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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 20North Woods ]IV Lot 20 Block 16 #051-064-29 Municipality of Anchorage Poge 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 54-5-4-74-4 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000199 PID Number: 051--064--29 Nome: ALMA SAUNDERS WastewaterSystem: [] New · Upgrode Address: 102.3 WEST 16TH AVE. ANCH. AK 995601 ABSORPTION FIELD No. of nedroems: Ph°ne:~907/f / 227--8215 3 DDeep Trench m Shollow Trench nBed DMound r~Other LEGALDESCRIPTION .o,, ..ti.g= o.6 ~PD/~. ~ 20 16 NORTH WOODS ~4 2.4-5.0 ~ 4.0 - - - 0.5-1.5 ~ 80' TOTAL (2 WELL= D New ~ Upgred~~="' ''~= 5.0 ~ Numb"r °' "n"=2  R. ~ 800 ~. FL ASTMD-5034/F810 ~. GREEN GENERAL 7/5-6/00 SEPA~TION DISTANCES · septic D Herding a S.T.E.P. -rom Tank Reid SteUon Tank 's~.. U~. ANCHORAGE TANK 1000 Well 200'+ 2OO'+ - - 25'+ STEEL 2 Su~oCeweter 100'+100'+ - - - LIFT STAT/.O~ Lot srz, ,n gollon,= J ~r Line 5'+ 10'+ - - - FoundoUon 5'+ 10'+ - - Dro[n NONE KNOWN I I Remerks: BENCH MARK TOP OF DECK CLOSE TO GAS M~ER 100.00 ~.¢.~"'~ "' ll f Inspections pe,ormed by: AWWC. INC. Dates: 1st 7/5/00 ~"' ~:~ ~ 4.~...~ ...... .~ Depa~ment of Health~/and Human Se~ices approval u~o.~.....: .... ...~ Reviewed and approved b~/ ~, ~ D~e: ~ / ~o o PERMIT NUMBER: PARCEL ID swooo,99 AS-BUILT DRAWING O '--064--29"U"BER: I~, ~~~ / // ~ ~IS~NO D~INRe~ ~DaL1 DBL2 24.7 31.9 ~ ~%',~%~w~~ ,.~o ~ow- co~ ~.7 ~ ~ gO2 , 83.8 49,8 ~ ~X MT5 58.4 59.7 A B FCO 17.4 27.0 _~ ST1 19.0 28.2 ST2 22,0 ,50.2 DBL1 23.7 31.1 DBL2 24.7 ._'31.9 FD 28.1 32.6 C01 51.7 38.3 MT1 54.4 59.4 C02 83.8 49.8 MT2 81.8 46.6 C03 92.5 61.8 MT3 92.6 62.4 C04 65.7 55.8 MT4 65,0 53.2 FS 58.0 48.2 MT5 58.4 59.7 ALASKA WATER & WASTEWATER c.J.G. ..... CONSULTANTS, INC. -~,~-~ ; SCALE: ~REPAREO FOR: PHONE NUMBER: PAGE NUMBER: ALMA SAUNDERS (907) 277-6215 2 OF 5 LEGAL DESCRIPTION: NORTH WOODS SUBDIVISION #4; LOT 20, BLOCK 16, TYPE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE PERMIT NUMBER: PARCEL ID swoop,,, AS-BUILT DRAWING OS'--O6 '--2'NUMBER: ~1[¢~ ~ - f'8,C)2~8,42 (AV~,) ~ I / ~~ WEST TRENCH ~ST TRENCH . ~/~ ~/oo ~ ~.E.~ ~ )~WN BY: AI ASI~ WA~I'ER & WASI EI~I ER__ r~ ~[[ ,~' z ~r ~ .~ ALMA SAUNDERS (907)277-62~5 ~ OF ~ ~ :~e:lre:~, b~s~t ~ NORTH WOODS SUBDIVISION ~4: LOT 20, BLOCK 16, ~k ~ .. .......... · ~ PROFILE DRAWING OF SEPTIC SYSTEM UPGRADE ofesstO~ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995'i9-6650 Upgrade Date Issued: Jun 27, 2000 Expiration Date: Jun 27, 2001 Permit Number: SW000199 Legal Description: NORTH WOODS UNIT IV BLK 16 LT 20 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Alma Saunders Owner Address: 21508 Snowflower Loop Chugiak, AK 99567- ParcellD: 051-064-29 Site Address: 021508 SNOWFLOWER LP Lot Size: 23029 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ~J Disposal Field [7~ SepticTank [~ 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. Date: Date: ALASICA WATER & WASTEWATER June 20, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for North Woods Subdivision #4; Lot 20, Block 16 To whom it may concern: The existing 3 bedroom house is currently served by a private well and septic system. The existing bed is in a state of failure and in need of an upgrade prior to the sale of the house. One test hole was excavated on the property. The proposed septic system will be designed within the 30 foot radius of this test hole. We are proposing that a 1000 gallon septic tank and two