Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
NORTH WOODS BLK 4 LT 21
Northwoods Block 4 Lot 21 #051-741-04 Inspection Report 171-12.doc ly / Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water & Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - hrip://www.muni.org/onsite - (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131453 PID Number: 051-741-04 ❑ New ® Upgrade Nome: DAWN HARMS ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address: PO BOX 772286 *EAGLE RIVER, AK 99577 ❑ Other Phone: N/A No. of Bedrooms: 4 Soil Rating: GPD/Sq. FL Total Depth from original grade: Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: F . Grovel depth beneolM1 FI. Subdivision: NORTHWOODS Block: Lot: 4 21 FTI added obove original graft: Grav glh: Ft. township: — anger — ea ion: — gravel width: (�I F\`\G Ft. Beds Number of fines:Distonce between lines: Ft. SEPARATION DISTANCES Total absorpt' area: Number of Iranchea: Dal. between Trenches: 7o Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines $0. Ft. Ft. Well EXISTING EXISTING 200•+ — 25'+ TANK ❑ Septic ❑ S.T.E.P. CHolding ❑Other Manufacturer. Capacity: Surface Water EXISTING EXISTING 100•+ — Go. Lot Line EXISTING EXISTING 5'+ - N/A Material: EX1Si1N Number of compartments: Foundation EXISTING EXISTING 5'+ - LIFT STATION Curtain Drain NONE KNOWN Manufocturer: Capacity: ANCHORAGE TANK 500 cal. Remarks: OLD LIFTSTATION WAS DECOMMISSIONED PER UPC Pump a� level at: TIMER ump off level at: TIMER High water alarm at: 48 Pump Make & Modal: 20-OSI-05-HHF Eleclficol Mspections performed by: CAPSTONE ELECTRIC PIPE MATERIAL House to tank EXISTING Tank to SCH40 - - drainfield Installer A+ HOME SERVICES Drainfield EXISTING CO/MT D3034 Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Fl. Inspection Dates: 1st 12/9/13 2nd — Locution and Description: 3rd - 4th - BOTTOM OF TRIM Q WEST CORNER OF HOUSE Community Development Department Approval Conditional approval: Date: ENGINEER'S SEAL 00600 0 04 p Q ...To 0, T �* �� P'•, ff ey..•..9.•.ness,- O� O dp '• CE— 973 .�04 Q4ed proallfess)°poo ��4400��0 Approved: z ' " Date:Ia !2 l3 Inspection Report 171-12.doc ly / PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: I OSP131453 051-741-04 TRACT C; NORTHWODDS S/D EXISTING 1300 GALLON PREMIER PLASTIC SEPTIC TANK, NEW GWM MT FOR \ PLASTIC TANK / 1 1 NOTE: ALL PROPERTIES SHOWN 1 ARE SERVED BY PUBLIC WATER. 1 1 A B ` 1 MH 18.35 31.60 1 LOT 22. BLOCK 4; 1 1 NORTHWODDS S/D 1 1 1 1 WATER LINE (APPROX. LOCATION)/1 2 \ p S \ s NEW 500 GALLON PUMP STATION WITH TIMER CONTROL PANEL. \ / O EXISTING 10' X 36' BOTTOMLESS / INTERMITTENT SAND FILTER. PASSED ADEQUACY TEST ON 11/27/13. 4 /V LOT 20. BLOCK 4; / SCALE: NORTHWODDS S/0 / J f1" = 40' GARNESS ENGINEERING GROUP, Ltd. p�I CONSULTANTS 8 GENERAL CONTRACTORS Q" •' • •' • • •' ""' 3701 E. TUDOR ROM. 900E 101 • nxCM9n6E. M 99907 • MM (907)337-6129 • FM (907)336-3266 KWE:...gorrnwngiM6rinq.w a PREPARED FOR: PHONE NUMBER: PAGE NUMBER:••• ••••• ••••••• DAWN HARMS 317-9828 2 OF 3 On .� fr Gar ess:' LEGAL DESCRIPTION: DRAWN BY: V 9. CE -79 3 v� NORTHWOODS SUBDIVISION; BLOCK 4, LOT 21 PNB ��011P a •.(2f �!�. '�c��� 4d TYPE Of WORK: DATE: 04o4p��Qoo PrOres5i01`Oa AS—BUILT DRAWING 12/10/13 (Rev. 01105) PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: OSP131453 051-741-04 GRADE = 102.07-102.65 2" INSULATION TOP OF TANK STI MH / AT INLET = 97.24 TOP OF TANK /�AT OUTLET = 97.31 INVERT OF BUNG AT INLET = 96.60 NEW 500 GALLON PUMP STATION GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. 10008 00,N, 51111£ 101 NKHO0A0E, M 98507 + WME (907)337-6175 ' F" (60 ) —3246 • MEB . wm gaOwm9lneM%p m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DAWN HARMS 317-9828 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: NORTHWOODS SUBDIVISION; BLOCK 4, LOT 21 PNB TYPE OF WORK: DATE: PROFILE AS—BUILT DRAWING 12/10/13 (n6, u„m) A. CE�79GQrness. XI re Rob Campbell From: Capstone Electric Ilc [capstoneelectricllc@gmail.com] Sent: Wednesday, December 11, 2013 7:34 AM To: Beverly Subject: 22753 McManus Date:12.11.13 Re: 22753 McManus Chugiak, AK 99567 Capstone Electric LLC license # 38752 approves the re -wiring of the lift stations controls and pump connections at the address above. Sincerely, Devin Rafeedie Owner/Project Manager 22356 Whispering Birch Dr. Chugiak, AK 99567 907.602.8893 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: OSP131453 Tax Code Number: 05174104000 Work Type: Septic Permit Effective Dates: December 09, 2013 to December 09, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: NORTH WOODS Site Legal Address: NORTH WOODS BLK 4 LT 21 G:1559 Owner/Address: HARMS DAWN L PO BOX 772266 EAGLE RIVER AK 995772266 Site Mailing Address: 22753 MC MANUS DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 20242 Total Bedrooms: 4 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. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: M_N/75 �O MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Suffivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. ( �'�rii-OL1 Phone: 907-343-7904 Fax: 907- 343-7997 UBMITTL DEC 9 2013 Property owner(s) DAWN HARMS Day phone 317-9828 Mailing address 22753 MCMANUS DRIVE, CHUGIAK, AK 99567 Site address 22753 MCMANUS DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd, Block & Lot ) NORTHWOODS, BLOCK 4, LOT 21 Legal description (Township, Section & Range) Lot Size 30'20 Sq.Ft. Number of Bedrooms Date of Payment: APPLICATION IS FOR: Date of Payment: APPLICATION IS AN: (®all that apply) Receipt Number: Initial ❑ Absorption Field ❑ Upgrade Tank ®* Septic Renewal ❑ ❑ Holding Tank Privy ❑ Private Well ❑ ❑ *LIFT STATION REPLACEMENT Water Storage a THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 30'20 Waiver Fees: Date of Payment: /a/ / g 113 Date of Payment: