HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 2 LT 5North Wood
Block 2
'Lot
#051-741-28
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wast*water Program, 4700 S. Bragaw St.
P.O. Box 19~650 Anchorage, AK 99519-6650
www.d.anchorage.ak.us (907) 343-7904
Permit Number: SW020391
Name:
Sean Stephensen
22355 Whi$1~ring Birch Dr.
688.0994 2
LEGAL DESCRIPTION
2 5 North Woods Phase 2
Page of
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PID Number: 051-741-28
Wast.water System: r"INew [] Upgrade
Well: [] New [] Upgrade
Public n. F,.
SEPARATION DISTANCES
T~To Septic Absorption tilt Holding PubZic/Private
Tank Field Station Tank Sew~ Un*
w,. 200'+ 200'+ NA NA 25'+
s~, w~,, 100'+ 100'+ NA NA
u~u~ 5'+ 10'+ NA NA
F~.~, 5'+ 10'+ NA NA
NA NA
c~. NA '50'+
*none known
Existing tank & field abandoned
New tankd & field insulated
ABSORPTION FIELD
2.0 ~,.
1.25 - 0.50 +1- ~,.
5 ~,. 2
R.P.C.
500
2.6
0.5 ~,
100 F,.
Fe D3034 & Sch 40
10/8/2002
TANK
n septic [] Holding [] S.T.E.P. I-I Other:.
Anchorage Tank 1250 c..,.
LIFT STATION
1250 c~ Orenco
44" ,. 42" "'1 48"
30 Gal. t~,L.t=t, ~ "5¥l~.
,~,,~, =,,~'o~r~ BENCH MARK
Bottom of siding
100 FI.
Engineer s Stamp
Inspections performed by: KND Enqineerinq, Inc. Dates: 1~
Development Services Department/~pproval
Reviewed and approved b ~--/. /'")4~'/4- Date:
(... ~)
A-D:36,3'
C-])=9,5'
A-E:42,6'
C-E:11,7'
A-F:24,6'
B-F=61.4'
A-G=52,8'
B-G:28.5'
A-H=39,7'
B-H=69.7'
A-I=60.7'
B-I=43.8'
AS-BUILT SYSTEM DETAILS/SITE PLAN
NBRTHWBDBS ADDN ~2, BLOCK 2, LOT 5
SCALE~
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Perml~ SW020391
PID# 051-741-28
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~ SEWER ROCK
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PREPARE3 FDR~
~AN ~EPHEN~EN
~355 WHI~PERIN~ ~IRCH ~R.
CHUOIAK, AK 995G7
(907)
finn BOOKS ~
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20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
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(907)696-6111/F~
October 12, 2002
RE: 22355 Whispering Birch Dr., Chugiak, AK
Owner: Sean Stephenson
To Whom It May Concern:
As per the Municipality of Anchorage (MOA) requirements:
I have insured that the electrical portion ofthe new Lift Station for the
above described property is installed as per all National Electrical
Code 0qEc), MOA, and the manufactm'er's requirements.
Sincerely,
eno
License #016224
C:~V[y DocumentsXRPC~lectrical Inspection Let~er. doc
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: Oct 07, 2002
Expiration Date: Oct 07, 2003
Permit Number: SW020391
Legal Description: NORTH WOODS PHASE 2 BLK 2 LT 5
Design Engineer: 0070 KND Engineering
Owner Name: SEAN & CHRIS STEPHENSEN
Owner Address: 22355 WHISPERING BIRCH DRIVE
CHUGIAK, AK 99567-5450
Parcel ID: 051-741-28
Site Address: 022355 BIRCH DR
Lot Size: 32921 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
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewatar 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.
Received By~~.
Issued By;
Date:
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 SEWEPJVVELL PERMIT APPLICATION
FOR a SINGLE FAMILY DWELLING
Parcel I.D. 051-741.28
Permit Number SWOgO~'?!
Property owner(s) Seen & Chris Stephensen Day phone 688-0994
Mailing address (1) 22355 Whispering Birch Drive, Chuglak, AK 99567 -5¥5'0
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub d.) Noah Woods Phase 2, Lot 5, Block 2
Legal description (Section, Township & Range)
Lot Size 32921
Acres/Sq.Ft.