five foot wide drainfields be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which show the soil classifications, groundwater monitoring, and the pemolation test results. The soils below the organic layers are a SM/ML to a depth of 13 feet (bottom of test hole). No groundwater was encountered during the excavation of this test hole. A percolation test was performed between the depths of 3.5 feet to 4.0 feet which had a percolation rate of 14.1 minute/inch. It is our opinion that due to the overall appearance of the soils, an application rate of 0.6 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 14.1 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 750 ft2 f. Total Depth: 7 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.5 i. Minimum Length: 80 feet long (2~ 40') j Effective absorption area = 800 ft 6901 Debm~c Road, Suite 2B ~ Anchorage, AK 99504 - Ph: (907)337-6179 - Fax: (907)338-3246 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The area for the proposed septic upgrade is generally flat; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thm~k you for your assistance. Presid~n! ,mess, P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a soil log, and a 7page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 - Ph: (907)337-6179 ~ Fax: (907)338-3246 NORTH WOODS #3 J j NORTH WOODS #4 J J LOT 1, BLOOK 14- Ji NORTH WOODS #4 NORTH WOODS #4. LOT 13, BLOCK 16 I J J I LOT 15, BLOCK 15 LOT 14., BLOCK 18 I I I "~ NORTH WOODS #4. NOR~ WOODS ~4 I m  ~ LOT 22. BLOCK 16 LOT 23, BLOCK 16 I J I C~ ~ ~ / BEDRO0" HOUSE J J NORTH WOODS ~ ~ x/~ I PROPOS[D SEP~C % J .~ LOT 21, BLOCK 16//~-~ ~ i ~ 6901DEB~RRO~,SUITE2B*~CHORAGE,~9950~*PHONE(907~57~I79*F~(eOT)558-SZ~6 1" = 100'~ j j j~ j~ ....... :'~ "'~ .............74;~ PREPPED FOR PHONE NUMBER: PAGE NUUBER:$[~':[ ''t--:~%~ ~ ' ~7 ~ ~ ..... :"'~ AL~A SAUNDERS (907) 277-6215 1 OF 2 v~ , ~[fr~/ A.~drness.. ~ NORTH WOODS SUBDIVISION ~4; LOT 20, BLOCK 16 ,r!:e~ · ~ .' .x~* SITE P~N FOR SEPTIC SYSTEM UPGRADE -~:~- "~ - ~ ....~-~'~-- .......TRENCHES PARALLEL TO SLOPE CONTOURS. //-~~---_J ~o I --' I '. '..:'-'-":"'" 0 A~Sf~ WATER ~ W~TE~i'ER K.D.W./~.L.~. ~.~~>'~1~/I ~,~ 5'"~%.:~ e~,. NORTH WOODS SUBDIVISION ~4; LOT 20, BLOCK 16 ~,,'. ..... ..-"~¢ ~.~ o~ ~o.~, DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. [SOil LOG - PERCOLATION TESTl '"' LEGAL DESCRIPTION: NORTHWOODS SUBDIVISION ~4; LOT 20, BLOCK 16, ~ .................... ..... DATE PERFORMED: 6/13/00 VO~:'~..' ~7953 ..'~ .. LOT 21, BLOCK 16 GH CL .... - .... GC OL SM , OH ~ SC S~/~L , ~ -- GRAVEL DEPTH TO 3ROUNDWATER DATE DRY 8/~ 3/00 DRY 8/~ 4/CO ~R~ ~/20/00 ~0 I ~ DATE READ~N~ CLOC~ NET T~HE WATE~ LEVEL NET DROP TIHE (HINUTES) ~EADJNG (INCHES) 12 6/14/00 - PERK HOLE PRESOAKED FOR 4+ HOURS PRIOR TO IISI, 13 1 1:44 ~ 6" 2 2:14 30 MIN. 4-1/8" 1-7/8" 14 ~ 3 2:14 6" 4 2:44 30 MIN. 4" 2" 15 6" 5 2:44 16 6 3:14 30 MIN. 3-7/8" 2-1/8" 17 18 -- lg PERCOLATION RATE 14.1 (~IN./IMCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN FT. ~,z~/¢ 4,0 FT. COMMENTS: DUE TO THE OVE~LL APP~NCE OF ¢ D,VjfiV,/~u~ OPINION THAT A O.6 APPLICATION ~[R[o.u[D .~ A~SKA WAT[. ~ WAS*[WAT[. ~, t ~ ~d/~'~ , C[.T~ *HAT ' DEPTH TO 3ROUNDWATER DATE DRY 6/13/00 DRY 6/14/00 DRY 6/20/00 UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 TelephOne 264-4720 -ITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEI~)~ /~-C~ PHONE J ~EW MAILING ADDRESS LEGAL DESCRIPTIONJ ' LOCATION NO. OF BEDROOMS ~, DISTANCE TO: JWell ~/~ Absorption~e~ Dwellings/ PERMITNO. ~ ~ Manufacturer Material __ No. of compartments Liq. ~pa~i~ in gaHon~ Inside length ~id~h Liquid /OOO IF HOMEMADE: ~ ~ DISTANCE TO; Well Dwelling PERMIT NO. O ~ ~ Manufacturer = - ~ Material Liquid capacity in gallons Q Well Foundation Nearest lot line PERMIT NO.  