The URL can be used to link to this page

Home My WebLink AboutNORTH WOODS UNIT 4 BLK 17 LT 6Onsite File North Woods Unit 4 Block 17 Lot 6 #051-064-47 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201500 PID Number: 051-064-47 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name DOUGHTY KENNETH & PATRICIA ABSORPTION FIELD ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 23431 Blue Skies Dr Chugiak Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 D/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot NORTH WOODS UNIT 4 17 6 Fill added above original grade Ft. Gr'a I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distan a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr c� hes From Tank Field Tank Line Fl? t. Well > 100' NA NA NA TANK 0 Septic ❑ S.T.E.P. ❑ Holding n Other Manufacturer Greer Capacity 1250 Gal. Surface Water > 100 NA NA NA Material Number of compartments Lot Line > 10' NA NA NA NA plastic 2 Foundation (> 10' NA NA NA LE STATION Manufacturer Capacity Remarks Gal. Alarm location Electlled by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer JRs Septic Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection15 12/23/2020 12128/2020 dates: Location and description 2� s/19/2Ck� 4.h bottom of siding31111 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Ak`i� Conditional Approval: Date �,F 9 TH ........ 4 .. �Date ...�s... �17V Septic System �1�� GJl. No.: � ��FgF�pROfESS1��t`�®- Approved % r Date as �ba 1 Note: this approval does not include well permit requirements. tRev uoiuzi iu) LOT 4 LOT 3 LOT 2 NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE 7 NEW 1250 GALLON TANK, TANK IS MIN 5' A WA Y FROM DECK SVSV2DCO r SUPPORTS SPLITTER OA I U� L A BM 4 BEDROOM �4 _gam r HOUSE _�- 0 -a EXISTING 99' x 60" SHALLOW A� TRENCH; UPPER TRENCH IS 49' x 2.8' ED, LOWER TRENCH NEIGHBORING SEPTIC IS > 10' ' IS 50' x 2.5' ED FROM PROPERTY LINE oNE SND � Rri lES �ve BLtje SK LOS THIS PROPERTY IS SERVED BY AWWU AND THERE ARE NO WELLS WITHIN 200'. SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,250 GALLON PLASTIC SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Tonk Replacement Record Drowings Prepared for '`*��rOt Kenneth and Patricia Doughty .•�P�� OF q��s��+ 23431 Blue Skies Dr, Chugiak Alaska 99567��;� NORTH WOODS UNIT 4 BLOCK 17 LOT 6 A4 TT" 0 k ..................I ..... 0 OSP201500................ �KLUTNA E1�CIi�EER1NG LLC .......... ..........`.. • DATE: 1 12 012 0 2 1 ��.CURTIS TOWNSEND.'•+ 19162 MOUNTAIN ROAD DRAWN: CLT 00o - No. C/ 14�,:'�s CHUGIAK, ALASKA 99567 = ♦c '••..,,♦ (907) 406-1058 SCALE: 1" 40' ♦ ++p�LSS� ♦ C�' ♦ PID: 051-064-47 SHEET 2 OF 3 ��ar��♦ FILE NAMESHEET NUMBERSURVEY DATESTAMP:SCALECOMPANYNMICHAEL KELLER MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:1AvvAAv.munl.org1ons1te On -Site Wastewater Disposal System Permit Permit Number: OSP201500 Work Type: SepticTank Upgrade Tax Code Number: 05106447000 Site Legal Address: NORTH WOODS UNIT 4 BLK 17 LT G G:1460 Site Mailing Address: 23431 BLUE SKIES DR, Chugiak Owner: DOUGHTY KENNETH E & PATRICIA M Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: menr Department 12!1512020 12/15/2021 26447 ❑ Disposal Field i1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. Ali requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B7 Issued By: I Date, (z_ z� Date: a� l 5Qa2D 4 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201500, Rebecca Carroll, 12/15/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201500, Rebecca Carroll, 12/15/20 Municipality of Anchorage Page / of 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 Permit Number: 51/~'7~ ~ PID Number: ~J-~ Name:~d~ ~F/'~/~ ~~ Wastewater System: ~New ~ Upg[ade ~Address:~/ ~1~ ~~ ~t~ ABSORPTION FIELD Phone: J No, of~dr~ ~DeepTrench ~ShallowTrench ~Bed ~Mound ~Other Total Depth from original gra~:/ LEGAL DESCRIPTION so,,,~.~: ~.~ ~s~.~. - Lot: Block: ~ / ~Subdi~n: ~ Depth to pipe bosom from original grade: Gravel depth bene~ pipe Township: ~ Range: Section: Fill added above original grade: ~ Gravel length: // I Gravel width: ~ Number of li~s: Distance betwe~ lines:~ WELL: D New /~ Upgrade / e~ ~. ~ lW~'~ Classification (Private.. A,B,C):/~(~, Total Depth: Ft. I C~ Ft. Total absorption area: Pipe material: ~,,0,~ Yield: '~ ~ Pump Set at: ~ Casing Height Above Ground: ~ ~ / ~L ~. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Li~ Holding Public/Private Manu~cturer:/ ~ /. Capacity in gallons: From Tank Field Station Tank Sewer Lines ~~ /~ Material: / ~ / Number of Compa~ments: We~ ~ .... ~ [ Sudace ~ wat.r /~D ~ /~g + ~ ~ -- LIFT STATION LOt Size in gallons: J ~,n,,,c~ Foundation /~ /~ __ -- -- "~u~P °n" 'evil "~mP o~" 'e~e' at: ~h w"ter a'~r~ ~t: Remarks: ~ ~ ~ BENCH MARK Location and Description: ~ A,,.me~ E~eva,o.: ~DO ~, ENGINEER'S SEAL Inspections pedormed by KMO~n~x~/x~ Dates' 1st /~h~/~ E~= '~$~'~ ~ ' ~'%'~' De artment of Health and Hum - ..... Reviewed and approved by: ~ Date: ~ ,~,e~4.~~~~,~:~ 72-013 (Rev. 9/91) MOA 25 AS ~SUILT SYSTEM DETAILS?SITE PLAN Penmi~ sw970344 ~lSSO aaU, S,T,D E ~~~ SEPTIC C 8~86,4' 8-D 25,6" C B-F 242' A 6=~8,7' EXISTING TAN a FIELD B-J 70,4' b~/ ~AN~ I I SEWER ROCK ~, 49' SOALE~ NT2 . SEWER RECK ~ 0%~- PREPARED FOR: ~ ~ '~ ~ KENNETH ~ PATRICIA OOOGHTY ~ FfELD BOOKS COMPUTED: ~N~ ~N~iN~,N~ ~__~o~ssiO~~ ~ ,*,E: 1/6/98 RAGLR RIVRR, AE 995??-8736 ~~ DW6' FILE: OR~O: NW1460 ::: ACA~nLE:97087.DWG dOBNo.: 97087 (907)696-6111/~AX (907~696-8111 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUlVaAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASRA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970344 DESIGN ENGINEER:KND ENGINEERING OWNER 'NAME:DOUGHTY KENNETH E & PATRICIA M OWNER ADDRESS:23431 BLUE SKIES DR CHUG~IAK, ~ 99567 DATE ISSUED:10/01/97 EXPIRATION DATE:10/01/98 PARCEL ID:05106447 LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 17 LT LOT SIZE: 26600 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 A_ND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18A3~C72) AND DRINKING WATER REGULATIONS (18A_AC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY:~ ISSUED BY: ,~,,~,~., DATE: DATE: 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 September 25, 1997 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Northwoods #4 Subdivision Lot 6, Block 17 - Septic Upgrade Permit Gentlemen: Following a request from the owner, we conducted an investigation of the existing septic system for the subject property. The observations in the monitoring tube showed the effluent above the lateral and in failure. The owner requested we proceed with a four bedroom upgrade of the septic system. On September 17, 1997 we dug two testholes for the proposed upgrade. The results of this test are attached. The lot is served by public water. The proposed upgrade system will be placed approximately 10' west of the east property line and north of the existing system. As indicated on the site plan the system can be served by gravity. The existing tank will be abandoned in place, and a diverter will be installed so the existing field can be used at some time in the future. Although the area is noted for high ground water, there was no ground water observed during monitoring of the testholes. However se have elected to maintain the system as high as possible to preclude any potential encroachment. As indicated by the site plan drainage arrows, natural drainage is away from this site and will be maintained after construction. There is no surface water within 100' of the proposed installation. There are no known curtain drains within 50' of the proposed installation. No public or private wells exist within 200' of the proposed installation. This upgrade should have no adverse effect on development of adjacent lots. If you have any questions, please contact me at 696-6111/FAX 696-8111. MUNICIPALITY OF ANC, I-tORAGI~ Respectfully submitted, ENVIRONMEhrI'ALSERVICE$ DIVISION ~1~ Engineering ~ff~, ~' ~' ~ SEP 29 1997 .E. RECEIVED attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test K D WASTEWATE DISPOSAL SYSTEM?SITE NORTHWOODS 84, ]BLOCK 17, LOT 6 4 178,3a 8 PLANI ING FIELD DESIGN CRITERIA l, 4 BEDROOMS X 150 GAL,/DAY/BEDROOM 600 GPO B, SOILS RATING~ 13,33 MTN/INCH APPL RATE 0,8 GPD/SF 3, 600 GPD/0,8 GPD/SF 750 SF 4, 750 SF /(5' WIDE) X (0,64 RF) 96'L 5, MIN, DESIGN SIZE B TRENCHES 48' LONG x 5' WIDE x 2,5' DEEP 6, DEPTH OF GRAVEL BELOW PIPE IS 2,5', 7, TOTAL DEPTH OF SYSTEM IS 4,5' FROM ORIGINAL GRADE, NOTES: l, TIE INTO TRENCH AT ENDPOINT, ?, INSTALL 1000 GALLON SEPTIC TANK, INSULATE 'rANK IF <4' COVER, 3 INSULATE TRENCH WITH 2' HD BURIAL FOAM IF <3' COVER, 4, CONTRACTOR WILL ENSURE MAXIMUM 2× SLOPE INTO SEPTIC