HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 23Northwoods
Block 3
Lot 23
#051 - 741 - 16
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Aflchorage, AK 99519-6650
www.d.anchornge.ak.us (907) 343-7g04
Page of
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020216
Name:
STEVE NII=YI=RS
22905 Northwoods Dr Chugiak
688-6708 3
LEGAL DESCRIPTION
3 2 3 Northwoods
Well: [] New [] Upgrade
SEPARATION DISTANCES
T~To Septic AbsorpUon I Jif Holding
Tank Field Station Tank
w.. 100'+ 100'+ NA NA
s~w,,. 100'+ 100'+ NA NA
~u. 5'+ 10'+ NA NA
F~.~,~ 5'+ 10'+ NA NA
c~,.o.~ NA '50'+ NA NA
tank Installed by Calklns Const,
PID Number: 051-741-16
Wastewater System: I-1 New [] Upgrade j
ABSORPTION FIELD J
'LC-./ "' _ ...... ; ............... _?_.
, ~-~ ., - I -
TANK
l~ Septic r'l Holding [] S.T.E.P.
Se~er Line Anchora.qe Tank
2s'+ Steel
LIFT STATION
[] Other:
BENCH MARK
TOP OF FOUNDATION
Inspections performedby: KND Engineering Dates: 1'~ 7/15/02
Development Servic. es Department
Date: ~
Reviewed and approved by: /' ~ Approval
V
AT SE Bt. DG
I 00 FL
Engineer s Stamp
AS-BUILT SYSTEM DETAILS/SITE PLAN PerMl~ S;,/020816
NF1RTHWBBDS S/II, LBT 23, BLOCK 3 PID#OSt-741-1G
KND
A-C= 10.2'
B-C= 13.8"
A-D=17,1'
B-I)= 20.5'
A-E= 52,4'
D-E= 50.9'
A-F=
B-F=
lOx15 x /
Anchor ESMt /'~ '~ ,
TANK -,~:: ~%r~.~.~" ' ER ROCK .... ' .....
PREPARED FORm SCALE, NTS
~TE~E MEYERS
~0~ NORTH~OODS
CHUGIAK, AK. 99577
(907)6BB-6708
,~c~.mO2033.DWG .m~., 02033
]-~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
[[. ,.;:.:.: ..:.: v....:.,.:.,.,.:.:.::..:,:.....:.. :.:.,.: :.: :..,:.:.:.: :.: v.:.:.::.: %:.......?...::,v.v.v...:.v::.:v...v: f: :1I
(907)696-61 ~ I/FAX (907)696-8t ] !
MUNICIPALITY OF ANCHORAGE
Development Sen, ices Department
On*Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Jul 09, 2002
Expiration Date: Jul 09, 2003
Permit Number: SW020216
Legal Description: NORTH WOODS BLK 3 LT 23
Design Engineer: 0070 KND Engineering
Owner Name: Steve Myers
Owner Address: 22905 Northwoods Dr.
Chugiak, AK 99567-
Parcel ID: 051-741-16
Site Address: 022905 NORTHWOODS DR
Lot Size: 27574 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of;
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
Ail construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4, From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
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
ON-SiTE SEWER/WELL PERMIT APPLiCATiON
FOR A SINGLE FAMILY DWELLING
O
Parcel I.D. 051-741-16
Permit Number SWO?-O ~/6
Property owner(s) Steve Meyers
Mailing address (1) 22905 Northwoods Drive Chuglak, AK 99567
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Northwoods Lot 23, Block 3
Legal description (Section, Township & Range)
LotSize ~q~ ~'TV
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Acresl~<'~
Number of Bedrooms 3
Day phone 688-6708
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(S'gn~'ure of pop rty ow e or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12J[X))
$ '00 --
Waiver Fees:
Date of Payment:
Receipt Number:
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)6908111
July 2, 2002
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Septic Tank Upgrade Permit - Northwoods Lot 23, Block 3
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit to replace the
failed septic tank on the subject lot. The area is served by public water. There are no
public or private wells within ,200' of our proposed tank location except as noted. There
is no surface water within 100 of the proposed system and there are no known curtain
drains within 50'. We do not expect there to be any adverse effect on adjacent lots by
the placement of this tank.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
I~I~D Engineering, Inc.
