HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 2 LT 10North Woods Phase 2 Block 2 Lot 10 #051-821-10 Municipality of Anchorage Development Services Department Building Safety Division On -Sita Water and Wastewater Program. 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 Pager of 3 www.d.anchorage.akus (907) 543.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5(t y LFO�68 PID Number. 0 S/- 001- 10 wnw: declnne 51ian& Wastewater System: ❑ New [,Upgrade AOdro,s: A ZA b !� y � �7 ABSORPTION FIELD Ph—:/ [7 — / b (j Mn0« a eetrmms: ? J Deep �eTrull W SnMae Tnxxh 13 so ow MN o otMr. LEGAL DESCRIPTION sow ftwq Ta« DeDFl lro w""w ww": r6e(,�,F,• FI. � &: W; 10 Sueawsbn* ('eecds M'-.( Depth io P"adan do p un ovew eJ FI. GavM depth WMath PDe: i / Ft. 7 TonWV: Rae": semen: Fe added above W" Vase: I Fr. GnvM LMX: � 3 / Fl. Well: ❑ New ❑ Upgrade Gnh,ei de r J\17 FL N,~ of lines: c. Pwnt° Delwe°n ws: FI. CIa Y6 W(Ph Ia.A B.CI%' TOW Oeoet: Cash tl: Tol«aeuixion �f 6O MilMM41: �/� (/ F ,„ ✓ er FI. Ft. / Fr 51 /n it/�J Oreier OateOeses/ SWC Water LM: a ontoM°d: %— b- QIT FL wird/ Ja1s-n v.«d: Papp s«aL Ca hetgn!.! i0: TANK GPM FI. FL SEPARATION DISTANCES VSepttc ❑lidding OS.T.E.P. [3 Other To From Septic Tank Absorption Field Utt Station Holding Tank hbicilprivate S+e'/wer Une , °' ;el /'(�Te/F �('j oaotr. 1&96041. WON 1004 Irof -- IX.st Mat" HDPE' Na dCatpanmenls: Sa,anwate,too LIFT STATION L01 UM Zr s :a: x4rM: J C FouMalwn ' f o \/ ' 1 •PIIIV Mr leer t: Np1 Yq1« MMeI al: In. N. tartan DMV✓ C t .^0(F1' ,I i I Peep Mane a EJ°Mml aneecnau Warned ey. amens: EX `„ ani was un � BENCH MARK c r us!if Ladason and oampson: R HOM ` aLanel n Of s 1 /, 1 wined erabm: 4/Il IQO / FI. Engin Imp -�G OF S d S ENGINEERING Road 17074 Eagle River Loop , M 7—DI-OV Inspections performed by: NODS: 1 Development Services Department Approval �e ROSERT C. COWAN �4 '�.� CE -8801 Reviewed and approved by: Date:ftrf '� • ... .•• v y ��11Y— PERMIT NO. SW040268 PACE 2 OF 3 DEPARTMENT OF ANDhHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAC, LOT 10, BLOCK 2. NORTHWOODS S/D #2 P.I.D. No. 051 -821 -lo DV (DIVERTE j FS (FLOW / / NEW TRENCHES / / / / It It/ / / / SEPT` AREA LOT 11 ST SEPTIC AREA \ k / LOT 9 O81.1 \& D8L2 \ NEW 1000 GALLON \\ TMT HDPE SEPTIC; TANK \ ° ° CLEANOUT INSIDE 0. \\ FOUNDATION \ \ 8 \ GC \ \AIL \ / 1-19CALE: _ I".. -0 111090T C. COWAN / t c, CE -8801 / tit se." �... / . ta�iooira� PERMIT No. SW040268 PACE 3 OF 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 10, BLOCK 2, NORTHWOODS S/D #2 P.I.D. N0. 051-821-10 FINAL GRADE NEW 96.3' 1000 GALLON POLYETHYLENE SEPTIC TANK CO1 CO3 CO2 MT1 C01 = 98.5' C04 CO2 = 100.5' .,FINAL GRADES 99.1' 2" INSULATION 96.0' NIT2 ]CO3 = 98.8' / C04 = 100.5' MT1 = 90.5' NO WATER FOUND 83.0' B.O.H. MT2 = 90.5' N. T. S A B ST1 32.0 22.0ST2 33.5 24.5TMT 340 19.0DBL1 R)�' 355 270DBL2 360 275DV 33.5 36.5FS - 72.0 . C01 - 63.5 58.0 CO2 17.5 - 23.0 CO3 44.0 - 63.0 C04 34.0 - 35.5 MT1 16.0 - 23.0 MT2 35.0 - 36.5 NO WATER FOUND 83.0' B.O.H. MT2 = 90.5' N. T. S ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 15, 2004 Expiration Date: Jul 15, 2005 Permit Number: SWO40268 Parcel ID: 051-821-10 Legal Description NORTH WOODS PHASE 2 BLK "2 LT -10 :• Design Engineer: 0003 S & S Engineering Site Address: 022324 SHADOWY SPRUCE DR Owner Name: Darrell Rosiere Lot Size: 27219 SO. FT. Owner Address: 22324 Shadowy Spruce Drive Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak . AK 99567-2276 This permit is for the construction of: ❑,/ Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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. Received By. Date: ! b S/o y Issued By. /1 I I Date: 7 15 W%(lam IPI,t MUNICIPALITY OF ANCHORAGE q jpllQq /9�v Development Services Department Onsite Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 15, 2004 Expiration Date: Jul 15, 2005 Permit Number: SWO40268 Parcel ID: 051-821-10 Legal Description NORTH WOODS PHASE 2 BLK "2 LT -10 :• Design Engineer: 0003 S & S Engineering Site Address: 022324 SHADOWY SPRUCE DR Owner Name: Darrell Rosiere Lot Size: 27219 SO. FT. Owner Address: 22324 Shadowy Spruce Drive Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak . AK 99567-2276 This permit is for the construction of: ❑,/ Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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. Received By. Date: ! b S/o y Issued By. /1 I I Date: 7 15 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.ok.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O �-/ ' 2 Z ( — (,7 Permit Number SW Property owner(s) rr'ell Po51 ere. Day phone V7-6101/ Mailing address (1) o(d�7 �naA�wQ�u�P Mailing address (2) C��N rA K� Zip Code 1'",1N567 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size "o� 7 a 19 Acr /Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade R THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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 ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 (Signature of property owner or authorized agent) Permit Fees: y G d 04 Waiver Fees: Date of Payment: 7 / q 1 0 y Date of Payment: Receipt Number: O iso O 5 Receipt Number: (Rev. 12/00) July 7, 2004 ROBERT C. COWAN, P.E. CMLENGINEERS (907) 6942979 FAX (907) 6941211 PE&THAMHOFM MUNICIPALITY OF ANCHORAGE APPROVALS Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWER 6 WATER MAN ME BIONS REFERENCE: Lot 10, Block 2, Northwoods Subdivision #2 SEWERSWATER It is requested that you issue a permit to install a new drainfield upgrade to serve the INSPECTION existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of ENGPEERNGSTIAIES the test hole is located on the attached site plan. At the time of excavation 7/1/04, no water ANDREPWS was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve WMINSKCTM areas or drainage patterns by the installation of the proposed septic system. The &FLOWTEST construction of this system will not