HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 22No th Wood
Unit 4
Block ! 6
Lot 22
#051-064-60
Municipality of Anchorage
Development Services Department
Building Safety Division ~
On-Site Water and Wastewater Program, 4700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page ,/of
www. ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:~v4./(~) ~'~/~'/' PID Number: (2' ~'/- O~'q--
Name:"/L~5~( -"~-'/~f~'~4 ~~ WastewaterSystem: ~ New ~pgrade
Address:
~l~ ~~~o~ ~P ABSORPTION FIELD
*h°*~gZ'?O~ O Number of Bedrooms:
~ ~ Deep Trench ~hallowTrench ~ Bed ~ Mound ~ Other:
Soil Rating: Total Depth from original grade:~ Ft.
LEGAL DESCRIPTION O, ~ GPD/Ft2
Block: Lot: ~ Subdivision:~ Depth to pipe bottom from original grade: Gravel depth beneath pipe:
Township: Range: Section: Fill added above original grade: ~ Gravel Length:
/
Number of lines: Distance belden lines:
Well:~ ~¢ ~New ~ Upgrade Gravel width: ~ ~ Ft. / -- Ft.
Classification(Private, A,B,C):~ TotalDepth:Ft. ~ Ft. Totalabsorptionarea: ~ ¢Ft2 PipeMatefial:~v~
Driller: ~ Date Drilled: ~ Static Water Level: installer: Date~ ~
Pump Set at: ~ Casing Height Above Ground:
Yield: ~ GPM t. Ft. TANK
SEPARATION DISTANCES ~Septic D Holding ~ S.T.E.P. D Other:
T~ Septic Absorpt,o~ Lift Holding 'ubliCPrivate Manufaoturen ~~ Capacity:
Tank Field Station Tank Sewer Line M~¢' : ¢ E0~/e¢ /Z ~0 GaL
Number of Compadments:
Sudaoe Water /00 $ /~0~ -- ~ ~ / LIFT STATION
Lot Line /O % / O ~ -- -- G . ~nufacturer:
"Pump on" level "Pump o~' level at: er alarm at:
Foundation /¢% /¢ ~ -- __ '
Cu~ainDrain -- -- / / "umpMak~°de/I ~' Eleotri~l Inspecfions~edby;
~ ~ ~ ~ Lo.rich and Des~ption:
h ~/~
Assu~ed Elevation:
/ CO
Inspections performed by: X~ ~ ~ - Dates: 1't ''r,'- O~ ,(
Development Se~ices Depa~ment Approval ~* ~49~ ~
Conditional Approval Date: *~ '~
R~vi~ed~nd~p~r~wdby: . ~e: ~'1 ~-/a
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RECORD NOTES:
1. Totol Depth of Trench is 5'.
Septic Site is Under 5% Slope.
2. Sewer Service Line minimum 2% slope.
5. Old Septic Tonk Abandoned.
4. Lots Served by Public W~ter System.
.5. New Trench Is 10' Minimum From Old Bed.
6. TH2 & TH5 Are Shallow Perk Holes.
RECDRD DWG MEASUREMENTS
A
ST CD1 28,5
STCD2 35,2
9CD 41
BuLL Run VaLve 41,5
CD1 72
CD/MT 118
B
88,8
34
38,5
39
64
130
Slight Slo?
~5 %
/
C.D,/MT Y
Run Volve
OTH1 )ouble C.O.'s
4ew 1250 Gollon Septic Tonk
-TH8
3 Bedroo
;light Slope
//
Old Beds~
St~ht Slope
o /
0
Septic Site
0
Snow£[ower
NDRTHWBDDS fi4 i l' = 50'
BLOCK 16 LOT 28 RECORD
NEW TRENCH/TANK ..DRAWING
SEPTIC SYSTEM i 8/6/09
to enter ~ m~d-poim
EERING
SBILS LBG PBRCBLAT!rIN TEST
DaCe Perqormed; 7/29/09
Perqormeol For~ Don In9rahem
Le9eL Description~ Northwoools 84, BLock 16, Lo% 22
DEPTH
(FEET)
..'.....'.../ :.: T ¥ ::':.,
5 -
6 -
7 -
8 -
9
lO -
12 -
13 -
15 -
16 -
~7
~8 -
~9 -
20 -
2~ -
Comments~ Presoaked
Or9enic
GM
SiLty Senol
w/ Gravel
T,H, Locetion~ See Attecheol Desi9n
F[e~ Terrain
Groundwater? No
Depth
Water Depth
ACteP Monitoring, Date:
De~e Gmoss Time Ne~ Time DePth Ne~ Drop
7/29 0 -- 4"
7/29 10 10 mir 55", 15",
7/29 12 --
7/29 22 10 mir 5,5" t,5~
7/29 35 10 mir 5,5~ j 1,5"
7/29 47 ~0 mir 5,5" J i,5"
7/29 50 -- 4"
7/29
Percolation Rate 7 min,/inch Penc Ho~e Diameter 6~
Test Run Between 3' and 4'
Penqonmeot By Nor±bRim En9 I ~ CERTIFY THAT THIS TEST WAS
Per~ormeol in Accorolance with AiL Stele/MunicipaL GuioleLines in E~Cect
ON THIS DATE, DATE~ 7/29/09
~~ ...~ TESTHBLE LBG
PO Box 770724 ~
~,~.~.~o~ ~ GEOTE CHNI CAL
Ez~!NEERING
SBILS LBG - PERCBLATIBN TEST
Date PerFormed~ 7/29/09
Performed For: Don Ingraham
Legal Description~ Northwoods 84, SEock 16, Lot 22
DEPTH
(FEET)
1 -- "
2 - :::}t.]~'i."~" :..