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
WELL
L19
D
WASTEWATER
NDRTHWDDD$
80
3
DISPOSAL SYSTEH
S/D, LOT 83, BLOCK 3
21 'x ~
\
\
\ \
\
\
\
17
Lo* 83 /
16
15
25
DETAILS/SITE PLAN
/
I
/
· /"'-.. 2 3
/
// ' / 21
, /
26 , /
/ //
/ · /
/ /
/ , 80
NOTES,
1. CONTRACTOR TO ABANDONED EXISTING TANK AN]) REPLACE
WITH A 1000 GAL TANK. INSULATE TANK IF 44' COVER.
.4/ ,
////
8. CONTRACTOR WILL ENSURE MINIMUM 8% SLOPE INTO SEPTIC TANK.
3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS ANQ ALL OTHER SETBACKS.
~SSlO ~ ~ D*~ 7/2/02 EAG~ R~R, ~ 99577-8736
~ ~ ~ N~ 459 ~ [~y..x.x.:.} x+:.x.:.x.x.:.:.:.:.:.:.:.:.x.x.:.~:x+:.x.>x.x.:+:.~.x.:.x<.~.x.~.:.x.:.:.x.:.:&:.x.;.:::.:.l]~
~ ~ 02033.D~ ~ ~ 0~033 (907)696-6111~ (907)696-8111
~¢ASTEV/ATER DISPBSAL SYSTEM DETAILS
NORTHWDBDS S/D, LBT 83, BLOCK 3
#
]~F NONE ARE
FOUND
1000
GAL TANK: :IN FAILURE
/ . 36'
PROPOSED REPLACEMENT
1000 GAL TANK
EX[SI'lNG 30' × 30'
SEF'~C SYSTEM
/
/
/
/
/
/
!
Lot
!
/
/
/
/
/
!
!
!
//// /
PREPARE]] FOR,
STEVE MEYERS
P8905 NDRTH~/OnDS DR.
CHUGIAK, AK. 99577
(907)688-6708
~ ~ 02053.DWG ~ "~ 02033
Scale, 1'= 20'
PAGE 2 DF 8
I~) ENGINEERING
Z044! PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
II':. :. :.:, :. :. ~-~. :. :. '.-:. ;. ~-'.. :. ~. :-:. ;-'.. :. ~. i. '.. ::~. '.. ¥.;. :. ;. :. :. %-:. :. ~-:. ~-;. :. ~. ~.:-:-'--: i;-:-> ;-;-:+ :.!.:.~.%.'..'.?.'..?,'.? :~ J
(907)896-8111,/'FAX (907)696-8tl t
MUNICIPALITY OF ANCHORAGE
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. 051-741-16 Expiration Date: G1-7-4
1. GENERAL INFORMATION
Complete legal description NORTH WOODS BLK 3 LT 23
Location (site address) 22905 Northwoods Dr
Current property owner(s) Myers Day phone 250-9907
Mailing address
61
Real estate agent Day pho �'
•
2. TYPE OF DWELLING: '`
a JUN i.
❑ Single Family (w/wo ADU) ;� ti
❑ Duplex 6 ^
❑ Multiple Dwellings (Single Family and/or Duplex) � O[ 6 8 9�'
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic .1x 1
Water Storage ❑ Holding Tank
Community Well ❑ Community ❑
Public Water System Public Sewer I
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ &Sb, 00 Waiver Fee $
Date of Payment 07/0Dli-1 Date of Payment
Receipt Number °fall b Receipt Number
COSA# DSc-16112161 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 7/1/19
•
.