prevent any future development on any of the adjacent properties. SITE PLANS If you require additional information, please contact us. Sincerely, RDAnoESIGN ?W2• 4, Robert C. Cowan, P.E. W&tEST RCC/bjj . Enclosure PERCOLATION TEST StFMIL ALB MECHAAIIM INSPECTIONS ON WE WASTEWATER GSPOMSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 1"1" = 40_ I DESIGN I SITE -PLAN A=F N 0 W �\ VUt A - \ - O \ �£ N=y<Z mo rr fZ'10 KZ m r,oz D r=im F~4 �l O_0 ;AS NO C.z K N \ n o \ \ ) m m m \ \ O T1 0 01 \ � H 5 \ \ W m \ to CA m \ \ � /X11 v Am \ m� Dn . \ \. \ \ \ OX O� O0N—OM N 0 W 0 Kma \ - O \ �£ N=y<Z mo rr fZ'10 KZ m r,oz D r=im F~4 �l O_0 ;AS NO \\ K N \ O O \ S� \ n. sA C 9� \ 0 \ C, \ m� Zovo <DXoo \ // r N�9 N\V w• =nn b a \x, , / / / / fp2 rir'Cm � \ �[cD Kzn// �A 00, 71 ri f \\/S• \ ld� X 6A \ / o M-0 ems // D i�0 / yVJIp Eel N 0 W \ i v N O O m sSSi VOA \\ TT V, Ln C) \ O O \ 0U \ \ O T1 0 \ � H a \x, , / / / / fp2 rir'Cm � \ �[cD Kzn// �A 00, 71 ri f \\/S• \ ld� X 6A \ / o M-0 ems // D i�0 / yVJIp Eel i C ;Ir o Pi 7 O m rQ sSSi ^ '�i��sC/ i C ;Ir o Pi 7 O m rQ Performed Fa Legal Descriptir Dept ,LI r • 1 5-6- Iryj 10- 11- 12- 13- 14- 15- 16- 0- 11-12- 13- 14-15-16- 18- 16- 20- 20- 5141 5149 k;th Sone gravel 15,C.H. WAS GROUND WATER ENCOUNTERED? S —� IF YES, AT WWII DEPTH? D Depth to Water After p Monitoring? bQy E Dater/ $l oy Reading DateK7&,�4 pth to Water Net Drop -6-o-5 �/ " 3% .r 13 " I PERCOIATIONRATE d(% _(fee) rem. nv�c a,w"c�cn n TEST RUN BETWEEN i..FT AND C Vi FT COMMENTS PERFORMED BY: S & S ENGINEERING I �'�aG, �Z�• CERTIFY THAT THIS TEST WAS PERFORMED INA e PA GUIDELINES IN EFFECT ON THIS DATE. DATE: ___43s..__ -. c�� S& ROBERT C. COWAN, P.E. CML ENGINEERS (907)694-2979 FAX(907)694.1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AAUrHORITM APPROV and MATERIAL SPECIFICATIONS SEWER& WATER WVNEXIEMIONS REFERENCE: Lot 10, Block 2, Northwoods Subdivision #2 July 7, 2004 SEWER&WATER ISPECWN GENERAL: 1. The scope of this project includes the installation of new trenches to serve the existing three bedroom residence located on the referenced property. ENGINEERINOSTUOIES ANDREPORTS 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. WEUISKMICON & KOW TEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. SITE PLANS 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROAnDESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. eoaTEST SEPTIC TANK INSTALLATION: PERCOLATION TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. &TRucnjm& 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of MCKANIM INSPECTIONS the tank. ONSITE WASTEWATER CISPCMSYSTDA DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 Page 2 Lot 10, Block 2, Northwood* Subdivision #2 July 7, 2004 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 10, Block 2, Northwoods Subdivision #2 July 7, 2004 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (FIDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 10, Block 2, Northwoods Subdivision #2 July 7, 2004 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER \ (—*' MUNICIPALITY OF ANCHORAGE n 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 \ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME c.f PHONE 9AEW ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION !3A No,¢?IAwoocl LOCATION NO. OF BEDROOMS 3 v Y DISTANCE TO: ell fi a Absorption area 141 Dwelling 7 PERMIT NO. 2/ I aZ Wf14.c Manufacturer Material No. of compartments L rn Liq. capacity in gallons IF HOMEMADE: Inside length Width __ Liquid depth —1DZ DISTANCE TO: Well Dwelling PERMIT NO. _? f Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. No. of lines Length of each line Total length of lines Trench width Inches Distance between lines FW Top of tile to finish grade - Material beneath tile inches Total effective absorption area Length Width Depth PERMI NO. a//7 Type-efcrib Cribdianwar Crib depth Total effective absorption area y DISTANCE TO: II ns," fil v Buildin foundation q r Nearest lot line J J Cl s De h Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER oaD PIPE MATERIALS 34 SOIL TEST RATING INSTALLER C REMAR S qq M /I .4 cti4'1-r on/zoo;ds_a• t r 4 APPROVED -e DATE LEGAL il 72-013 (Rev. 3/781 Q C7� TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF�*TH= S LEtJGTH= J0 GFZAVEL_ 17EF}TH= 5 THE LENGTH DIMENSION IS THE LENGTH (IFJ FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTAFJCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MIFJIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIFJ FEET>. FZEGEU I FZEF> SEPT 10 TFit-7FC S 12! E=- = 1LC3(3ID (3nL_L_01tJS, 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. --- TWQ C 2 ] I tJSF=ECT 101 r-4!3 FIRE FZECMU I REQ --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. • MIFJIMUM DISTAFJCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MIFJIMUM DISTAFJCE FROM A PRIVATE WELL TO A PRIVATE SEWER LIFJE IS 25 FEET AND TO A COMMUNITY SEWER LIFJE IS 75 FEET. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZM I T EXP I RES E>ECEMEER 31s 1.S�_S2 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO cINCLUDE MORE THAN 3 BEDROOMS. SIGNED:__jLLtur__�_ aIL O___--------- ISSUED STEVEN L SFCFICKS CONST �V � MUFV I C I F"FiL I TAY of Fir4 H0FZnCaE - DEPARTMENT HEALTH AND ENVIRONMENTALeQkOTECTIOFJ 825 STREET. RNCHORAGE, AK. 9. b1 :3 V " - 264-4720 Ii�cS ii a3 Sa Ot 1—SITESEWER > F}EFZM I T RQJt/!t� PERMIT NO. C 821176 APPLICANT STEVEN L SKAGGS CONST PO BOX D CHUGIAK AK 99567 688-2831 Ut LOCATION LEGAL L1O 62 NORTHWOODS II LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF�*TH= S LEtJGTH= J0 GFZAVEL_ 17EF}TH= 5 THE LENGTH DIMENSION IS THE LENGTH (IFJ FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTAFJCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IFJ FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MIFJIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIFJ FEET>. FZEGEU I FZEF> SEPT 10 TFit-7FC S 12! E=- = 1LC3(3ID (3nL_L_01tJS, 