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only [] Well Only []
Sewer and Well [] Water Storage []
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub [] Jacuzzi []
Swimming Pool [] Water Softening Unit []
Therapy Pool []
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.
(Signature of properb/owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
~b"~D ENGINEERING, INC.
20~41 PTAPdV~GAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907')696-8111
October 7, 2002
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Sewer Upgrade - North Woods Phase 2, Lot 5, Block 2
Gentlemen:
The existing septic system has been identified to be in failure, and the owner has
requested we proceed forward to obtain a septic permit on the subject lot. On
September 19, 2002 one testhole was excavated for the proposed septic system
upgrade. The results of this test are attached. The general slope of this lot is from east
to west at a grade of approximately 1-5%.
We have designed our system utilizing the existing testhole that was excavated for the
2-bedroom house. The lot is served by public water. We propose to install two 5' wide
shallow trenches. Water was encountered during the excavation at 10', and during
monitoring at ~-2C. ~, ~5 '
There are no public or private wells within 200' of our proposed system 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 development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
lI"J'sIT.~ Engineering, Inc.
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER
NBRTHWBBDS
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DISPBSAL SYSTEM DETAILS/SITE
ADDN #8, BLOCK 8, LOT 5
/ .~\\ \
PLAN
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DESIGN DETAILS
8 BDRM X 150 nPD = 300 GPI~
\
300 GPO/.6 GPO PER SD. FT. (12.3 MIN/IN.)= 500 SQ. FT
(500/5'(W)) X I(RF) (0.5' nRAVEL) = 100 FT. TRENCH
USE 8 TRENCHES - 50 IL) X 5' (W) X
To*~I dep*h oF S)'S~:eM Is~*S' FrOM Original
To*~t depth oF gr~vet berG. dls~rlbu*lon pipe Is 0.5'
PRESSURIZED LINE DETAILS' 1, R~SI~UAL HEAD = 5'
E, HOLE SIZE = 3/16' = 1,00 ~AL. PER HOLE ~ 30 PSI
3, 30 GALS (PUMP ~ELIVERY)/1,00 GALS,/HBLE = 30 HBL~S
4, 100 LF LATERAL/30 HOLES = 3,33' SPACING PER HOLE
5. ALL HOLES SHALL HAVE CAPS INSTALLE~ PER MANUFACTURES
NOTES'
1. USE 1250 GAL S.T.E,P, INSULATE TANK IF <4' DF COVER.
INSULATE TRENCHES WITH 8' HI] BURIAL FOAM,
3. CONTRACTOR WILL ENSURE MINIMUM 8% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LnT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
PREPARED FOR~
SEAN STEPHENSEN
8~355 WHISPERING BIRCH DR.
CHUGIAK, AK 99567
(907) 688-0994
RS.D BOOKS ~
~ SEWARD ~ V80
m'~,~ ¢atc~z:~ KMD
~ ~ 10/4/02
~ ~ ~ N~ 559
~ n.a 02073. DWG ,,m ~ 02073
Sc~te, 1'= 100'
PAGE I DF 8
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-611 I/FAX (907)696-8111
WASTEWATER
NDRTHWBBDS ADDN ~2, BLBCK 2, LBT 5
DRIVEWAY
DISPBSAL SYSTEM DETAILS
EXISTING SYSTEM
TO BE ABANDONEI
39'
10'
24'
~T
PREPAREI] FDR'
SEAN ~Tr'PHEN~EN
~355 VHISPERING I~IRCH ]DR.
CHUGIAKo AK 99567
(907) 688-0994
BOOKS
SEWARD
~ KMD
10/4/02
N~ 559
~ ~ 02073.DWG .ce .~ 02075
Sco,[e, 1'= 20'
PAGE 2 DF R
/]~]~) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER. AK 99577-8736
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(907)696-611 l/FAX (907)696-8111
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for:
Sean & Chris Stephensen
Date Performed: 09/19/02
Project:
North Woods Phase 2, Lot 5, Block 2 TEST HOLE # 2002-1
2-
3-
4-
5-
6-
7-
8-
9-
10-
11---
Depth
(Feet)
Org-black topsoil w/organics
SM - silty brown overburden
GP - brown/gray w/sand
to
GM/SM - reed dense, gray w/
occ. cobbles to 1.5'
& sandy pockets
seeps
B.O.H.