4
6. DSD SIGNATURE
pp System #1 Approved for bedrooms rt , . Lf
Y
tt4�C'. Stmvun ��. cng
System #2 Approved for bedrooms Pc 2`''
Disapproved pi?OFEss
Conditional approval for bedrooms, with the following stipulations:
,kotl((((((rr(�
G�Q�ITY OF,qAif( /
N••
AT-ER
..D W SrEWq"0 m=
P r�R
Ro �
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/SR`(,rt•-
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Original Certificate Date: '7^ �1 '
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: NORTH WOODS BLK 3 LT 23 Parcel ID: 051-741-16
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑Well log is filed with Onsite (or attached) Well production at time of test gpm
Date drilled Water storage tank volume gallons
Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No
Cased to ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height(above ground) in. Collected by
Date of flow test for COSA Date of Sample
Static water level at beginning of test ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 715102 years ❑ Required maintenance completed
Tank type/material Steel Age of lift station years
Measured operating fluid level in septic tank 46" Lift station material
■❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 9/26/18
D. ABSORPTION FIELD DATA 5/3/82
Which system tested (date installed) 5/3/82 Adequacy test date 612728/19
❑� ALL standpipes present per record drawing Results ID Pass For 3 bedrooms
Total measured depth from grade 4 ft(max) Fluid depth prior to test 1 in
Measured depth to pipe invert from grade 3 ft(min) Water added 450 gal
❑ N/A—pressurized field New depth 3 in
❑� Monitor tubes go to bottom of effective. If not, state Elapsed time 30 min
depth into effective
0Code-required soil cover over field Final fluid depth 1 in
❑ System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) no
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑Yes if No ft ❑ Yes if No ft
Neighboring Tank > 100' ❑Yes if No ft Private Sewer/Septic Line > 25' ❑Yes if No ft
Absorption Field on Lot> 100' ['Yes if No ft Holding Tank > 100' 0 Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft
❑Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' ❑✓ Yes if No ft Surface Water> 100' ❑✓ Yes if No ft
Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100' El Yes if No ft
Water Main > 10' ✓❑ Yes if No ft Community Wells> 200' p Yes if No ft
Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10' p Yes if No ft Wells on Adjacent Lots:
Water Main > 10' -' ✓❑ Yes if No ft Private Wells > 100' ❑� Yes if No ft
Water Service Line > 10' ✓❑ Yes if No ft Community Wells> 200' ❑✓ Yes if No ft
Surface Water> 100' ✓❑ Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION ��`At It
� C.. At
I certify that I have determined through field inspections and review ,!
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I hereby certify that I have surveyed the following described
1
S`c_�F.i q- 'r1,•/.J P t :.�l ..e,,..(
,ti+ Anchorage Recording Precinct, Alaska, and that themnprove-
�. t - 't y merits situated thereon are.within the property lines and do not
3 •pie. • : overlap or encroach on the property lying adjacent thereto,that
:. `'.•• •:''' • ' } no improvements on property lying adjacent thereto encroach
er:' ^� `F f •"� ,� N� on the premises in question and that there are no roadways,
re . • 1`. k.-. S transnussion lines or other visible easemenis On said property
/4 =•:• < • ••• •• •• •c:: except as indicated hereon.
• 1 ..4o.:_„-„,,,•• • Dated at Eagle River, Alaska
0,„.1....•':vLe:t ti.. J: .• n �'-,. this �L-? ' day of_ OC-t, �zOoO
nto.SF.;,-: . '.' ROBERT C. JOHNSON. ',itcz
vj�:!,p'•., .'' • . SCALE: Registered Land Surveyor No. LS
•k�!L,r"*".••••:..6.: __' , 1” L -0 ' Box 77.8156, Eagle River, Alaska 99577
Phone(907)694-2553
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41
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel.I.D. ~-/- ~-/-/-
1. GENERAL INFORMATION
Complete legal desCription Lo t
23, Block 3~
Expiration Date:
Northwoods S/D
Location (site address or directions) 22905 Northwoods Drive
Current Property owner(s) Tommy Thompson Day phone
Mailing address 22905 Northwoods Drive, Chugiak, AK 99567
688-6713
Lending agency
Mailing address'
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: ¢,/-~/Z, ~/~,.---
NUMBER OF BEDROOMS: 3 ~' '¢/~-r/~ ~
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners.
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 less than 30 days old. 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.
72-025 fRev 01'00)-
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show 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 wilh all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
Address
ENGINEERING
/~,~&c,/. /&~',~,~.i:ska 99577
Engineer's Printed Name
DHHS SIGNATURE
/,,/ Approved for
Disapproved.
Conditional approval for
Phone
Robert Cowan Date
bedrooms.
bedrooms, with the following stipulations,
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date: ~ - ~ ~ - O I
Original Certificate Date:
Reissue Date:
ECEiVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES AUG
Environmental Services Division ~uN~O~^UW OFAN
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3'4~,4¢7.~/~,L SE~WCES
~,- Health Authority Approval Checklist
~ Legal Description: ~.:~..-z~ ~ ,~, I~~0¢ 0 ~ I Parcel I.D.:
A. WELL DATA
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC Water system number ,,~/~ ¢ ~ /
Date completed
Date of test
Static water level
Well production
Da~of sample:
Cased to Casing heig~
W~erFy protected (Y/N)
FROM WELL LOG ~ AT INSPECTION
~ g.p.m.
Nitrate Other bacteria
Collected by:
g.p.m.
