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Home My WebLink AboutNORTH WOODS UNIT 4 BLK 16 LT 28 ~ 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 PHONE [ZNEw JMAILING ADDRESS ~/ ~ LEGAL DESCRIPTION LOCATION ~S S~eS ~ ~ ~" O ~~ NO' OF BEDROOMS J Well. ,. I Ab,orption aCea Dwelling OI PERMIT NO' ~D lq ~Z~ Manufacturer ~ C¢¢~S~ '~ 'n.¢~ ~ Liq, capacity in gallons H~EMADE~ Inside length Width Liquid depth ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~z ~¢ Manufacturer Material Liquid capacity in gallons Q Well~ "' Foundation Nearest lot line PERMIT NO. ~ Top of tile to ¢[nish grade ~,O' ~ Material beneath tile 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: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) ASTM 27 q 4 SOl L TEST RATI N~' - ~. 131 L, REMARKS ~ ~ ~~~ ~ DEP'F. OF HF~,] -H 8 ._~~ E~W~ONMENTAL ~ )Ti<:~i )i, RECE:' APPROVED % ~ DATE LEGAL 72-013 ~e~"~v. 3/78) PERMIT NO: DATE ISSUED~ APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: LOT LOCATION: MAX BEDROOMS: MU~-~ ~ C:IPRLIT'¢ OF 8~NCHOR8GE DEPARTMENT OF HEALTH 8ND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 Ln~I--SITE SEI4ER' PERMIT 05/09/84 STEVEN L. SKAGGS CONSTRUCTION P 0 BOX 6?0690 CHUGIAK~ AK 9956? 688-28~1 SUBDIVISION: NORTHWOODS #4 SECTION: ~ TOWNSHIP: 15N 2279? (SQ. FT. OR ACRES> BLUE SKIES AND DOLLY LOT:-28 RANGE: iH BLOCK; LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. BED DEPTH TO PIPE BOTTOM (FT.) 2. 5 GRAVEL DEPTH (FT. > 0. 5 TOTRI~ DEPTH (FT.) _?.. O.~- GRRVEL WIDTH (FT. > t6. 0" GRAVEL LENGTH (FT. > GRRVEL VOLUME (CU. YDS. > 18. ~ TANK SIZE (GALS> i, 000. 0 SOIL RRTING (SQ. FT. ,-'BR) ilo 2.0 ~ · l. 0 5,0 58. 0 000. 0 ~.~ ilo DEPTH TO PIPE BOTTOM < ~.5 FT. REQUIRES INSULATION DEPTH TO PIPE BOTTOM < 4. 0 FT. MAY REQUIRE A LIFT STATION TANK MUST HAVE AT LERSTTWO COMPARTMENTS I CERTIFY THRT: i. I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF RNCHORAGE <MOA> AND THE STATE OF 2. I WILL INSTALL ~HE SYSTEM IN ACCORDANCE WITH ALL MCR CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ~. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY E~ISTING WELL, WASTEWRTER'DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF ~ BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE 8N ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN RN AREA COVERED BY MOA.BUILDING CODES, THEN (i> RN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTRINED~ 42> AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT¢ AND (~> THE ELECTRICAL WORK MUST, BE DONE BY A LICENSED ELECTRICIAN SIGNED RPPLICRNT: STEVEN SKRGGSC~~RI]CTION 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: ,.~T£t, IEN L, LEGAL DESCRIPTION: SLOPE DATE PERPORMED: SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop i I: z7 /o o, d4 o, Rd ii ,'X~ lO o ,o~ o, ~Z PERCOLATION RATE ~ (minutes/inch) TEST RUN BETWEEN ~_~, Z.~ FT AND ~ FT 72-008 (6~79) CORWlN & ASSOCIATES, INC. CONSULTING ENGINEERS 1549 E. TUDOR RD., SUITE 204 ANCHORAGE, ALASKA 99507 (907) 561-6151 PERCOLATION TEST DATA SHEET CLIENT Steven L. Skaggs Construction ADDRESS P.O. Box D, Chugiak, Alaska ZIP CODE 99567 LEGAL DESCRIPTION TOTAL DEPTH OF HOLE ZONE TESTED 3 DATE Lot 28, Block 16 Northwoods Phase IV 3 FT. FT. TO 3.5 FT. 5/31/84 READING CLOCK NET TIME DEPTH NET DROP TIME TO DATUM +H20 3:15-3:25 10 0.5-0.22 0.28 +H20 3:26-3:36 10 0.5-0.26 0.24 +H20 3:37-3:47 10 0.56-0.32 0.24 FINAL PERCOLATION RATE 131.6 sqft/bdrm(min./in.) PERFORMED BY Tod Sherman Note: The southeast corner of the drainfield was reperced due to a change in soils. 