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. --- TWQ C 2 ] I tJSF=ECT 101 r-4!3 FIRE FZECMU I REQ --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. • MIFJIMUM DISTAFJCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MIFJIMUM DISTAFJCE FROM A PRIVATE WELL TO A PRIVATE SEWER LIFJE IS 25 FEET AND TO A COMMUNITY SEWER LIFJE IS 75 FEET. OTHER, REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEFZM I T EXP I RES E>ECEMEER 31s 1.S�_S2 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 THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO cINCLUDE MORE THAN 3 BEDROOMS. SIGNED:__jLLtur__�_ aIL O___--------- ISSUED STEVEN L SFCFICKS CONST �V � Russell Oyster 694-2774 Performed for. O & E EN(,NEERING & DEVELG MEN Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 n _ , 1104 Mailing SOIL LOG Legal Description: lOr /D.0 /-S 2{ NaP Depth (feet) Soil Characteristics 0 2 G P- 64 VO 3 4 la-sr-si�-r, 5 SAND WrTlJ t�ag/3Gr S 6- 7- 8— 76 2 so Shy s 10 — 11 12 13- 14 3_14 — 15 16 _ Earl Ellis 688-2280 Tel. No 66E- � 9�7 ssG 7 u/o10 ' u,BD PLOT PLAN PERC.TEST ��G /�AT�� 3O M.w/�i✓G!J 2-0 Ground Water Encountered: Yes No If yes, what depth— Proposed epth Proposed Installation: Seepage Pit— Drain Field �•..'....r, Russell L Ouster r IK G✓zf£ fl- ..S - u5� IK G✓zf£ fl- ..S • '-� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Parcel I.D. 051-821-10 Certificate of On -Site Systems Approval Expiration Date: 2-11- 1. rI1 1. GENERAL INFORMATION: Complete legal description NORTHWOODS #2; BLOCK 2 LOT 10 Location (site address) 22324 Shadowy Spruce *Chuglak Current Property owner(s) Matthew & Michelle Barlow Day phone 223-5609 Mailing address Real Estate Agent 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual M Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Public Sewer ❑ WaiverNariance request for. Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5S0 + 33 0 Waiver Fee $ Date of Payment Receipt Number COSA# OSGZZ 1055 Date of Payment Receipt Number Waiver # f 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. Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation, Separation distances were measured to readily identifiable features. Hidden defects or o �;��• " encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, : groundwater levels that may fluctuate Burin the ) quality ( * : I' y ( y g year), uali of construction materials and u . workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and """""' 'r" " ""' """"' are outside the control of GEG. Satisfactory test results do not guarantee future performance of the j; system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of �1. • . • .. • • • • the well or septic system. GEG makes no representation whether an alternative well or septic system Af I y Garr .ss can be installed on the property in the event either of the currents stems fail to perform adequately in -79-3l) y: r the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right tures-,ol whatsoever. #AECC884 6. DSD SIGNATURE —rX_ System #1 Approved for Z bedrooms bedrooms L\iY�OFIIr��i��� hU ; bedrooms, with the follo it stiRulii 6@TE o R AND c� System #2 Approved for Disapproved Conditional approval for =� ,,L� ..' r - v �ATER Jm PRonr No 1VI Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Thid, Legal Description: NORTHWOODS #2; BLOCK 2, LOT 10 ParcellD: 051-821-10 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) 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 C AWWU WATER Static wa1W a Sat beginning of test ft. Well production at time of test Water storage tank volume gallons Well disinfected (form test? ❑ Yes ❑ No ❑ C bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample B. TANK DATA C. LIFT STATION Age of tank(s) 18 years ❑ Required maintenance Tank type/material 5� "G""` Age of lift station Measured operating fluid level in septic tank 39" Lift station mated ❑ Standpipes/foundation cleanout per record drawing Commen Date of pumping 9/22/21 D. ABSORPTION FIELD DATA DUAL TRENCH Which system7/22/04 . tested (date installed) Adequacy test date 2/11/22 ❑ ALL standpipes present per record drawing Results Q✓ Pass For 3 bedrooms Total measured depth from grade `9.91 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.33 ft (min) Water added 606 gal ❑ N/A — pressurized field 16 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 120 depth into effective 'JSB•-9.91 Elapsed time min ❑ Code -required soil cover over field Final fluid depth 9 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) ')"JO date of test} Gallons introduced N/A gallons iJ IA If yes, enter date i Comments/Deficiencies: 'TESTED EASTTRENCH ONLY -WEST TRENCH WAS DRY AND REMAINED DRY THROUGHOUT TESTING - 1982 DRAINFIELD WAS NOT LOCATED COSA Checklist yellow sheet E. SEPARATION DISTANCES AWWU WATE-R] From Private Well on Lot to: (Please enter distances if less than required or if community well) F. ENGINEER'S COMMENTS 1982 DRAINFIELD IS IN ELECTRICAL EASEMENT *MET CODE AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION l 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 d ,J fre a Gorn ss; CE -7963— kax-f ofessior #AECC884 Septic Tank/Lift Station on Lot > 100' Community Sewer t�tf'for/Cleanout > 100' ❑ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft rivate Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption F' _ 100' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' unity Sewer Main > 75' ❑Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No *5�+ ft Surface Water > 100' Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' [) Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if Iess than required) Building Foundation > 10' [] Yes if No ft If absorption field is under driveway comment below y Property Line >, 10' [j Yes if No ft Wells on Adjacent Lots: Water Main > 10' [] Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' [D Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS 1982 DRAINFIELD IS IN ELECTRICAL EASEMENT *MET CODE AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION l 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 d ,J fre a Gorn ss; CE -7963— kax-f ofessior #AECC884 F- LU w m F— R m 0 m o 0 O z 0 n N m m -D1 D =i OO v O Z Z Z -'I N -' 0 0 W N .. D X a D D O O C C O r OD m = m 77 17 v v m W v m a O v o z_ z m z 0 0 0 m x a v -0 v❑ m m O O n Z XO � Z Z D 33 O-01 O O < y 707 — 0 y D m i ? C m X m N z O z -q c O ❑ S z 1 m O Z 1 Dm O 0m a X m m O D o D 0 77 Z < � z m y � m 2 ED { Z x .1 cn -4 y (� W >Ln O O X T C) m m m p z 77 Z D D e ? m m m m m m x m0 0 n o Z w Z n m m 0 n Z O O z z D3 m m m m ❑ ❑ ❑❑❑❑rMM. # m# D W v g v D 77 m -I 1 Cm D 3 D DO O G7 in # O D M O m -! N m m m 2 < D m m v 9 3: v m Z m m r z m -OI D mi Y 0 O n Z � Z m z vi D m S' 70 z O o O Z o n Z X o r D {m K z I m Z n 0 �s c) D � � o D v M c m O Z a s m O >> Z O n Z � � m z vi O m Parcel I.D. 051-821-10 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION UBM TAL APR r� !k5 Expiration Date: 4-7-1_7 Complete legal description North Woods, Phase 2, Block 2, Lot 10 Location (site address) 22324 Shadowy Spruce Dr Current Property owner(s) Heather and Jarrod Blanchard Day phone Mailing address Real Estate Agent 10611 N Decker Dr. Tucson, AZ 85742 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Fx I Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System El Public Sewer ❑ WaiverNariance request for:. Received by: ® �lz ��/ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Sad Date of Payment Receipt Number COSA# t�S(J5l1(a� Waiver Fee $ Date of Payment Receipt Number Waiver 9 S. 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil 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 the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE _�Z System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 04/09/15 Conditional approval for bedrooms, with the following stipulations: By: /Nf w `� " Original Certificate Date: The unicip. lit of forage Development Services Division (DSD) issues Certificates of Onsite 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesh.t f c If more than 1 septic system is on the lot: COSA Checklist # of i Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: North Woods #2, Block 2, Lot 10 A. WELL DATA Well type Public If A, B, or C provide PWSID # Date completed Sanitary seal (YIN) _ Total depth ft. Cased to ft FROM WELL LOG Date of test Static water level ft. Well production 9 - p.m -WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Parcel ID: 051-821-10 Well Log (Y/N) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION Collected by: ft. B. SEPTIC/HOLDING TANK DATA TankType/Material Septic/HDPE Date installed 07/22/04 Tank size 1000 gal. Number of Compartments 2_ Cleanouts (Y/N) Y 7-) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N �^ i Date of pumping ?/�%/O++)S Pumper S1�Z.S P&A. w- F 02 / C. ABSORPTION FIELD DATA Date installed 07/22/04 Soil rating (g.p.d.e or fO/bdrm) 0.6 g.p.d./sf _ System type Shallow Trench Length 76 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 9:7 ft. Eff. absorption area 760 ftp Monitoring tube Y Depression over field N Date of adequacy test 04/07/15 Results (Pass/Fail) P8S$ FOE 3_ bedrooms Fluid depth in absorption field before test 0 in. Water added 463 gal. New depth 6 in. Elapsed Time: 130 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d, Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN), "Pump on" level at in. 'Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON "LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: - Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS As - 3rti, 14 o ` G. ENGINEER'S CERTIFICATION I certify that 1 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. Engineer's Printed Name Steven R. Pannone Date 04/09/15 COSA canary sheet_2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ B or q4gs�Op P/49 TH*�d� �! SHANE A. HOLT d e LS -6914 o� O THE INFORMATION HEREON IS FOR THE USE OF LENDINGED LOT LINES A5 SPECIFICALLY T SHOW ANY CONFLICTS BETWEEN EXISTINGION STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I4 NOT TO BE USED RECORD, POSITIONING THAN THOIONA FARING ON THE RECOVEMENTS, OR FENNOT SHOWN EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTES FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 7" NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 10, BLOCK 2, NORTHWOODS SUB. PHASE 2 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN'NOTED. DATED AT ANCHORAGE,ALASKA THIS _21ST DAY OF _APRIL 2015. HOLT LAND SURVEYING 600 HIGHVIEW DRIVE ANCHORAGE,AK 99515 ZZ9�4, FB I7Z-Z 345-5513 B �Rp�ll' I r��-e.l,,•� \ Municipality of Anchorage • -� Development Services Department Building Safety Division i On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.821.10 COSA # f)qDyU Expiration Date: W/Z 8 1. GENERAL INFORMATION Complete legal description Narthwoods S/D, Not, Block 2. lot 10 Location (site address) _22324 Shadowy Spruce Or Current Property owner(s) _ Larry 6 Jeanne Standlev Day phone 688-5589 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 22324 Shadowy Spruce Drive, ChuaiA AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. Name of Firm Pannone Engineering Services ILC Phone 272-8218 Address P.C. Box 102954 Anchorage AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 10/9/07 Engineers Comments: In conducting an adequacy lest, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. Ile reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. 7hc operational life of all wells and septic systems depend on the local soil condition, ground water •�.�� ()F A gay levels that may fluctuate during the year, and the water usage of the family being served by the system. .•.