Total length of lines Trench width Distance between lines No. of lines Length of each line ~ inches Top of tile to finish grade Material beneath the Total effective absorption area Q inches Length I Width Depth ~1 PER~ ~ .~ Type of crib~/~ Crib diameter ~/~ Cribdepth~/~ Total effective ab~rp~ar~ e Well DISTANCE TO: ~/~.. Building~¢fo~ndation Nearest lot line ~O/ ~ Ciasa_ Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RA~ING INSTALLER REMARK~ I I ~ 7' APPROVED } DATE LEGAL 3/78) F'ERM I T NO · [:,FtTE i SSLIED: 84000? FIPF'L I CFINT FIDDRESS: CONTFIC'I' F'HEINE: CHBMBERS CONST. P. 0 BOX O CHUGiRK., BK ~567 688-28~1 LEGRL DESCF.! I F': LOT SIZE: ["IR:.':: E EDP T C MS - SUBDIVISION: NORTHWOODS ~4 SECTION: ~&4 TOWNSHIP: (SQ. FT. OR RCRES) LOT: ....kl EL]ZK: RRNGE: LISTED BELOW FIRE THE OF'TIONS B',,,'RILRBLE TO 'T'OI_I IN DESIGNING '.r'OLIR SEPTIC S'.r'STEM. CH']SSE THE OP'I"ION THRT E,E_T FITS 'COl_IR SITE. DEPTN TO PIPE BOTTOM (FT.) GRR',,,'EL. DEPTH (FT.) TOTRL DEPTH '::FT. GRR'¢EL WI[."TH (FT.) GRR'¢EL LENGTPI (FT.) GF..'R'¢EL VOLUME (CU. "r'[:'S. ) TRNK SIZE (GRLS) SOIL. RRTING (S~;!. FT. ,.'"BR) :+::+: GF.:FI',,,'EL LENGTH 2::- ~.~, ._ FT. 4.0 5.5' 4.0 2.0 0.5 2.0 6.0 6.0 6.0 2.5 ±9.0 5.0 i±~. 0 ** ~6. O 64. 0 26. E 25.2 2~. 6 1,000~0 ** 1,000..0 ** t, 000.0 ** 152 152 REC,!U.[RE=, MLILTIF'LE F.'_NS (NOT E::.:',CEEDING ~.~.,,._ F'T. ERCH) ,+,* TRNK MUST HR',,,'E RT LERST THO C:OMPRRTMENTS I CERTIF'¢ TI~'4RT: i. I RM FFIMILIRR WITH THE REE.!UIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTN B"r' THE MUNICIPRL. IT"r' OF RNCHORRGE (MOFI) RND ]'HE STflTE OF RLRSKfl. 2. I WILL INSTRLL THE S"r'!-;TEM IN RCCORDRNCE WITH RL.L MOR CODES RND REGULRTIONS., RND IN COMPLIRNCE WITH THE DESIGN CRITERIR OF' THIS PERMIT. 2. I WILL RDHERE TO RLL. MOB RND STFtTE OF FtLRSKR REQUIREMENTS FOR THE SET 8RCK DISTRNCES FROM RN"r' EXISTING WELL., WRSTEWRTER [:'ISPOSRL S"r'STEM OR PUBLIC SEWEF.:RGE S'¢STEM ON THIS OR FtN'¢ RD..IRCENT OR NERRBN" LOT. 4. I UNDERSTRND THFIT THIS PERMIT IS ',,,'RLI[:' FOR R MR:.'";IMI..IM OF -~: BEDROOMS RND FIN"r' ENLRRGEMENT 1.4ILL REL.]UIRE RN t~D[:'ITIONRL PERMIT. IF R LIFT STRTION IS INSTRL. LED IN RN RRER COVERED BN' MOB BUILDING CODES, THEN (±) RN ELECTRICRL PERMIT RND INSPECTION MUST BE OBT~INEDJ (2) RS-BUILTS WILL NOT BE RPPRO~ED WITHOUT RN ELECTRICRL INSPECTION REPORT;~ RND (~)THE ELECTRICRL WORK MUST BE DONE 89 R LICENSED ELECTRICIRN. S I GNE[:, RPF'L I CRNT: I :~;SUE[:, E:'-r' [:'RTE ....... ;_-7.:;:; ........ ,_;.:-',.-_-Z¥-; ............ ........ i .................. ~MUNICIPALITY OF ANCHORAGE~ Department"If Health and Environments' '~Protection ~ .. 825 L Street, Anchorage, AK, 99501 ~ t. 264-4720 Permit ~ ,~6~9 HANDWRITTEN PERMIT * * * Applic~t: ~ Mailing Address: W~, Y' - - ~egal Description: ~~ ~?~ ~~~t Size: T.~pe of Soil ~sorption System Is: Trench: Drainfield: ~eepage Bed: Holding Tank: aximum of edrooms: Soi ing(sq.ft/br) The Required Size of the Soil ~Lbsorption System Is: 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 TM ~,"~)~9~__.) 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" 215 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 accordande with codes. (3) I understand that the on-site sewer system may require enlargement if bedrooms. 