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? YES What depth? 10'
Depthtowateraftermonitoring? 8.3' {{.,g% Date? 9/26/02
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 9/20/02 1:00 6" -
2 1'.30 30 rain 3 8/16" 2 8/16"
3 * 1'.31 6" -
4 2:01 30 mln 3 9/16' 2 7/16"
$ * 2:02 6" -
6 2:32 30mtn 39/16" 2 7/16"
12-
13-
14-
15-
16-
17-
18- * Water Added
19-
HOLE PRESOAKED
20- PRIOR TO TEST
Percolation Rate 12.3 (rain/in) Perc Hole Diameter
Test Run Between 4.5 feet and 5,5 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
,/~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI~CTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE
MAI LING ~DRES~
LEGAL DESCRIPTION
J Well Absorption area Dwelling
~ Manufacturer ~~ Material ~r~~ No. ofcompartmonts
Liq, capacity in gallons Inside length Width Liquid depth
) OD O IF HOMEMADE:
O ~ Manufacturer Material Liquid capacity in gallons
O Well Foundation Nearest lot Jine ~.~ PERMI~O
~ DISTANCE TO: ~O~ *
No, of lines ~j Length of each line ~ Totallengthgf~n~ Trench width Distance betweenlines~ /
~ ~ Top of tile to finish grade ~.¢ Material beneath tile Total effective a~i~are~
Length Widt~ Depth PERMIT NO.
~ ~ Type of crib Orlb diameter Orib depth Total effective absorption area
~ Well Buildin~ foundation Nearest lot line
~ DISTANGE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIAL8
8OIL TEST
RATIN~
INSTALLER
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
~, MUNICIPALITY OF ANCHORAGE
.~ Departmen .%/-~f Health and Environments~Protection
825 ~ Street, Anchorage, AK. J9501
; 264-4720
' * * * HANDWRITTEN PERMIT * * *
Permit ~ ~,~]o~ ~ND/OR ON-SITE SEWER PERMIT
Applicant: ~ ~ ~ Mailing Address:
Location: ~~ ~hone Number:
Legal Description: ~-~%~. ~ ~
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms: ~
~~J~ Lot Size:
Seepage Bed: J~ H~lding Tank: Soil Rating(sq.ft/br) ~/V
The Required Size of the Soil Absorption System Is:'
DEPTH ~'~ LENGTH /~ GRAVEL DEPTH g ' 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 = /~0 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 fee% 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 8 3 * * *
I certify that:
(!) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I w~l install the system in accordance with codes. '
(3) I ~erstand~tb~ the on-site sewer system may require enlargement if
t~e/residen~z%remodeled to include more tha~ 3 be~rooms. .
Signe~: \j~. ~'~~ Issued by: ~, '~A~,'< ~_.,C~f
/~pplican~ - v // , _[ ~/ 6/
Date: ~/~ ,/~C~
SWD/024 (1/81)
,~*~ ~ ~"-~, i [] SOILS LOG
DEPARTMENT OF H E ALT ~?~.~:i.~NV~ RONMENTAL PROTECTION PERCOLATION
:~* .~ . TEST
825 L. Street, Anch0~age~ A~aska 99501 2~720
,SOILS LOG- PERCOLATION TEST
SLOPE / E PLAN '
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
I Gross Net Depth to Net
Reading Date Time Time Water Drop
· ~ PERCOLATION RATE ~- / /'~/r'/td/'~') (minutes/inch)
TEST RUN BETWEEN ~' '~'~ ~ FT AND ! FT
.. ,,,.-.. - .~ .... , - ,_
72-008 (6~79)
'O &. E ENC.,'NEERING & DEVELO, MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for: Name: '~7"~'//'~F/L/ 4, ~.~,'~'~5 ~'ox, r..sT'T, Tel. No.~ ~/
Mailing Address: ~.~. ~ ~/ ~~,~x<. ~.. ~P,J'~ 7
Legal Description:
Depth (feet)
0
Soil Characteristics
PLOT PLAN
12__
13__
14__
15__
16__
Ground Water Encountered:
Proposed Installation:
Comments:
Performed by:
PERC. TEST
Yes ~ No.__ If yes, what depth
Seepage Pit__ Drain Field__
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 ~
1~O S~R (907) 343-7904
TIFICATE OF HEALTH AUTHORITY,APPROVAL
FOR A SINGLEFAMILY DWELLING
Parcel I.D. 051-741-28
'1. GENERAL INFORMATION
Complete legal description
Expiration Date:
North Woods Phase 2, Lot 5, Block 2
Location (site address or directions) 22355 Whisperincl Birch Drive, Chuqiak, AK 99567
current Property owner(s) Bean & Chris Stephensen
Day phone 688.0994
Mailing address
same as above
Lending agency., .