3 - '..~ ':. :,,:':.~':: :"
5 -
6
7 -
8 -
9 -
~0 -
12 -
:13 -
:15 -
:16 -
:17 -
:18 -
:19 -
20 -
Commen~s~ Pmesoclked
Organic
GM
SiEty Sand
w/ Gravel
T,H, Location: See Aetached Desi9n
FEat Ternain
Omoundwotem? No
Depth
Watec Depth
AC~eP Monitoring,
~ Dc~e Gross Time Net Time Depth Ne~ Drop
1 7/29 0 -- 5' --
2 7/29 10 10 mir ,
65" 1,5"
3 7/29 12 -- 5. __
4 7/29 22 10 mir 6,5" 1,5"
5 7/29 25 -- 5# --
6 7/29 35 10 mir 6,5" 1,5#
7 7/29 37 -- 5- __
8 7/29 47 10 mir 6,5" 1,5"
9 7/29 50 -- 5. __
10 7/29 60 10 mir 6,5" 1,5"
PercoLation Rate 7 min,/inch Parc Hote Diameter
Test Run Between 4' and 5'
Performed SyNor-'t;hRim En9, I ~ CERTIFY THAT THIS TEST WAS
Per~'ormed in Accordance with ALL State/MunicipaL Guidelines in E~ect
ON THIS DATE, DATE~ 7/29/09
N OR THRIM
Eh,l ®I N EEIE / N
907. 6~4. 7028
T, H, 3
7/29/09
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 22, 2009
Expiration Date: Jul 22, 2010
Permit Number: SW090121
Legal Description: NORTH WOODS UNIT 4 BLK 16 LT 22
Design Engineer: 0838 NORTH RIM ENGINEERING
Owner Name: DON INGRAHAM
Owner Address: 21524 SNOWFLOWER LOOP
CHUGIAK, AK 99567-0000
Parcel ID: 051-064-60
Site Address: 021524 SNOWFLOWER LP
Lot Size: 28685 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15,65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE ENTIRE SUBSURFACE DISPOSAL FIELD AND ALTERNATE IS NOT WITHIN A 30 FOOT RADIUS OF A
PERCOLATION TEST. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO THE
CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE
AS-BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE
SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL.
Received By:. ~ ,,-~-~
Issued By: , _~. ~ (~C'~?/~'~r~'~--- /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99507
www. muni.org/onsite
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Property owner(s) bO// ~'"~¢, ~ V'~; '1~:~.~.
Mailing address
Site address
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size ,~ 0~"'oE S .Sq. Ft.
Day phone 5'~'..~-
Zip Code ~'~,.5'(7
Zip Code
Number of Bedrooms -.~
THIS APPLICATION IS FOR (~;~] all that apply):
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial
Upgrade
[] Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(~ro pe~'~o~ ergo rized age nt)'~) ~''
Permit/Rush Fees:
Date of Payment:
Receipt Number.
(Rev. 11/05)
oqq- gC
Waiver Fees:
Date of Payment:
Receipt Number:
NodhRim Engineering
PO Box 770724
Eagle River, AK 99577
907-694-7028
July 8, 2009
MOA On-Site Water & Wastewater Program
4700 Bragaw St
Anchorage, AK 99519
RE: Northwoods//4, Block 16, Lot 22
Failed Absorption Bed
The referenced property has a flooded absorption bed. The design calls for a new trench
and new septic tank & private sewer lines. Public water serves the area lots so no water
well conflicts are present.