'the residence is remodeled to include more that/~ S-igne~:App~ic~~ ~-- ~' Issued by:~ ,/~/~.~ ~~ ~ Date: /--- r~ ~-~ / SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST 7 8 9 10 11 12 13 SiTE PLAN III SLOPE WAS GROUND WATER ~J_ S ENCOUNTERED? P IF YES, AT WHAT E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /-I ~_0 z:¢~ -~. /,~o I zl~.~ s 1,11 ~0 ~ ' I0 ~ 1,36 ~ 3.'z/ II /,/z ~;az II /,I~ O.z / 14 15 16 17 18 19 20- PERCOLATION RATE ~r (mirtutes/inch) TEST RUN B~ETWEEN 3 FT ~J~JD J~L FT CERTIFIED BY: DATE: 72-008 (6/79) ~-' MUNIC[PALI[Y OF ANCHORA(I~'~ Departmen_ of Health and Environment.~ Protection 825 L Street, Anchorage, AK. 99501 264-4720 ~ * * HANDWRITTEN PERMIT * ~ * Permit ~ ~~ELL A~D/OR ON-SITE SEWER PERMIT Location, Phone Number, ~.~------__~k~/J Legal Description: ~a~ S'~ ~~ ~t Size: -' TFpe of Soil ~sorpti~n System Is: Trench: Drainfield: ~eepage Bed: Holding Tank: Max~um N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) ~~ The Required Size of the Soil Absorption System Is: 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 = /~-) GALLONS * ~ Permit applicant has the responsibility to inforl~ this department during the installation inspections of any wells adjacent to this property and the number of residences that ~he well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departme will be subject to prosecution. Minimur~ distance between a well and any on-site sewage disposal system is 100 fe 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 lnsure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 I certify tha~: -[t) I am familiar ~ith 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) ! understand that the on-site sewer system may require enlargement if res bedrooms. ' ~he idence is remodeled ~o include more that/3~ Signe~: ,%~ ~ ~~" Issued by:~ .~/~. ~ App~ican~ Date: SWP/024 (1/81) SOILS LOG DEPA~RTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Ala~la 9~J501 26~472([ SOILS LOG-- PERCOLATIONTEST' PERFORMED FOR: DATE PER'f;ORMED~ LEGAL, DESCRIPTION: SLOPE [ SITE PLAN l~tlq I"'~, I t t t b! I-Ik-J,4~J~,~ I l 1tt II , f L_~ ~I I I~ tr,-,l I'll I 10 11- 12- 13- 14- 15- 16~ 17 18 19 20- COMMENTS,'' WAS GROUND WATER ~_ ENCOUNTERED? i~ Q P E tF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /.t~? z ,'~ ~ /, ~ / 0 ~. ~ ~ I,.3~ ~o~ ' I~ 1,1~ . 0,~ ~;3z l/ /,13 O.Z/ PERCOLATION RATE ~ (minutes/inch) ParcelI.D.# MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 051-064-29 1. GENERAL INFORMATION Complete legal description NORTH WOODS SUBDIVISION ~4: LOT 20. BLOCK 16, Location (site address or directions) 21508 SNOWFLOWER LOOP CHUGIAK. AK 99567 Property owner Mailing address Lending agency Mailing address ALMA SAUNDERS 1023 WEST 16TH AVENUE Day phone ANCHORAGE. AK 99501 Day phone (907) 227-6215 Agent JOHN LEVY W./ REALTY EXECUTIVES Day phone (907/ 561-2220 Address 54-1 w. TUDOR ROAD. SUITE ~ 105 ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XXX If community well system, provide wdtten 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: XXX If community wastewater system, provide written confirmation from State ADEC ing to the legafity and status of system. 72~)25 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants Inc. shall be paid $1000. O0 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of fha 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 inspecJion, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal/c, r~d State codes, ordinances, and regulations in effect on the date of this inspection. /,// Name of Firm ALASKA WATE-F~ & ~YST, E'~;~JR CONSULTANTS, INC. Phone (907)337-6179 .?