Receipt Number: Q169 26 Receipt Number: Permit No. l /t J S l/ 1'3 f `►� Waiver No. (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS December 9, 2013 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-7904 Ref: Lift Station Upgrade for Northwoods Subdivision; Block 4, Lot 21 To whom it may concern: The existing 4 bedroom house is served by an existing 1300 premier plastic septic tank, a PVC pump station, and a 10' by 36' bottomless intermittent sand filter. An adequacy test was performed on the drainfield on 11/27/2013 and found to pass for 4 bedrooms. During our inspection, we found that the existing pump station did not have a timed control panel and the PVC riser was separated and taking on groundwater. Due to these issues, the homeowner has chosen to upgrade the pump station. We are proposing that a 500 gallon Anchorage Tank lift station with a timed control panel be installed for this property. We request an expedited permit be issued. 1. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 2. TOPOGRAPHY: There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. n E., M.S. NOTE: Attached is a design drawing, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND TRACT C; NORTHWODDS S/D EXISTING 1300 GALLON PREMIER PLASTIC SEPTIC TANK b EXISTING PUMP STATION TO BE REPLACED WITH A 500 GALLON U STATION WITH TIMER CONTROL PAN EXISTING 10' X 36' BOTTOMLESS INTERMITTENT SAND FILTER. PASSE ADEQUACY TEST ON 11/27/13. - LOT 20, BLOCK 4; NORTHWODDS S/D " 1 1 \ 1 \ 1 NOTE: ALL PROPERTIES SHOWN \ 1 ARE SERVED BY PUBLIC WATER. \ \ 1 1 1 1 \ 1 \ \ LOT 22, BLOCK 4; NORTHWODDS S/D \ \ \ 1 1 \ 1 1 -WATER LINE (APPROX. LOCATION) 1 1 \1X OF WORK: DESIGN FOR PUMP STATION UPGRADE 12/9/2013 o F+ GARNESS ENGINEERING GROUP, Ltd. .7* CONSULTANTS & GENERAL CONTRACTORS • • • . • • • • • • • ...... • ...... • • 3701 E. SUDOR ROM. SUITE 101 • n NOME. M 99507 • WME (90)X5]]-6179 • FM (907)336-3448 • WMITE:...geme r4nwiNxom PREPARED FOR: PHONE NUMBER: PAGE NUMBER; •• •••••• ••••: ••• DAWN HARMS 317-9828 1 OF 1Gar OQQ ess..- LEGAL DESCRIPTION: DRAWN BY: s •. CE- •'.� NORTHWOODS SUBDIVISION; BLOCK 4, LOT 21 J.L.M. Op _' •1.?. ,q. 'I3Ao, OF WORK: DESIGN FOR PUMP STATION UPGRADE 12/9/2013 Municipality of Anchorage Page _L of 3 DEPARTMENT OF HEALTH AND HUMAN 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 �q Sw 9 a O�7 O'71—g1—O� Permit Number. PID Number: Name: /T /1 � k- e T6 OMA S Wastewater System: V New ❑ Upgrade Address: PO ga %7o ( ( q, 4 Kcrg77 ABSORPTION FIELD Kwrr, Phone: `�[�^ ^ U Z d No. of Bedrooms: r /I -' ❑Deep Trench ❑Shallow Trench O Bed ❑Mound {$Other LEGAL DESCRIPTION Soil Rating: ^/ 0 Total Depth from original grace, \ �•0 GPD/Sq Ft. Lot: ^ Block: $ybdiv' on, Depth to pipe botloTmonginalgraoe: Gravel depth beneath pipe •1 \ d rP, ,1 00 S . _ Ft. at Ft. Township: Range: Section: Fill added above original grade: Gravel length: \ 36 .& Ft. Ft. WELL: ❑New ❑ Upgrad Gravel width: IO\Numberofli Ft s: Dfanp eween lion: 3113" Ft, Classification Pmeie, A,B,CC , Total P Cased To: Total absorption area: ////�� 30l/ Pi met rlalr:'1.SO _h 440 C IMSA G / I Ft Ft. So Ft D�3 FBia Driller. Date Grilled: Static Water Level: Installer. ,,JJ II �WC!(it ECgVa7xr pate IMtalled: p -! Ft. Yield: Pump Set at: Cmng Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES 9Septic 0Holding ❑S.T.E.P. To 3aMic Abwrylion Lm Holding dkRrivap Manufacturer.Prem �e� Capacity in gallons: 3 �O From Tank Field sufli" Tank $ewer Gees WeWell,\+^—� 7 Material: I Number of Compartments: rT dLN o e��e O( Surfac Watere It1+ (0011- 100'+ LIFT STATION Lot ��� d II\ \ Size In Ions: Manufacturer. % Line n� Foundation ton "Pump on"bvelpk lk "Pump olr'bvat: s11 High water alartrtn.SM. 7� Curtain �� p n Pu o Mike ModN� 41 R Eleetn I In�spectJ r POT e �rmed Yf Drain j C, „ Remarks: BENCH MARK Location and Description: ,f-� BO-Hoer, ,!7 OF S I v i►i Assumed Elevation: ID O Ft EN 1.� * 'a Ab LNUMEERING 17034 Eagle River Loop Road, No. 204 Inspections performed by: Iff RiverAlaska, 99SZZ Dates:1 f-- gra 2nd 'na t ` ROBERT C. COWAN 4! I V D7-9q Department Health Human Services of and approval �t'r\\\•..._ :„...;•1 Reviewed and approved by: a419:&� 6U. �. �% Date:. 72-013 (Rev. tuat) MOA 25 PERMIT No. SW980429 PACE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tele hone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 21, BLOCK 4, NORTH WOODS S/D P.I.D. NO. 051-741-04 \ O� LOT 22 .TNB) \ �\ 10'x15' ANCHOR uoo GALLON EASEMENT PREMIER SEPTIC TANK (P VVNrLENE) w ti2�OC / k~��q�O� ♦TN GP \111,-INB9 ST ST • fCU P �O 6 ,�< 4p'yf 00 UR STATION —Cn TB , V Nn AIR LINE MTI \ \ / 3 \ f V2 vt wALE: 1'40' LOT 20 4. /V) v / 9 ROBERT C. COWAN ....,�! f`P� CE -8801 In f 1,40f,�. ' ..... �� PERMIT NO. SW980429 PAGE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HE'4UH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Ataska 99519-6650 • Tete e hon343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 21, BLOCK 4, NORTH WOODS S/D P.I.D. NO. 051-741-04 MTI -106..O' MT1 MT2 MT2=108.0' FINAL GRADE FVI-FV4 ORIGINAL GRADE INSULATION w eftm °ev MTI=103.2' BOTTOM OF SAND=100.9' GROUNDWATER AT 97.9' FINAL GRADE 99.6' INSULATION N. T. S. B01=s{ . �• * 4!9)h *:-7� 96.4' NEW 1300 GAL. _ POLY. TANK 96.2' ROBERT C. COWAN CE -8801 ...::.. �s ,•• jet 2r 1 Zl1 L ............... A 8 C FCO 21.0 3.5 — 92.9' B.O.H. ST1 25.0 9.0 — ST2 27.0 12.0 — C0 1 28.5 14.5 — MH 29.5 16.0 — MT1 — 47.0 61.5 MT2 — 45.0 54.0 FV1 — 79.0 78.0 FV2 — 78.5 76.5 FV3 — 78.0 74.0 FV4 — 77.5 72.0 AUG -31-1999 1533 S&S ENGINEERING 900 South Grantham • Wasala, Alaska 99654 rhonc# (907) 373-3893 • Fax# 373-3894 trot«; If�•v"•yl.:ahtS rkcyvic Z'NG. L'puc.ernl�.S 1„fr S1t471ew+ //-log t)o. 907 694 1211 e ,r4 c h:fr sOr)R7o.J A -'r J.oi ;,/ V"' 8« Nurfl.y�eeef S S■b G:7U Crteke, /k/as latkr% w:eco( 6� Reo,dJ•.J y.o N. E. C, f h9kn: /'tp�:✓...M7'S kat 4 {�;iocnbcrl F�ac�r:Ghaw , L;6.e"e Pa. Ill 30 0 Svc. rdtbrs►�. Pres s.c.. P.02/02 Itlirf.ratsA Permit Number: SW980429 MUNICIPALITY OF ANCHORAGE Department of Heafth and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ,D g 2- 4q lst ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT�z� Initial Date Issued: Nov 04, 1998 Legal Description: NORTH WOODS BLK 4 LT 21 Expiration Date: Nov 04, 1999 Parcel ID: 051-741-04 Design Engineer. 