Mailing address
Day phone
Real Estate Agent
Mailing Address
Unless_ otherwise requested, HAA. will be hem by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
Day phone
3. TYPE OFWATER SUPPLY:
IndMdual Well r-']
Individual Water Storage []
Community Class Well []
Public Water System []
'P/PE OF WAS'i ~-WATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
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 BYENGINEER :" ~';
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 ahdlor wastewater disposal system is(are) safe, fun~;tional
and adequate for the number of bedrooms and type of structure'indicated herein. I further verify that
based on the'ir~formation obtained from the Municipality of Anchorage files and from my investigation and
inspectidn,'the on-site water supply and/or wastewater disposal system is(are) in compliance with all
applicab~:;Municipal and State codes, ordinances, and regulations in effect at the t me of installation
. .'~ame of Firm KND ENGINEERING. NC Phone (907) 696-611t
"Address 20441 Ptarmigan Blvd.. Eagle River. AK 99577
Engineer s Printed Namq Kenneth M. Duffus Date 10/14/02
-,.,. t.
DSD SIGNATURE
/ Approved for .~ bedrooms.
Disapproved.
Condi~onal approval for . bedrooms, ~th the fol~owmo shpulabons:
Additional Comments
By:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer s Report
Other
Original Certificate Date:
(Rev. 01~2)
MuniciPality of Anchorage
Development Services .Department
' 4.700 $~uth 6regaw St.
P.O. Box 196650 -Ah-c~otag~. AK~ 99519-6650
www,cLanchorege.ak.us · (907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: North Woods Phase 2, Lot 5. Block 2
WELL DATA
Co
Parcel ID: 051-741-28
Weft type PUBUC
Date completed
Total depth
If A, B, or C provide PWSID # --
Sanitary seal (Y/N)
Cased to __.ft.
FROM WELL LOG
Date of test
Static water level
Well producfion
WATER SAMPLE RESULTS:
Coliform colonies/100 mi,
Arsenic: rog JI.
SEPTIC/HOLDING TANK DATA
Nitrate __ mg./t.
Date of sample:
Welt Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
Other bacteda
Collected by:
g.p,m.
__ colonles/lOO mi.
Tank Typa/Matertal se~cJ~eel Date installed 10109/02
Tank size 1260 gal, Numberof Compartments L Cleanoute (Y/N) I
Foundation cleanout (Y/N) Y._Oepresslon ever tank (Y/N) NHIgh water alan~ (Y~) ~
Date of pumping New Tank Pumper
ABSORPTION FIELD DATA
Date instefled 10/08/02 Soil rating (g,p.dJft~ or ~/bdrm) 0.6 System ty~e trench
Length t00 ft. Width ~ ft. Gravel below pipe 0.6 ff.
Total depth 2.5 fl, Eft. absorption area 600 ft~ Monitoring tube Y D6pressi0n over field 14
Date of adequacy test NA - New 6'/stem Results (Pass/Fail) Pass For 2 bedrooms
Fluid dept~ in absorption field before test __in. Water added __ gal. New depth
Elapsed Time: __mln, Final fluid depth , ,,in. Absorption rate >=
Any rejuvenation trealment (past t2 mo.) (y/N & type) N If yes. give date
in.
g.p.d.
ED
LIFT STATION
Dat~ installed t0R9102
Pump on level at 44in.
Datum boflom of tank
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankifift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Size in gallons t2_$~ Ma~nhole/Access (Y/N)Y
· Pump off level at 42 in. High water alarm level at 48
Cycles tested 3 Meets alarm & circuit requirements? Y~
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 0'+ Property line ~;'+ Absorption field
Water main t0'+ Water service line t0'+ Surface water t00'+
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line t0'+ Building foundation lQ'* Water main t0'*
Water Service line 10'+ Surface water t00'+ Dn'veway. partdng/veNcle storage 25'~.
