HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 13 LT 5Northwoods Block ! 3 Lot 5 #05! -732-26 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Boz 196650 Anchorage, AK 99519-6650 Page Of www.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWOCOO!30 PID Number: bSI-73-z-ZG Name: a e b a!n 14 C vin Wastewater System: DJ New ❑ Upgrade Address: n.dgo/Z7ltVz C vo (c 95b7 ABSORPTION FIELD Phone: Number of Bedrooms: 6 r9lu � [-!p '3 D b ❑Deep Trench OL Shallow Trench O Bed O Mound ❑ Other: LJEGIAL DESCRIPTION Sail Rating: �7 Total Depth from original grade: (�1. Cf GPD/FI? Ft. Black: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: ��/y 13 0%9(.t - S DD ` Ft. 3, () Ft. Township: Range: Section: Fill added above original grade: -Z Gravel Length- f FI. Ft. Well: ❑New ❑ Upgra Gravel width:f s Numberoflines: Z Distance between lines: ' Ft. [r9, S A. classification (Private. A, S. C): Total Dept: Cased to: Total absorption area: Pipe Material: (7 3Q 3q t FI. 7S� F1' I F90 Duller: Date Drilled: Sialic Water Level: Installer: pec Dale Insmlled: S�Z3 s/2 FL (zle6o''.rJCat Yeltl: Pump Sail: Casing Height Above Ground: TANK GPM FL FI. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding PubliclPrivat Manufacturer: \�.tyt Capaoty: From Tank Field Station Tank Sewer Line Gal. 0�9 y ^- ._- Malenal: Number of compartments: well Drl� IVI Surface Water (pp-`� (170 LIFT STATION �y f Size: Manufacturer. Lot Line 06 f -' Gal. 'Pump on'level at: 'Pump ofr at: High wafer alarm at: Foundation 7 jQrf in. in. Curtain Drain 1/wit I bo _ .-. Pump MakeB Electrical Inspections performed! by: Remarks: BENCH MARK Xf 5i'/H of /N c Q aw%1 Location and Description:.,VK ppnn 4c, 6e- c«t' fJcF.{2... LV' c,&rkr. h& Assumed Elevation: Ft. Engineer's Stamp OF 4G ®@ g e•••....a.nuso'°rsaf.�i .• e% �® �o Inspections performed by: KND EH6fI14cI:VI14c1 Dates: list !C173100 2nd $/-z V�00 �..4e... ........... Department of Health and Human a� Services ap o o ,� KanaCEt M. Duf /man Reviewed and approved by: /G�///� / LV Jofz�c Date: �P a�'�o $P�4®�ooq�Qt�•����®� (Rev. 11199) V f�p N ESSlO P A—C=65.1' B—C=19.3' A—D=74.1' B—D=41.3' A—E=89.7' B—E=50.0' A—F=56.6' B—F=58.2' A—G=100.0' B—G=65.2' A—H=71.8' B—H=71.2' AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW000090 N❑RTHW❑❑DS S/D, ADDN #3, LOT 5, BLOCK 13 PID#051-732-26 N N vw SEPTIC SCALE, NTS i ...�F..��45 h VIVL1'n M. vu C' % / CE -71 Aj i,1 �t�ssloK�F � TH#KND00- Primary Fleld H CD - F Existing Fleld TB A 3 BDRM a a a 5 =-a -------------' 97A FINAL GRADE MM fI cR / SEWER ROCK TRENCH 1 46.7' — FINAL GRADE .J SCALEI 1' = 50' MONITDR 93.7 SEWER ROCK TRENCH 2 C9_0.7_5_>,[ 46' 79.2 m PREPARED FOR: JOE LANHAN P.O. BOX 671142 CHLIGIAK, AK, 99567 FIELD BOOKS MIPU m: ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 eouNoartr: WALATKA DRANK: vBG AMM WALATKA CHECKED: KMD A 'LT'WALATKA DATE 6-9-00 On. RM. cRiD: NW1459 (907)696-6111/FAX (907)696-8111 ACAs FRE` 00002.DWG °B "°'` 00002 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000090 Legal Description: NORTH WOODS UNIT III BLK 13 LT 5 Design Engineer: 0070 KND Engineering Owner Name: KND Engineering Owner Address: 20441 Ptarmigan Blvd. Eagle River , AK 99577- 5- 2 3--00 Date Issued: May 05, 2000 Expiration Date: May 05, 2001 ParcelID: 051-732-26 Site Address: 023047 LIVE ALDER AVE Lot Size: 26834 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 3 This permit is for the construction of: n Disposal Field Fv� 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL PERCOLATION TEST WHICH CONFORMS TO 15.65. O1 SUIL- PERE. 7P --ST Received By: Issued By: Date: >7-- S--6yo Date:.S-S—t�f� IKND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 April 18, 2000 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit — Northwoods Add. #3, Block 13, Lot 5 Gentlemen: At the request of the owner for the subject lot, on April 5, 2000, we excavated one testhole for the subject property to upgrade the existing system. The existing system is still functioning but the owner desires to construct a new system due to the age of the existing facility. We installed a monitoring tube and monitored water in the testhole. The results of the percolation test and water monitoring are attached. We propose to install a 5' wide shallow trench with the retention of the existing field for use in the future. The existing tank will be excavated and its integrity verified. Additional fill will be provided over the system as required. This lot is relatively flat and slopes from south to north away from the existing field and the house at approximately 2-3%. The property is served by public water. There are no other public or private wells within 100' of our proposed system location. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, 11KND Engineering Kenneth M. Duffus, P Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA NORTHWOODS S/D, ADDN #3, LOT 5, BLOCK 13 NO PUBLIC WELLS WITHIN 200' OF PRDPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PRDPDSED SYSTEM EXCEPT AS NOTED. ALL LOTS SERVED BY PUBLIC WATER Ar 0 � OF ALS * 9 *� . `.. CE -7116r Wa / PAO AW 1 \%PgSSI0 'L 'k'rah'__t DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/0.6 GPD PER SQ. FT. = 750 SQ. FT 750/5' X .58 R.F. (3.0' GRAVEL) = 87 FT. TRENCH Use 2 trenches 43.5' (L) x 5'(W) x 3'(D) Total depth of system is 4.0' from original grade. Total depth of gravel below pipes Is 3.0'. NOTES; L USE SPLITTER TO EVENLY DIVIDE FLOW INTO TWO TRENCHES. 2, USE 1000 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER. 3, INSULATE TRENCHES 1,1/2' HD BURIAL FOAM IF LESS THAN 4' OF COVER, 4, CONTRACTOR WILL ENSURE MAXIMUM 2X SLOPE INTO SEPTIC TANK. 5. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER, PREPARED FOR: JOE LANHAN P.O. BOX 671142 CHUGIAK, AK 99567 FIELD BOOKS BOUNDARY: WALAT STAKING: WALAT ASBUILT: WALAT DWG. FILE: ACAD FILE. 00002 COMPUTED: DRAWN: CHECKED: DAIS: GRID: JOB No.: 00002 Scalel 1'= 100' PAGE 1 ❑F 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 WASTEWATER DISP❑SAL SYSTEM DETAILS NORTHWOODS S/D, ADDN #3, LOT 5, BLOCK 13 I #KND00 1 ?d Primary Field K�ID f g Field 0 0 3 BDRM 60 of OF AL - 41��� PREPARED FOR; JOE LANH P.O. BOX 671142 * . 49 TH� * �A CHUGIAK, AK 99567 `._ KENNY M. S.' CE -7116 W4 / ,, .... .` W 1� ............' W 1 \� y ph'OF'ESSION� FIELD BOOKS COMPUTED: BOUNDARY: WALATKA DRAWN: KMD srAewc: WALATKA OHECKED: KMD ASBuaT: WALATKA DATE: 4/17 DWO. Fly: MID: NW145 ACAD FILE: 00002 BOB No.: 00002 (-DIVERTE >C ❑ 1000 S T FC❑ n N Ll TT Scale: 1'= 20' PAGE 2 OF 2 J_4SJSV ZJ ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 111/FAX (907)696-8111 IK14D ENGINEERING A� 20441 PTARMIGAN BLVD. m Gig EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for: Joe Lanhan Date Perform( Project: Northwoods #3, B13, L5 TEST HOLE # Depth (Feet) SEE ATTACHED SITE PLAN ORG - rootmat FOR HOLE LOCATION JIM 14- 15- 16- 17- 18- 19- 20- SM/GM - loose w/ cobbles to 6" SM—increasing density w/depth Dry, no water B.O.H. GRvuNO w!f oIV�q�00 HOLE PRESOAKED PRIOR TO TEST Was Ground water encountered? NO What depth? NA Depth to water after monitoring? NO Date? 4/13/00 Reading Date Gross Time Net Time Depth to Water Net Drop 1 4/5/00 1:00 7" - 2 1:10 10 min 62/16" 14/16- 3 1:10 62/16- - 4 1:20 10 min 55/16- 13/16- 5 * 1:21 7" - 6 1:31 10 min 65/16" 11/16- 7 1:31 65/16 - 8 1:41 10 min 59/16" 12/16- 9 1:41 59/16" - 10 1:51 10 min 414/16" 11/16" 11 1:51 414/16" - 12 2:01 10 min 43/16" 11/16" * Water Added Percolation Rate 14.55 (min/in) Perc