0003 S & S Engineering Site Address: Owner Name: Robert Shafer Lot Size: 20242 SQ. FT. Owner Address: PO Box 773303 Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River. AK 99577 - This permit is for the construction of: ❑,7 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by catling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. This permit is for a bottomless Intennittant dosing sand filter system. —D'_-n�n ChcxnuJ� 5-19 V A-0 &Ire Ib SF - 4b'C-1Iec- Received By: Issued By: Date: �o Date: //' I/ . 98_ October 5, 1998 ROBERT C. COWAN, P.E. ROBERTA. SHAFER PE. CML ENGINEERS (907)694-2979 FAX(907)694.1211 HEXTHALTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and human Services P.O. Box 196650 SEWER& WATER Anchorage, AK. 99519 MAIN EXTENSIONS REFERENCE: Lot 21, Block 4, North Woods Subdivision nON R c Request you issue a permit to Install an Innovative (Bottomless Sand Filter) septic system to serve the proposed four bedroom house on the referenced property. Three test holes were excavated and percolation tests were performed for test holes no. 6 and 7. ENC.NNEERiNGSTUDIES The approximate location of the test holes are indicated on the attached site ANDREPORTS plan. At the time of excavation, groundwater was encountered in test hole no. 5 at 5.0 ft. Atter seven day groundwater monitoring, the monitoring tube was checked and the groundwater level was WELLNSPECTION unchanged. During the excavation of test hole no. 6, groundwater was encountered at 5.0 ft. &FLOWTEST After seven day groundwater monitoring, the monitoring tube was checked and the groundwater level was unchanged. For test hole no. 7, groundwater was encountered at 7.0 ft. during excavation, and at 5.0 ft. after monitoring. SITE PLANS We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. ROAD DESIGN There are no points of contamination within the proposed well radius that can be seen on the attached site plan. If you require additional information, please contact us. SOIL TEST Sincerely, PERCOLATION TEST C �L Z� Robert C. Cowan, P.E. RCGsrj STR=LJAALB MECHANICAL INSPECTIONS Enclosure ONSITE WASTEWATER DISPOS&SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 .JUL 16 199 14:07 FROM NU CASCADE PAGE.004 Model 2048 Few �.�rrBLASI . METERS FEET 140 120 400 0 L , • , p 0 O 10 1S 20 ZS 30 CPM 35c. 3 0 t 2 4 5 6 7 m3ln CAPACRY pMl=00 ASD Wtt= 100 300 60 I lee9m ) Mout We. 80 20C 7btn1 WXT Now LOA.m 40 —� r 10( 1 20 9.6 0 L , • , p 0 O 10 1S 20 ZS 30 CPM 35c. 3 0 t 2 4 5 6 7 m3ln CAPACRY pMl=00 ASD Wtt= I lee9m ) Mout We. OrletNIm19r HI Rew 7btn1 WXT Now LOA.m W.E. Now TeW 2%W22.2M6= K 1 4 9.6 93 19.1 3 1 16 I 20 21 24 2Cf60M2 Y. 1 6 11.3 10.7 22.0 4 6 27 29 2 0E01 022 1 1 8 13.0 111 2<2 37 ick I l0.8 6 3; 20481522 111 1 11 1l.6 weer elm ar Wrtq wtmut Irator. LOA . jovh of eseemlry-e9r09tete 99m0 —water Md end fnotar• RECEIVED SEP 1 1999 MUlI.0 y2.: r��_.w�g� ®Mnnoanxoe. n Oept. HeAR14r6eM94lAi�n$'OePMAW oe olwa "W-orviceA! 016C4A"E 1 A' wr efte" AmA.1990 prrtea Y tti UZ A. W-45TEP *A -OTAL PAGE.004 A* ' /fir-J� l+• • °`•. NOW V W O; 'ref'\ �Vig ,,•,;;! ��� 1 � \ � ���Ws LO 1 1 11 s\ 1 \ DO e< Vl T ;� � j • i � \ �� /z 1� CN ♦4429 29 nt\t byYo t\' _ \ o r� *'T\ a _ i -nom---- -� l�1 I L \ O �o oz Z= a xrw Zm� v ma cJ via `meg = zz;'I 13y � W W Y C:J S W W � �� P' �• O � p I U �amz• gz 1z k;, N W W m VI o / nbpe N c S7 --JJ'o O S W-ozC WIYrWV d N \\\ \� I VON _ a 1W� a \`\ { w c� c� \ 3 v~iv=ia ��ocoi in a n6 o p \\\\ moo W F CLl D L) W o� o� \\ ��N 0 E" Ll►w- A L� oz w w i o z C\ II Q: ��. W �� ato Ir °�a' lea C7 II o U aooz aooz CL d' N 1.aZ—O WZLa <—O Ffv.�7C Eyy4co 00 Oto O a=> QaVIlO ajNN.-to c„^NN��=0 V ods c u n ti IV;)S NOIS30 NVId 3115 ,09 = „L ••• r r •; •)! Ej Q Z <a f�- •. VO iL� G1 1 pox W 1 �m it,, t 12 2'Z 1 CU `c/ C , `'O i se, y n/ S14 r. a1 2FOrc f�j REQ_= uoi3 U V LL, � J N aW Ja d Cal A ` IX vi Q Im N -- CN — � r / Q Z <a f�- F CD �\ Y Na �d Z F V LL, � J N aW Ja OLl J' 20 j �\ a Ld i S' Lj w y I / Q Z <a f�- F CD Li -i / �d 0 LL AN Li _ �- \ M o W0F Nis cn N N C1 2 O 4 W 2FW O N w ONX a = ... W F � 63U Cit �d 0 LL �O \ M a Ld Lj w F Q G apl \\ M _ N n �OOQ VU, O ^ , w U .1000, oF � a 0 �� U 4 Si^n. 000 a OtY U U W \ \ y�um n II N II Z v 4W0 \ dGpZ Q N WQ3OJ WZOO \ c3d� n 00 Q V in to w o o j NC4NN a iyjJ 11V130 NOIS30 ,0£ = „ o W0F Nis cn N N C1 2 O 4 W 2FW O N w ONX a = ... W F � 63U ilo:`\/2- )\ � ` z� 2 . : � o @ _ _ % In c ,m & E - & . 2 Ln // �/ _` jz , e z x m m C:)b — q \ E- a ® � w �! E- a! Q � C , \ o /_ :i ! � ! � §® & | Ix + =10 )\ 000 [ 2 ® / m � - §2 1*I30 Na22 \}\ _ ] C? q w �2f ; ;!| © _ _ § b � § Q ,LO ) \, ® E : • $ IN C/) c 22 O � u01 § m CO ! w 3 - � � CLgm � \ uj m ±• E § ƒ�| ƒ \ \ C\1 / / § \ §S/ i ! tp I ° l=r. �z m �\� 2|�! mt& 31e08d \N PERF4 LEGA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST RUN BETWEEN FT AND FT / COMMENTS - f ��O N / 70eIttl C 4 �' -rliF-tom � 1071 f ( X /,7ea.C/ PERFORMED BY: S & S ENGINEERING 17034 Eagle RivOr-1 oop Road W CERTIFY THAT TH 5 TE/$T WAS PERFORMED IN ACCORDANCE WITIE6W&AAba11X.9QW GUIDELINES IN EFFECT ON THIS DATE. DATE: Q �a ( 9 72-0081R". 