SEPTIC/HOLDING TANK DATA
Date installed ~'~ '~ .- ~ Z.- Tank s~!ze //~r.~ Number of Compartments '2--- Cleanouts~=_~N)~__
Foundation cleanout (Y/~. ~J' ~ Depression (Y~ /J High water alarm (Y/N)
Date of P,Uml~!hg' ~:IG.-- O0 Pumper -~"~'"A. ¢¢'2 '~?' J~
ABSORPTION FIELD DATA
Date ihstalJ'ed '~''''' -~-~Z--- ilSoil rating (g.p.dJfF or fF/bdrm) /~O ~x~&-~System type
Length:. .D, ~ Width ~ Gravel thickness below pipe /~/! Total depth
Effectiv~.bsorption area_ ~'o/.~ Monitoring Tube present, N) /V Depression over field (Y~)
Date of adequacy test '~ '~/?'' ~ o Results ~il) ~,~'J" For .~ bedrooms
Fluid depth in absorption field before test (in.); J~ ¥ Immediately after~'4,~ gal. water added (in.):
Fluid depth / .~ (ins) Minutes later: /''-s~r~ Absorption rate = '~-~'O'~ ~ _g.p.d.
Peroxide treatment (past 12 months) (Y~}/~" If yes. give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) '~ --..-"Pl:TCh-C~f"
High water alarm level at* .~ *Datum
lev-el at*
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot On adjacent lots
Absorption field on lot
Public sewer main ~ Public sewer manhole/cleanout
S~e Lift station
SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOTTO:
Foundation /,¢' ! Property line /~9, I'/~ Absorption field
Water main/service line / O I ~ Surface water/dra nage /O~ /''/'~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /~ / ~ Building foundation ,,,~4,, ' Water main/service line T/¢ / P'
Surface water /DC, /'P Driveway, parking/vehicle storage area /¢ /
Curtain drain ~J~/¢~ /~'..-J,~cJ/-'J Wells on adjacent lots ,~,~ t,/" u//~/J __
F. ENGINEER'S CERTIFICATION
I certify that lhave determined thru field inspections and review of Municipal recor~tr~f;t~l~A~stems
are
in conformance with MOA HAA guidelines in effect on this date.
HAAFee $ ~ d>-~ ,p~
Date of Payment
Receipt Number ~2~/~
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
..... .. MUNICIPALITY OF ANCHORAGE ,.. a~ rI ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTJ:'(;TION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE I ..~r.N EW
MAILfNG ADDRESS
LOCATION NO, OF BEDROOMS
~ell Absorption area D~elling PE~IT NO.
~<h ~ Manufacturer~____F~.~ ~ Material ~ ~- ~.~ No. of compartments
~h Liq. ~ gallons IF HOME.DE: Inside length Width Liquid depth
~ Well Dwelling PERMIT NO.
DISTANCE
TO:
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO.
mSTANC. TO:
~__ N°' °f lines _~ ~12~, ~,Length, °f each linel~,l~ Total , r Mf Trench width:~o ' ~') ' ~ Distance between lines
~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
~ ~' I~ inches ~OF~$
Length Width Depth PErMiT NO.
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
j Class Depth Driller Distance to Jot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area{s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
INSTALLER
REMARKS
'I'*' ~UNICIPALIT )F / qCHDRA,~E
APPROVED
72-013 (Rev. 3/78)
Permit ~
Applicant: ~ r?% ] ~ T
Location: P~F~
Legal Description: L ~3
Type of Soil ~b-sorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms:
Departme~i af Health and Environmenta',~ ?rotection
825~-JL Street, Anchorage, AK. 9'6501
264-4720
* * * HANDWRITTEN PERMIT * * *
~O!~L~ ~ AND/OR ON-SITE SEWER PERMIT
~mS~Ma iling Address:
Phone Number:7
~~LOt Size: ~ 7~O~
Seepage Bed: ~ Holding Tank:
Soil Rating(sq.ft/br) /~
The Required Size of the Soil Absorption System Is:
DEPTH Z-/ LENGTH GRAVEL DEPTH /' WIDTH c~l~ 2(,o~ /
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 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 ~epartment
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
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more ~at ~edr%oms.
Signe~: ~?~e~' L~6/~f,~?~/C Issued by:
Date: / ~__
SWP/024 (i/S1) .
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
LEGAL DESCRIPTION:
2
3
4
7
8
SLOPE
[] SOILS LOG
PERCOLATION
TEST
SITE PLAN
10
11
12
13
14
15
16
17
18
19-
20-
COMMENTS
PERFORMED BY:
72-008
WAS GROUND WATER /U;0
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~obert A.