Curtain drain 50'+ Wells on adjacent lots
COMMENTS
ENGINEER S CERTIRCATION
I ~ertlfy that I have determined through field inspections and
rat4ew of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer s Printed Name Kenneth M. Duffus
Date 10114/02
HAA Fee $375.00
Date of Payment
Receipt Number
(Rev. ~2~0~)
Waiver Fee $
Date of Payment
Receipt Number
3?£
o
Zo .
MUMU° , UTY OF PUMOR
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. 051-741-28
1. GENERAL INFORMATION
Expiration Date: S_�_ 2 0 ^; OZ.3
Complete legal description Lot 5, Bk 2, North Woods Subdivision, Phase 2
Location (site address) 22355 Whispering Birch Drive, Chugiak, AK 99567
Current property owner(s) Charles Sims Day phone(907) 250-8655
Mailing address 22541 URSA Major Circle, Chugiak, AK 99567-5337
Real estate agent Brooke Stil.tner @ RE/MAX DyDay phone(907) 244-6742
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well ❑
Private Septic
Water Storage ❑
Holding Tank
❑
Community Well ❑
Community
❑
Public Water System 0
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer.
COSA Fee $ J J L
Waiver Fee $
Date of Payment
Date of Payment
Receipt Number 26 `i 7`T 5
Receipt Number
COSA # ()5C-2 0 31 P)
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 Pinard Engineering Phone(907) 232-1347
Address PO Box 871347, Wasilla, AK 99687
Engineer's Printed Name Paul E. Pinard
6. DSD SIGNATURE
System #1 Approved for 2, bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Date 6/5/21
IF .444
co
O p�
®c °� PaE91' Ec. Pin�;rd e4 `
e P
fJPRf1i:rc�1(S��FA
bedrooms, with the following stipulations
sfz(
ll(tt(lf�
ON-SITE `y
�oIAIA
WATER AND
Z
PROGRAM
�i O
%i))vrSER\l\ -0V; �:
f Original Certificate Date:
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
Legal Description: Lot 5, Bk 2, North Woods Subd, Phase 2 Parcel ID: 051-741-28
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA – Public Water System
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 19 years
Tank type/material Sap±de/Steel
Measured operating fluid level in septic tank _4_ . 0 r
® Standpipes/foundation cleanout per record drawing
Date of pumping 5/14/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) –1118/02
® ALL standpipes present per record drawing
Total measured depth from grade aft (max)
Measured depth to pipe invert from grade _2_,5 ft (min)
❑ N/A – pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
Structure served by this system
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 19 years
Lift station material Steel
Comments: Lift station is part of a
STEP tank.
Adequacy test date 5/ 2W21
Results EX Pass For 2 bedrooms
Fluid depth prior to test —.4 in
Water added 450 gal
New depth b in
Elapsed time 75 min
U Code -required soil cover over field Final fluid depth !. in
❑ System presoaked Absorption rate 300 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) Nnn P Known
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: Per MOA files/inspection report, both ST & SAS were insulated
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'
® Yes if No ft
Wells on Adjacent Lots:
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' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ❑ 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 7 ft Surface Water > 100' ® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' 41 Yes if No.
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No _
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'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10']
Yes
if No
ft
Community Wells > 200' C$ Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
16
OF A
.. ................
..
° Padl E. Pinard o
CE -4 3
ft
ft
If,
ft
8495Y
O� o°
s ,��•oh �r 2Q 'I
�v P c�'`' syr ti o0
4Ci/ �57�Oo °cP• Lot 6
�Q ; 9
7"n"
s Lot 5 `P.- � �q
•o
/ phd 1 h
Al
O�^ �.0
q0 �J
O / y�
a �
n' o
Chain link fence
/ l0 -0
2S Manhole f 0
cc] o
/ eV
/ o ! septic vent (typ)
/ QjC Lot 10
416,90
/ 1S,9o
/ / (ZY
0Qo Sh
/ 0
OWire fence /
2
4�
/
Cb
Lot 4
O° Lot 11
Al
Note: this lot is served by community water system.