`P- �j These conditions are outside the control of the evaluator of this system. All systems eventually fail and .0 ♦•• satisfactory test results do not guarantee future performance of the system, nor do they guarantee that rw there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future i performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report Is for the sole benefit of the owner listed ��� c Steven R. onnone� above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever.o da 5. DSD SIGNATURE aaaaa'�ESSt�a:••• V* Approved for 5 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE ,9G% WASTEWATER Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / Original Certificate Date: IOLZI07 iFar. t t,DS) Municipality of Anchorage .. Development Services Department .p Building Safety Division On -Site Water & Wastewater Program `• •' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 943-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Nw6mcs SN N& 2 Bleck 2. tot 10 Parcel ID: 051-021-10 A. WELL DATA Well type PPA Date completed _ Total depth ft. Date of test Static water level Well production if A. B, or C provide PWSID # _ Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform oolonies/100 mL Arsenic: _ ugA B. SEPTIC/HOLDING TANK DATA ft. 9 -P.M. Nitrate mg/L Date of sample: _ Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. Other bacteria colonies/100 mL Collected by: _ Tank Type/Material _ SeetiMPE Date installed 7/22/2004 Tank size 11110 gal. Number of Compartments 3 Cleanouts (Y/N) yn Foundation cleanout (Y/N) Yn Depression over tank (YM) No High water alarm (Y/N) No Date of pumping 10/11/2001 Pumper Jiro P rolm C. ABSORRTION FIELD DATA Date installed 7/22/2004 Soil rating (g.p.d./fte or f 2/bdrm) L6 System type 5 -wide Length 36/36 ft. Width 6/5 ft. Gravel below pipe 4/4 ft. Total depth f ft. Eft. absorption area 711 it2 Monitoring tube Yo Depression over field No Date of adequacy test 6/30/20M Results (Pass/Fail) Pon For 3 bedrooms Fluid depth In absorption field before test YA in. Water addedgg gal. New depth= in. Elapsed Time: NO min. Final fluid depth/Q,3_0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Na If yes, give date D. LIFT STATION Date installed Size In gallons N/A Manhole/Access (Y/N) _ "Pump on" level at _ In. "Pump off' level at _ in. High water alarm level at Datum E. SEPARATION DISTANCES Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/litt station on lot N/A Absorption field on lot Public sewer main Sewer /septic service line Meets alarm 8 circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15 Property line -4 Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line X32 Building foundation 12 Water main 10+ Water Service line 10+ Surface water N10+ Driveway, parkinyvehicle storage 40+ Curtain drain Nmm Ktmm Wells on adjacent lots 200_ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspeallons and review of Municipal records that the above systems are in o, _....:.. conformance with MOA COSA guidelines in effect on this date. • ? •j (�%Slever R. Panrorej+L' Engineer's Printed Name Steres R. Po mm Pi No r a 49 rf Date l `t l0 •�ei6 " t k•�• COSA Fee $ 3� Date of Payment G� p Receipt Number /0 / (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. Municipality of Anchorage -� Development Services Department Building Safety Division +. On -Site Water and Wastewater Program „' r; 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o Parcell.D. 051-821-10 HAA# �Oan-to •. Expiration Date:a^ / I " �✓r 1. GENE;j. INFORMATION Complete legal description Lot 10 Block 2; Nort woods Subdivision #2 Location (site address or directions) 22324,Shadowv Spruce Dr. Chugiak. AK 99567 .Current Property,o"'' gst'f •.4 Mailing address Lending agency Mailing address Darrell Rosiere Day phone ( 504)427-0104 Day phone Real Estate Agent Barb Crittenden / prudential Dayphone 689-1802 Mailing Address 16635 Centerfield Dr. Eagle River, AK 999577 Unless otherwise requested, HAA will be held by DSD for pickup. _)/W7 44-- 4 % I q /o •/ 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well R Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S d S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date s/'//o`% r 5. DSD SIGNATURE • BERT C. COWAN !ti r� a -eaol + Approved for _� bedrooms. Disapproved. i itcop `%i ..�' Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other BY: loll;Original Certificate Date: g — — O (Rw. 01A3) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1.07' 10 13L&Crc a- 14047NWOO AJ # 2 ParcellD:©S'/-11'Al 0 A. WELL DATA P J >4 L I C W A-7 t t Well type _ if A. B, or C provide PWSID # _ Well Log (YIN) Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform / mg./l. Sanitary seal (YM) _ Wires properly�cted (YIN) Cased to ft. Casoy1reight (above ground) in. FROM WELL LOG g.p.m. 00 ml. Nitrate mg.h. B. SEPTICIHOLDING TANK DATA AT INSPECTION ft. 9.p -m. Other bacteria colonies/100 ml. Date of sample: _ Collected by: Tank Type/Material S EA rr c/ H 0 P E Tank size /009 gal. "-Number of Compartments a Foundation cleanout &N) Y4 -i 7 Depression over tank (Ye Datip of pumping 44 - v* w/ Pumper V C. ABSORPTION FIELD DATA Data installed 7)iIY4I Soil rating..d.W or fly/bdrm) O_6 Length IL re nkft. Width Date installed 7 /3-a JO y Cleanouts &f) YiS High water alarm (Y/ l9 ` 0 Systemtype 1;N91,uw 7AtNCMtj Gravel below pipe 19 ft. Total depth -7 ft. Eff. absorption area Lft2 Monitoring tube'fts Depression over field Nv Date of adequacy test NSA - A4 Results (Pass/Fail) Fluid depth in absorption field before test _in. Elapsed Time: — min. FinAdep� _. Any rejuvenation treatment 12 mo.) (YIN & type) added_ gal. For -3 bedrooms New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access `Pump on" level at _ in. "Pump off" level a High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES pas' -4 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer On adjacent lots Public sewer manholetcleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/MOLDING TANK ON LOT TO: Building foundation is, Property line _ 3 Absorption field S �� Water main 104 Water service line Surface water / o 0 Wells on adjacent lots OXO 0 if SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3;L, Building foundation I i i Water main ) 0 Water Service line / 0 rtSurface water %00 �+ Driveway, parkingivehide storage 4(d f Curtain drain 0 d ^0- K ✓dual Wells on adjacent lots as a rt F. COMMENTS �tiOFgpw G. ENGINEER'S CERTIFICATION y' I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. tORM a COWAN tea A4,A r C. Ce r✓ rb ce -13901 Engineer's Printed Name I�,✓ 1f�, f 9 Data 1q10 (�h�.PR^f .