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~ \ - ~,L~ L\- .~ ~\ HAA# ~ ~-~ ~ -~/'~ ;~ ~ ~)~ GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~'~,~'~ J~'~,,~1,1 t~ Mailing address ¢.-2/~; ~/..~ ,~~,a ~.. Lending agency Day phone Day phone Mailing address. Agent 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 sluewwoo leUO!l!pPV :suo!Telnd!ls §U!MOIIOJ eqT ql!M 'SLUOOJpeq JOJ leAoJdde leUO!l!puoo 'pe^oJddes!a · suJooJpeq ,~:> Jo, peAoJddv ,-~ ~InJ.VNgI$ SHHa '9 sseJppv Z9~66 e)lselV ' ', ~ · '3'd 'uo~loedsu! s~ql ~o elep aq~ uo ~oeJia u~ suo~eln~aJ pue 'seoueu~pJo 'sepoo ele19 pue led~o!un~ lie ql~ noUe~ld~Oo u~ s! ~e~sXs lesods!p Jele~e~s~ Jo/pue Xlddns Jele~ e3~s-uo eq1 'uo~loedsu~ pug uo!~seAu~ Xm moji pub seHj e~eJoqouM ~o Xl!led~o~un~ moJ~ peu.e~qo uo.3e~4oju, eq~ uo peseq leql X~HeA Jeq~nj I 'u~eJeq peleo!pu~ eJn~onJ3s jo edX1 pue ~mooJpeq to Jeqmnu eH1 ~o~ elenbepe pug leUO~1ounj 'eje~ s~ ~e~sXs le~ods~p ]~le~alse~ Jo/pug Alddns Jele~ e~!s-uo eq~ leq~ s~oqs uo~eoHdde leAoJddv X1poqlnv q11eeH s~ql ~o uo!le~lseAu~ Xm leql XJ~JGA I '~Oleq u~OHS el~p uo[leP!leA eq~ jo se pue OleJeq pex!J~e leas X~ Xq pe!j~Heo sM M~NIDN~ AG NOI~O~dSNI JO Municipality of Anchorage Department of Health & Human Service~ ~ r HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~ IfA, B, orC, attach ADEC letter, ADECwatersystemnumber/2F--'¢~/~) Log present (Y/N) Total depth Sanitary seal (Y/N) Cased to Date completed Driller Casing height Wires properly protected (Y/N) ; On adjacent lots FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~//~ Absorption field on lot Public sewer main Sewer service line ATINSPECTION g.p.m. ; On adjacent lots Public sewer manhole/cleanout Petroleum tank r-rt o ~o~ g.p.m.,~ ~ > WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed (,,/g fZ: Cleanouts (Y/N) Y' High water alarm (Y/N) Date of pumping Tank size / ¢~:~ Compartments Foundation cleanout (Y/N) ~/ Depression (Y/N) Alarm tested (Y/N) ' 'c'///¢ ~--~¢~///~, Pumper ~'il~':~ p~w~ j0,~J SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /'/'¢ To property tine Surface water/drainage On adjacent lots Absorption fi¢;d Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION 'Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed (~Y Length , ~JG Width Total absorption area Depression over field (Y/N) Results (pass/fail) Soil rating Gravel thickness Cleanouts present (Y/N) Surface water System type Total depth Date of adequacy test for ,~ bedrooms On adjacent lots If yes, give date Property line ,, To existing or abandoned system on lot Cutbank -~' Water main/service line Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building fOundation On adjacent lots Go~ Surface water /~)o-~- Curtain drain Waiver Fee: $ Date of Payment Receipt Number HAA Fee $ Date of Payment Receipt Number ,,~/-TZ~ 72-026 (Rev. 3/91) Back MOA 21 Signature Engineer's Name Date E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Daytozl · 20210 DenalarS~, Chu¢iak, Alaska Driveway, parking/vehicle storage area #/.~ ; ' i. i~ ' , ' ' ~'/.'".~ !!" ~: ." ',,b" '.~ ~..' !