I
/ �
AS -BUILT NO CORNERS SET THIS DATE
®®®®®1 B
OF . Ak
• •
I hereby certify that I have performed a Mortgagee's inspection
in ASPLS Standards the following
P•
� ®
•��,
accordance with of
described property: LOT 5, BLOCK 2,
49th
WOODS SUBDIVISION PHASE
NORTH II
• • •' • 00
00
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the lines
®••"�L/
property
� . glizabeth L Walatka . o
and do not overlap or encroach on the property lying
_,a
®c�adjacent
s�F
thereto, that no improvements on the property lying
• 8036 — LS • • ���®
�
adjacent thereto encroach on the premises in question and
•
�F • , 5 ®
that there are no roadways, transmission lines or other
SCALE: V= 50' 0 pRoFfSSIOt0'1- Y
��
visible
hereoneasements on said property except as indicated
®®®®14-®
Dated at Anchorage, Alaska
this 11th day of MAY '2021.
EASEMENTS RECORD, OTHER THAN
THOSE SHOWNN ON THE RECORDED
FRED WALATKA & ASSOCIATES, L.L.C.
PLAT ARE NOT SHOWN HEREON FB 21-3, 12-13 BE
pg
Engineers and Surveyors
907-248-1666
UNLESS OTHERWISE NOTED.
This drawing is a representation of conditions found at the time the mortgage location survey
was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose.
The information contained on this drawing shall not be used to
establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original
client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered,
the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
PINARD ENGINEERING
a P.O. Box 871347
Wasilla, AK 99687
(907) 357-ENGR (3647)
8
ADEQUACY TEST
LOCATION: Lot 5, Block 2, Northwoods Subdivision, Phase 2
APPLICANT: Charles Sims
22355 Whispering Birch Drive
Chugiak, Alaska 99567
SEPTIC TANK TYPE/SIZE: Steel/1250 Gallons, per MOA Records
ABSORPTION SYSTEM: Shallow Trenches, per MOA Records
DAILY FLOW:
2 BEDROOMS x 150 GAL/BR = 300 Gallons
TEST DATA
JOB
NUMBER: 21-092
DATE OF TEST: 5/20/21
FIELD STAFF: PJ Pinard
NUMBER OF BEDROOMS: 2
SCUM: 0.0' SLUDGE: 0.0'
NEEDS TO BE PUMPED: Yes No XX
CURRENTLY IN USE: Yes XX No
Time
Flow
Rate
Volume
Cumulative
Volume
Septic Tank
Septic
Tank
Soil Absorption System
Comments
P1V1
(GPM)
(GALs)
(GALS)
Liquid Level
A Level
Monitor
Tube 1*
A SAS
Level
Monitor
Tube 2*
A SAS
Level
4:30
4.0
-
-
4.0'
-
0.3'
-
0.3'
-
Start Flow - Meter 7000
4:45
4.0
90
90
4.1'
0.1'
0.3'
0.0'
0.3'
0.0'
7090
5:00
4.0
90
180
4.1'
0.0'
0.4'
0.1'
0.4'
0.1'
7180
5:15
4.0
90
270
4.1'
0.0'
0.4'
0.0'
0.4'
0.0'
7270
5:30
4.0
90
360
4.1'
0.0'
0.5'
0.1'
0.5'
0.1'
7360
5:45
-
90
450
4.1'
0.0'
0.5'
0.0'
0.5'
0.0'
Stop Test - 7450
f.73�il�ld:�-1
Date
Time
SAS MT1
SAS MT2
5/21
4:15
0.3'/-0.2'
2'
0.37-0.PM
*ALL MEASUREMENTS IN FT.
TEST: PASSED XXX FAILED
COMMENTS: Testing on this WWDS found it to be operating satisfactorily. There was 0.3' of measurable liquid
in the SAS MTs prior to beginning the test. With the addition of 450 gallons of test flow to the
system (significantly more than the design daily flow), the level in the MTs rose to 0.51, which is the
invert of the SAS distribution piping. Recovery measurements, taken 22.5 hours after stopping the
test flow, showed a return to the starting level in the MTs (note the residence is occupied).