Hole Diameter 6" Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. /2-U7S 1Hev. 3/76) 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 PKNEW L, UPGRADE MAI LIN ADDRE qlbo- x to LEGAL DESCRIPTION LOCATION / a✓w^ S� NO. OF BEDROOMS 2 bm a 3 DISTANCE TO: el Absorption area Dwelling P MIT N . U Y . a~. Q Manufacturer Mater' No, of compar_ ants W� y Liq. ca a ' y' Ions IF HOMEMADE: Inside length Width �� Liquid depth --� O Y DISTANCE TO: Well Dwelling PERMIT NO. Ja 02< z< Manufacturer Material Liquid capacity in gallons Lu DISTLu ANCE TO: e,)I , Foundation Nearest lot line P ITN LL Z Zw No. of lines Length of each line Total length of lines Trench width Distance betweer'Iinas F- inches [P cc f- Top of tile to finish grade Material beneath tile LO Total effecti atimrea inches, Length idth Depth PERMIT NO. W 0 Q I`_ wa of crib Crib diameter Crib depth Total effective absorption area Lu DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO, W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 2 pQ SOI L TEST RATII`jG Z p borooyn INSTALLER [ J G 6�3-106 IL REMARKS APPROVED DATE LEGAL kC + 5P� /2-U7S 1Hev. 3/76) Permit #_ Applicant: Location: MUNICIPALITY OF ANCHORAGE,., Department�f Health and Environments `Protection 825 i, Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT Mailing Address: U BSD Phone Number: (a 69 Legal Description: LSa r3 N01(2i-/'-w690ds 1T Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: r/ _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 31.>- DEPTH /.z DEPTH The Required Size of the Soil Absorption System Is:' LENGTH 10 9� GRAYCL 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 /dy�� GALLONS ?ermit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number 3f residences that the well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department ;gill be subject to prosecution. Kinimum 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 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include morethat 3 beArooms. Signed: Issued by: Applican Date: SWP/024(1/81) ` d SOILS LOG MUNICIPALITY OF ANCHORAGE PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PERFORMED:Ii�N3 LEGAL DESCRIPTION: Lo.f.5' Bialk SLOPE r SITE PLAN II t I f2 L FT—FT—� i 1- 2- 3- -4 5 6 7 8 9• 10• 11 12 13 14 15 16 17 18 19 20 COMMENTS S;Ii- , Sang, gravel, (GM) (Very Ac4rj below ra Feet) WAS GROUND WATER S rod ENCOUNTERED? No L O e P E IF YES, AT WHAT DEPTH? a 6 -7 i i3 �vYl'i n"• "f f✓T ;�, ,> r 3 PERCOLATION RATE_ �I��•�i , (minutes inch) TEST RUN BETWEEN J X? FT AND FT ST 9.3'-0x4 4 PERFORMED BY: R e slj ur / se) n CERTIFIED BY: 72-008 (6/79) DATE: Reading Date Gross Time Net Time Depth to Water Net Drop I'n .5Q +H).O 71463 )%A3 10 vr� os' 4 4 .0c ` j TTA A 3 a 711113 /On,lna, .405 ,035 a 1°;33 m33 �Q tHaO7/1?�1 15 10mfno• .46 , 0-f 3 iOV43 °5© rll,l7i`if fl 1,-53 10 mins' ,4F< <o4 r "53.46 + 711 i/S3 X,03 10 M1,651 .4.3 103 a 6 -7 i i3 �vYl'i n"• "f f✓T ;�, ,> r 3 PERCOLATION RATE_ �I��•�i , (minutes inch) TEST RUN BETWEEN J X? FT AND FT ST 9.3'-0x4 4 PERFORMED BY: R e slj ur / se) n CERTIFIED BY: 72-008 (6/79) DATE: CHR1�S �tjo,r{� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program << 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OS/— 73,E a fo HAA # Expiration Date: — I — 0 ro 1. GENERAL INFORMATION Complete legal description `AZO -Wi GUodd l 4Ve% S Location (site address or directions) .2304-7 -&4 Current Property owner(s) ,G_ tL a' Rdhl;' .47l kae7o&iLDay phone Mailing address Lending agency Day phone Mailing address n Real Estate Agent �1-{W-t WiSNriulSlcu Day phone 35/-oy3P Mailing Address _Crr�f.Qa.,d aatx*, ezy[.y Unless otherwise requested, HAA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site a Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Er Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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. Name of Firm Eagle River Engineering Services iijul VFW id., ue Address Engineer's Printed Name r_hrj:0Ahtr Gt�Dod S. DSD SIGNATURE ✓ Approved for bedrooms. Disapproved. Phone (,,&7q - 5195 Date 17M/os Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / p-�1 Original Certificate Date: L7 (Roy 01102) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: N07714�u4S -*3 L -c 6 13 Parcel ID: D.S L % 3 z -2, (0 A. WELL DATA Well type _ If A, B, or C provide PWSID # _ Date completed _ Sanitary seal (Y/N) _ Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RES Coliform _.�colonies/100 ml. Nitrate mg./I. Well Log (YIN) Wires properly properly protected (Y/N)_.e:::::� Casing height NW*7k ft. in. Other bacteria colonies/100 mi. mg.11. Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material . Auz Date installed'711/s/Q3 Tank size J,, ears gal. Number of Compartments _� Cleanouts (9N) Foundation cleanout ®N)* Depression over tank (Y(F�- High water alarm (Y/N)�a Date of pumping 4/1605 Pumper JR rS % kWL'ng C. ABSORPTION FIELD DATA Date installed 5&4L00 Soil rating ffd / or ft2/bdrm) A -Z Length 4llo ft. Width 5 ft. System type aatlaw T.rr" Gravel below pipe - 3.01 ft. Total depth T-7_ ft. Eff. absorption aret-m ft2 Monitoring tube }1, Depression over field u2fg �_-- Date of adequacy tes __ AJj2 Results (Pass/Faiar�S 1) _F�,- For 2 bedrooms ' Std [owr^t�r'S Fluid depth in absorption field before test Q_ in. Water added%%gal. New depthn. Elapsed Time: 326min. Final fluid depth I In. Absorption rate >= Ll Sd d- g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) ,* aru lgnewvi If yes, give date r2J'X *Ir $tf orN Exi*H11 C rroud t *'I Tscfsd tJorfli Tr=.►M, only D. LIFT STATION Date installed NO u I Size e in in gallons 'Pump on" level at_ in. Datum E. SEPARATION DISTANCES 'Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer mai service line Manhole/Access (YIN) High water alarm level at Meets alarm 8 On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation -t,5 # Property line *V Absorption field +S r Water main t 10' Water service line + 10 Surface water 10o Wells on adjacent lots + A00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Tin Property line -a /0' Building foundation '+10' Water main + 10 • Water Service line +1,01 Surface water r 100 • Driveway, parking/vehicle storage + 10 ' Curtain drain .frau kilam Wells on adjacent lots + y00 F. COMMENTS G. f9*F0R#11st0 til a++RN655 ouC- 001 L-A kO A:Ad AV MAL - 1w that 1 have determined through field inspections and review o/ Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. NIRlg70PFERR Engineer's Printed Name ChriftPp r Q. uJ od CE.M Date lWO r Nm99riti_ HAA Fee $ 4 3o • n Date of Payment -Ni i 5 Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number 04 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program S. T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-732-26 HAA# 04 n Z,S�tp 1. GENERAL INFORMATION Expiration Date: —6--- 1 (p — 0 _15— Complete legal description NORTHWOODS SUBDIVISION #3• LOT 5F BLOCK 13 Location (site address or directions) 23047 LIVE ALDER AVE * CHUGIAK AK 99567 Current Property owner(s) , VANESSA MCDONALD Day phone 688-8556 Mailing address 23047 LIVE ALDER AVE * CHUGIAK AK 99567 -------------- Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System N Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells ora public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I v nes for this application, my investigation, based on procedures outlined in the Health Authority Approval 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA, DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Phone 337-6179 Datero i! O _1/""o' Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ````(OFffff�i/iii `� .