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NORTH WOODS BLK 4 LT 26
Northwoods Block El Lot 26 #051-741-09 Municipality of Anchorage Community Development Department Page / of On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 0 S P 12(/0 $ PID Number: C S j " 74�/- 0? ❑ New XUpgrade Name: ABSORPTION FIELD K-pDeep Trench E] Shallow Trench ❑ Bed ❑ Mound Address q 22733 33 zva&-% l&S b /Q I ❑ Other Phone 7 f' _ Q Number of Bedrooms Soil Rating c �• Total depth from original grade G I V -S .3 O GPD/SF - 5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath p/ipe I Ft. Subdivision Blockkt Lot �^ 26 Fill added above original grade C. 5- Gravel length / S T Township Range - Section Ft. AO .? Ft. Gravel width 3 Ft. Beds: Number of Lines Distance between lines I — Ft. SEPARATION DISTANCES To Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area Number of trenches Dist. between trenches I — From 74 Ft' Ft. Well �Q nQ nG nG A.^, TANK Septic ❑ S.T.E.P. El Holding ❑ Other Manufaglurbr I (� "T— Capacity Gal. Surface Water Qtr, / "V Material =:S( Number of compartments a Lot Line /O / r 6'fi — •-. NA Foundation S'.r-Z5'd- — LIFT STATION Manufacturer Capacity Gal. Curtain Drain ., _ — Remarks Pump on level at in. mp off level at in. High we alarm at in. Pump make and del Electrical Inf ections performed by PIPE MATERIAL Housetotank^�^_ Tank to /'V drainfeld �C Installer Dminfekl CO/MT r Inspector BENCHMARK (Assumed elevation) it Inspection „ dates: 1 Z 2n° Z Z Location and description 3n'!!� r 2 4" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Enginneeeegftmmp a+�c OF�t Conditional Approval: Date Q �`�e..a..�s q�a�� a'49TH :e 0' Steven W. Eng Approved _ Date Inspection Report_l-lS12.d6c I \/\R G§/ % eewu eme CD®®W CD'D® »9»99x/ f [ k m 2g �7 ozrezaz oommJz $! m 9 :E [ a ae,am_z ) \~}\?� g 14 \»(D N / &_<- s 0»J::g , zSa0 E£2�;; � / lwEye\.. Eo°=s •�� d q2ƒ3/E -70 (D n 2 3 ��® F- m m w 7 2 2 9 // A 2 a c (D n % ® J/% y » . m 9g y ® 2se , 3 » m « o 7it &_ % :K e \§ S / /` 2 o : e \ 2 ® ® / % krtb ~ \ w R) �p §§§R /\j « § f O / ems= cn §/ n F- g 2 E--1 3 , / / 2 c . m G / } x f I \/\R G§/ % eewu eme CD®®W CD'D® »9»99x/ ozrezaz oommJz :E a' a ae,am_z \~}\?� \»(D / &_<- z 0»J::g e/ zSa0 E£2�;; / lwEye\.. Eo°=s q2ƒ3/E (D n // A (D n J/% . m / e � c0 ^ 0 z F- u \ © % @ / 2 t 2 O ® G { f / / 3 \ @ . F- u m ! y . w 0Q G 2 / c 2 w » # £ E2 / 2 | +1 ƒt AA a / A {/ 2 W O 2 CD f )u / { \ > \ / LLI \ L) ~ » =e % / ! Cl) (U = \� \ \\ ° \ {/ / S ) ) \ \ / > 3 ± \ \ j , w G Lr) + 3g G f $» �: w / U R f 3 \/ f k V) b ` \ ® \ > m �� ® aj E, u /0 j E / � S g , 2\ \>x Q „ w G \/ } =f \& _ ; obi 3 CD / E f / z F— * ® \ aiQ / a 2 \ �\ ;k e $O0 ) //`\� ƒ j \ \f](\ 0 0O/� o2® 3 / 2 ! G J S❑ILS LOG — PERC❑LATI❑N TEST FE(� INEERING Performed For: Steve Gould Date Performed: 7/2/12 Legal Description; Northwoods B4 L26 1 - 2 - 3 - 4 - 5- 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - DEPTH (FEET) Organic T.H. Location; See Attached Design Fill & Overburden GM Silty Gravel Groundwater? No Depth -- Water Depth After Monitorino,None Date: 7/10/12 # Date Gross Time Net Time Depth Net Drop 1 7/2 0 7" 2 7/2 10 10 min. 8" 1" 3 7/2 12 -- 7" -- 4 7/2 22 10 min, 8" 1" 5 7/2 25 -- 7" -- 6 7/2 j 35 10 min. 8" j 1" 7 7/2 37 -- 7" -- 8 7/2 47 10 min, 8" 1" 9 7/2 50 -- 7" -- 10 7/2 60 10 min, 8" 1" Percolation Rate 10 min,/inch Perc Hole Diameter 6" Test Run Between 4' and 5' Comments: Presoaked. Meagured to nearest 1/10th inch. Performed By NnrthRim Eng, I `—z^ CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ON THIS DATE, DATEi 7/2/12 OF TESTH❑LE LOG NOR THRIM * as I ENGINEERING T. H. 1 PO Box 770724 .... .