Please review the waste~vater system design for the single family home. I have included
design plans & specs, design guidelines, & soil tests. If there is need for additional
information or clarification please give me a call.
Sincerely,
Steve Eng, PE,
Design Enclosures
Northwoods #4, Block 16, Lot 22
SPECIFICATIONS & DESIGN GIIIDEI,INES
Wastewater System Sizing: This is an existing 3-bedroom, single family home. The
absorption bed has failed. A new design is submitted for a new trench & new septic tank.
The owner desires a larger tank than required. The neighboring lots are developed as
indicated in the drawing. New soil tests were conducted. A 5' deep trench will be
excavated with new 1250 gallon septic tank. The old tank will be removed or properly
abandoned in place. Public water serves the area lots. No adverse impacts are expected
from septic system replacement. No conflicts to the other lots will take place by this
septic system construction. The easements are located on the drawing and are not
encroached upon. The soil tests revealed similar soil. A conventional septic system will
be used, application rate of 0.8 GPD/FT2. Trench Length = 750 FT=/5'x 0.58 reduction
factor = 66'; I line (~ 66', 3' effective depth.
Specification Requirements: All components and work must comply with the Municipality
of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and
Wastewater Regulations.
· Two compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.
· 5' minimum between the tank and bed. 10' to property lines.
· 3' of cover is required for trench; I" insulation for one foot soil cover may be used.
· Tank & solid pipe must be set on well compacted, stable soil.
· 4 inch diameter cleanouts with airtight caps are required I' to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from the
tank positioned to provide cleanout access towards the tank and towards the absorption field.
· All cleanouts must extend to at least ground level.
· In solid pipe runs, ASTM D-3034 may be used in lieu ofcast iron.
· Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock.
· Drain rock to be ~ inch to 2 ½ inch screened. Drain rock to be distributed uniformly
throughout the trench.
· Perforated pipe to be installed level with perforations down.
· Silt barrier (filter fabric) to be installed above the drain rock.
· Smeared trench sides must be raked or scarified before drain rock placement.
· The finish grade must be mounded to promote drainage over the trench.
· Insulation must be placed over any pipe installed under driveways or parking areas.
· Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS
ASTM D266 I,
· Sewer Service Line is minimum 2% slope.
· Septic Tank to be pumped every two years or when required.
· Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI or equal)
· Old Septic Tank to be removed or pumped, filled with sand/gravel, crushed, & buried.
DESIGN NOTES:
1. Totol Depth of Trench is 5'.
Septic Site is Under 5% Slope.
2. Sewer Service Line minimum 2% slope,
5. Abondon/Decommission Old Septic Tonk
4. Lots Served by Public Woter S~stem,
O ~Sl~ght Slope r
~5 ~
O~H!
C. 0.'$
ew 1250 Collon Septic Tonk
'ight Slope
3
Septic Site
o
Snow towe
NORTHRIM ~'~ NBRTH~,/BFI])S ~4 r= so'
ENGINEERING,.,...J~~ ......... ]3LBCK 16 LBT 88 V/ASTE~/ATER
,,o ~,o,, ,,o,,, --~:~.,~.~.:,~ LAYOUT
· ~. ~,-,. A,o.*o ~95,, . NEW TRENCH ~a.: ~r 3
907. e9,~. 7028 SEPTIC SYSTEM 7/81/09
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F~I~.~N EERING
SDILS
LOG - PERCDLATIBN TEST
Date PerFormed: 6/89/09
Per?armed For: Don Ingraham
Legal Description: Northwoods f~4, BLock 16, Lot 88
DEPTH
(FEET)
17
20-
COMMents:
T,H. Location:
Organic FLat Terrain
GM
S[tty Grave~
See Attached Design
Presoaked
Groundwater? No
Depth
Water Depth
AFter Monitoring. None Date: 7/7/09
IDa~e Gross Time Ne~ TIMe Dep%h Ne~ Drop
6/89 0 -- 4- __
6/29 10 10 Mir 5.25' 1.25'
6/89 18 -- 4, -_
6/29 22 10 Mir 5.25° 1.25'
6/29 25 -- 4, __
6/29 35 10 Mir 5.25' 1.25'
PercoLation Rate 8 Min./inch Perc HoLe Biameter 6'
Test Run Between l' and 8'
F
DE:
PerForMed By j~ic~:~J2~.~.~g, I -~~ CERTIFY THAT THIS TEST WAS
PerFormed in Accordance with AIL State/Municipat GuideUnes in EFFect
ON THIS BATE, BATE, 7/7/09
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Na~{, ~) ~pgrade
~ ~ Wastewater System: D New
Address:
~t~ ~ ~~~ ~ ~7 ABSORPTION FIELD
Phone: ~.ofB~ooms: ~DeepTrench ~ShallowTre~ch~ed ~Mound ~Other
LEGAL DESCRIPTION So~.~.n~: ~.~GPD/Sq. Ft. Total Depth from ori~al~rade:
Lot: ~~ BI~ [~' ---1-- lit ~~°~S Depth ,o pipe bottom from original~.~ Ft.gra~ Gravel depth beneath pipe
Ft.