No. 1457-E
G & S ENGINEERING
SRB 196X
EAGLE RIVER, ALAgKA g95"r/
PH, 694.2979
PERCOLATION RATE /~C (minutes/inch)
TEST RUN BETWEEN ~"'"' FT AND F · FT
i/ {
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
Lot 23; Block 3; Northwoods Subdivision
Location (site address or directions) 22905 Northwoods
Property owner
Mailing address
Johnson
22905 Northwoods
Day phone
688-2330
Lending agency
Mailing address
Day phone
Agent
Joe Perozzi/TARGET REALTY
Day phone 694-2388
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Address p,o. Box 774627, Eagle River, Alaska 99577
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well ××x
Public water -
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
,. NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverifythatbased 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
Address
17034 Eagle Rivet' Loop Roa~ No. 204
E,~ie Rive;', ~' '--
~,~ ~B77
Engineer's signature
Phone
Date
DHHS SIGNATURE
//~._ Approved for
Disapproved.
bedrooms,
tional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does th is 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
Legal Description:
A. WELL DATA
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
:Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter.
Date completed
Cased to
ADEC water system number
Driller
Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static wate'r level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot '¢"~> P ~'
(-4"
Absorption field on lot
Public sewer main
g.p,m.
Public sewer'service line
AT INSPECTION
; On adjacent lots
g.p.rrlTr3__ c~, ~ ~0
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~'''
Cleanouts~/N)
High water alarm (Y/~
Date of pumping
Tank size / z>oZ~' ~,,~. Compartments
Foundation cleanout (Y/~) /J Depression (Y~
Alarm tested (Y/N)
7- ~-Cz '¢,,.-./.¢'r~x_,r,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ o / ~- On adjacent lots
To property line /o ~'/' Absorption field /Z'~
Surface water/drainage l~ ~
Foundation ~ /
Water main/service line
72~3~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
Manufacturer
"Pump on" level at
High water alarm level
Meets MOA electrical codes ~-~
SE~OM LIFT STATION TO:
VV~ell on lot On adjacent lots
Manhole/Access (Y/N)
~ Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed z~. ¢2 --- ~ %-
Length '¢pc~ ~ Width '~o ~
Total absorption area ~ t:) ~) ¢
Depression over field (Y,~ /J'
Resu It~____a~a il) ¢~.S
Peroxide treatment (past 12 months) (Y,~
Soil rating / ¢1 ~ 4/~¢... System type
Gravel thickness /¢~" Total depth
Cleanouts present d~.TN) y
Date of adequacy test "~.-/o
~¢. ¢.,~o¢~[ If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ¢.~
To building foundation
On adjacent lots
Surface water
Curtain drain
/
On adjacent lots 'J .//J,' Property line
To existing or abandoned system on lot
Cutbank ~/~' Water main/service tine
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA g
)ection.
Signature
Engineer's Name
Date
~ & $ ~NGINEERING
17034 Eagle Rlve~* Lool~ Road
Eagle River, Alaska 995??
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev, 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99503
WALTER d. HICKEL, GOVERNOR
(907) 349-7755
April 6, 1992
FOR: Roger Shafer
S & S Engineering
PWSID # 213001
My review of the records on file in this office reveals that the Northwood Subdivision Class
"A" Public Water System, is in compliance with the routine coliform bacteria sampling
requirements listed in Table C, and with the inorganic sampling requirements listed in
Table B of 18 AAC 80.200.
Sincerely,
Byron Roys
Project Engineer
BR/of
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF ~ALTH AND ENVIRONi~ENTAL PROTECTION
APPLICATION FOR ~B~ALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a)
Legal Description_( include lot
, block, subdivision, section, township, range)
Location. w~Y''~t~-~'/-~'(address or direct ~ons)~..~.
Buyer ~ ; Other ~ (~plain);
(d) Lending Institution ..~~ O~P /~ Telephone
(e) Real Estate Co. & Agent~,~7~ ~Z' ~~ -- /(~
Address
(f)
Telephone j~/~ - ~ ~ 0 gl
Mail the HAA to the following address:
~_1~ of Residence
Sihgle-Family~
Number of Bedrooms
Multi-Family F--[
Other (describe)
Water Supply- - .,
Individual Well~--~ Community~ Public~-~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
.Sewage Disposal~
Onsite ~ Public ~ - Community ~-~ Holding Tank ~
', \
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status°
[Page 1 of 2]
Engineering Firm Providing Inspections, Tests~ File Search~ Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify tha~ my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, fnnctional 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 regula-
tions in effect on the date of this inspection.