TANK, 5. CONTRACTOR ABANDON EXISTING TANK IN PLACE, 6, CONTRACTOR TO INSTALL DIVERTER CONNECT l'O EXISTING FIELD, PREPARED FOR', I<ND ENGINEERING 20441 PTARMIGAN BLVD KENNETH & PATRICIA DOUGHTY P,O. BOX 671ia6 EAGLE RIVER, AK, 99577 CHUGIAK, AK 99567 (907)696-6111/Fax (907)696-8111 DATE~ 9/84/97 J DRA~/ING ~ J SCALE~ 1" = 100' 97087 S1 / VACANT K D WASTEWATER ]?ISPOSAL NORTH~/OODS fi4, BLOCK 17, LOT 6 SEPTIC O9 PwbUc ~/ote~ S oTH EXISTING GAL, 4 BDRM SEPTIC SEPTIC SYSTEM/SITE PLAN PREPARED FOR: 7 2 SEPTIC NDO]OO'OO'W 178,32 PubLic Wo,-~er- SEPTIC PRBPBSED SYSTEM [H ~97-I. KENNETH & PATRICIA DOUGHTY P,O, SOX 671186 CHUGIAK, Al< 99567 O% 'ING FIELS I<ND ENGINEERING 20441 PTARMI6AN BLVD EAGLE RIVER, AK, 99577 (9OY)696 6111/Fo, x (907)696-8111 I)^TE, 9/a,I/97 DRAWING I1 SCALD 1' = 50' 97087-S2 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST - x ~ -~. 17- ? 7 PERFORMED FOR: -~__ , ~ DATE PERFORMED: LEgaL OESCRIPT,O.: ~Ft~?0d5 Cfi ~[17 ~6 Township, Range, Section: ~g ~ 1 2 3 4-- 5-- 6. 7 8 9 10 11 12 13- 14 15 16 17 18 19. 20- COMMENTS ~'~ 0/~-- WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN IF YES, AT WHAT DEPTH? E Depth to Water Alter,_~, Monil0ring? I,~r5 D,ie: ~9-~3- ~'7 Gross Net Depth to Net Reading Date Time Time Water Drop J ?-/f-~7 ~,: 2..~ - ,~" -- ;g ~:3~ /~ ~,'~ 7'~" ,v/~," , ~ ~:q~ - ~,, _ PERCOLATION RATE '-~' ~ ~,~ {m,nutesJinch) PERC HOLE DIAMETER TEST RUN BETWEEN 4 FT AND 'J~ FT ^CCORD^.CE W,TH ALL STA'E .O 5, EFEEOT ,/ ATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502~0650 SOILS LOG m PERCOLATION TEST 1 2 3 4-- 5-- 6 7 8, 9 10 11 12 13 14 15 16 17 /7. 7~ 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? DEPTH? pO E SLOPE SITE PLAN Monitoring?Depth to WaterAfter..,_,l,.~/(.5 Date: Reading Date Gross Net Depth to Net Time Time Water Drop / f-l/- f7 5: Z.z:~ -- &" -- ~ ' ~ ',ql I~ ~,'~ 7 53~ ,' t3~&" ~ ~ ~:q~ - ~.. , ,, ~ q= o~ ~o ~,'~ 7q//~'' ~v" PERCOLATION RATE /'~,~ ~ (minutes/inch) PERC HOLE DIAMETER .. TEST RUN BETWEEN 4__ FT AND ~'~ FT b// AOOORDA"OE W'T. ^LL ST^T[-/.O M..IOIPA~.,DEL.NES,. E..EOT OL ,Z~^TE. DATE:, 72-008 (Rev. 4/85) ~ 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 PHONE ~ [] UPGRADE MAILING ADDRESS · LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS II Absorption area Dwelling ~ b ~ Manufacturer ~1[?~'~ ~ ~ T~ Material~ ~L No. of co~artments Liq, capacity in ~all~ns HO~MADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer · -- ~ Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ DISTANCE TO: --~ ~ ~o. of lines ken,th of each line Total Ionoth of linos Trench ~[dth Distance between lines ~ ~ ~ inches ~ ~ To~ of tilo to finish ~rade Matafial boneath ti~e Total effectiue absorption area ~ inches Length~/ Width Depth ~ PERMIT NO. ~,~ Type of crib ./~ Cdb diameter ~/. Crib depth ./. Total effective absorption area Building foundation Nearest lot fine ' C'as~ r --' ~ ~ ~ ~pt~ ;' Driller Distance ,o Io, line m PE.MmT NO. ~ DISTANCE TO: ~uild[ng foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER ~ '~ ~; m' ; ............... ~;!" ' '~' .'' APPROVED DATE LEGAL Vlv/e4 Lo+ n 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 PHONE [~i~ N EW MAI LING ADDRESS LEGAL DESCRIPTION - LOGATIO~ ~ J Absorption are~ Dwelling PERMIT NO. ~<h ~ Manufacturer~ ~.t~iagre~/ No. of compartments ~ ~Li) ~p~n inside length Width Liquid depth . gallons IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer · --~ Material Liquid capacity in gallons No of nes~ Top ~5-fJni~h g~ade- - ~ Material beneath tiJe~ ~ Len~_.~_~__~.~: ~i~t~._~ Depth PERMIT NO. ~ ~ Type of crib Crib diameter ~ ~ Crib depth Total effective absorption ~rea ~ DtSTANOETO: Buildingf°undati°n / 8ewerlin° ~ ~/'Septictank/ / Absorptionarea(s) OTHER / ~ /~ SOILTESTRATINGPIPEMATERIALS /' , ' ' =,, ~ ~ ,~ j .. deepe~, th~ ~ed on the T , installa~ p~mit~ soil ~.,~ test mus~ be~pmpleted to verify ~ha~h~bottom of the the ~eter table an~6' above bedrock. ~, 2. A c%eanout must be installed ~, Cb 4' from the founda~on w~ 1. ~~ x I ~'~' ..'; = ~'~.. '~ ~_ ~ ' DEPFIR'ThlENT OE' HEFtLTH RND. ENVIRONMENTFIL PROTECTION 825 L STREET., RN'CHORFIGE., 264-4720 ~3~"-~---E; ]: "ti"tE :~.:.E; E: ~.,4t[£ F=: F' EZ F4:Ir'-1 .l]T PERMIT NO: B, FITE I SSI...IED: 840077 0]::'2~/84 FIPPL. ICRNT: RDDRE%S: CONTRCT PHONE: FIRCTIC DEVEL. OPEMENT 4460 BU:.-];INESS PFIRK BL:VD RNCHORRGE., FfK S~:.q. 50 Z.'