Fill added above original grade: I. G~th~l~
WELL: ~ New D Upgrade Grave,~ ~/~ NumberCines: Distance between lines:
Classification (Private. A B.C)~ Total Depth: Cased To: Total absorption area: Pipe ~aterial: ~
Driller: Date Drilled: StaticWaterLeveh Installer: Dateins~fled'
Yield: GPM ~ Pump Set at: Ft. ~ Casing Height Above Ground:Ft. TANK
SEPARATION DISTANCES ~s~.ti~ ~ Holding ~ S.T.E.P.
To Septic Ab,or,tion L,, Holding Public/PrivatE~Ma~fa~tu~r: ~~(--
From Tank Field Station Tank Sewer Lines ~ ~
Well ~ ~ ~ ~ ~,~ Ma~~ ,umberof~mpartments:
Surface LIFT STATION
Lot Size in ga~
Foundatio~ t~I ~l ~ ~ ~ "Pump on" level at: "Pump off" level~rm at:
Curtain ~ I
Drain ~,~ ~} I Pump Make & Model Electrical Inspections pedormed by:
Remarks: BENCH MARK
Lo~n and Description:
I Assumed Elevation:
Inspections
r[ r~(& s ENGINEERING
Department of Health and Human Services approval ~, ~:',,~:: ~,,
72-013 (1/91)MOA25
Permit No.
Page ~'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
of ~'
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Descripiion: I,,OT'~P- ~ 1~ I,-JOF-,T'PII..Jo0]~5 ~
PID No.: ~-"fO~,4~
72-013 A (2/91) MOA 25
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW910116
DESIGN ENGINEER:S ~ S ENGINEERS
OWNER NAME:RILEY DAVID P & PEGGY J
OWNER ADDRESS:21524 SNOWFLOWER LOOP
CHUGIAK, AK. 99567
DATE ISSUED: 5/24/91
EXPIRATION DATE: 5/24/92
PARCEL ID:05106460
LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 16 LT
22
LOT SIZE: 28685 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
May 16, 1991
ROBERTSHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907)694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESrGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
Mu~cipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 22; Block 16; North Wood~ IV
PERMIT REQUEST NARRATIVE
The existing seepage bed is currently in a state of failure for two
reasons. There is a small point on the lower end of the system where
s~wage will periodically surface, and while performing soils testing
for the upgrade we found the existing system to be encroaching
groundwater.
The proposed absorption bed is to be shallower and consist of over 1200
sq. ft. of absorption area as opposed to the existing 720 sq. ft. of
absorption area.
This and all surrounding properties are served by the North Woods water
system with the supply w~ll over 200 ft. from this property.
We anticipate no adverse effects
install~ of the proposed system.
/gm
on n~ighboring properties
by the
ON S}TE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
1" = 60'
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ~---------'~--~'~------' ~------~:~t"~"~-"~"~" DATE
LEGAL DESCRIPTION: [~"7~"Z-- [~::~ I (¢~:~"'J ~..-~...~ Township, Range, Section:"~lSLOPE ~SSlT~E PtLA~NN
5
6
7
8
9,
10-
11
12
13-
14
15
16
17
18
19
2O
1
2
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~¢ OL
DEPTH? p
Depth to Water Alter .../~
Monitoring? /
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE '~"-- / (minutes/inch) PERC HOLE DIAMETER
COMMENTS
: ' ' " --5"~' ' ' ~f / /¢ "'¢~// CERTIFY THAT THIS TEST WAS PERFORMED IN
Eagle River, Alasi(a Y¥~.. ~'~E~
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN T ON THIS DATE. DATE:
72-008 (Rev. 4/85)
I,i I
~'~ MUNICIPALITY OF ANCHORAGE '~-~
O, , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska ,~9501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE
,.-~'~"~'~'~"_.~ ~_~',~ '~.~C~ ~ ~ ~ ~ :~I ~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well I Absorption area Dwellin~ PERMIT NO,
DISTANCE TO: COZ~U~i T ~I /~ /
Material No. of compartme~
~ Z Manufacturer ~C/~O~'' ~ .