Reviewed by: Paul Pinard -�tx
Date: 5/28/21
MUNICPAUTY OF ANCHORAGE
Development Services Department ? -7 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
Owner Street Address- ` w_
Septic Tank:
-Sludge level "fro`—inches -Pumping: required es no -Pumping completed je i7o
Lift station:
-Pump basket cleaned yes no -Effluent filter cleanedey s no
-Control floats cleaned mcs 110 -Proper float settings confirmed s no
•Operation satisfactory d9 no
Alarm System:
-Dedicated electrical alarm circuit yes no QAudible and visual alarm inside dwelling yes no
-Alarm system operation atisfacto not satisfactont
Manhole Riser
Ground water intrusion at riser to tank connection jLe-s /n
-Ground water intrusion around pipe penetrationsey s%� -Weep hole functional yes no
-Manhole Fid: Functional es no Insulated ves no Properly Secured (y_es no
Other
-All manufacturer required inspections and maintenance completed t es n
Comments:
Qualified Maintenance Provider:
�J // L
Technician &ndrw Date of maintenance
r
Company e S+vr Pv,-A2 pry
Signature„r; Date 0�
Parcel I.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
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water ,'~
If community well system, provide written confirmation from State ADEC attest- .
lng to the legality and status.of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
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
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~i~NI!DN~ ,ka NOIJ. O~dSNI dO J.N~]IN=m.I.VJ.S
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /~F~--/~.~ ,~//~jd34,r/,~/~' z- Parcel I.D.
A. Well Data (2,+~A-/~_ ~ ~ ~
Well type ~,~-t~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
g.p.m. ~
g.p.m.
AT INSPECTION
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; 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 GI
Cleanouts (Y/N) '~
High water alarm (Y/N)
Date of pumping
Tank size
Foundation cleanout (Y/N)
iI/.
Compartments
~'( ' ' Depression (Y/N)
Alarm tested (Y/N) tJ
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~)/~" On adjacent lots
To property line ~ ~ Absorption field
Surface water/drainage
Foundation ~:>
Water main/service line ~'~.~'-~-
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. L~F'r STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Length . ~ Y
Total absorption area
Date of adequacy test
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
.Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed
Width
,1-z~ IZ~.~,-,~t.~ Cleanout present (Y/N)
'~ / ~/9 ~ Results (pass/fail)
Water level in absorption field before test
Soil rating (GPD/Ft2) Z.-~
Gravel thickness
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain /~ ~'
E. ENGINEER'S CERTIFICATION
Surface water
System type J:~
~" Total depth ~ '
¥ Depression over field (Y/N)
/~,"/~-~--~ for ~ Bedrooms
After test ~'~/~ /~F~~'~'
If yes, give date
,,.2~ On adjacent lots /%////' Property line
/ Z~ To existing or abandoned system on lot
~'~4.~ ~ Cutbank /J~,~-~ Water main/service line
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec~q~f~t~ of this inspection.
- ~avid R. Dayton P~. ~,?L?"~,,' i~;, .... % ~ e~
.'hu~liak, Alaska ~56~ ~ ; / ~,:%, ~ . .... ~
Engineer's Name ~ v~ $ :: '-' '~ , - ' .' . ~
Date ~ .d;~, ,~,,, ,,~..~. ~ ~
HAA Fee $
Date of Payment
Receipt Number
72-028 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
~~~ Chugiak, Alaska 99587
20210 Donalar
September 7, 1993
696-2417
ADEQUACY TEST
Legal Description: Lot 5, Block 2, Northwoods ~2
Septic System: 1000 gallon, 2 compartment, steel tank
Absorption System: 20 x 38 bed
Soils Rating: 231 sq. ft. per bedroom
Requirements: 150 gallons per day per bedroom, system designed for
3 bedrooms. Owner saya house is 2 bedrooms.
Tested for 3 bedrooms.
Test:
Water was pumped into the absorption bed while measuring
volume, water level rise and time.
After pumping was stopped, the water l~ve~ drop was measured
at timed intervals and the results plotted on a graph of time
and gallons absorbed and extrapolated to 24 hrs.
Results:
The absorption system is currently functioning adequately
for a 3 bedroom home.
Note:
There was 3~" of water standing in the system before the test.