•• ••• 0 0r_ CJ i �Z WATERVID Y ; VMTEWATE : PROGRA 1N—; - a Attachments: 01%"TSEN HAA Checklist Manitenance Agreements l ) Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other Original Certificate Date: By: (Rev. 12101) } Date of sample: Collected by:, ik B.. SEPTIC/HOLDINGII TANK DATA Tank(Type/Material STEEL Date installed 9/15/83 Tank�size 1000 gal. Number of. Compartments —?L; Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N)' NO High wate(alarm (Y/N) N/A Date of pumping 6/10/2004 Pumper . JR's :PUMPING C: ABSORPTION FIELD DATA eE�ow ExisnNc crzo,� **TESTED; NORTH TRENCH ONLY f Date installed tailed 5/23-24/2000 Soil rating p.d./ r ftp/bdrm) ` 0.8 System type SHALLOW TRENCH ' Lengi h F. 46 ft. Width 5ft. Gravel below pipe 3.04 ft, , 2 Total depth 5.7 ft. Eff. absorption area 750+ ft Monitoring tube YES over field NO Date , 'Depression of adequacy test 6/3/2004 Results (Pass/Fail) **PASS For 3 bedrooms i, i t l Fluid �d epth in absorption field before test 0 in. Water added 795 gal I' New depth 7.5 in. . Elapsed Time: 326min. Final fluid depth 1 in Absorption rate >= 450+ g,p,d, . ^ - ir ` I An ;,re uvenation treatment (past 12 mo. /N & t e NONE Y 1 (P ) (�' YP) KNOWN If es, give date Y 9 i i e D. LIFT STATION Date installed _ 5 "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Ac Pump off' in. High water alarm level at in. Cycles tested Meets'alarm & circuit requirements? PUBLIC WATER j. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot Public sewer main O ots i e Public sewer manhole/cleanout Seis service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:.... i� a Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ . Water service line 10'+ _ _,Surface water 1001+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10,+ Building foundation 10 + Water main Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage— X10'+, Curtain drain NONE KNOWN Wells on adjacent lots 200'+ j F. COMMENTS i G. ENGINEER'S CERTIFICATION v F �� I,` . QQv �.NQS O . �. I certify that I have determined through held inspections andp �� review of Municipal records that the above systems are in 0""'.' conformance with MOA HAA guidelines in effect on this date. Q ••Je re A. ':136mes ; is Engineer's Print Name JEFFREY A. GARNESS 0� 9� ' — 53�Q I. Date r'ro f es"sto�°a� HAA Fee $ 72-)'( Waiver Fee $ v ff bate of Payment `'i -I Date of Payment Receipt Number Receipt Number (Rev. 12/01) ' MAY. 15. 2002 5:OOPM .— 4 - 0 FIRST AMERICAN TITLE 561 1948 -3- N0. 531 IP. 1 _Z'7bIP M HA57' 145.00 %4 Q tz SCALE re LIVE Al -DER Avl:. AS -BUILT NO CORNERS SET THIS DATE EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED F6 02-11 PLAT ARE NOT SHOWN HEREON. pg. 43 BE -6- V I hereby certify that I have performed a Mortgagee's Inspection of the following described property: La T 51 SLocIC 13, 14op.7-0 weon6 svBDrvtSio� uu IT, M2. Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent theroto 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. Dated at Anchorage, Alaska this day of MAY 20 OZ FRED WAL.ATKA & ASSOCIATES (907) 248-1666 Engineers and Surveyors JRs Pumping PO Box 773415 Eagle River, AK 99577 Service Agreement (907) 694-6454, Number: 013397 Order Date: 07 -Jun -2004 _ Bllllnp Information Service Date: 10Jun-2004 12:00 am _ Gamess Egineering Gro _up ._,J Technician: Tony 3701 E Tudor Rd Job Description: 1000g Suite 101 P.O. Number. Anchorage. AK 99507 Terms: Net 30 (907) 337-6179 Salesrep: Nikole Job Type Repeat Meagan & Chris Map Book: Map Grid: 21- . Job Slta Information ^ ] Cross Streets: Voyles atw — ^— --" Andrew Job Comments: Last service 04/19/02 100og —' --- -' 23047 Live Alder (Selling home Checked and pumed tank & fleld. Some water in one field pipe, Chuglak, AK 99567 monitoring tube has some water -sludge In c/o's on outflow, side of tank (907) 337-6179 Tax Percent: .0 Service Typs Qty Price Each x 2 Men Tax -- --- — Extension - Actual Contractor Job 1 $100.00 No No $100.00 Additional Location Comments: Diagram: Gallons Planned: 100 Alva Aider Ava. Gallons Actual: bW Hose Length: 3 Double Tank: rJ Homs Pump System; [� Baffles Inlet: (� Tank D¢ck Baffles Outlet; �w • . .