¢~.~____--z:;t_~,4..~ Telephone Address (e) Real Estate Company and Agent Address ~~ - Telephone ~ ~ 9¢- (f) Mail the HAA to the following address: TYPE OF RESlDE. NCE Single-Family [~ Multi-Family i-i/. Other Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public ~' Note: If community well system, must have written confirmation from the State Department o! Environmenta Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] ,, \ Note: If cdmmunity welt system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (H/84) ENGINEERING FIRM PROVIDli' ~NSPECTIONS, TESTS, FILE SEARCH, D~, ~ 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 syst. em is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firrr~ & S ENGINEERING Telephone (~" ~'~'~'~,~? Address SR B 1~6X Date EAGLE RIVER, AK 99577 DHEP APPROVAL Approved for -.~' bedrooms by Approved /~..~ Disapproved Terms of Conditional Approval Conditional CAUTION The'Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority App.[oval 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 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 P84-4720 Legal Descrilation' L"'"I" 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: To Septic/I-~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer' Line Cleanout/Manhole Water Sample Collectec by Water Sample Test Results Comments A If A, B. C, D.E.C. Approvea~N) Date Corn pleted ~ / Yield Cased to De~.~ o/f ~routing -- / ~mp Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots '~¢rp ~A' : On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot : Date B. SEPTIC~ TANK DATA To Property Line To Water Main/Service Line Course Date Installed l~'~'~'¢'~ StandpipeS) Air-tight Capsd~)N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic~ank: To Water-Supply Well '~.-~;~C~ Lo ~ Size ! ~ No. of Compartments Foundation Cleanout(~N) /ID[~te Last Pumped ; for Temporary Holding 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) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ' Width of Field ~ Square Feet of AbsorptiOn Area Depre. s~sion over Field (Y/~ ~"'"~;Ults of Last Adequacy Test "'$eparationDJstance fr6m Absorption Field: To Water-Supply Well To Building Foundation Lot t'~ To Water Main/Service Line I,~ ~,~' To Stream/Pond/Lake/or M~or Drainage Course To Driveway., parking Area~ .~r Vehicle Storage Area Comments 'I~Z) Type of System Design Length of Field Depth of Field ~ Gravel Bed Thickness Standpipes Present~N) Date of Last Adequacy Test To Property Line ! ~'~ To Existing or Abandoned System on ; On Adjoining Lots To C~tbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions ,. ~lanhole/Access (Y/N) iik~ / "Pump Off" Level at [//'.~ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certifyIhatJ, h.&v¢_cb.e_c_k e d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. , b& 5 ENGINEERING Date II IM I IOQ~, Signed~ ~ igOX ~""' ' ' .... MOA No. ,?J~-~-4:~-o .~ Receipt No. % ~3 (oq?~ ~ Date of Payment (',o ~ '~-¢~'~'~ (~ Amount: $ (~ ~ ~'~ Page 2 of 2 72~026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA q950t Bill Telel~hone: (9OX) Add,'e~; 274-2533 DATE: May 16, ,~986 PWS I.D.# 213001 To Whom it May Concern: According to records on file in this office the NORTHWOODS Water System is in compliance with the State Drinking Water Regulations Sincerely, Distri~ Engineer 1. General (a) Legal D~sc~ipt. ion (include. lot, block, subdivision, section, township, range) Location (add~ess o~ directions) (b) Applicants Name S7~L/~ _~"~"~..