��-�� HAA Fee $ r 3 o.. ad Waiver Fee $ Date of Payment (0/ Date of Payment Receipt Number © S"' y 1 3 Receipt Number (Rev. 12/01) in. SEP -15-2004 12:00 S&S ENGINEERING 907 694 1211 P.02/02 'Y STATEMENT OF NON -OBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Ekkdm Operating Committee (EOC) has no objection with the location of a LEACHFIELA within the utility easement located along the NORTHWIESTEI boundary of the following property. LOT 10, BLOCK 2, NORTH WOODS SUBDIVISION PHASE 172. according to plat. #82-204 Section I Township Zb N. Range SW, S.M. This nonobjection Is granted with the full understanding and agreement by all partie3 having an interest In the above property that this leachneld encroachment will in no i way restrict or limit the current or tulle ability of EOC to fully enjoy the benefft of the easement for any and all utility purposes that it presently enjoys under the easement This non -objection is further conditioned by the stipulation that EOC will be held harmless from liability for any and all damages to the encroachment that may result ; from the existing and future use of said easement by EOC, Its oontractors, successot: agents, licensees, or assigns. G� LLJMM STATE OF ALASKA SS. THIRD JUDICIAL DISTRICT The toreping agreement was acknowledged before me this T 20jay' by Notary Public for the StaY Alaska My commission e*,res: i�orwrPc�a( I PATRICIA A.MaROBERTS t STATE OF ALASKA 08/04/04 WED 13:48 FAX 8898499 VISTA REAL ESTATE ER I la 002 ASBUILT SEWARD &ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE.' r i FOLLOWING DESCRIBED PROPERTY: -yO OF Atq,� .ept 2 DATE:........ AND THAT NO FNOACHMEN�S EXIST EXCEPT AS CRS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID•//y* ArTMl t R...:. ... .. '...s .jo EASEMENTS, COVENANTS, OR RESTRICTIONS �'w�s6G r WHICH DO NOT APPEAR ON THE RECORDED SUB DI- " °un^• "'•'' s.•'e VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: �LS-5918, r '• �/ ANY DATA HEREON BE USED FOR CONSTRUCTION �'�"`��;��t�,,, ,,.•'�c�� OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN: �� r ,AQY►wT�� SEP -15-2004 12:00 S&S ENGINEERING 907 6S4 1211 P.02i02 STATEMENT OF NON -OBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Ekkdna Operating Committee (EOC) has no objection with the iocation of a LF-ACHFIELD within the utility easement located along the NORTFIV _ STEL boundary of trw following property: LOT 10, BLOCK 2, NORTH WOODS SUBDMSIGN PHASE tf2. according to plat, #82,204 Section 4I Township JE N, Range 1W S.M. This nonobjection Is granted with the full understanding and agreement by all partieA having an interest In the above property that this $eachfield encroachment will in no i way restrict or limit the current or future ability of FOC to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easemenC This non -objection is further condhionW by the stipulation that EOC will be held harmless from liability for any and all damages to the encroachment that may result ; from the existing and future use of said easement by EOC, Its contrectors, successoh agents, licensees, or assigns. STATE OF ALASKA SS. • THIRD JUDICIAL DISTRICT 20�`Th foregoing ly ing agreement was acknowledged before me this � If Notary publicfor the State�f My commission e�ires• 'f -D ; E TA'"PU��CIA A.McROBEF SaTE a AIA•SKA !! TOTAL P.02 Parcel I.D. # MUNICIPALITY ANCHORAGE O DEPARTMENT OF HEALTH H 8 HUMAN SERVICES Division of Environmental Services 39 On -Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING OSI -S,>1-10 \� 1. GENERAL INFORMATION Complete legal description HAA # iNc11 LLVA Lot 10; Block 2; North Woods #2 Location �sitg,.address or directions) 22334 Shadowy Spruce Chuaiak, AK ,Property owner ''Russell Olin Day phone 688-1427 MAiling address' '---R.O. Box 771441 Eagle River, AK 99577 t Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank _ Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72a25(R«.1/91) F,a11 MOAC21 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm —,10 Emilie River Loop Read No 204 Phone Gq &Iay 9 Address Eagle River, Alaska 99577 s Engineer's signature 6. DHHS SIGNATURE V_ Approved for `� bedrooms. Disapproved. Conditional approval for Additional Comments Date / At 91 OF A RORERYC. COWAN e CE -8801 bedrooms, with the following stipulations: 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 engineers work. 72ca m«. w,) SKk MOA921 Municipality of Anchorage E C E I V DEPARTMENT OF HEALTH & HUMAN SERVICE E D Environmental Services Division i§ 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 3W.4'x$41997 Health Authority Approval Checkllstj" p1' Health & Human Services rvices Legal Description: LoT SOT QtoCK Z N11 S � �0 _ '�_r —ru D 0Z A. WELL DATA Well type Ar If A, B, or C, attach ADEC letter. ADEC water system number 213,001 Log present (YM) Date completed Total depth Cased to Casing height (above A}_ Sanitary seal (Y/N) Wire y protected (Y/N) FROM WELL LOO AT INSPECTION Date of test Static water level Well action g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. EPTI TANK DATA Date installed 11 -24f -SZ Tank size 1000 Number of Compartments 2- Cleanouts0N) YaS Foundation cleanout ON) yrs Depression (YQ 4e High water alarm (Y40 l�a DateofRimpbig c1�20-_91 Pumper J.Q. QuinPrr16 C. ABSO#kiON FlELD DATA Dat; lrjjWled (I - 2y'--82 '' Soil rating (g.p.d.V or /b r 215,0 System type So p Length �i8 I Width32 I Gravel thickness below pipe 0.5 t Total depth 5 t Effective, absorption ars&_!,'5i&0 Monitoring Tabe present ®N)_=_ Depression over field (Y)q 1j, Data of adequacy test 6 AG Results 4SW-WI) PASS For 3 bedrooms Fluid depth in absorption field before test (in.); * e Immediately atter Sao gal. water added (in.): 0" Fluid depth m M (Ins) Minutes later: to Absorption rate = Y'Sc t a.p.d. Permdde treatment (past 12 months) (YM) dede kmvJd If yes, give date 72-028 (Rev. 3198)• aF GArve-rso MT oA -%AsAt , yr &JAs Or -Y D. LIFT STATION Date installed Manhole/Aocess (Y/N) High water alarm level at' E. SEPARATION DISTANCES Size in gallons "Pump on" level ar Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 200'+ Absorption field on lot Zao I f Public sewer main service line "Pump off" level ar On adjacent lots _.