4/851 0 72-008 (Rev. 4185) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /JOQ S1/A1,6lie LEGAL 2- 3- 4- 5- 6- 7- 8- 9- 10- 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 •3•4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - c cv DATE Z (>�� /VD/�/iL�i lly+ ownship, Range, Section: A SSkkolQ-Q B�s�a oat 01-0 141I.T Goc so " Gwen s2cP s G /11 9. D' 1} COMMENTS // WAS GROUND WATER ENCOUNTERED? \'JJ•�' J S IF YES. AT WHAT / L DQ/PTH? J 0 Abe �ri.rSjI111-e- E pNmWater An Monimrin 7 Dric 12/�� j ` ROBERT C. COWAN i3� y , �CE-88800111 ORMEO: SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop 7/9 i 7-;3,0j2. 7 A _ 131,., / ,4 � 30 Iw'.) 3 t e -7 — 4:a n 301,1/,o — 5 /3 70 tit., /—""-_- -- rr PERCOLATION RATE(mmutesnnch) PERC HOLE DIAMETER c TEST RUN BETWEEN ?� FT AND 3 FT S %N/3 4,c> etfN iG"Ie /� T PERFORMED B17034 Eawle a p' cop Road NO '304 1 /(✓. Lys � - U'CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE Wt,k IlLv"'AT�AND ?JRiPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-006 (Rev. 4185) 01 PERFORMED LEGAL DESCRII DEPTH (FEET) 1 •'/S 2 d 3- 4 4 V 5 Lfl, 1) 12 13 14 15 16 17 18 19 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST V� 02 C— w G &m DATE Op J Township, Range, Section: SLOPE WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DepthtoMonitoring? ontt WAbler Mani�( p Winp? •5 D�1tJV � /o 1i _SSEAL) OF kh It- Jr t . . .......... .. .... y , Nr7 r`1'A J .0 ROBERT C. COWAN f n c f —88UI if:AP Reading Date Gross Net Time Time Depth to Water Net Drop /v'30 4 b' OXei /Z & ., 00 Ae,r I AJ - ! 101 ' 41 — 30 Ol w. / -2 -t 20 -� I &/o /J t SDo- tr 'ul ERCOLaYION RATE (mmutevmch) PERC MOLE DIAMETER 6 TEST RUN BETWEEN '2—fFT AND S FT COMMENTS S 8 d FNGINSERRIG 17364 Ce,)le River Loop Road No. 204 Eagle Viror, Alaska 99577, PERFORMED BY: 1 Z✓'`� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: b/ } / V 72-008 (Rev. 4165) PROPERTY OWNER AGREEMENT FOR TIIE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL 14 SYSTEM This agreement, dated 199,, is made between the Municipality of Anchorage Department of I alth and Iluman Services (D1I1IS) and the property owner(s) of: i«iOSt�1�9�4_.P-7 3 7�i�lti. This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and . operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) X11-5�r5 (Printed Name) (Signature) (Printed Name) §V0*s;11wJ unu :e'arn to bofwe rte Here) Mb CVWJ ebn bow" 7 4 1. RAY'S SERVICES A SUPPLIES Specializing in on-site wastewater disposal systems OPERATION AND PREVENTATIVE MAINTENANCE CONTRACT Produt:t $ales Permit N: S\1qa OSI Zcj and Dlstrlttutl ` _ Legal Description: 1,1Az t -y- %AN� \Jwp S S 1j Rays Services will perfomt operation and ntaintertance of the Onsitc Sewage Disposal System as outlined Septic Tank: The sludge and scorn accumulation in the septic tank will be measured amorally. The septic tank will be pumped when either the sludge or scum accumulation reaches 25% of tank capacity. Effluent Lift Station Tank: The sludge and scum accumulation in the lin station Link will be measured semi-anmmlly. The tan will be pumped when sludge accumulation reaches 8 inches. The lilt station tank pump and controls will be observed semi-annmlly to verify their perfontmuce. Pmnp trip counter slid nm tittle$ will be recorded. The screened pump vault will be observed and cleaned when a discernible elevation difference between liquid inside plc screen and outside the screen is observed. Sand filter. The surface area around the sand filter will be observed monthly for signs of faihtre such as lush vegetation growth or etlluett ponding. Liquid levels within the filter will be observed through.lhe observation pipes and levels recorded. inagement Items which are not included in this contract include: Seviees I. Corrective and/or repair maintenance if necessary. 2. Emuent sampling and analysis if applicable. 3. The cost of tank pumping. llte goal of Rays Services is to observe the operation, and perform maintenance for the onsite sewage treatntetn system to allow for proper, long lent functioning or the system and compliance with the conditions of the installation permit. Rays Services will perforin the operation and maintetancc of the system as outlined above for $2M.00 per year. Pa>wlent in full for the first year is required prior to incitation of the contract. This contract period will be for the year following the date signed. Property owner or authorized representative 43'— �dte Rays 8-z�.tiy Date I Partesmter Potaluct Oisnibutimn - Onsite Alanagement Services - Onsite System Evalvatimts P.O. Box 772804; Eagle River, Alaska 99577; (907"96 -7297 P4 SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: -57 Eiil 7l_l L, .SK/ic-C+S CC9J,157 DATE PERFORMED: Net Time LEGAL DESCRIPTION: L-07- 71 r3Lor K 4 NOrLTN 1`UC0b,; r11A.SE I ( SLOPE SITE PLAN 9 0_ 2 b ru LGw) 3- 6(jN- .e= 0- cv,3SLL-S 3tl—/O V 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 END �LT. 13R-A7t SRNUy Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN # AND FTS . w n T, , , — , . I / 7 .If Zk / /7 C✓c �/7 PERFORMED BY: 'iO A .S// !T M 4A) CERTIFIED L/ 72A08 (6/79) L DATE: N Municipu ityg of Anchorage r PO. H 6-650 ANCHORAGE. ALASKA 99502-0650 (907) 264-4111 TONYKNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit 0: 840457 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 21 Block 4 North Woods Subdivision #941 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 rl� /11� MUM ICI F 1L I TY (D F= F=#r41= ezzF=l GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PP,OTECTIOt4 825 L STP,EET, ANCHORAGE, AK. 99501 264-4720 SON—SITE SE4JEFi F'EF ZM I -T- PERMIT PERMIT NO: 840457 ENGINEERED DESIGN DATE ISSUED: 06!14!84 `APPLICANT: STEVEN L. SKAGGS CONSTRUCTION ADDRESS: P.O. BOX 670690 CHUGIAK, AK 99567 CONTACT PHONE: 688-2831 'LEGAL DESCRIP: SUBDIVISION: NORTHWOODS M1 LOT: 21 BLOCK: 4 SECTION: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 20242 (SQ. FT. OR ACRES) I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET - FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL'ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER, DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING 'THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND 'ELECTRICAL WORK. MUST BE DONE BY .A LICENSED ELECTRICIAN. SIGNED APPLICANT: STEVE S GGS CONSTRUC ISSUED BY DATE DATE CODES, AS—BUILTS (3> THE (� n. 000 CORWIN & ASSOCIATES, INC. CONSULTING ENGINEERS 4321 GRAPE PLACE SUITE 204 ANCHORAGE. ALASKA 99504 (907) 561.6151 SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER TREATMENT SYSTEM Northwoods Phase I Subdivision, Lot 21, Block 4 1.0 General 1.1 The Drawing, Sheet 1 & 2 of 2, shall be a part of this Specification. 