.": 56]:0744 L. EGRL DESCRIP: L. OT SIZE: LOT L. OCRTION: MRX BEDROOMS: SUBDI',,,'I%ION: NORTHI.4OODL..] ~4 SECTION: 3: "FO~4NSHIP: .15N 26447 (Si:.], FT. OR f~CRES) E:HUG IRK 4 LOT: RRNGE: BL Dr-:l'.': '. '17 DEPTH TO PIPE E~OTTCIM '::FT. GRFI',,,'EL DEPTH (FT.) TOTFIL DEPTLI (FT. ::, GRFt'v'EL ~4I[:,TH (FT) GRR',/EL LENGTH ,::FT. ) GRRVEL k,'OLUME (CU. '¢DS. ) TFINk' SIZE (GFIL. S.':, SOIL. RRTING (:.:.';f-.]. FT. ,.."BR) LISTED BEL. Ot.4 FIRE THE OPTIONS FIVFIILFIBLE] TO '¢OU IN DESIGNING "fOUR SEPTIC S"r'STEM. CHOOSE 'THE OF'T:[ON THFIT BE'_=;].. FiTS ?'OUR SITE. 0.5 "2"~:. 0 .5. 0 4.._ 0 ii0. 0 ,.~._ .~ . 0 *:+: :1.., ;~'~ ::L 7 :.'2 .1 '72 ** GF.'.FIk,'EL L.ENGTH }'-7'5 FT. F-:EI;!UIRES MULTIPLE RUNS (]NOT EXCEEDING 75 FT. EFICH) *:+: TRNK MUST HR",/E FIT LERST TWO COMPRRTMENTS I C:ERTIF¥ THFIT: ::L. I FIM FF:IMILIFIR WITH 'THE REQUIREMENTS FOR ON-SITE SEP.IERS FIND WELLS FIS SET FOR]'H B"r' THE MUNIC:IF'FILIT'¢' OF F~NCHORI::tGE (MOFI) FIND THE STF:rTE OF RLFISKFI. 2. I klIL..L. INS;TFIL. L THE S'¢STEi',I IN FICC:ORDFINCE I,.ItTH FILL MOB CODES RND REGULRTIONS, RND IN COMt::'LIFII'4C,'E I,.IITH THE DESIGN Ci:~:ITERIR OF THIS; PERMIT. :~:. I I.,.IIL. L. FIE:,HERE T: FILL MOR FIN[:, STFITE CF FILRSKR F.':EL.-::!UIREMENTS FZF.' 'THE '.=-SET BFICI<: DI:STFINCES FROM Fii'.,t¥ EXISTING i.,.IELL, ~4RSTE.WRI"ER [:,ISPOSRL S'¢STEM OR PUBLrC SE!.4ERRGE S'¢STEM ON THIS OR FtN'¢ FIDJFICENT OR NEFIRB'¢ LOT. 4. I ..I',I[,ERSTF-IND THFIT THIS F'ERM'IT IS ',,.'FtLIE:, FOR R MR::-::IMUM OF' 4 E:E[:,ROOMS FIND FIN¥ ENL..FIRGEMENT I,.IILL REE'!UIRE FIN FIDDtTIONRL PERMI'T'. IF FI LIFT STFtTiON IS INSTRLt...E:[:, IN FIN RREFt Z:O',?E-RED E:"r' MOFI E:UII_[:,ING CODES., TI--IEI",I ,:::.1.::, FIN EL."F~TRICFIL F'ERi'~IT FIND II",tSPECTIEIN ["lUST BE OBTFIINED.~ (:2::, FI:=']-BUILT'-% Iii i',I TE[ HF i E[ I [ ii ._. ...... · '-': .: E '"PJP~:],, :L:: ..I~"H:¥I? t'SN ELECTRICFIL INSFECTION F..EF'ORT.~ FIN[:, ,:'m:':, ]"HE E,'"r' R L. I CENSED ELEE:TF.: I ii: I FIN. 4E~.EE:TRIC"L. k~i"IUST ~ [:,~.~ ,' ,, ......................... ~ _ ~.MUNICIPALITY OF ANCHORAGE Department~ ~ Health and EnvironmentaT '?rotection ~ 825 ,. Street, Anchorage, AK, ~9501 - 264-4720 ~'Z,//~ '~7 * * * HANDWRITTEN PERMIT * * * Permit ~~/~ ~ ON-SITE SEWER PERMIT Location: ~.~J. ,~/~ ~ .~ ~0~ ~u~er: ~'~ ~, Legal Description: ~ ~ ~ /7 ~¢~~ ¢ Lot Size, Ty~e of Soil ~sorPtion System ~s: ~..>3 T/EN Trench: Drainfield: / Seepage Bed: Holding Tank: ~aximUm N~ber of Bedrooms: .~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: DEPTH ~ _ LENGTH ~ ~. GRAVEL DEPTH ~,,~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~,~T-O 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 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 and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * 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~uire enlargement if t he~?~iden~~modeled to include mo~~o_msl ~ Ap~icant ~" SWP/024 (1/81) [:,EPI::tt':::Tt'"IEI'.,IT O~ i.-IERL_TI-..i ir:lNg':, EI''I,, II;;;:ONt"IEt',ITFtL. 825- '"L'" STREET., FtNCHORI".:IGE., FI[( ':;~950~L 264--4720 : RNCHOF-'.'RGE 694-2::~3:& : EI"-'IGLE RIVEN C~ ]"~ ....... :5;; Z "'Y E S; E~ 11..,4 ~ [~&' F:> E~ t~_" ~"I 21[. '"~ PERNIT NO. 03::202]:0 FIPPLICRNT: STEVE SI-':.'FtGGS PHONE: 688-283:t RE,DRESS: PO BOX D CHUG I FIK., RI..'.'. LEGRL DE£;CRIPTION ..- SUBDIVISION: NOF...'THI4OODS .~4 BLOCK: t7 LOT: LOT SIZE 0 SQ. FT. TOI4NSHIP: .... RRNGE: SECTION: -.. f"IR;,.,;INLIN NUf'tBER OF BE:DROOl"IS =. 3: SOIL NFITINO = :L?'2 t;-'"2 t72 ,.'.'Si;! FT. LISTED BEL. OF.t RRE THE OPTIONS FIVRILIqBLE TO '-r'OU IN DESIGNING "r'OUN SEPTIC S'¢STEN. CHOOSE THE OPTION TI-IRT BEST FITS 'COLIN SITE. HIC'TI'I = 2. 5 FT. LENGTH = SS. 0 FT. NOTE ~ - .":-"75 FT. RE6,~U ]: RES THO TRENCHES TOTRL DEPTH = 5. 5 FT. NOTE ! REg!LI ]: RES INSLILRTtE~N GRR","EL DEPTH = Z::. 0 F'T. NOTE ~ '-' I"'iR'¢ REL.qLIIRE L]:FT STRTION GF-'.'RVEL VOLUI"IE = 27. OCLI. TRNI'( SiZE = ±., 080. 0 GRLLONS (THO E:Or¢IPRNTr'IENT TRNK) b~, ,.. TI I - / .:.,;ri ~_. a F'T~ :" / 0 L, EN.~TH .."= . 40. F% 0 " e · T¢tTFIL [:'EF'TH .... FT,/ E'iNR'v'EL DEPTH = %._~EI. ~ GF..'RVEL 'v'OLUhlE = 2SL G CU. TRNI.( SIZE = t, 08¢. ¢ GI"'iLLONS (THO CONPf:INNTI'IENT TRNI::.') ~--..!t Z [:. ~rU-'E_ IE::~ F-'::F::It :.T. !f~.4 F= LT.: ~b.[2:: 12:,~':=; .']: HIDTH = 5. 0 F'"r'. LENGTH = 81. 