—..�-1l.E�... L/F NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charges: $100.00 $0.00 $0.00 5100.00 Actual Charges: Customer agrees to the terms and conditions printed on the back. THIS IS A BINDING AGREEMENT. Signature and Title of Customer Representative Accepted by JRs Pumping Date Data Accepted For your added convenience We accept Visa and Master Card payments Over the phone. After 30 Days 1.5% WILL BE CHARGEDI Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 A~chorage. AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 051-732-26 '1. GENERAL INFORMATION Expiration Date: Complete legal description NORTHWOODS SUBDIVISION #3; LOT 5, BLOCK 13 Location (site address or directions) 23047 LIVE ALDER AVE * CHUGIAKw AK 99567 Current Properly owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SANDRA DA~S Dayphone 688-0209 23047 LIVE ALDER AVE * CHUGIAKt AK 99567 Day phone Day phone Un/ess otherwise requested, HAA wi/I be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~] Individual Holding tank Community On-site ~E~ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Cerlificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid ~ at, or prior to closing for the engineering services provided. 4. 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 Health Authority 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. NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Englneer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 ali wells and septic systems depend on the local coils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the eva/uator of the system. Satisfactoq, test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operetiona/ requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ['/"" Approved for ~) bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory - ' ...PROGRAM ..'",o'-, - / Manitenance Agreements g.<? ~,_ .~c~ .,.,., Supplemental Engineer's Recrt ~Jl~.,;;;;;;~?~ Other (Rev, Original Certificate Date: Municipality of Anchorage Development Services Department Bulk:ting Safety OMalo~ On-Site Water & wastewater Program 479O South Bmgaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. cLanchorage,ak,us (9O?) 343-79O4 . Legal Das~ption: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST NORTHWOODS S/D ~5; LOT 5~ BLOCK 13 Parcel ID: 051-752-26 Wall type IqJ~UC If A, B, or C provide PWSID#~ D~~ Wires property protect~ (Y/N) _ ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG Date of mst / Stetlc~ It. .JNefl'~roductlon g.p.m. WATER SAMPLE RESULTS: AT INSPECTION .,,.. J g.p.m. Coliform ~n.Nitrate ~ mg./L. _ .co onles/100 mi. · - . Date of sample: ~ Collected by:. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tankalze 1000 gal. Number of Comperlments 2 Foundation deanout (Y/N) YES Depression over tank (Y/N) NO Data of pumping 4/19/2002 Pumper C. ABSORPTION FIELD DATA PBELOW EXISTINO GRADe Date installed 5/23--24/2000 Soil rating ~lor R~t~[llTt) 0.8 ' Length 46 ft. Width 5 .ft. Total depth ~.7 ff. Eft. absorption area 750+ ff~ Monitoring tube YES Date of adequacy test 4/22/2002 Results (Pass/Fall) *epA.sS Fluid depth in absorption field before test 0 in. Water added 1040gal Elapsed Time: ,326 min. Final fluid depth 2.5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Date installed 9/15/83 Cleanouts {Y/N) YES High water alarm (Y/N) N/A JR's PUMPING e~FE:STED NORTH TRENCH ONLY System type SHALLOW TRENCH Gravel below pipe 3.04 ff. Depression over field NO For 3 bedrooms New depth 10 in. 450+ g.p.d. If yes, give date D. UFT STATION Date installed. Size in gallons M~__ _ "Pump on" level at in. 