~ f"~/ANCHORAGE DISTRICT oFFICE j~' 800 E. DIMOND BLVD,0 SUITE 8-470 r ANCHORAGE, ALASKA 99515 WALTER J, HICKEL, GOVERNOR (907) 849-7755 April 16, 1993 Mr. Tobben Spurkland SUBJECT: Northwoods Subdivision (Chuglak Utilities) Class "A" Public Water System, PWSID 213001 Dear Mr, SpurkJand: I have completed a review of this office's files concerning the monitoring status Of the above:referenced Class "A" Publto Water System and found the following:. .3, The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 4, 1998. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Inorganio Chemical Contaminants'Sample results were submitted to this Department on April 21, 1992. This does meet the provlslons of 18 /LAC 80.200(a), of the State Drinking Water Regulations, ' The last Radioactive Contaminants Sample results were submitted to the Department on July 1, 1992. This does not meet the provisions of 18 MC 80,200(a), State Drlnklng Water Regulations, ... 4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 2, 1992. Based on analysis of the previous VOC samples results have been satisfactory. Thls does meet the provisions of 18 AAC 80,20[:)(a), State Drinking Water Regulations. Issuance of this letter does 'not Imply that the above-referenced Class "A" Publlo Water System is In 'compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to coniact this .office at 349-7755, Sincerely, Michael Lu Environmental Eng, Asst, II D. R. DAYTON, P.E., R.L.S. ~~~ Chugiak, Alaska 99567 20210 Donalar (907) 696-2417 April 28, 1993 ADEQUACY TEST Legal Description: Lot 28, Blk 16, Northwoods Subdivision #4 Date of Test: April 28, 1993 Septic Tank: 1000 gallon, 2 compartment steel tank Absorbtion System: 18' x 36' bed Soils Rating: 131 sq.ft, per bedroom Requirements: 3 bedroom - 450 gallons per day (DHHS Records) (DHHS Records) (DHHS Records) Test: Water was injected into the absorbtion bed while monitoring time, volume, and rise in the bed liquid level. After injection was stopped, the absorbtion rate of the bed was monitored at 10 minute intervals. The results were plotted on a graph of time and gallons absorbed. Results: The bed accepted 489 gallons of water in 1½ hours with a bed liquid level rise of 0.20 ft. The absorbtion rate measured and graphically plotted show the absorbtion system is currently functioning adequately for a 3 bedroom home. ,% MUN C PAUTY OFA.C.ORAGE / o,v,s,o, s .v,c s CERTIFICATE OF INSPECTION FOR HEALth AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date.. January 28, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) . (a) Legal Description (include tot, block, subdivision, section, township, range) Lot 28; Block 16; Northwoods~ Location (address or directions) Snow Flower Loop (b) Property Owner Brlinq Telephone: Home Mailing Address, Business (c) Lending Institution Home Savings and Loan Telephone Mailing Address Anchorage, Alaska (d) Real Estate Company and Agent RB/NAX OF ~.AGLF:, RZVER - Laurel Crouse Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska Telephone 694-4200 99577 (e) Mail the HAA to the followina address: or: Check here ]~, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by Laurel Crouse TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/861 Front i ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION A s 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 a~l Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .5 & $ ENGINEERING Telephone Address 17~4 ~:~1~ I~;v,~ I__n~_~ ?._.,____.1 .~.~.-. Date Ea.l, River, Alaska 99577 / Approved for ~ bedrooms by .... Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 fRev 8~86) 8ack MUNICIPALITY OF ANCHORAG~ MUNICIPALITY OF ANCHORAGE (MOA) ENVi,RONM~NTAL sERViCeS DtVISIOt~IEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED WELL DATA 264-4744 Legal Description: L¢>~" ~.~ ~./~ /~1~ A Well Classification 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/l-~ Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by If A, B, C, D.E.C. Approved"~;N) Date Completed Yield Depth of Grouting Pump set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) 2..~c~:::~ ~ -/' ;On Adjoining Lots ~c-~/-/- ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments B. SEPTIC/-','CLD'.:;(; TANK DATA Date Installed Standpipes~)'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 Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ~ - .L.L -~Size ? ~>¢)&:~ No. of Compartments ~-, Foundation Cleanout~[~N) Date Last Pumped '-~ / - ,,~C:) - ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pdnd;'Lake; 0¢' Major D~-ainage Page I of 2 72-026 CRev 8/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ -- Width of Field / ~ Square Feet of Absorption Area Depression over Field (Y/~J~ Results of Last Adequacy Test / ~) Z:~/~,/,~. TYpeof System Design Length of Field ~ ~ Depth of Field 7_., Gravel..~ed Thickness O, '~ Standpipes Present'N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Z.-~ .t- To Property Line To Building Foundation ~.~ ~..~' To Existing or Abandoned System on Lot 'N'///3, ; On Adjoining Lots ~ t:> I ./. To Water Main/Service Line .,~-~ / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / ¢~ ~ Comments ~ <~,.-'~--.~'~.~-E.. J~,~.,% I~" ~',~¢~,~ ~c,v'~> ~'~,)'~.,~ ; ~/~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. sigr~L ,ii ENGINEE,~ING Date C0~]~4 I~,~1,, ~1~ I_~n ~ ~ ~OA NO. ~e River, Ala,ka .5~ ~ ~/~/ ~ Receipt No. Date of Payment ~-/-- ~ ~ Amount: $ /~ ~ ~o ,~ Page 2 of 2 72-026 (Rev 8/86/ Back D~PT. OF ENVIRONMENTAL CO~SERYAT~ON ANCHORAGE/WESTERN DISTRICT OFFICE / 360~ "C" STREET, SUITE 1334 / ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-5775 DATE: 2-5-88 PWSID #: 213001 To Whom It May Concern: According to the records on £ile in this o¢¢ice, the CHUGIAK UTI- 'LITIES/NORTHWOODS Water System is in compliance with the State o¢ Alaska Drinkinq Water Requlations, Sincer. ely, Ronald S, Klein Environmenta] Field O¢¢icer ~ MUNICIPALITY OF ANCHORA~I~ MUNICIPALITY OF ANCHORAGE o,r.'PZ. OF HEALTH & DMSION OF ENVIRONMENTAL HEALTH ENVIRONMENI'AL PROTECTION: DEPARTMENT OF HEALTH aND mm,'Z~NTAL PRarEcr'zON - APPLICATION FOR HEALTH ALrfHORITY APPROVAL CERTIFICA~I 1. General Information Application DaRE C E IV f D (a) Legal Dsscription (include lot,~?block, subdivision, sectign, township, range) Lo~ion ~a~e~s 6~ ~lrectfon~% (~) Applicant is (ch~k one) Lending Institut_ion (d) Lending Institution Telephone ; Owner/builder ~--] Te le phone Address (e) Real Estate Co. & A~ent Address Telephone 2. Type of Residence Single-Family Numbe~ of Bedro~,s Multi-Family O~er(des~i~) 3. Water Supply Individual Wall ~-~ C~,mmity ~ Public ~ Note:. If ea~m~nity ~11 system, must have written confirmation frcm the State Depa=tment of Enviro~mmntal Conservation attesting to the legality and status. Is the well adequate fo~ the number of bedrocms specified in this' ~I~A (Y/N) ~ 4. Sewage Disposa~ Onsite ~-~ Public ~--~ Community ~-~ Holding TapR ~-~ Is the wastewater disposal system adequate for the rnmber of bedrooms ..