0 F'T ! NOTE ~ - :).75 FT REQUIRES 'TLbiO TRENCHES TOTFtL [:,EF'TH = 5. 5 FT. GRFIVEL DEPTH = I. 5 FT. GNFtVEL ',,.'OI....UI'flE = 2.':0. 0 CU. '.¢[:,S. 'TFli'.,Ii::.' SIZE = I, OE~EL 0 GFtL. LOi''IS (TglO COi',IF'I::II~:TI"IEI'.'IT TFIi'.,II.:::::, i CEF.:T I F'¢ 1.. t FiN FFft"IILTF~N HITH THE REQU:I:NENEi'.,ITS FOR Ot''I--.SITE SEHERS Ffl'.'ig, HELLS FIS SET FORTH B'.r' THE I',I!...II',IiCIPFiLIT'.r' OF' FINCHORFIGE f:tND THE STFtTE OF FILRSI<:I:t. -"- .IE ii'4 FtCCORDFINE:E H ITbt THE CODES FIi'.'I[:, HI::IVE NECE ZVED ;.'2.I HIL. L IN: Fl tl. ...... '"-'.:,~- '-:,TE.H ..... F:I COPM OF." THE CODE ':";UNNF:hr:;:'.¢ tqlqD DII::IGF~'.I:rh~f F:tT'TFICHI"IEt'.'ITS HHICH ]:S PFIRT OF TNIS PENN I T. 3:. I UN[:,ERSTFIND THI::IT THE Oi''I...S]:TE SE,klER S'¢S"I"E[,'I I'flF-I"r' REQUIRE Ei'.,tLFINNGEHENT iF THE NESIDENCE IS NEi'flODELE[:, 'TO II'.,ICLLIDE t"IONE THFIN 3: BEDNO0t"IS. F'ERP,]:T FtPPL. ZCFtI',IT HI:tS "i"IIU F;'.ESPONS:I:BILZT'¢ TO II'-'IFORN PERSOi'.,INEL DUF..'ING ]"HE ZNSTI-:tLLI.-.ITIOI'.,I INSF'ECTIONS OF FIi",I'¢ HELLS FID._'rFICEI'.,tT TO THIS F'ROF'ERT'¢ FIND THE ,~.,IUI','tBEF...' OF NUSII::,EI'.,ICES TI...IFIT THE HELL !..'IZLL SERVE. I.F Ff LIFT STFITZON IS ]:I',I£;Tt:::tLL. ED., FIN ELECTF;:ICFtL PENt'.IIT FIND INSF'ECTI'ON I',IUST BE OFi:TFiII'.,IED. FtS...-BU]:LTS Ct::tI',Ii',IOT E:E FIF'PRO',,,'ED H]:THOUT FII'.,I EL. ECTF:.'ICFiL II'.'ISPECTION NEPOF,'T. THE' EL. ECTF:.'~.CFIL HOI:;:I.::: NLIST BE I?,Oi'.4E B'¢ Fi LICENSED ELECTK'IC:[FII'.,I. S I GNED: F'IPPLICFff,IT: 5TE'.,-'E SI.:.'.'!::IGGS [:'RTE: MUNICIPALITY Of ANCHORAGE Department :-~ Health and Environmenta],~otection ~-, 825 ~ Street, Anchorage, AK. ~J~501 ' ~ 264-4720 ~ * * * HANDWRITTEN PERMIT * * * Permit ~ ~ /0~?~ ~ ON-SITE SEWER PERMIT Applicant: ~~- %~S~~. Mailing Address: Location: L& .~ I~ ~n~~ ,~hone Number: ~5~-~S~ Legal Description: ~_ . ~_i- Lot Size: Type of Soil Absorption System IS: Trench: Drainfield: Seepage Bed: u'/' Holding Tank: ~aximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: ' ~_~~ o ~ ~o ,, ~ · DEPTH ~ LENGTH~~ ..~GBAVEL DEPTH C¢ The length dimension is the length(in fee~) of the trench or drainfield. depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE TM /(](2)(ii) 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 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 and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * * I certify that: (1) I a~ 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 that 3 bedrooms. Signe~:~ ~' Issued by: C,~ ~~' ~ Applicant Date: /O- o SW~/0Z4(1/Sl) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERCOLATION TEST PERFORMED FOR:~m~L~~ LEGAL DESCRIPTION: DATE PER FORMED:~~~.__ 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17, 18- 19- 20- COMMENTS WAS GROUND WATER ~C) ~. ENCOUNTERED? O P E IF YES, AT WHAT ~ DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /a, : :zq 41-izo U,,;Z? - ,50 z I b:3'tl ,~ , qz . O ~ ,q~ it,,:,.t'ls . qZ, . $ ~/,,:~¢ ia .:il7-,_ . P.RFORM.D.": 1oo_ d 72-008 (6/79) M U kl V MPA U ll ll OF AH C H O R!/—tl `�"J E Development Services Department = Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-064-47 Legal description Northwoods #4 Block 17 lot 6 Site address 23431 Blue Skies Current property owner(s) Doughty Expiration Date: 7-21-23 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaLJune 2022 MUHMPAUTV OF ANCHORA CSE Develo ment Services Department E p p `--; Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051 064 47 Complete legal description NORTHWOODS #4 BLOCK 17 LOT 6 Location (site address) 23431 Blue Skies Current property owner(s) DOUGHTY Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units X Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age <2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ®❑ Wide Trench ❑ Seepage Pit Waiver request for: NONE Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $__6 50 Date of Payment SA,/22 COSA# C 2 H0 � Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Northwoods #4 Block 17 Lot 6 Parcel ID: 051 064 47 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for COSA Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Static water level at beginning of test ft. Comments B. TANK DATA Measured operating fluid level in septic tank 56 Date of pumping 7/21/22 ❑ Required maintenance completed, if AWWTS Comments: level