'pump o~ ' , High water alarm level at in. ~ Cycles tested. Meets alarm & circuit requirements?. Septic tank/lift station on lot Absorption field on lot Public sewer main E. SEPARATION DISTANCES *PHR/IC. WATER SEPARATION DISTANCES FROM WELL ON LOT TO: $ On adjacent lots Holding tank SEPARATION DISTANCES FROM sEpTIc/HOLDING TANK ON LOT TO: Building foundation 5'+ Propert~ line 5'+ Water main 10'+ Water service line 10'+ Absorption field 5'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation. 10'+ Surl'ace water 100'+ Wells on adjacent lots. 200'+ Water main 10'+ Driveway, parkingNehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and re~iew of Munidpal records that the above systems am in conformance w~h MOA HAA guidelines in effecf on this date. Engineer's Printed Nam? JEFFREY A. C, ARNESS Data HAA Fee $ Date of payment Receipt Number (~ev, 12/ol) Waiver Fee $ Date of Payment Receipt Number MAY. 15. 2002 I'; 5:007M FIRST ,~MERICAN TITLE 561 1948 -B- NO. 531 P. 1 E:~,ST 145'.oo V~& 'I~,'(' r~ 5~';' . ' ,.- __ ,~ LIV~- A~.Av~' EASEMENTS OF RECORD, ~)THER THAN THOSE SHOWN ONTHE RECORDED r'"/~ 07..-/) PLAT ARE NOT SHOWN HEREON. p~. 4'$ AS-BUILt' NO CORNERS SETTHIS DATE I hereby certJfy that I have performed a Mortgagee's Inspection of the following (~escribed property: gLOcK 13.~ ,Vo~'r', weop~ Anchoc~ge It~corclln9 precinct, Alaska, ~d ~h~ the improvements situated thereon ue within the property lines and do not ove,,tap or encroach On the property lying adjacent Ihereto, that no Improvements on property lying adjacent thereto encroach on the Fremlsea In quest[on and that there are no roadways, transmission lines or o~er vislble easements on eaTd property except es Indicated hereon. Dated et Anchorage, Naska this /'-<f day of /4/I y 20 0 FRED WALATY. A & ASSOCIATES (907) 248-1666 Engineers end Surveyors 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 C� Parcel I.D. # 65-1- = Z Zfl HAA # on= rs� 1. GENERAL INFORMATION Complete legal description G 0 i 5� 13C1� 1 3 o, -I-6, tjQ" eJ S L40c' '3 Location (site address or directions) Property owner 30e- 1_ o M h c m Day phone Mailing address (C) 13ON: f/ 1/ 2 cq _, c k A -(z. 99567 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. n 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. 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 n1ev. 1/91) Front MOA 4121 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 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 furtherverify 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 (<N1) EcNCalNisF_EIN(j Phone 36L37g1 Address 2 b'/ 1/ P rate 62 / Engineer's 6. DHFIS SIGNATURE Approved for 3 Disapproved. Conditional approval for Additional Comments M e Date Or .s7�1'��S � e Sao a lea, e........ .....O�. ��A� PROFESSIO�P� bedrooms. iWITi1 .s•734 - bedrooms, with the following stipulations: Date o —0 0 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 orderto 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. 151) Back MDA 921 KKEIVED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES JUN 13 2000 Environmental Services Division MUNIGIPALIiY Qf ANCHO 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907,)i643WA4ERVICEs DIVI.