~ Liq. capacity in gallons
/ ~ O~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ Manufacturer ~ ~ j ~ ~ ~ Material Liquid capacity in gallons
Q Well Foundation j Nearest lot line P~RMIT NO.
No. of lines ~ Length of each line Total length of lines Trench width Distance between lines 6
3~ / JO ~ / ~ j ~ inches
~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth TotaJ effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer Jine Septic tank Absorption area(s)
PIPE MATERIALS P,V,c~OTHER,
INSTALLER / ¢0 ~.~ ~,'~
/ II
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
MUNICIPALITy OF ANCHORAGE
MUNICIPALITY OF ANCHORAG~EPT. OF HEALTH &
DEPARTMENT OF HEALTH AND ENVI RONMEN~(~E~rI~TECTI(~
825 L, Street, Anchorage, Alaska 99501 264~,720
SOILS LOG - PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18-
19-
20-
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
_ ECEIVED
COMMENTS
SO,:
PERCOLATION
TEST
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? //~D SL
o
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
+H~o t ;~ ~ ~. i ~
PERCOLATION RATE ~, ~ (minutes/inch)
TE~T R~?N BETWEEN ~ FT AND "~'~"-FT
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY:
D, EF'F/RTMEI'4T OF HEFiLTH FIND EN, I B. tql h:,',lTh L F'~'EtTE' [:T I 1[ N
. ,:,..:._ '"L'" STREE'r., I:INCHORFIt~iE., FIK
~:,4--4,~k~ : IINUIIU .ll,.aE :,:~ =1=.~ : ERGLE RI'v'ER
F'ERM ZT N-
RPF'L I CFINT: S[:::I:1131]):5 C:ON:STR PHC NE '
RE:,DRESS: PO E:OX
L. HUb IFII<., i-II:::...-' -l=._ ~;, ,"-'~
,_E ~ML [.E.=,L.,.~.I,' ~ ~L,,~ %UDE:,I',/I%ION: NORTHklOO[:'2:~4 BLOCK: ;-ZZ LOT:
L .,T SIZE E~ :5~;~. FT. 'TOi,.tNS;HIF': RHNbE: .... =,EL. TI JN: ....
llH~',II1Jfl NUME;ER OF DE[.,ROC¢IE; 3. SOIL RETTING i59 i._,:: :L59 ,:~2 FT. ,. E,R..
LZ%TEE:, ~,EL. CW FIRE THE ]F'TZONS Ft',,.'F:IZLFIDLE: TO '¢OU ZN D, ESZGNZNG 'T'OUR
: ~:TEM. CHOOSE THE,.r~.~."]'-'~P*~_,,,, THFIT ~,E:,F FITS '¢P~LIR_ SITE
[4ZDTI. t = 2.._, '~ FT.
L~N;~q I.--1 = -: ..... - .... -- .,:c
,::,~J. El FT. .I['~ClTE ~ ..,~ .. FT. REbilJZRE_, ~.._ TRENCHES
TCTI',L ~E. F F,'i = L,. E~FT. . NOTE ~ R'EE~_ZF'.EE ZN'SJLFITZ3N
ur,..t~,=~. C'EF'TIi = 2:. C~FT. ~ NOTE .... MFI"? RE'}LZRE LIFT _,T TZ.JN
TtqNK
SIZE
Li$:.M. ElGFILLONS <TFIO ,_.LM, I IRT, ,EN,
~ ...-~, -, .~:,=..
I...IZDTH = :Lg.,=, '"' FT.
L~,~,~T,i = z.,:, E~ FT.
TOTFtL DEPTH = 5. E~ FT.
.... "":'~ ~-'"~': <TI...IO ~:OMF:'FIRTMENT TFtNK)
TFfNK SIZE = % HHH ~.~ u
WIDTH = ._,.=: ~D FT.
LE~ ¢ H = ~57'. g FT.
'rOTRL .... ~., Ttl = 6. 0 FT.
GRFI',,,'EL DEF'TI.t = 2. C~ FT.
GRFI',/EL '.,,' ..... ][ lIME = ~,.~. .... ~ZlC:U. , E'-'
TRNK ~51ZE = ::L., '-TM:' : ': '
~*:b. D ........ ~::, '::TP.IO COMPtqRTMENT TFINK)
Z C-ERTZF¥ THFIT:
::L. Z RM FFIMZLZFIR klZTH THE F'FR~LZF~'EI'"IENT'5 I L,~ CN'-':BZTE :,ENER:, FIND WELLSH=,-'- 5ET
F qRTH BY THE Mt_tNZC~PRLIT'¢ OF FINC:I"iORFIGE FIN[:' THE E;TFITE OF I'ILI"I:,I'..H.