measured before pumping. D. ABSORPTION FIELD DATA Collected by Date C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 1998 Adequacy test date 7/21/22 ALL—standpipes-present-per--record-drawin Total measured depth from grade 6.8 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4 ft (min) Water added 600 gal ❑ N/A — pressurized field. New fluid depth 3 in FO -1 Per record drawings, field is insulated. Elapsed time 60 min ❑O Monitor tubes go to bottom of effective. Final fluid depth 0 in If not, state depth into effective ❑■ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2500 gallons 7/20/22 date Any rejuvenation treatment (past 12 months) no If yes, enter date none Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 32 in Effective depth used 0 in Effective depth remaining 32 in Comments/Deficiencies: Belly in line after tank repaired. Field Cos, MTs repaired. COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Q Yes if No Community Sewer Manhole/Cleanout > 100' Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100'❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft 0 Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' D Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' ❑i Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑■ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm C&M ENGINEERING Engineer's Printed Name CHARLES BALZARINI COSA Checklist June 2022 Phone 907-854-5558 Date 8/6/22 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 1. GENERAL INFORMATION Complete legal description HAA# ,,~A cl t4' 0 L~I~ Lot 6; Block 171 North ~Ood Subdivision Location (site address or directions) 25431 Blu6 Skies Drive ', P~crs Cr6~k Property owner Mailing address Lending agency Mailing address Michael & June Sharp CiO R~max o4 Eaal6 River Day phone 16600 C~n.texfZeld O~Zua Day phone Eag~a ~iue~, AK 99577 Agent Sharon Minsch/ REMAX OF EAGLE RIVER Address 16600 C~nt~rfi~Id Driv~ Eaql6 River, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well X×X Public water Day phone AK 99~77 694-4~00 NOTE: ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: NOTE: If community well system, provide written confirmation from State ADEC attest- Individual on-site XXX Holding tank 'Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£O attesting to the legality and status of system..:!': 72-025(Rev, I/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. Name of Firm Phone ~ ~'/7/"~-~;2 ~ Address Engineer's signature DHHS SIGNATURE S & S ENGINEERING/~/ _/. 17034 Eagle Rive ~P React ~=.1,. River. ~ c= 99577 bedrooms. 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-O25(Rev. 1/91) Ba~k MeAtY21 ': ': Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~r ~-~ {~L,I/--I1 .~d~tZ~ J~' 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 FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot '~3~ ~"¥' Absorption field on lot '?~-,~ z> Public sewer main Sewer service line Wires properly protected (Y/N) .g.p.m. ATINSPECTION ; On adjacent lots g.p.m. ~ < >- o:, -r ; 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 ~ ~/~ '~ ~'~ High water alarm (Y~_ Date of pumping Tank size \'7~ Compartments Foundation cleanoul~l) ~ Depression (¥/~) /-~ Alarm tested (Y/N) ~-~"';~/~5 Z.// Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK Tp: Well(s) on lot -~..~c)~ On adjacent lots To property line ~ ¢ ~ ~"-5'" / Surface water/drainage Absorption field Foundation ! ~'~ / Water main/service line ~ / '/- 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" High water alarm level Cycle~te~d Meets MOA electrical codes (Y/N) N TO: On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~L..~ ...._ dc~ Z~ Length ~ [ Total absorptiOn area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~) Soil rating (GPD/FF) Width ..~_.~1 Gravel thickness / ~ ~ ~) ~1~ Cleanout present4[~N) t/~,"".2-'/--/c-"~ /~' Resulted. fail) /,,4.-~5 '~,,5- / Total depth Depression over field (Y/t~3 for ~/ Bedrooms After test /'g"~/~ '~-".~'/"J' If yes, give date "~/'//~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~ ~ Jr' ~[~ On adjacent lots Property line To building foundation On adjacent lots Surface water \ Curtain drain To/existing or abandoned system on lot Cutbank '~ [ A-- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or Signature ..... ~/'2 ~/" ..~'.