1.2 All materials and workmanship shall meet the require- ments of Anchorage Department of Health and Environ- mental Protection Permit. 1.3 All excavations and depths are advisory and are to be verified or modified in the field by the Contractor as directed by the Engineeer. 2.0 Seepage Bed 2.1 The gravel for the bed shall be screened to the sizes indicated; 0.5 to 2.5 inches. 2.2 The bottom of the excavation shall be raked with the backhoe blade to ensure that the bottom has not been compacted during excavation. The bottom elevation shall be level plus or minus 2 inches. 2.3 An observation pipe shall be placed as shown in the drawings. It shall be Rigid PVC, ASTM D-3034. The section shown with holes may be either drilled 0.5 inch holes at 6 inch centers on opposite sides of the pipe or a section of regular perforated sewer pipe may be clamped to the solid section with a no hub coupling or solvent joint. A rubber rain -cap (Jimcap or equal) shall be placed on the top of the pipe. 2.4 The insulation shall be two inch high density extruded or molded burial type rigid polystyrene board rated at not less than 2.4 #/cu. ft. density, a compressive strength of not less than 35 psi and a water absorption of not greater than 1% by volume. n 2.5 The top and sides of the bed shall be planted with a White Clover and Red Fescue Mix or Blue Grass. 2.6 The septic tank or bed must not be closer than 100 feet to any body of water or existing private well, or 200 feet to any existing community well. 2.7 The gravel shall be covered with a layer of engineering fabric consisting of untreated building paper or a non -woven fabric such as Mirafi Fibretex 200 grade, or Poly -Filter X or equal. 2.8 The distribution pipes shall be ASTM 2729. The pipe shall be laid level. 2.9 The berm around the seepage bed shall be constructed on at least a slope of 1 foot vertical per 3 foot horizonal. 2.10 The sand shall be a medium to fine washed sand with no more than 38 passing the 200 sieve. n SOF 41, tF, �� • ce J. Corwin Ye ��.,• Nom. CE3287 C'✓ OFESSI L DETAIL NO.I - N.T. S. L+.A PLAN . VIEW ANTS AIRTIGHT CAP TOP OF FILL' STANDPIPE . TEES r G i 117 4 ADD a b,; o v. PERF. PIPE SEQTION B- B N. T.S. G7 •D ' coo 5\����\'�S�1� • ,, raiz (� a •' z a :"moi :�j l a jo: ° 6 ��x • O/ r�.�op CD < J Y• Z O rn gOOp W min.) pt 0y N y c co m No 0 Z m � arn z m o m v o_ y 0 T 0 DI y z F)m r o o C) :053 a m :�t; ••..� y,+ a '4 �e • •S1 'O rO W m r?`'t^ .c n D m 3� o m >� mo CD3 �mx �" z mN Dz n m ,�� m D r -i -1 cn o y>n 'nm ar r -I" N Dom r m J Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 RUSH! t CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel LD_ 051-741-04 Mailing address Real Estate Agent Expiration Date: ,Z - 1.2 cL S11! NORTHWOODS; BLOCK 4 LOT 21 22753 MCMANUS DRIVE *CHUGIAK, AK 99567 DAWN HARMS Day phone 22753 MCMANUS DRIVE *CHUGIAK, AK 99567 Day phone 317-9828 2. TYPE OF DWELLING: Single Family (w/wo ADU) r ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) DEC 1 1 201113 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 1. GENERAL INFORMATION e Date of Payment Individual Water Storage Complete legal description Location (site address) Individual Holding tank Current Property owner(s) Mailing address Real Estate Agent Expiration Date: ,Z - 1.2 cL S11! NORTHWOODS; BLOCK 4 LOT 21 22753 MCMANUS DRIVE *CHUGIAK, AK 99567 DAWN HARMS Day phone 22753 MCMANUS DRIVE *CHUGIAK, AK 99567 Day phone 317-9828 2. TYPE OF DWELLING: Single Family (w/wo ADU) r ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) DEC 1 1 201113 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Date of Payment Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ WaiverNariance request for: n/a Distance:= Received by: " ` .�. Date: COSA to be released to the engineer, unless otherwise requested by the engineer. LI COSA Fee $ Z � Waiver Fee $ Date of Payment /41/a'110 Date of Payment Receipt Number i 4_�iS6 Receipt Number j yJ 131(_4 o COSA # Waiver # k,_ 5. STATEMENT OF INSP8CTION.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. /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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD, can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed 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. 6. DSD SIGNATURE System #1 Approved for _ bedrooms. System #2 Approved for Disapproved. Conditional approval for in bedrooms. 