2. Z NZLL IN=, L .... THE S"?%'TEM ZN RCCORDRNCE ~4ZTH THE CODES FIND HFI'v'E RECEZ'¢ED
Ft C:OF'"F OF THE: CODE SUMMFIR'¢ FINE:' [:'ZRGRFIM FITTFP}HMZNT% I.,.tHZCH Z~; PI=IRT OF
F'ERI'i Z T.
Z LNDE't~'STFINE THFFF THE: ON--SITE =,E.h~. S~r'STEM MFI'¢ RIr:R~ IRE ENLFIR']EMENT ZF THE
RESZDENE:E Z% REMODELED' TEl ZNE:LL!DE MORE THFIN ~: BECRLJII_.
F'ERMZT FIPPLZCRNT HFt~; THE F,.E_FUt4_ZE~ZLZT"/ TO INFORM FEF=,.NNEL [:'URZNG
THE II'.~TRLLFtTIC$1 INSF'ECTI-' '- . _ [HI=,
.,[~:, OF FIN¥ P.tELLS Ft['~TFt~L]NT TO" ':' PROPERT'¢ FIND'
THE N MEFR' OF RE=,.~E,E'MCE'5 THFIT THE P.IELL ktILL SEF¢¢E.
IF F~ LIFT STFtTION 'IE; IN~STRLLE[:,., RN EL. ECTRICF~L PERMIT FIN[:, INSPECTION MUST
'r . i-iI r~
DE ]ETi:qINE[:, F'B--E.ILT:5 CRNNOT BE FfPPRO'v'E[:, t.,.I~TI..I ..... FIN ELECTRICFtL INSPECTION
REPORT. THE EL. c-'''r°~ .~,~,~ P~ORK ..... :,] DE .... ~ .... ' -' -
.... r, ....... ,..., ,-- '.F,~c E:'¢ R LIC:EN:SE[:, =LE.TEIUI-IN
MUNICIPALITY OF ANCHORAGE~°
Department...~f Health and Environmenta ~rotection
..... ~ 825 Street, Anchorage, AK. ~9501
264-4720
P.erm'~'l~ ~ P~ ~! O~Q~ * * * HANDWRITTEN PERMIT * * *
· ~kk .?.~/0~ ON-SITE SEWER PERMIT
~pplicant: ~ V~%~ ~ C---~,~ ~"~. Mailing Address:
Location: Phone Number:
~hrv~,q Lot S~
T~pe of Soil Absorption System Is:
Trench: Drainfield: / Seepage Be~: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
DEPTH
The Required Size of the Soil Absorption System~ Is: ·
The length dimension is the length(in feet) of the trench or drainfield. The
d~pth 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 = /Oo(D GALLONS * *
P~rmit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any System without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
a'nd 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 ~1~ 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 residence is remodeled to include more th~ 3 bedrooms.
Appl~antU ' U~
iVlUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
SLOPE SITE PLAN
10
11
12
13
14
15
16
17.
18
19
20-
COMMENTS
WAS GROUND WATER S i
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ ;~ /0 .~./D ~,~
~ I ;~ IO 3,~ o./~
(minutes/inch}
-.-~.,5"- FT
PERFORMED BY:
72.00~ [6/79)
CERTIFIED BY:
9076941211
S AND S ENGINEERING
PAGE 02
LL
. 897a •
.• Municipality of Anchorage , •8
� �
On-Site Water and Wastewater Program ti, ih 01
(907) 343-7904 ii JUL 18 Aim.
Certificate of On-Site Systems Approval <<
a E g L.
051-064-60 A'-- i'— Is
Parcel I.D. Expiration Date:
1. GENERAL INFORMATION
Complete legal description North Woods Unit 4 Block 16 Lot 22
Location (site address) 21524 Snowflower Loop
Current Property owner(s) Donald & Nancy Ingraham Day phone
Mailing address PO Box 672075 Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El Single Family (wlwo ADU)
El Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well El Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
ffAA', i t
Received by. r� ' , / Date: /K�
COSA to be released to the engineer,unless otherwise requested t e engineer.
COSA Fee $ 5ZC, Waiver Fee $
Date of Payment //ci1 It Date of Payment
Receipt Number dlr-�/ Receipt Number
COSA# 0.5C.O 1301 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.