- r[ Health Authority Approval. Checklist Legal Description: GBi K SLk 13 14" 4D0 3 Parcel I.D.: C5!5 I -13Z--7h A. WELL DATA Well type Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RES Coliform D of sample: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Nitrate Casing height Wires Collected by: (Y/N) Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Tank size/, D� Number of Compartments Foundation cleanout (Y/N)/N) V High water alarm (Y/N) IVA Pumper —7; C. ABSORPTION FIELD DATA 9.p -m. Date installed 5ZZ y Soil rating (g.p.d./ft2 or ft2/bdrm)d_lsystem type Aa6Low -eacA Length y(o ` Width 5 / Gravel thickness below pipe 3, r9 Total depth Effective absorption area 7 SD Y Monitoring Tube present (Y/N)� Depression over field (Y/N) /V Date of adequacy test Results (Pass/Fail) P For A bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth bins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date —� 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /l/ Absorption field on lot /1/4 Public sewer main A/, Sewer /septic service line A14 - Cu On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: off' level at* Foundation — Property line (Absorption field � Water main/service line ___Surfac a er drainage _-7V7,�_ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r 1,59 if Property line /©fi Building foundation /0 fi Water main/service line 40ff'*- Surface water 100.f- Driveway, parking/vehicle storage area Sd -t _ i Curtain drain >z /OD z Wells on adjacent lots V�47— 2 06 d - F. ENGINEER'S CERTIFICATION 1 certify that / have determined thru field inspections and review of Municipal rrX4 dbia." in conformance with MOA HAA guidelines in effect on this date. A 'N ,e x Signatu y�4} ddi // 0 0e.0 ae,e,• .n Engineer's Name %eei�rl1� l�+t - �.. ., ...... Date /,77)(� s•S CE 7176 HAA Fee $ �l l J Waiver Fee $ Date of Payment 1 Date of Payment Receipt Number N l L Receipt Number 72-026 (Rev. 3/96)* Ij- systems are Ira 9 I�a -a �AA Time APPLIC 'NT FILLS UPPER HA`" , ONLY Time Time PropattyOwder 'LJE'r'i ,'v,.�z ` %'{;: [OUT r"" Phone Date Date Inspector Inspector Mailing Address _ ,...,,. t� 0' (,� _ _ 21p Code ('c'' `, ._t ., .., j ' <'. j Buyer MUNICIPALITY OF AN Address - Zip Code Lending Institution `- Phone Address Zip Code RECEIVE Realty Co. & Agent 'CONDITIONS OF APPROVAL Phone Address Zip Code Legal Description l,'l. 5, f/� t_ 1f Y]C?r�l�� )r:f • i JYI� s /TT DATE 11."' l DATE Street Location C,E{ x-57" %'W �`✓ Type of esidence BY: G?Single Family Soils Rating Date Sewer Installed ❑ Multiple Family No. of Bedrooms �--= ❑ Other -a 3 Well to Tank Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. L'ommunity For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal �dividual tr-, ! z' Year Individual Installed: t? ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank s - 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 AN DEPT. OF H°i',LTi i ": ENV IRON:f=ij,1TAL PROTECtIOK t�`(�`� �•4r �r °� w..4 45 4 1"&3 RECEIVE (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL - DATE 11."' l DATE W �`✓ BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received -a 3 Well to Tank Septic Tank Size o 43 0 ALASKA 6I01ROWnTAL COnTROL SCR US, IX 6ngineerinq & 6nuironmental Studies MUNICIPALITY OF ANCHORAGE KEPT. Oft'°/.LM November 4, 1983 ENVIRONPA-- MAL PROTECTION Municipality of Anchoragefi:,. �; j Department of Health & Environmental Protection N0V Street Anchorage, C 1- Anchoo rage, Ak. 99501 Re: Health Authority On October 31, 1983 our company inspected the sewer system located on Northwoods Phase III Block 13, Lot 5. All 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. OF A4. 11 (v_ � • p >)Y O+Cl9 +O BOYO+O + r✓� n a+++..0 ° $f +s wee Y....+wc JA -;P, °Q:y tle, rn -.Lero C. Reid, Jr. 4 �f Y o. 2251-E ,•°��00 EFSI4°aPZ 1200 blest 33rd Auenue, Suite B 9 Anchorage, Alaska 99503 9 907) 276-1361