(Y/N) [Page 1 of 2] 2-15-84 5. ~Firm Providin~Tests' Data and Information I certify that I have checked, verified, c~ conformed to all MDA ~ Guid~! effect on the da~e of this inspection. d ~/1-~ ~ly~ Date Signe Nam~ of Firm ~ Tele Address .; ( ENGINEER SEAL) 6. DHEP Approval. Approved fox ~ bedroon~ p rove T . sap o d Terms of .Conditional App=oval Conditional The Municipality of Anchoraoe D~pa3~tment of Health and Environmental P~otection dces' not guarantee the continued satisfactory performance of the wate= supply and/o~ the em. This a proval indicates that, as of the validation da. te. wastewater disposal syst - P. .... :-~d b/ an engineer registe~e~ ~n s~n above, based on the data an<~ ~n£crmat~on rurn~= -~ system is safe and func the State of Alaska, the ware= supgly and wastewater disposal tional fo~ the number of bedro<m~ and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/dS/s [Page 2 of 2] A® Well ClassifiCation C~mm IZDI' ~/ Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Eleot~ical Wiring in Conduit (Y/N) Sepa~ation Distano~s' f~c~ Well: To Septic/Holdin~ Tank c~ Lot To Nearest Edge of Absorption Field o~ Lot To Nearest Public Se~r Line Cleancut/Manhole Water Sample Collected By Wate~ Sample Test Results C(~,u-~ nts. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 I: Z8, B, Iock i ,/ orfhwc ods If A, B, ~ C, D.E.C. Approved(Y/N) Date C~91eted Yield Depth of G~outing Pump Set At Sanitary Seal on Casing (Y/N) Dep~essio~ Around Wellhead (Y/N) ; On Adjoining Lots . ; On Adjoining Lots To Nearest Public Se~r To Nearest Se~= Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~ / - ~L Size ; ~0~ ~a I. No. of C(~,~a~ttm~nts ~ J Sta~ims (Y~) Ye~ Aid-tight ~ps (Y~)~ F~n~tion Clean~t (Y~)~5 ~ession o~ Ta~ (Y~) ~O ~te ~st ~d ~h/ ~L~ P~ing~inte~n~ ~n~a~ ~ File (Y~) '~ ; fo~ Holding Ta~ High-Wate~ ~a~ (Y~) ~ ~a~y Holdi~ Tank ~t (Y~) '~ ~p~at~on Distan~s ~'~ptic~oldtng Ta~: To Water-Supply ~11 +~0' To ~ilding F~ndation ~' To Property Line To Water Main/Service Line Cou~s~ '~ To Disposal Field ~7' To Stream, Pond, Lake, o~ Major D~ainage Comments [Page 1 Of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~3-/- ~ Width of Field / ~ ' 13/. Square Feet of Absorption A~ea /O.~ Depression ove~ Field (Y/N) i~O Results of Last Adequacy Test Sepa~atiOn Distance f~om Absorption Field: To Water-Supply Well +~00! To P~operty Line /~' ~k&%p~jJ Type of System Design ~C(~J _ Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent (Y/N) Date of Last Adequacy Test ~ f~Y\/ To Buildir~ Foundation ~ ! Lot ; On Adjoining LOts '4-~.~0/ TO Water Main/Service Line ~! To Cutbank(if present) To Stream/Pond/Lake/or Majo~ D~ainage Course To D~iveway, Pa]~king A~ea, or Vehicle Storage A~ea /~! To Existing or Abandoned System cn Con~ents D. LIFT STATION Date Installed Size in Gallons "P~-~9 On" Level 'at High Wate~ Ala_-m Level at Tested for Electrical Codes (Y/N) Dimansions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Cc~f¢~nts ** Check Pem~itted Bed~ocm Rating AGainst HAA Request ** .~f~ %' I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~/~X. ~C KB1/d5/s [Page 2 of 2] ENGINEERS SEAL. 2-i5-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 PWS i,D, # BILL SHEFFIELD, GOVERNOR Telephone: (,,qO7J Address: 274-2533 To Whom It May Concern: ]cording to [ecords Water Regulations. on file in this office the L/(.~'~,.~])B~ Water System is in compliance with the State Drinking Sincerely,