~ Telephone Applicants Ad.ess (c) Applicant is (che~ o~) ~nding ~n~titutioo ~; ~r~uil~r~; (d) ~nding Institution ~lepho~ Ad. ess (e) Real Estate Co. & Agent Add~ess Te le phone 2~' _Type. of Residence Single-Family ~-~ Number of Bedrooms 3. ,Water Supply Individual Well ~ Multi-Family~ 3 Other (describe) Public ~-~ Note: If cc~munity ~11 system, must have w~itten confirmation f~cm the State Department of Environmsntal Conservation attesting to the legality and status. Is the ~11 adequate for the number of bed~ccms s~ecified in this HAA ,~j~). 4. Sewage Disposal Onsite~ Public~ Cc~m~unity~ HoldingTaak~ Is the wastewate~ disposal system adequate for the number of [Page 1 of 2] 2-15-84 5. Engineering Fibrin Providing Inspections~ Tests, Data and Information I c~rtify that I have checked, verified, c~ conformed to all MOA HAA Guidelines ir effect on the date of this inspection. Signed b~ Date 6. DHEP A~_ proval ( ENGINEER SEAL) Approved for___ ~ bedrooms Approved ~ Disapp~o~d ~-~ Terms of Conditional Approval The Municipality of Anchorage Department of ~a!th and Envi]:onmental P~otection dc not guarantee the continued satisfactory perfo~manoe of t?~ water supply and/'~ t~ wastewater disposal system. This approval indicates that, as ~f the. ~lidation da shown alcove, based on the data and info~mation furnished by an engineer registeree the State of Alaska, the water supply and wastewater disposal system is safe and f tional fo~ the numbe~ of bedrocms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] A® Well Classif icat io~F)fF/~ Log P~esent (Y/N) Well Total Depth ~t)//~-- Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit ~(Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot ~- To Ne'arest 'Edge of Absorption Field on Lot To Nearest Public Sewer Line C leancut/Manhole Water Sample Collected By Water Sample Test Results C~Eents MUNICIPALITY OF. ANCHORAGE (MOA) If A, B, c~ C, DoE.C. Approve~/N) Date Completed ~J~-- Yield AJ/~_ Depth of G~outing.... #'//~ Pump Set At Sanitary Seal on Casing (Y/N)/~/~ Depression Around Wellhead (Y/N)/T/~ ; On Adjoining Lots '%///4- ; On Adjoining Lots F~///~ To Nearest Public Sewer ' ~/F~ TO Nearest Sewer Service Line on Lot M~;~ pet. "' B. SEPTIC/HOLDING TANK DATA Date Installed ~/~.~ Size /69~6D No. of Compartments Standpi~s ~) Air-tight Caps ~) F~n~tion Clean~t ~pression o~ Ta~ (Y~ ~te ~st P~d P~ing~inte~n~ ~n~act ~ File (Y~) ~; for Holding Ta~ High-Water ~a~ (Y~) ~/~ ~y Holdi~ Tank ~t (Y~) ~paration Distan~s ~ ~ptic~olding Ta~: To Water-Supply We 11 4/ To P=operty Line > / O ! To Water Main/Service Line ~O ! course To Building Foundation To Disposal Field / To Stream, Pond, Lake, c~ Major Drainage C. ABSORPTION FIELD E~TA Soils Rating in Absorption Staata Date Installed Width of Field ~' Square Feet of Absorption A~ea /~OO ~ Type of System Design Length of Field .--'~ O'-O' Depth of Field ~ ~' Grail ~d ~ick~ss ~ ~' Stan~i~s ~esent ~) To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Depression over Field (Y~ Date of Last Adsquacy Test Results of Last Adequacy Test Separation Distance frcm Absorption Field: ~/~ To P~operty Line /~ ~ ~ O t To Existin~ or Abandoned System ; On Adjoinin~ Lots ~ ! To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course ~)~/~ To D~iveway, Pa~kirg A~ea, or Vehicle St,c~a~_ %em ! LIFT STATION Date Installed Size in Gallons "P~ On" Level at HiGh Water Alarm Level at Tested for ~- Electn:ical Codes(Y/N).. Di. neions Manhole/access (Y/N) K///~ "Pump Off" Level at /L)~ Vent (Y/N) M./~ Pumping Cycles du~ing Adequacy Test. M~ets MOA ** Check Permitted Bed~ocm Rating ~gainst HAA Request I oertify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed KB1/d5/s [Page 2 of 2]