-6lacentIots Public sewer manhole/cleanout L.ifl station SEPARATION DISTANCES FROM EPTI TANK ON LOT TO: Foundation 1 Property line 101+ Absorption field IN 1 Water main/service line1 o It Surface water/drainage too '+ Wells on adjacent lots 700 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101 Building foundation Z91 Water main/service line 10 r t Surface water 1001-1- Driveway, paridng/vehicie storage area '79 It Curtain drain 0J.J4 X. 004 Wells on adjacent lots 2001 + F ENGINEER'S CERTIFICATION I cerdly that I halls determined thru field inspections and review of Municipal records 006 ms are In conformance Wftb MDA HAA quid fines in effect on MIs date. Signature �ft✓'r '— .n El Engineers Name t4ed3 i 4 T (f- 61Ca N7r /��//jM1 /p WWn C. COW/W rft Data — "1 ( ! 7 �P CE - 8801 �ry HAA Fee $ ?J TV ' 1-3 Date of Payment _2 &IJ2 % 1 Receipt Number ,� Z -5) 1 I NLI / 72-0211 (Rev. 3/913)' Waiver Fee $ Date of Payment Receipt Number O MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES �1� - 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 Parcel l.D.ff f •_21-�ia1'�C HAA ii 1�1-`�'.l�'`;•I i 1. GENERAL INFORMATION Complete legal description Lot 10• Btoch 2• Nonth Wood6 Subdiv.ia.Lon, M2 Location (site address or directions) 22334 Shadowy Saauce. Chug.iak Property owner Ruaa¢,C.t' Olin Day phone 688-9131 Mailing address PX. Box 671844 Cht giak_ Athan 99567 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Re.191) From M0A-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/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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 S s S ZNGINEERING Phone 17034 Eagle River Loop Road 204 Address ^.ieske 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Date :?CucF IN Conditional approval for bedrooms, with the following stipulations: Additional Comments DateZ-=X s4' 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. 724251R«, 1911 Ba nay nl Municipality of Anchorage Ak Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST IN Legal Description: �� ko qNV-Z r" -R-XA `^ 0c*SParcel I.D. �-Z A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 213 00 1 Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Date completed Cased to Casing Wires; FROM WELL.LO 9— p.m- SEPARATION DISTANCES FROM WELL TO:, Driller (Y/N) AT INSPECTION MUNICIPALITY OF ANCHORAGE elipARC; RENTAL SERVICES DIVISION Septic/holding tank on lot Zo 14- ; On adjacent lots Absorption field on lot t } ; On adjacent lots _ Public sewer main Sewer service line WATER SAMPLE RESUL Coliform of sample: B. SEPTIC/HOLDING TANK DATA Public sewer etroleum tank Nitrate Collected by:. m r, 1 5 1992 p.m. R EIVED Other bacteria Date installed Tank size loon Compartments �- Cleanouts(DN)—Foundationcleanouto'/N)`—; DepressionJ /(Y High water alarm (Y( Alarm tested (Y/N) 4`A Date of pumping Pumper Tib GsstpaoL Q�.rndt.k.� c�mPudt�� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: � 1 Wells) on lot �� L On adjacent lots 0 Foundation i To property line 10l�- Absorptionfield )`t� Water main/service line tot ~ Surface water/drainage ) oo 0 72-026 (Rev. 7191) FW1 CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size In gallons Vent(Y/N) High water alarm level Meets MOA electrical ( on lot Manufacturer Manhole/Access (Y/N) "Pump on" level at - • "Pump off' levetat ANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed Soil rating 2 a System type 55-b Length Width 32 Gravel thickness 0•5 Total depth t Total absorption area )5��+ `� Cleanouts present45VN) Depression over field (Y Date of adequacy test 17- �a ResultsJJ:EiiXail) picSS for � �'�r�P-�zC bedrooms Peroxide treatment (past 12 months) (Y& �AO AC If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot o a.t- On adjacent lots '�1� Property line - t of To buildingfoundation t To__ \\elIxisting or abandoned system on lot ►- On adjacent lots 30 "k- Cutbank�Water main/service line Io Surface water 1 c C> Driveway, parking/vehicle storage area 7S 1 {- Curtain drain - )A //� E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in efect`p1tlheoate of this inspection. 5 & S ENGINEERING 17034 Eagle River Loop Road No. 204 ' R' e1 •' (, `'•,U •! ado 1' -• •, y�bg', Signature-. iagla Rivec ht+•4299H77.ti r. Engineer's Name ����•�•" •� �.i••. Date `'L- e'ty i��•cNo. o�e21 AF :a HAA Fee $ �•%D P.!7- Waiver Fee: a Date of Payment Date of Payment Receipt Number a'S�3 yr h� / %Z) Receipt Number 72-029 (Ra. W) 810 MOA 21 or KUM WALTER J. NICKEL, GOVERNOR E DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE (907) 349-7755 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 November 4, 1992 Mr. Ray Shafer S. & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 SUBJECT: Northwoods Subdivision Class 'A' Public Water System, PWSID 213001 Dear Mr. Shafer: have completed a review of this office's files concerning the monitoring status of the above -referenced Class W Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on October 1, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on April 21, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on July 1, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on