The water level dropped to 3¼" within 4 hrs. The s~anding water may
indicate the system is in its waning years.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township,.range)
Lot 5; Block 2; North Woods
Location (address or directions)
Wb~'A?~'-g
(b) Property owner
Mailing Address
(c) Lending Institution
(d)
AHFC#48289
520 East 34th Avenue
Telephone:(home)
Anchorage, AK 99503
Business
561-1900
Telephone
Mailing Address
Real Estate Company and Agent RE/~,!AF 0F FAGLF R!!/ER A~n: Lee
Address 16600 Centerfield Drive #201 Eagle River, AK. 99577
(e)
Telephone.,
694-4200
Mail the HAA to the following address: (or check here~, if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road No. 204
2. TYPE OF RESIDENCE
Single-Family. k~ ¢ Number of bedrooms ~P
3. WATER SUPPLY ~/'
Individual Well [] community,S( Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site~ ~ 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.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of thevalidationdateshown below, Iverifythat my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Date
S & S ENGINEERING
!?n~4 ~n~_le River Loop Roael
Eagle River, Alaska 99577
Telephone
6. DHHS APPROVAL
Approved for __~_'~--
Approved __
bedrooms by~~ Date
.... Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated 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 ordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
M~NJCIPALITY OF ANCHO~
~NViRONMFNTAL SERVICES~
U L 1 ? 1§8!)
RECEIVED
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~
Well ClassificatiOn
Well Log Present (Y/N)
Total Depth__ Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments "~g3 5 ~ ~;2 ~
Date Completed
Depth of Grouting
If A, B, C, D.E.C. Approved(~CN) ~
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Date
B, SEPTIC/HOLDING TAN K DATA
Date Installed ~-2..-tS'~Size ~
Stand pipes (~¢)/N) ~ Air-tight Caps~ig'N)
Depression over Tank (Y/~
Pumping/Maintenance Contact on File (Y/.Nt/
Holding Tank Hig~-Water Alarm (Y/N)
SEPARATION DISTANCES FROM S EPTIC/HOLDING TANK:
To Water-Su pply Well ..?_.~,~ I~ To Building Foundation
\ ~ ! ~ To Disposal Field
To Property Line
To Water Main/Service Line
No. of Compartments
~' Foundation Cleanout~N)
rip. ate Last Pure ped
; for
Temporary Holding Tank Permit (Y/N)
To Stream, Pond, Lake or Major Drainage Course
%
CC mments ~lj-~_~ ~
J,o1 ~.~
I
5'-
72-026 IRev. 7/88: Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field (Y~
Type of System Desi~gn
Length of Field
Depth of Field
Gravel Bed Thickness ~::~ ,~/.~
Statndpipes Present~d?/N)
Date of Last Adequacy Test
Results of Last Adequacy Test~^ -" -~ '~~'-~~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
.~.~ I~ To Property Line 7--,~' ~''~
To Water-Supply Well
To Building Foundation~
Lot 14
TO Water Main/Service Line [ ~-~ ~''~
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ")f¢'"1"~¢~-~ ,~--~'~¢,TK~-'~, I, ~
I c:= To Existing or Abandoned System on
On Adjoining Lots ~'~'~::~'~
To Cutback (if present) ~/~
D. LIFT STATION
Date Installed
Size~
"Pump On"
High Water Alarm Leve~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines ir~ee'~ ~~ate of this
inspection.
Signed 5 & S ~NEERtNG
Company 17034 Eagle River ~=~°ad N°' 2~
Date ~ .,,, , . . ,~
~/~ 7~ Receipt No.
~- ~ Waiver Fee: $
~' ~ Date of Payment
Page 2 of 2
D~PT. OF ENVIRONMENTAL CONSERVATIO
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
STEVE OOWPER, GOVERNOR
563-6775
DATE: July 14, 1989
PWSID: 213001
TO Whom It May Concern:
According to the records on file in this office, the Chugiak
Utilities/Northwoods Water System is in compliance with the State
of Alaska Drinking Water Regulations.
CT: gd
Thank You,
Cindy Thomas,
Environmental Engineer
APPLI~"~,NT FILLS OUT UPPER HA,/h ONLY
Buyer
Address Zip Code
Lending Institution Phone
Address Zip Code
Realty Co. & Agent Phone
Address Zip Code
Street Locatio ¢ rl.
Typ._e of~.~l~esidence
Lf~ingle Family
[] Multiple Family No. of Bedrooms
[] Other
Water Supply
~ In~d. ivi~lual ATTACH WELL LOG, A well log is required for al(wells drilled since June 1975,
~Sommunity For wells drilled prior to that date, give well depth (attach log if available)·
· [~ Public Utility
Se~s.~osa~,
[] Public Utility When Connected to Public Utility:
[] Holding Tank
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:
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
DATE
BY:
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
72-023 (3/82)