/ / / // 1 Address 6901 DEBARR ROAD, SUI'ITE.2B(,ANOF~ORAGE, ALASKA 99504 ~ /' Engineer's Signature ' .,,i~'"///~/~/~'~ ,_Date In conducting this evaluation, AWl/Vt, It~6. a~te~CtCted to proCde a thorough, conscientious engineering analysis of the system in accordance with ADEC and l~O/f DH~S Guidelines & Regulations. The reported results described the performance of fha 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, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of ,~'<~ tha evaluator of the system Satisfactory test results do not guarantee future peffor/nance ~ ~ . ~. . . .~. .~.L~?~, of the system, nor do they guarantee that there are no hidden defects or encroachments. /~'~" ///.,~y..~-~_~h AWWC, Inc. can therefore not provide any warranty for future estimate of how long the ~ K.C : system will continue to meet the operational requirements of the ADEC or MOA DHHS. ~ f. ~.~ ;..~.~.~.l ~.~.~'.....i :".z.~...~ The content of this report is for tha sole bsnefit of the owner listed above. Any ~ ~ ~ / ,.~..~..~._ reliance upon or use of this report by any other person or party is not authorized, v~.~..,; nor will it confer any legal right whatsoever. '(//). co ~'7.Je/ffr¢~/, A. ~3cne~ss,,'' -7955 ..' 6. DHHS SIGNATURE '(~'~U"/". Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~..~-¢~Z/..d .~ .~ ~'C-/. .~,~'~- Date '~ ' / ~ ' © O The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: NORTH WOODS S,/D #4; LOT 20, BLOCK 16, ParcelI.D.: 051-064-29 A. WELL DATA Well Type Log present (Y/N) Total depth PUBLIC WATER SYSTEM IfA~ B, or C, attach ADEC letter. ADEC~ Date complet~_.d ~ ~ Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG Date of test / Static water level ~ AT INSPECTION g.p.m. J g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 7,/5-10,/00 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N). YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N,/A Date of Pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed 7`/5-10/00 Length 2 © 40' .Width Soil rating ~or ff2/bdrm) 0.6 System type TRENCH 5' Gravel thickness below pipe 4.0' Total depth 7.0' Effective absorption area 800 SQ. FT. Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (Pass/Fail) For 3 Bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): __ Fluid depth (ins) Minutes later: Absorption rate =. Peroxide treatment (past 12 months) (Y/N) · 72~025 (Rev. 3~96)* Computer Version If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N), High water alarm level at* Size in gallons .------~ ~- "Pump on" leve~level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main PUBLIC WATER On adjacent lots .~-On-a"d~acent lots sewer manhole/cleanout Liff station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Absorption field 5'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain 10'+ Building foundation 100'+ NONE KNOWN 10'+ Water main/service line 10'+ .... Driveway. parking/vehicle storage area 10'+ Wells on adjacent lots 100'+ F. ENGINEER'S CE/g~IC, A~O~/ I certify that lh~ve d~te/i~/n~/~l of Municipal r~cords/th~h~ ~ Signature ~ Engineers Name~ Date~~ eld inspections and raw'aw ystem$ are In conformance this date. JEFFREY A. GARNESS HAA Fee $ '~-) r.J'Z> *~;' Date of Payment '"~//~_,/~"/2 72-026 (Rev. 3/93)* Computer Version Waiver Fee $ Date of Payment Receipt Number APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE voo~ 1. General Infor~ation Application Date NOU3~O~ Legal, Description ( include~ lot, block, sulldivision ~ Locati.