� ...... Eagle River, Alaska 99577 a °7B9"°28 GE❑TECHNICAL Date: EE 7/10/12 1 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121108 Tax Code Number: 05174109000 Work Type: Septic Upgrade Permit Effective Dates: June 11, 2012 to June 11, 2013 Design Engineer: NORTH RIM ENGINEERING Subdivision: NORTH WOODS Site Legal Address: NORTH WOODS BLK 4 LT 26 G:1559 Owner/Address: GOULD STEVEN R & SARA J 22933 NORTHWOODS DRIVE CHUGIAK AK 995675463 Site Mailing Address: 22933 NORTHWOODS DR, Chugiak Lot Size in Sq Ft: 28923 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. Fro r ober 15 to April 15, a subsurface soil ahsor tion system and during freezing weather must either: Covered, sealed, and heated to pWent freezing. Special Provisions: PRIOR TO CONSTRUCTION: A new testhole and percolation test shall be completed to substantiate the permitted design. The engineer's sealed results shall be submitted to the MOA field inspector during the first "bottom -of -hole" inspection. If the results require a design revision, an approved change order shall be onsite prior to any more construction. The contractor may proceed at his own risk prior to obtaining the 7 -day groundwater elevation. Received Issued Issued By: 61/11/ 2 - MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. C)5-1 7411' 09 Property owner(s) S Mailing address -a Site address IS:= . Day phone 2 cc- Legal c Legal description (Sub'd., Block & Lot) L 2r Legal description (Township, Range & Section) Lot Size Z 9Z Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: _ (® all that apply) - Absorption Field Initial ❑ Septic Tank Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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: property owner or Permit/Rush Fees: Q — Waiver Fees: Date of Payment: ���i��eZ Date of Payment: . Receipt Number: Receipt Number: Permit No. OSPI a! iU Waiver No. GABuilding\On SiteTormsWilent FormsTerm4 App 010411.doc - (Rev. 1/11) Date: 6/1/12 To: Jay Crewdson, PE MOA On -Site Services MEMO Steve Eng, PE, PH (907) 694-7028 tel North Rim Eng@aol.com Subject: North Woods S/D, Block 4, Lot 26 Jay, Number of Pages: 4 I followed your direction for septic system replacement design. This system is designed to previous soils information. Soils will be verified prior to construction. The owner is under hardship due to failure. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks-� C)e N�INEERING North Woods S/D, Lot 26, Block 4 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3 -bedroom, single family home. Most of the neighboring lots are developed and this lot is adjacent to a greenbelt. The current wastewater system has failed. A test hole will be completed during construction to verify the soils. The previous soils information is being used for design basis. These lots are large and are served by public water. No adverse impacts are expected from development. No conflicts to the other lots will take place by this septic system construction. The lot easement is located on the drawing and is not encroached upon. Previous soil tests reveal silty glacial till. An application rate of 215 FTI/Bedroom is being used. 215 FTI/Bedroom x 3 Bedrooms = 645 FTz, Trench Length = 645 FT/ 6' effective x 2 = 53.75'; 1 line @ 54'. Soil and groundwater will be verified prior to construction. Groundwater monitoring may take place during construction. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet. • 5' minimum between the tank and bed. 10' to property lines. • 3' of cover or insulation is required for trench; an equivalent of 1" insulation for F foot soil cover. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain - rock. • Drain rock to be %z inch to 2 '/2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier (filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage over the trench. • Insulation must be placed over any pipe installed under driveways or parking areas. Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) 0 E (U \ W ° aee � (J; ■ 3 c: 0 3�0 j G3 Q e e g § y@ 3 2 \cfy4 5 So x=\333 \ G w /&#»92 -- § c / > c /3\ƒ}\ Ln § y # | ze$>3° \u ^ �, ± 2 uLLJ 0 0 ©®lv�o At U & §zww«a) // t : \_ \ $ CL ` } _, ,/ d \ y °0 ° E ° ° ! m \2/ m i / 3 2 7 I/ § 2 ® ƒ _ 9 > & \ S \ \ 0- / \ L. y e Gb g @r 2 m L \ d° � � �• 1, * R �4 2At j ¢2I�t. \ / \ ?\® # / { lco e : 0 { \-C \ ® § { / 3 \ { / w Q \ e LLI / m w ! 0 \ u -L | 3 « f I } \ / / k ai �\/ / �� ® c w _ j U � / > ® ® 2 0 !! : Cl)o I \ �/ } 0 y \ 2 f) ^ ƒ Lc \ }/ \ \ » ® 2 [ \ L \ p ± y _ & j 2 ®LLI 2 � § ° { ® ° w u ± ® w / < 9 6 S i ® \ & ®u u ° ® « w w ± e =) LLJ Lij± (! L \\ °(� a, 27 ! �� ar \§a G jg jL //ƒ 2\}— A'� 2 2& o2/ 2\�® /2\1 %°f\ ,g ow ° ®�°®`C . C)< `- °_L%_ %{ T\ �S= ®®~0)- _oj ` « \ £6/c/- - 2 !,°°\°® `-���®�»c�` \o ! C4 >—Ce e£2 .O aee0a)2=u % \/;2 ` (°u®~3\S�\ \\§!) ° _- ��� _ \ [ +> -P ai § \ \ 0 c LLI e>mJ g0e|; ) § z w¥aa K //�$ ..:..... ...... ,t t ''MUNICIPALITYOFANCHORAGE DEPARTMENTOF.HEALTH& EN PEVIRONMENTAGPROTECTIO "MNVIRONMENTAL' ENGINEERING DIVISION N 826 L Street -;Anchorago,'Alaska ' -99601 'Telephone 264.4720 ONSITE:SEWAGE;DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 'PHONE., . i MAILING ADORES - s : s ' Z O? J ' O UPGRADE r LEGAL D SCRI PTION LOCA ION ' . , - - NO. OF BEDROOMS' �>< ` DISTANCE TOc a Absorption are. Dwelling Ea Manufacturo PERMIT W Ma de N ~ Llq, caP city in gallons No, Of comb menta IF HOMEMADE:" Inside length .' Width Liquid depth oZZ•, 'DISTANCE TO `. Well Dwelling - Menuteeturer' ... .. ' . PERMIT NO. mS; DISTANCE TO Well 0 Foundation 'a .. ate. Liquid capacity in gallon, �,.. ,Nearest) line�,fy PERMITNO W 2 ! No. of liner- r„ F 2 W ,. Length of each line Total, len t of lis Tren d �' Distance t an lines H Top of the to finish grade Inches , - o _. Material neath file' .. W, Lengih Width i "Ana.h Total off ti a sorption area t7 _ : Depth .. t Type of crib T NO m —y .Crib diameter PERMICrib depth , W . . . ,?" Total effective aMorption area v' ".DISTANCE TO:' Well - Buildip foundation ' -- Nearest lot ling ,3 Gass Depth , Driller Diftance o lot he PERMIT NO. � 'DISTANCil Building foundation -' Sewer line - - Septic tank Absorption area(ii) . OTHER . PIPEMATERIALS SOIL TES ATI G INSTALLER ' t t ,s h • : ! PiAPPROVED •t' , py" a"!,' Y �.,1:•' TE _LEGAL IIZN ea{,c ,�.7Y-01j.lRa -3/781, MUNICIPALITY OF ANCHORAGE Development Services Department 7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-741-09 1. GENERAL INFORMATION Expiration Date: Complete legal description NORTH WOODS BLK 4 LT 26 Location (site address) 22933 Northwoods Dr Current property owner(s) Mailing address Real estate agent GRAHAM GAVI N Kathi Olmstead 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 947-0940 Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment ILJ IQ 0 2 1 Receipt Number 5 5 COSA # OSC211096 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone 694-7028 Date 3/4/20 OF * :49Qr iSteve Eng r ; ; /� CE -6256 ' A 4 %21�'++ bedrooms, with the following stipulations: .,% \TY OF A, A, `g. UN -SITE WATER ANB M G WAST'-V'ATER z J T SERvS�`,,, 1 ►'� Original Certificate Date: - r 2d Z 1 The Municipality of Anchorage Development Services DNision (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 Legal Description: NORTH WOODS BLK 4 LT 26 If more than 1 septic system on lot: COSA Checklist # of 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 COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 8.5 years Tank type/material septicStl Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 4/28/20 - — D. ABSORPTION FIELD DATA 7/2/12 Which system tested (date installed) same ❑ ALL standpipes present per record drawing Total measured depth from grade 9.5 