N ~ -. ' ,,~ ,, ~:- ~'!~IN~;~p~ Telephone
ame o~ ~lrm ~ ~__:~:_v - -
. . ,
DHEP Approval. · // . ~'?~'.. ,~%~i.~'~ / /
Approved for -- ~. bedrooms By . :~:~~f/:
Approved ~ Disapproved ~
Condition~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TRE 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 REQUIRE-
MENTS. 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.'
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A®
Well Classification A
Well Log P~esent (Y/N)
Total Depth Cased~to ·
Static Water Level .!/~n~ Set At
Casing Height Above Ground
Electrical Wiring in Conduit (
Separation ,Distances f~om Well:
MUNICIPALITY OF ANCHORAGE (MOA)
(HAA)MUNJClPALITY OF ANCHORA~i:
HEALTH AUTHORITY APPROVAL DEPT. OF HEALTH &
CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTIOI~
AU6 1.. 1984
RECELVED
If A, B, c~ C, D.E.Co Apprbqe-Sf~/NJ '
Date Completed Yield
Depth of Grouting
Sanitary Seal on Casing (Y/N)
Depression A~ound Wellhead (Y/N)
To Septic/~g Tank on Lot ~-~o /~' ; On Adjoining Lots
To Nearest Edge of Absorption Field on LOt ~_~oc~ /~ ~ On Adjoining Lots
To Nearest Public Sewe~ Line
C leancut/Manhole
Water Sample ColleCted By
Water Sample Test P~sults
C~n~fents
To Nearest Public Se~r
/,~;//~~ Nearest Se~r Service Line on LOt
; Date
Be
Date Installed f~"/~//¢~._ Size /~2~ No. of Compartments
Standpi~s ~) Ai=-tight Caps ~) Foundation_/ /~..Clean°ut (Y~
~ession ove= Ta~ (~ ~te ~st ,F~d
P~ing~aintenan~ ~n~a~ on File (y~)~/~ ; fo~
Holding Ta~ High-Wate~ ~a~ (Y~)~ ~=a=y Holdi~ Tank ~rmit (Y~)
~p~ation Distan~s ~ ~ptic~ng Ta~:
To Water-Supply ~11 ~ /~ To ~ilding F~ndation ~ /
To P~ope=ty Line
To Water Ma~n/se>~
Course
2~
~E3 "",'~ To Disposal Field
~--'~~¢i"0 Stream,. Pond, Lake, ~
jor
Drainage
Co~ntsj~_
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y~
Results of Last 'Adequacy Test
.~/~i Type of System Design
/
Length of Field ~3cfp
Depth of Field ~ /
Gravel ~d Thick.ss
Sta~i~s ~ese~t ~) , ,t
Separation Distano~ from Absorption Field: /
To Water-Supply Well '~c~O /~g To P~operty Line /~ ~
To Building Foundation ~,(~ / To Existing or ~ndo~d System'~
Lot '~ ; ~ ~joining ~ts ~ ~ /
To Wate~ Main/~vi~ Line ~ /~ To Cut~if pre~nt) ~/~
To St~eam~ond~ke/~ Majo~ ~aina~ C~se ~/~-
To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea /~) /
Corm~nts
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
"Pump On" Level at /L/.
High Water Alarm Level a
Tested for /
Electrical Codes(Y/N)
Comments
ing
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Cycles du~ing Adequacy Test.
Meets MOA
** Check Permitted Bedroom Rating Against HAA R~quest **
I eertify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
, III/ .
:
2-15-84
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
DATE: 7~
PWS i.D.
To Whom It May Concern:
r~l],ng to records on file in this office the
((.-'~..-/ Water System is in compliance with-~-~e State Drinking
Water RegUlations.' .
Sincerely,
Time ,, ' Time ,,~ je
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~/~"~,,~/' ~'--~// Phone
Mailing Address "~
Buyer
Address
Lending Institution ~t'/~/ ~'/~ ' ~ 70/~- *"2-- ~--4-~ ,,,/ Phone
Address
Realty Co. & Agent Phone
Address
Legal Description /----- ~:~) 7'"-
Street Location
'l'ype of~J~e§idence
[] Single Family
[] Multiple Family No. of Bedrooms
[] Other
Water Supply
[2~.b;mYvidual ATTACH WELL LOG. A well log is required for all wells drillsd since June
[] Community 1975. For wells drilled prior to that date, give well depth (attach log if
[] Public Utility available.)
Sewage_.,~)sal
IZ;rlndividual Year Individual Installed:
[] Public Utility When Connected to Public Utility:__
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.