June 2, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class `A' Public Water System Is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above Information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II printed on recycled paper by GU. MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services O DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # %sy-1�O HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10; 8Pock 2; North Woods Phase II Location (address or directions) Shadowy S &uce (b)Propertyowner Kon 8,'At " Telephone: (home) 688-9300 Business Mailing Address P. 0. Box 1282 Peters CKeek, Ak. 99567 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here a If hold for pick up.) List contact person and day phone number below: 5 & 5 ENGINEERING 17034 Eagle RiverLoop Road Ne. 204 Eagle River, Alaska 99177 2. TYPE OF RESIDENCE Single -Family ]Q( Number of bedrooms - 3. WATER SUPPLY Individual Well ❑ CommunityX% Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site lK(X Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72 -US (R". 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 thevalidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection. the on-site water supply and/or wastewater disposal system is In compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address s & 5 ENGINEERING 17034 Eagle Kivu' L�r Date Eagle River, Alaska 99577 6. DHHS APPROVAL Approved for ' 3 bedrooms by oealVIIXA Date AXY Approved CI)k Disapproved Conditional Terms of Conditional Approval CAUTION The Municipalityof Anchorage Departmentof Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph5above byan 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 DHHSdo notconduct inspections oranalyze data beforea certificate is issued.The Municipalityof Anchorage is not responsible for errors oromissions In the professional engineer's work. 72-025 (Rw.7/88) Back Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) • u X1PALHeatth Autho(Ity Approval (HAA) iZ_NVEN1QJECKLI§T,; FESRUARY1984 343-4144 1c,89 Legal geQription: RECEIVED Well Classification Well Log Present (Y/N) Date Completed Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: If A, B, C, D.E.C. Approved ON) 4__ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot �� ; On Adjoining Lots — To Nearest Edge of Absorption Field on Lot leGlo -A-; On Adjoining Lots To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results To Nearest Public Sewer Cleanout/Manhole Comments �►��5 (T% y�3 t B. SEPTIC/HOLDING TANK DATA ; Date Date Installed,C42-2 No. of Compartments Z StandpipesON)1—Air-tight CapsVYN) Foundation Cleanout(l) Depression over Tank (Y/6D fJ natp Last Pumped A2— IA—el rJ Pumping/Maintenance Contact on File (Y/N) A ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) fJ A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: r t To Water -Supply Well -2,-Cx> '}" To Building Foundation To Property Line o t �" To Disposal Field 141 To Water Main/Service Line X01 To Stream, Pond, Lake or Major Drainage Course �� k Comments nom (Rw. rise) From Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 9=> ¢ls%?— Type of System Design i S� Date Installed f3Z— Length of Field Width of Field 'N 2 r Depth of Field 3r (�i�NiiQi Gravel Bed Thickness p,S r Square Feet of Absortion Area Sat. Statndpipes Present4=4) Depression over Field (UR Date of Last Adequacy Test Results of Last Adequacy Test5t%br-� 3 C32 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To To Property Line to t To Building Foundation Lot r_%, In To Existing or Abandoned System on ( On Adjoining Lots �v } To Water Main/Service Line �t To Cutback (if present) a A To Stream, Pond, Lake, or Major Drainage Course % Cts 1- - To Driveway, Parking Area, or Vehicle Storage Area _- —195-1951 Comments D. LIFT STATION to Installed Size in ons "Pump On" Leve High Water Alarm Level 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. "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Inspection. , ' s Signed - 5 & S rblr,NEFRING Company 17034 Eagle River Loop Road No. 204 Eag o rver, Date /2 /f �i MOA No. e- /k� X03 Receipt No. ✓ —I 13� • . Date of Payment Amount: $ 70•r/V 77-048 (Rw. 7/80) Back Receipt No. of this,:;.- ),ate Waiver Fee: $ Date of Payment Page 2 of 2 or MUMSTEVE COWPER, GOVFRNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 December 8, 1989 S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 PWSID: #213001 According to the records on file in this office, the Chu iak Utilities/Northwoods-Deerhorn Subdivision Water System is in compliance with—the State of Alaska Dr nk ng Water Regulations. Sincerely, / VERA E. CRAIG Environmental Field icer VEC:bas (nn, v 4n & t_-� 6 -lo -4 Time APPLIC 'NT FILLS OUT UPPER HAI"` -ONLY Property Owner t�N 15 Phone c Date \- Date Mailing Address�Y J Zgj Ti Inspector Zip Code Inspector Buyer Field Notes: MUNICIPALITY OF ANCHORAGE CFPT. C' :"'fit' ^• Address i RKENEU Zip Code Lending Institution I ( ) CONDITIONAL APPROVAL' DATE 2 Phone Address / Solis Rating Zip Code Well To Absorption Area I Realty Co. 6 Agent Septic Tank Size on 11— Q'L_ Phone Address Zip Code Legal Description LOT /O $K L /VOv2TN&C.bOb Z Street Location 7 Type of Residence , yr1 Ingle Family 0 Multiple Family No. of Bedroom ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. Pe-6mmunity For wells drilled prior to that date, give well depth (attach log 11 available). ❑ Public Utility SewerD sposat G✓Individual 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. (nn, v 4n & t_-� 6 -lo -4 Time Time Time Time c Date Date Date Date �iLsn Inspector Inspector Inspector Inspector 41aAA Field Notes: MUNICIPALITY OF ANCHORAGE CFPT. C' :"'fit' ^• icC 13 192 RKENEU ( y, APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE 2 BY: C-0 Solis Rating Date Sewer Installed Well To Absorption Area I Well Lop Received Septic Tank Size on 11— Q'L_ Well to Tank rzar OM