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-741-09 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes FOR 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 years Lift station material Comments: Adequacy test date 3/3/21 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 6 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) no If yes, enter date 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' ED Yes Community Sewer Manhole/Cleanout > 100' [3 Yes if No ft rl Yes if No f Neighboring Tank > 100* ❑ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No f Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' El Yes if No f - Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' 0 Yes if No f, El Yes if No ft Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' 0 Yes if No fi [I Yes if No fl From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ED Yes if No ft Surface Water> 100' Yes if No fl Property Line > 5' Q Yes if No it Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ft 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 less than required) Building Foundation > 10, ED Yes if No ft It absorption field is under driveway comment below Property Line > 10' P/1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 1 U Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Di Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION certify that / have determined through field inspections and review of t4unicipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. .-49mi* Steve Eng CE -62W Aji 4/2 1 Parcel I.D. 051-741-09 Municipality of Anchorage On -Site Water and Wastewater Program e a (907) 343-7904 Nks n s r Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: % a. _ / R _/ (m Complete legal description North Woods, Block 4, Lot 26 Location (site address) 22933 Northwoods Drive Current Property owner(s) Blalse & Nicholas Gill Day phone Mailing address Real Estate Agent 22933 Northwoods Drive, Chugiak, AK 99567 2. TYPE OF DWELLING: Fx1 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 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for, Received COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52 -1(.9 - Date of Payment Receipt Number 6�633i1i COSA# t75Gy fes( 5Z Date: %'((Z Z Waiver Fee $ Date of Payment Receipt Number 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. 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 System #1 Approved for __�!? bedrooms System #2 Approved for bedrooms Disapproved Date 12/22/2014 AW .............. 5lsven R.,f5annone I I #4 CE -8149 li r •..... _:W Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: The Municipality of choraga 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 blue sheet c _ - If more than 1 septic system is on the lot: COSA Checklist # I of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: North Woods, Block 4, Lot 26 A. WELL DATA Well type Public Date completed _ Total depth ft. Date of test Static water level Well production Parcel ID: 051-741-09 If A, B, or C provide PWSID # AWWU Well Log (YIN) Sanitary seal (Y/N) _ Wires properly protected (Y/N) Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION ft. ft. g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y / Depression over tank (Y/N) N Date of pumping L�,s l�fp%l `( Pumper S C. ABSORPTION FIELD DATA Date installed 7/2/2012 Length 62 ft. Collected by: Date installed 7/10/2012 Cleanouts(Y/N) Y High water alarm (Y/N) N Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type Deep Trench Width 3 ft. Gravel below pipe 6.0 ft. Total depth 9.5 ft. Eff. absorption area 744 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12/18/2014 Results (Pass/Fail) PBSS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 6 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons — in. "Pump off" level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas 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 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 12/22/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ Seven � �flannone CE -8149 rel Municipality of Anchorage eGC kl. Development Services Department Building Safety Division 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 -OW 7y/— Q p COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description North Woods, Block 4, Lot 26 Location (site address) 22933 NORTHWOODS DR, Peters Creek, AK 99567 Current Property owner(s) could Steven Day phone 240-0385 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Susan Bickman Day phone 240-0385 Dynamic Properties Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System IN 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/10/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septLkA firms are subject to these various and dynamic characteristics and are outside the control of the r OF34 a evaluator of the well and septic system.M1M 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory � r 3 c R bedrooms, with the following stipulations Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other WASTEWATER i By: ' ��/ r Original Certificate Date: 7-17-1a i Municipality of Anchorage e E • ' ` Development Services Department Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: North Woods, Block 4, Lot 26 Parcel ID: 051-741-09 A. WELL DATA - Public Water Well type na If A, B, or C provide PWSID # _ Well Log (YIN) na Date completed na Sanitary seal (YIN) na Wires properly protected (YIN) na Total depth na ft. Cased to na ft. FROM WELL LOG Date of test Static water level na ft. Well production na g.p.m. WATER SAMPLE RESULTS: Coliform NA colonies/100mL Nitrate NA mg /L Casing height (above ground) na in. AT INSPECTION na na ft. Arsenic: na mg/l Date of sample: na Collected by: NA B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/2/12 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping • NEW Pumper- NEW C. ABSORPTION FIELD DATA Date installed 7/Z112 Soil rating (g.p.d./ftz or fe/bdrm) 0_8 System type Trench Length 62 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 9.5 ft. Eff. absorption area 744 ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Pail) NEW For 3 bedrooms Fluid depth in absorption field before test - in, Water added_ gal, New depth - in. Elapsed Time: -_ min. Final fluid depth._ in. Absorption rate >= _ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date = D. LIFT STATION Date installed na Size in gallons na Manhole/Access (YIN) na "Pump on" level at na in. "Pump off' level at na in. High water alarm level at na in. Datum na Cycles tested na Meets alarm & circuit requirements? na E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot na On adjacent lots na Absorption field on lot na On adjacent lots na Public sewer main NA Public sewer manhole/cleanout NA Sewer /septic service line na Holding tank na Animal containment areas na Manure/animal excrete storage areas na SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10'+ Absorption field 51+ O 3 a® 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 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain (None Known) Wells on adjacent lots 200'+ F. 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. Engineer's Printed Name Steve Eng Date 7/10/2012 COSA Fee $490.00 Date of Payment �7 T//,Q J/Q Receipt Number 6Q6T?h��n/� (Rev. 11105) - Waiver Fee $ Date of Payment Receipt Number, 4cesaae.ae Ei O 3 a® C, 0 SPaven W. Eng \` PE 6.256, _ S.