~g~, (adct~ess~gr directions )~ · % ,zOo (c) Applican~ is (check one) Lending Institution .~; Owner/builder ~-~; (d) Lending Institution __ Te le phone Address (e) Rmal Estate Co. & Agent Address Telephone 2. Type of Residence Single-Family ~ Numbe= of Bedrooms Multi-Family ~--~ Other (describe) 3. Water Supply Individual Wall ~ C~£.~nity ~ Public ~ Note: If cra~nity w~ll system, must have wzritten confirmation frQm the State Department of Environmmntal Conservation attesting to the legality and status. Is' the ~11 adequate fo~ .the number of bedroons specified in this HAA )' 4. Sewage Disi~sal.. Onsite ~ Public ~--] Cor~lunity ~ Holding Tank ~-~ - · Is the wastewate~ disposal system adequate for the number of b~drocms (Y/N) !;c-~/~e~/ / [Page 1 of 2] 2-15-84 5. _Engineering Firm P~.oviding Inspections, Tests, Data and Information I certify that I have checked, verified, c~ confc~d to all MOA 5~A Guidelines in effect the date of this inspection. Signed te ~ Signed by Date ~.//~/~ ( ENGINEER SEAL) 6. DHEP Approval App~0ve d foz ~ bedr oats App~o~d ~ Disap~oved ~-~ Conditional ~-~ Te~ms of Conditional Approval ~ne Municipality of Anchorage Department of Health and Enviro[-,,~ental P~otection does not guarantee the continued satisfactory perfc~mance of the water supply and/c~ the wastewate~ disposal system. This approval indicates that, as of the validation date shcwn abo~, based on the data and infc~mation furnished bi; an engil~ger registered in the State of Alaska, the water supply and wastewater disposal system is safe a~Td func- tional for the number of hedroc~s and type of structure indicated. , (D EP S AL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 NOUOa.to~a ~11 Classifi~ti~ /~/~1/~: - If A, B, ~ C, D.E.C. ~o~d~) ~p~ation Dis~n~s ~ ~11: To Septic/Holding Tank on Lot To Nea=est Edge of .Abso=ption Fiel~ on Lot To Nearest Public Sewer Line Cleanout/Manhole Wate= Sample Water Sample Test Besults ; On Adjoining Lots ; On Adjoining Lots To Nea=est Public Sewer Nearest Sewer Service Line on 'Date Date Installed StandPipes Dal~ession ove~ Tank Size ~-tiGht Caps Date NO. of Oa,ga=tments 21eanout Holding Tank Permit Tank: To :Building Foundation To Disposal -Field ~? / To stream, Pond, Lake, C~ Majo= D~air~%c3e C. ABSORPTION FIELD E~TA Soils Rating in Absorption Stmata Date Installed Width of Field ? Type of System Design Length of Field Depth of Field ~/~ ' Gravel Bed Thickness /~ _~ ~(3~{~/~ J Dimensions / Manhole/Access (Y/N) / "Pump Off" Level at " Vent (Y/N) Pumping Cycles aming Adequacy ~st. M~ets LIFT STATION - Date Installed /.~ Size in Gallons "P~ On" Level at HiGh Wate~ Alarm, ~vel at Tested for Electrical Codes(Y/N) ' ** ** Check Permitted Bedroom ~ating Against HAA Request I certify that I have checked, ~rified. c~ confo~ced to all MOA HAA Guidelines in effect on the date of this inspection. . Ccmpany ~B1 ldS/s [Page 2 of 2] DEPT. OF ENVIRONMENTAL CONSERVATION RILL SHEFFIELD,. GOVERNOR Telephone: (907) 274-2533 Address: 437 E. Street Suite 200 Anchorage, AK 99501 March 1, 1984 PWS #213001 To Whom It May Concern: Our records indicate the Northwoods Subdivision #4 Drinking Water System to be in compliance with State of Alaska Drinking Water Standards. Sincerely, Environmental Field Officer JFH/msm cc: DHEP 825 '%" Street Anchorage, AK 99501