337-6179 Date 1 :�G 2 bedrooms, with the following stipulations: till(((((((((((( ��( OF AN�tio ON-SITE WATER AND WASTEWAjER Original Certificate Date: lij,— /,;�-13 The Mun'icifialityidrAnctiora§6' Develop, amt 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 errorsor omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory fp— isms Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: NORTHWOODS; BLOCK 4, LOT 21 Parcel ID: 051 -741-04 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level PUBLIC WATER If A, B, or C provide PWSID# _ Well Log (Y/N) Sanitary seal (Y/N)_ Wires properly protected (Y/N) Cased to ft. Casing height (abo round) in. FROM WELL LOG Well production g.p.m, WATER SAMPLE RESULT$. Coliform ��colon ies/100 mi. Nitrate mg./L. 3sefic: ug./L: Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/POLYETHYLENE Tank size 1300 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (YIN) NO AT Collected by: F1 Date installed 8/2-27/99 Cleanouts (Y/N) YES High water alarm (YIN) YES Date of pumping Pumper C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 8/2-27/99 Soil rating (g.p.d./ft'or qbdrm 2.0 System type ISF Length 36 ft. Width 10 ft. Gravel below pipe 0.25 ft. Total depth *2.83+ ft. Eff. absorption area 360 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **11/2/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 6 in. Water added 564 gal. New depth 4 in. Elapsed Time: 903 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date - **PRE-SOAKED WITH 668 GALLONS ON SAME DAY. D. LIFT STATION Date installed 12/9/13 Size in gallons 500 Manhole/Access (Y/N) YES "Pump on" level at TIMER in. "Pump off' level atTIMER in. High water alarm level at 48 in. I1 �aC NEW Meets alarm & circuit requirements? YES Datum Cycles tested q E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent Absorption field on lot On adjacent lots Public sewer main Sewer /septic service line areas manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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/ JEFFREY A. GARNESS Date I Z- i I / t3 (Rev. 11105) t 4 T_ y,( ............. A. Garness.: CE— 95 •' c� 04pf�Pa.li��l /13.�c�oo 4 Q�pro fessio�dt ti3 �00 F Av o Ir N !y h iST�NC ASF ag\Yb, . 00 coo N s .71 00 +� v �iir' no o3'aa°5£ri�r�n vA � EL i y. � oam m W N •-1 S b a � Q 7 p W A N qalt ` Plo�� *�o ^� .So• �.: •�� i f O mm Gi s o -• a y a • e� ..SPA ••":'� PC, h4 v VI c 3 -•t c j O v 7 i ` �[ -.000 O .2 Q D 01 A N o �'• m M / i AV ,�••yy M (q, 0 tl Cx •�.' Q M D C y h •••1••• iN•4p CL Gf � �• O S' OO.• _ O C IA U O a o N b Q X y b 7 12/04/2013 08:54 APLUS PAGE 01 mmcipAtl7y o;:,kxcmRAta. R Community Development Department • On -Site W*W & WsatmaterProgmm P: 907-3434904 • F: 907.343-7997 • P.O. Box 196650 Anchorage, AK 99S19-6650 • http://waw.m mi.ora/building Intermittent Dosing Sand Filter Maintenance Log Owner. _T)eal,10 10 Ido., -meg 8treetAddressPhone 8 it - 9 8 k$_ Legal Desc, PID Sea 'c arutc: -Sludge level inches •Pumping: required ma -Pumping completed yes no Absorption Field: -Liquid level. inches -Flushing valves per approved desig 3 o -All flushing valves opei;,4 distribution lines flushed, and flushing valves closed yes no -Pump basket cleaned yes no •Biotube effluent filter cleanedev R no ,Timer float setting^inches -High level float setting inches -Reference point_ -Pump on rAl"D AS -Pump off #niaades -Cumulative lifetime cycles Y:_I19 h -Cumulative run time hours ,Operation satisfactory ves no Air Systertt; -Air pump filter cleaned b no -Air pressure 5 asi -Date of latest install or rebuild -,Air system operation is a ry not satisfactory. irrm Sysstmm -Dedicated electrical circuit Cey s� po -Audible and visual alarm inside dwelling 4PLI10 -Float setting °i3 inches •Alarm system operation satisfactory not s fa ory Com f I .....,...Lt.. ..,`a:? �^+....:'La..-.........k S,..... K,,..I'.!✓pr.,....! .4!L.%?,�i?✓-e .'..../.1?tiQ.....�-c.C?'4�i.�. ,�3.Z�- ^ ........................................................................................................................................................... ......� y.,�:....Q.!✓.�r.....�iu:�..... �..f�d���..�........w„ o r lGie:�...4?....C?ti?...�� tt�t.,.. �.rr.5.7!f�«.�._-...�: 3�0 5, ................... ............... ....... ........:......:............................................................................................ .................................... nteriance Provider. Technician Date of maintenance !/ Z Company Signatuf'®�-� 7�i�� Deter Log_040313.tloo '* ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND Scott Reynolds THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this 7 } Day of /l1w em h c of 2013, by and between Scott Reynolds herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On -Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Eanipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the A W WTS for the entire term of the A W WTS In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AW WTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the A W WTS installation and maintenance requirements as provided by the A W WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with. and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: Scott Reynolds b. Municipality: Director. Community—Development or designated authori C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining Provisions of the Maintenance and Repair Agreement, NER: By: 0 A44 (signature) Date: 19 Nov 2013 Scott Rey olds (print name) STATE OF Al ASK?k (�_Ck( t -f o f->) i f I S'n Ic-riv) ss. C�caf7� Nov The foregoing instrument w s acknowledged betore me this day of / y o v 201 by Sc_-ct-� (c�� . it 7IBJ T RY PUBLIC FOR � Y7ommission expires: �. f p .o REPJC�� f� ryEm� t W IVI',T'31 . #1903264 ' 701.IC - CALIFORNIA AILANO COUNTY 0 �6 i i. EXPIRES SEPT. b, 2014 MUNICIPALITY: By: (signature) Date: (print name) Title: Parcel I.D. 