~'- ' Engineer's Na~034 Eagle Eagle R~ver, AlasEa Date Date of Payment Rece,pt Number .') Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back 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 I. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township,.~ge) Location (address or directions) (b) Applicant Name t-~ ~L.,~,_'/~L,~.~p Telephone: Home ~'~-*~:~ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder J~'; Buyer []; Other [] (explain); (d) Lending Institution I',~r~,~C[A"t...~'D ~--~.~"~ Telephone (e) Real Estate Company and Agent Telephone ~ (f) Mail the HAA to the following address: $ & $ ENGINEERING S~B 196X EAGLE if. IVE~:~ AK TYPE OF RESIDENCE Single-FamilyJ~- Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community [] PublicJ~ 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 I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDi .~INSPECTIONS, TESTS, FILE SEARCH, r~ A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this insp~osnENGiNEEEiNG Name of Firm ~R~ i96X Address Date Telephone D HEP APPROVAL . Approved for ~ bedrooms by Approved .~.._ Disapproved ~onditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MC~,.~) MUNICIPALITY OF ANC~C'~RA~F DEPt. OF HEALTH'F~IE~''I~TH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTIO~IHECKLIST - FEBRUARY lg84 264-4720 291g RECEIVED Well Classification Well Log Present (Y/N) Total Dept Static Water Level c~sing Hbigh~..Ab0ve Ground El~c~'~ical Wiri~g in Conduit'(Y/N) Separation Distances from Well: T0'Septic/.f~J~g Tank on Lot Legal Description: ~ ~ '~ IfA, B, C, D.E.C. Approved ~[;;!~l) Date Completed Yield Cased to ~ Depth of Grouting ~."1 / ~ Pump Set At //"'% Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To ~ieSt Edge of Absorption Field on Lot ~ ~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments [~ z:> ~'f'MC¢--%Oc~ ~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/H4~'Bt/~'~rANK DATA Date Installed Standpipes ~i~/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/l=le,~H-ng Tank: To Water-Supply Well '7.-c~ o l.p_ To Property Line To Water Main/Service Line .Cpurse comments Size ¥'/-~'~ No. of Compartments Foundation Cleanout (~'N) Date Last Pumped ~.-~.~--'i~ ~/~ ; for '---- / Temporary Holding Tank Permit (Y/N) To Building Foundation \'7_. To Disposal Field ~5' ~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata \~ o¢~'ll~¢1-''- Type of System Design -~:C:~ Date Installed I~ -dr ~¢¢ Length of Field ¢¢'~ / Width of Field ~..~¥-I t/"' Depth of Field , :~ / Gravel Bed Thickness '~, ~" Square Feet of Absorption Area ! c~i~, ~ ~¢' ~ Standpipes Present ~N) Depression over Field (Y/(~. Date of Last Adequacy Test Results of Last Adequacy Test ~J~'~""~¢~l - Separation Distance from Absorption Field: To Water-Supply Well 7...~ I..p To Property Line '~ '~ I.~ To Building Foundation ?.5' /¢ To Existing or Abandoned System on Lot .~.¢,.~ r.~ On Adjoining Lots "-~ ~-~ ~ ~ %4- To Cutbank (if present) To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pure p Off" Level at Vent (Y/N) Pure ping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify tl~t~l'~l~~l, or conformed to all M~)A and I--)AA guidelines in effect on the date of this inspection. Receipt No. .~"'~ ~)//~) ~ Date of Payment /2~/.~;~'/? Amount: $ ~--"~~ Page 2 of 2 72-026 11/84) MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRDNMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date . (a) Legal. Desc~ip%ion ( include .lot,. block, subdivision, section, townsh'ip, range ) Location (add~ess o~ directions) Applicants Add~ess ~/X/~¢0 .~"]/.z_S/~/f~$ /~ IP-_[ °. /$~I, /drK, C/~?~'02- (c) Applicant is (check or~) Lending Institution ~; Owner/builder~--~ Buyer F---l; Other~ (explain); (d) Lending Institution __ Telephone Address (e) B~al Estate Co. & A~ent Address Te le phone _Type of N~sidence Single-Family Number of Bedrooms 3. Water Supply Multi-Family ~-~ Other (describe) Note: If c~nity ~11 system, must have w~itten confirmation f~cra the State Department of Environmental Conservation attesting to the legality and status. Is the ~11 adequate for the n~mber of kedrccms specified in this HAA Sewage Disposal Onsite ~-~ Public ~ Community ~--~ Holding Tank ~-~ ' · Is the wastewater disposal system adequate fc~ the rnmbe~ of b~drocms ~/N) [Page 1 of 2] 2-15-84 5. Engineering Firm P~ovidin~..I.nspections, Tests, Data and Information I certify that I have checked, verified, or confczvaed to all MOA HAA Guidelines ir effect on the date of this inspection. Sig~d ~ Date ( ENGIMEER SEAL) 6. DM~__P. Approval Approved for -// bedrocms Te~ of C~nditional Approval The Municipality'of Anchorage Elepartment of Health and Environmental Protection dc- nct guarantee the continued satisfactory perfo~mancs of t~e water supply and/or th: wastewater disposal system. 