`a a 4i9 ASBUILT f,�i�xrs— I HERESY CERTIFY .THAT I HAVE SURVEYED THE I SCALE - FOLLOWING DESCRIBED PROPERTY: AND '4 eTHAT NO £NCROAC�IMENTS EXIST E41 -XCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. WW.lm : PATE aZ GRID- -1,4, irs9 FB: 3d/ DRAWN: Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. -DJY Zyi oy HAA 1. GENERAL INFORMATION Expiration Date: Complete legal description location (site address or directions) Z a -Y.5 B Current Property owner(s) _��lreic r !-/,�.vmry Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Cffa7s Woo,' Dayphone X61- 7T7/ ,3/// G r4r /� /4 1 44 59a-0 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site (� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® 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, Iea itit rify that myshoinvestithat gation. based on procedures outlined in the Health Authority Approval Guidelines for this application the 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 t 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. N�va� .�a✓� S� Phone Name of Firm - loy5'- s% Address iiJy I/ Date 9-�.K—o Engineer's Printed Name 5. DSD SIGNATURE �C Approved for bedrooms. ag K Disapproved. 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: A �1 l�f I] 1�t r a Original Certificate Date: I+' (Rov. 01102) Municipality of Anchorage Development Services Department Building Safety Division On-Sfte Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-650 www.ci-anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: iJs rtiUsso wA t sy —AZ—,VL— Parcel ID:_ gP % A. WELL DATA . Well type�/81.�G Date completed _ Total depth ft. If A. B, or C provide PWSID # Sanitary seal (Y/N) _, Cased to ft. FROM WELL LOG Well Log (Y/N) Wires properly Prot /N) Casing he' above ground) in. Date of test Static water Ievei ft. Weil production g.p.m. g.p.m. WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg.A. Other bacteria colonies/100 ml. — Ars t:m9 d• Date of sample: — Collected by: B. SEPTIClHOLDING TANK DATA TankType/Material arae` Date installed Tank size /Odp gal. Number of Compartments Cleanouts419N) Foundation cleanout (MLO Depression over tank (Y(I�,,VV Hi � s� r wwtrn.Tj 9h water alarm Date of pumping 9/R/ev Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (9•p•d.M2 or .A-16— System type Length f/S� ft. Width 3 ft. Gravel below pipe Q" ft. Total depth ft. Elf. absorption area4J22L-ft' Monitoring tube 4e e,_ Depression over field Date of adequacy test - !/a/py Resuds((!RyFail) , For S bedrooms gal. New Fluid depth in absorption field before test -,4?_ in. Water added -19V depth.3e-rin. Elapsed Time: A:90- min. Final fluid depth /110_ in. Absorption rate >= ya O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(n type) % d AQ if yes, give date ti -+ D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. 'Pump off _ in. Datum 08 tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot N Public sewer main Sewer o e/Access (YIN) High water alarm level at in. Meets alarm & circuit requirements? On adjacent kits v b✓ E* adlacent kits Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTICMOtDINt3 TANK ON LOT TO: Building foundation /'/ Property line 4e' Absorption field .? 91 Water main s e V ' Water service line I reSurface water > IAO ' Wells on adjacent lots I goo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ' Building foundation .1 >_% • Water main Water Service line 1i0' Surface water 0/00 ' Driveway, parkingNehide storage �$tL Curtain drain Wells on adjacent totsY Act " F. COMMENTS [to, biz J R ENS��AG. ENGINEER'S CRTIF CTION SC T�arK � 1 car* that 1 have determined through field inspections and review of Municipal records that the above systems are in g conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name -' sD ' ` Date 9-1'f-0¢laltlydl' HAA Fee $ 01 Waiver Fee $ Date of Payment "�"' /n« Date of Payment Receipt Number Receipt Number (Rev. 12101)