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 051-741-04 HAA# 17 1. GENERAL INFORMATION Complete legal description Expiration Date: 4 If/C90N e Lot 21; Block 4; Northvoods Subdivision Location (site address or directions) 22753 ticManus Dr. Current Propertyowner(s) Christina &Richard Caron Day phone 208-832-5128 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 8044B Early Ct. tit. Home AFB, Idaho 83648 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site fR ❑ Individual Holding tank ❑ ❑ Community On-site ❑ Public Sewer ❑ loin/1'05- CERTIFICATE -- The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION 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&SENGINEERING Phone G�ly'�rJ7�i Address Ie River Alaska 99577 Engineer's Printed Name 10i9f Z7 C • C Da//t✓ Date 5. DSD SIGNATURE r 1 ROAERT C. COWAN +gy CE-8801 Approved d�bedrooms. p` _ `i,; Disapproved. i`*J Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 6 L . _ 0 , ` t(�(\`n�� _ Original Certificate Date: Ll (Ra 01Q1( 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: L C, -r V', *Z?q jjoyafi pp©t� Sib * Parcel ID: 0S 1 -741 —oq A. WELLDATA P0'Ft-IG tOA-MR- Well type _ If A. B, or C provide PWSID # _ Well Log (YIN) Date completed _ Sanitary seal (Y/N) _ Wires properly prot (YIN) Total depth ft. Cased to ft. Casing h ' (above ground) in. FROM WELL LOG SPECTION Date of test ft. Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULT . Coliform onies/100 ml. Nitrate mg.A. Other bacteria colonies/100 ml. Ars ' . _ Mg./l. Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA q Tank Type/Material ""S1 tiDPE Date installed Tank size 115 gal. Number of Compartments 2 Cleanout Y/) Foundation cleanout &) _S7 Depression over tank (Ygl�O High water alarn-0) Date of pumping10 $ Pumper --Z]7 C. ABSORPTION FIELD DATA Date installed � Q Soil rating g.p.d./ftZ r it�lbdrm) 2_O System type Q.D.S. F. Gravel below i , %t5 ft. Length ft. Width �� ft. pipe depth r ft. Eff. absorption area _31:p_fe Monitoring tube _S. Depression over field ►� Resultss•aiq Forte` --bedrooms Date of adequacy test Ib�3/D it v Fluid depth in absorption field before test in. Water addegal. New depth_, in. It d Elapsed Time: Q min. Final fluid depth Q (pCC)+ in. Absorption rate >_ _ g.p.d. (p ) (YAD type) !J0 If yes, give date Any rejuvenation treatment (past 12 mo. D. LIFT STATION Date installed 8 Z Q Size in gallons _ Manhole/AccessCfDN) _ ��E 5 li n 'Pump on' level at �Q in. "Pump off' level at5t, in. High water alarm level at y4,6 „ in. Datum "fbF of wit+04"t Cycles tested 5 Meets alarm & circuit requirements? ' r. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Towc (R3rq-MV_ Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer On adjacent lots On Public sewer manholelcleanout Holding tank TION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 • Property line 18.5 ' Absorption field ZO I + Water main 10 Fr Water service line 10 % Surface water (001+ Wells d0ri- Wells on adjacent lots ACO 14 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11 Building foundation I G I Water main Ig t { Water Service line ID rf Surface water —too t i Driveway, parking/vehicle storage 10 r4 - Curtain drain _A^GYI KK t7>Vyyeils on adjacent lots 2� ra F. COMMENTS G. ENGINEER'S CERTIFICATION r., I certify that I have determined through meld inspections and - -- review of Municipal records that the above systems are in 5,„• conformance with MOA HAA guidelines in effect on this date. 00, - . Rosea G .COWAN Engineer's Printed Name 66'd e.� �, �vug .. `r✓f��M1 CE-asof Date_ if D /s—dos— HAA Fee $ f -i _,xp) . 0c) Waiver Fee $ Date of Payment _ I cce!s Date of Payment Receipt Number _-7c"["I Q Receipt Number (Rev. 12101) mm mm tv 0 �O �U vOD �a N p "h y N N A y v pu ti / _ ° 'QjGt� A O �3�ss 00 N C. V� le ^y\ ° ' n0` A. !P N N w M 'VIrn (0 10,� L7 A m N Municipality of Anchorage pt •br Development Services Department p Building Safely 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 051-741-04 HAA# HA020427 Expiration Date: - //- 0�- 1. GENERAL INFORMATION Complete legal description Lot 21; Block 4; Northwoods Subdivision Location (site address or directions) 22753 McManus, Chugiak `Current Property owner(s)rarnlyn h rharlPs Harriann Dayphone_Ass-1515 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address KnrthRtnr Day phone .: Rolf M41top/ per, .arr R-7,, Dayphone 694-4994 11940 Business Blvd. Ste. 100 Eagle River, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. /7 2 R� a-/ it z2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System Individual On-site 9 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 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates or Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal andlor water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the dale of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certifid'ates 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 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. NameofFirm S & S Engineering, Address 17034 N. Eagle River Loon Ste. 204 Eagle Engineer's Printed Name Robert C. Cowan VO,+CONA'TO6. 4C- NAA /S �Ea�Cfr�4 S�(rNK� /%nD Nj; OA.I2{J iN)AINi�L .vA^�-E- A4.c4ln d -i i,'�' f}rTgcrftA, 5. DSD SIGNATURE Approved for L* bedrooms. Disapproved. Phone 694-2979 River,AK 99577 Date cr�// /0'2 - Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: i�t/ 4L:::�`Original Certificate Date: 9 - Inn. 12m) Sep 10 02 01:41p C. Rolf Hilton, CRB 907-694-4995 MunidpaUty of Anchorage D"dopment Services Department 8.tedD� S ' OrSim Nowrtr rWAed NauwatQ AoOr" .. ... 4700 Braes. SeaC T.O. ante 196M Asdbr M AK 995194630 1907134}7904 PROPERTY OWNER �FF THEMW11VANE OF AN ON-SUE W1DISPOSAL This agreement, datedO is made between the Municipality of Anchorage Development Service Department SD) and the property owner(s) of: LOT ai BLOCK q IdVA-T'N wooa This agreement is made for the purpose of maintaining An on-site wastewater disposal system on the subject property. The property owners agree to the folibwierr Submit to the Mtmidpality of Anchorage. on an normal basis, an inspa:tion and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engin has inspected all cUlvent and air pumps, timers, and alarms. and that any deficiencies have bean repaired and that the system is functioning as designed. (Printed Name) Foregoing f til inP-1 My P.2 (Signature) C)N6 S� r roc' `(Y1. C o.ro n (Printed Name) �quc was acimowledged before me by �D =���— on this ''iLti day of 1, 20Q L! and--- t✓ i� name) MTAL P.02 _.