'lY~is apprcval indicates that, as of the validation da sho~n abo~, based on the da'La and information furnished by an engineer registered the State of Alaska, the water supply and wastewater dispcsal system is safe and f~ ticnal fo~ the numbg~ of bedrooms and type of st~cucture indicated. ( DHEP SEAL ) 7. Mail the HAA to tb~ following address..' KB2/d5/s [Pa~ 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AIFI~ORITY APPROVAL (HAA) Well Classification ~ Well Log P~esent (Y/N) Total Depth ;U~ .. Cased to S~atic Water ~evel Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances frc~ Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line A4UNICIPALITY OF ANCHORAo~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 If A, B, c~ C, D.E.C. App=ove~/N) Date Cor~pleted ~%///r- . ... Yield ;~)//~ Depth of G~outin~ . . Pump Set At Sanitaz-f Seal on Casing , Depression A~ound Wellhead (Y/N) ; On Adjoining Lots ~t){/~ ; O~ Adjoi~in~ Lots To Nearest Public Sewer Cleanout/Manhole Water Sample Collected By Water Sar~ple Test Results C~nts JuI~- To Nearest Sewer Service Line on Lot N / F{" ; Date SEPTIC/HOLDING TANK DATA Date Installed ~/~/~. Size Standpipes ~/N) Air-tight Caps ~f~I/N) Depression ove~ Tank (Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~//~, for Holding Tank High-Water Alarm (Y/N) /t;//~- Tempo~a~,.Holding Tank Permit (Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well ~/~ , To Property Line To Water Main/Service Line Course No. of Cu,~a~tments Foundation Cleanout ~/N) To Building Foundation To Disposal Field ~ ~-~ To Stream, Pond, Lake, c~ Major D~aina~e ABSORPTION FIELD [~TA Soils Rating in Absorp~tion, strata Date Installed Width of Field Square Feet of Absorption A~ea · Depression over Field (Y~ Results of Last Adequacy Test /?O ~ Type of System Design Length of Field Depth of Field ~,~- Gravel Bed Thickness Standpipes P~esent~/N) Date of Last Adaquacy Test ~- Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ 7 ~O! To Wate~ Main/Servi~e Line To Stream/Pond/Lake/or Major D~ainage Course A;~r To D~iveway, Parking A~ea, or Vehicle Storage A~ea / ~/f4~_ To P~operty Line ~-~ TO Existing or Abandoned System ; On Adjoining Lots ~ .~ o ~- ~[' To Cutbank(if ,present) D. LI~ S~TION Date Installed /~ Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) C~nts Dimensions fu///~ Manhole/Access (Y/N) · "Pump Off" Level at Vent (Y~) ~ing Cycles ~ing Adequa~ ~st. ~ets ~A ** Check Permitted Bed~ocm Rating Against HAA l~equest I certify that I have checked, verified, or oonfc~m~d to all MOA on the da ts of this inspect ion. S ig~ed ~.~-~~~ Date Company ,/~'~ MOA No. KB1/d5/s [Page 2 of 2] HAA Guidelines in effect 2-15-84 ALASKA el OIROrlml llTAL COI]TROL sel ulce,$, IFIC. ~nqinee~inq G ~nuironmentel Studies April 5, 1984 Mr. Keith Bandt Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 SUBJECT: Northwoods IV, Lot 6, Block 17 Dear Mr. Bandt: On April 4, 1984 this office inspected the installation of a seepage bed (Permit #840077) on the above property. The 'previously' installed drainfield was abandoned prior to the new excavation. The bed w~s installed in the soils test location and in soils not previously excavated. A foundation clean-out was installed. If this office can be of further assistance, please contact us at (907) 561-5040. Sincere ly, Larry D. Montgomery Engineering Technician LDM/caj 1200 LUCsi 33rd Aucnu¢. $uii¢ [~, Anchoraq¢, Alaska 99503"{907} 561-5040 DEPT. OF ENVIRONMENTAL CONSERVATION To Whom It May Concern: April 5, 1984 BILL f~EFFIELD, GOVERNOR ~lephone: ~0~ 274--2533 Address: 437 E. Street Suite 200 Anchorage, AK 99501 According to records on file in this office Northwood Subdivision (Phase IV) Water System is in compliance ~ith the State Drinking Water Regulations. Sincerely, An ch o rag e/We s tern District Supervisor JCA~msm cc: Alaska Environmental Control Services 1200 W. 33rd Avenue Suite B Anchorage, AK 99503