In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.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 7118!2017
Air"G OF A,• skk�
Ale*: 49 � •77.*fA
f
6. DSD SIGNATURE ." ' f,J
)3.' ;
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: North Woods Unit 4 Block 16 Lot 22 Parcel ID: 051-064-60
A. WELL DATA
Well type A If A, B, or C provide PWSID# 213001 Well Log (YIN)
Date completed Sanitary seal (YIN) Wires properly protected (YIN)
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 7/29/2009
Tank size 1250gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N/A
Date of pumping 5/12/2017Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 7/29/2009 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 gpd/sf System type Shallow Trench
Length!97/,-) 1
le ' Width 5 ft. Gravel below pipe 3 ft.
Total de tt1 ft-' Eff. absorption area 690 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/12/2017Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 7.5 in. Water added 459 gal. New depth 1 1 in.
/
Elapsed Time: 240 min. Final fluid depth 7.5 in. Absorption rate >= '#`1b t 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 (Y/N)
"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 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ��`oF 4L 1
,�P'c�. qs 1�
I certify that 1 have determined through field inspections and AwCo. `4 7:V 1
review of Municipal records that the above systems are in 0*: ,4,9 TH 1' ••*,'
conformance with MOA COSA guidelines in effect on this date. /••••• •+, • "•• 0
Steven Pannone •
Engineer's Printed Name 'i•• .Sleven *R•. 'annon e . ii
Date
7/18/2017 ii��i9k CE-8149 . �
COSA canary sheet_2-6-15.doc
m Lot 15 I Lot 14 I Lot 13 7973B
N- EAST 239A1
\ cp hain link fence (typ)
N
cciM
200
vent26.0 c, 20.0 Note The property is served by a
public water system
cn
°02StoryFrameOHouseon
260 -'�20OH\ ePtic
" q�, --28 5-- co
Q , ° ° 20.0 6�:`deck
4,: ..
I—
Lot23
Lot22 0
Lot 2 vit 1o ; Z `%NA N
septic vent N 0
c j '�F-• • • • • •A�qs 1�
° 49th j� •. :\/
° 1
1 I /x• f., . .. ..— /.
. . .
/ .Brett A. Wilmot . 00/t ire••• 112392- LS ••.�
L=74.34 Ease I1��0 • . . . • • ;ao
/ R=50.00
eh.,
11 ><%`S"���
/ C,
/
/ �� •
�3,>2 AS-BUILT NO CORNERS SET THIS DATE
I I SNOWFLOWER LOOP �� I hereby certify that I have performed a Mortgagee's inspection
of the following described property. LOT 22. BLOCK 16,
I — NORTH WOODS. SUBDIVISION. UNIT IV
1
1 rh Anchorage Recording District. Alaska. and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
S adjacent thereto,that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways transmission lines or other
visible easements on said property except as indicated
hereon
SCALE: 1 40' Dated at Anchorage.Alaska
this 16th day of JULY .2017
EASEMENTS OF RECORD,OTHER THAN
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES
PLAT ARE NOT SHOWN HEREON. FB 14-5. pg 28-29 Engineers and Surveyors
BE (907-248-1666)
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 FAMIIT'I~ DWELLING~
Parcel I.D.# O S--! -- O~f -- G o ,-~-s,! '-"~:~HAA.~#, -~=:~ ~'-"~,~') ,~'L'/~
1, 'GENERAL INFORMATION
Complete legal description Lot
Location (site address or directions) 21524 Sno~£3.o~e~ r.oop
Chuqiak, AK
Prpp.erty owner ,, Don.,.Inqraham Day phone
Maiiing address P~O. Box 672075 Chugiak, AK 99567
562-5420
Eending agency Greatland Mortqaqe
Mailing address '
Day phone
563-5889
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
3 "4
XXX
If community well system, provide written confirmation from State ADEC attest-
~ng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
XYD(
Individual on-site
Holding tank
Community on-site
Public sewer
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, 1 verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
s & s ENGINEERING ~0 ~i ~ ' ,~-(] '7 ~
Name of Firm 1/03e F. agie F, iwr ;.u~p ~,v.~ ,',~o. 1~ Phone
Eagle River, Alaska 9957~
Address ~/'2 ~
Engineer's signature -.. ~ Date /~7 ~ /E ~
DHI-I/S SIGNATURE
'~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By:
Date
The MunicipalitY of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
ApprOval certificates based Only Upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspeCtiOns or:analyze data before a certificate is issUed. The Municipality of Anchorage is not
reSpOnsible for errors or omissions in the professional engineer's work.
72-025(Rev, I/91) Back MOA if21
i ~'/IRONMENTAL SERVICES
Municipality of Anchorage ~,
DEPARTMENTOF HEALTH & HUMAN SERVICES D[C 0 L~ 1~'
Environmental Services Division
825 L Street, Room 502, AnchOrage; Alaska 99501, (907) ~I~E-.~I VE, D
Health Authority Approval Checklist
LegalDescription: ~r~.~ ~,~c~ !~oj ~l?3'~l[t*~)3j~'Parcell.D.:
A. WELL DATA
Well type ~.L/~ A
Log present (Y/NI
Total depth
Sanitary seal (Y/N)
If A, B, or C; attach ADEC letter. ADEC water system number
Date completed,
Cased to r'
FROM WELL LOG
g.p.m
Casing height (ab0ve ground)
Wires properly protected (Y/N)
AT INSPECTION
Date of test
Static water level
Well production
WATER
g.p.m.
Coliform Other bacteria
Date of sample: Collected
B. SEPTIC/HOLDING TANK DATA
Date installed ::~/~.~/~ / Tank size Ioo{3 q~ Number of Compartments ~ Cleanouts
Foundation cieanout ON) ~ ~' Depression (Y~- ~0 High water alarm (Y/N)
C. ABSORPTION/FIELD DATA
.~, Dateinst~l!~d */~/¢/ S~ilrating (~rff~/bdrm)0.4 ~Systemtype
Effective absorption area ~ E~ ~, Monitoring Tube present) ? Depression over field (Y~
Fluid depth in absorption field before test (in.); ~ ~ Immediately a~er~/ gal. water added (in.):
Flu,dde th ~ ms Mnutes ater' i~1~ , Absor tonrate = ~'~ --
P _ ( ) r' . ~ ~ p . g.p.d.
72-020
3/96)*
D. LII
Date installed
Manhole/Access (Y/N)
Size in gallons
level at* "Pump off" level at*
High water alarm level.at*
Cycles tested
E. ~ES
SEPARATIOI
Septic/holding tank on lot
Absorption field on lot
LLON LOT 'TO:
On adjacent lots
acent lots
Public sewer main Public
Sewer/septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation __ .~././_ Property line ~;'~' AbsorPtion field ~0/~
Water main/service line [~) i -{,. Surface water/drainage I~')/'{' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~O I{,~ Building foundation I~ ~ J~ Water main/service line
Surface water I ~ ~ ~ ~ Driveway, parking/vehicle storage area O
Curtain drain k! 0rJ~ .~./~ll I,"J ~J
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru fieldinspections and review of Municipal r
in conformance with MOA ~ guio~lines in effect on this date.
S gnature ~~Z- ~
Engineer's Name
Date I ~['~ /~ ~'
Wells on adjacent lots
HAA Fee $ ~ ~-Z)'
Date of PaymE
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
APPLIC- 'NT FILLS OUT UPPER HAi LoNLy
' ...~,X. 1 ][.gj ~ t(~(~ -. Phone
Property Owner ~ ~)L~,~ ~
M~iling Address ~'~ C), '~ )'-/~. ~
Buyer
Address Zip Code
Lending Institution Phone
Address Zip Code
Phone
Realty Co. & Agent
Address Zip Code
Street ,ocat,o. U3'
T~eof Residence
Single Family
[] Multiple Family No, of Bedrooms
[] Other
Water Supply
[] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community For wells drilled prior to that date, give well depth (attach log if available),
Public Utility
Sewer Disposal
~lndividual Year individual Installed:
LJ Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTFCTION
RECEIVED
(/~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ,~ ' I '~ --% "'ii'
Soils Rating Date Sewer installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3182)
ALASKA I dlROFlmeI1TAL COFITROL S(![ uI'CeS, IF1C.
I~(lin¢~ri~q 6 ~,uironrn¢~tot $1uclics
February 10, 1984
Municipality of Anchorage
DEPARTMENT OF HEALTH &
ENVIRONMENTAL PROTECTION
825 L Street
Anchorage, Alaska 99501
Re: Health Authority
On February 3, 1984 I inspected the sewer ,system located on Northwoods Phase IV
Block 16, Lot 22.
Ail the standpipes are capped and protrude above ground level. The finished
grade looks good and surface drainage is away from the septic system.
The well is a community well and did not require our inspection. According to
Mr. Bruce Erickson of Alaska Department of Environmental Conservation, the
community well is up to standards at this date and no water sample is required.
Sincerely i;,,;1%1
Tod Sherman
TS/caj
o. 2251-5
1200 UJesl 33r~J ~ue,ue. Suite [~ e AncNoro§e, Alosko 99503.(907) 561-50z10