+ 8217 `U0411W diva '3 e8c:O1 20 60 das -�� nonpiciP2'i'y of Anchorage Dment Services ij'Department Building Safety Dlwsion ✓'- /. " Onsite Water and Wastewater Program `�L- 4700 South Bragaw St.' • ' """ ' P.O. Box 196650 `Anchorage,%AK 99519.6650 r -, www:ci.anchorage akus; ` ('(907)3434904,- CERTIFICATE OF, HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DIfVELLINGitc�l Parcel LD:QSl. 7!f/-.py l ,HAAS Expiration Date • Q .2 of = D �3 1. GENERAL INFOFkM6TION C15moletie legal d Scriptton : % a l : .(3 �'d ck Y, N U h T'H N o o 13 Location (mite address nr �rections) C hij (r A Cy4e6t Property owrier(s� ARO �'`~� d Cd4Rerc I /lq;kft Sdni. Day phone - CS, k �' !S'. I r �.Maihng address-,�,_b+ :. . • .. %•'l� /JOR,TfiSTA(' MORT4Y}G'k', o�'SS—�7fab°' Lending agency � Day phone Mailing address' Real Estate Agent Rb Lt rMr}roN PAa,Nh`tisR.E'Dayphone ,G `)H •. t. -r.S .. t pJ:iT v I•t• 1, .., :. r ..., , ,. 1 ., .: : MailingAddress.. t (,.q`�O''' �JSr'�rEu iLVID. 'Svrr4 Un!ess otherwise requested HAA will be held by DSD for pickup i R cr s 7 7 2.•NUMBER OF.BEDROOMS-.7'.y: 3.- TYPE OF WATER SUPPLY:`,' TYPE OF WASTEWATER DISPOSAL: Indnndual Well, ❑ Iridividual On-site ❑..._ . Individual Water Storage ❑ Individual Holding tank -❑ Community Class • Well .- , ❑ Community On-site. ❑ _ . Public 1Nater.System ❑ Public SewerEl The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 Arichorage 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. S AS ENGINEERING - Name of Firm Phone Address Ea9fa Rirai, Alaska 99577 . Engineer's Printed Name b !j F'.7- 5. DSD SIGNATURE Co Date �1 �3lDoL Approved for. bedrooms. _ . _ ►f! i� .,, �c;� Disapproved.... +li'��iiisice*� x Conditional approval for 4 bedrooms, with the following stipulations: At. the time of title transfer the new.property owner shall sign the attached Maintenance Agreement which 11 shall be returned to this office before an HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: (Rw. DIM) Municipality of Anchorage ., Development Services Department Building Safety Division On Site Water & Wastewater Program •' "' 4700 South Bragaw St P.O. Box 195850 Anchorage, AK 99519-6650 www.d.andiorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L a T 2-1 0" c.k k/ N o It i•/{ too o B S Parcel ID: OSI —7'11 —oY A. WELL DATA pu b%.i C Well type _ If A. B, or C provide PWSID # _ Date completed _ Sanitary seal (YIN _ Total depth R Cased tD R FROM WELL LOG Date of test Static water level ft Well production g.p.m. WATER !SAAMPL�ELTS: ColforIp coloniesl100ml. Nitrate mgA. mgA. Date of sample: B. SEPTICIHOLDING TANK DATA Wen Log Wires pM)vV protected (YIN) height (above ground) in. AT INSPECTION Other bacteria Collected by: , R 9— p.m—colonies/ Tank Typelteriat S 4 P T µ D P PC Date Installed $/ 9 i Tankatze'IJOW gal. Number ofCompartments� Cleanouts�lN) yfrS r Fopttdation cleanou&) JU Depression over tank (Ya NJ High water alarm N) Y t 3 Date of pumping I 0 y� �) Pumpers7 RS C. ABSORPTION FIELD DATA ; Date installed /i /41 Soil rating g.p.d.lfl2 or fl2/bdrm) a C System type Length fL Width 10 n Gravel below pipe D . 1 S it. Total depth S fL Eff. absorption area 3 60 fe Monitoring tubeyE-f Depression over field NO Date of adequacy test $ ) a r A i Results OwFsiq Po --(j For _Y__ bedrooms Fluid depth in absorption field before test MY_ in. Water added 6rrrr gal. New depth DRQ Elapsed Time: N/A min. Final fluid depth W4- in. Absorption rate >= G G O g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N4) , -t k row ✓ If yes, give date " D. LIFT STATION Date Installed "Pump on"level at S6 in. Datum roP u< +"Ary A061 -0- E. SEPARATION DISTANCES Size in gallons a`0 6 "Pump off level at Y- 0) in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot -� Absorption field on lot Public sewer main Sewer/septlo Manhole/Access(&N) Y#J High water alarm level at 9 in. Meets alarm b drauit requirements? YleJ On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation r Property line j tr. 1 Absorption field a d41 Water main / D Water service line /0 f Surface water ©0 f Wells on adjacent lots AJ14 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line it Building foundatkm r Water main /0 4 Water Service line /D �" Surface water / v o Driveway. parkktgNehide storage Curtain drain N+Nk K-JOwW Wells on adjacent lots #114 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in ,. conformance with MOA HAAid fi as in effect on this date. Tia ?� Engineer's Printed Name d ZnA e' CaW.4tjF�OSSAW cov'srr CE•8801 Data a V 0 2. f �`�, •? HAA Fee $ 375- oa Date of Payment 1/2 7 /a x Receipt Number b •x (Rev. 12x01) Waiver Fee $ Date of Payment Receipt Number c. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# - 051-741-04 HAA# U Q26nLA 1 1. GENERAL INFORMATION Completelegaldescription Lot 21, Block 4, Northwoods S/D Location (site address or directions) •i.t .-";,Mike Thomas NHN McManus Drive Day phone .......................... .' ,.Lending agency Day phone .,Mailing address Agent' " Day phone JJ _ Address. " Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. . TYPE OF WATER SUPPLY: Individual well Community well Public water XXX 694-2202 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-M kw.1/91) Front MOAI21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and 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 b S ENGINEERING Phone 17034 Eagle River LOOP Road NO. 204 Address Eagle River, Alaska 99577 Engineer's signature az_z 11—Ir 44i :nDate g 6. DHH6 SIGNATURE V Approved for E00S bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 111Th, Date? - /-92 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 orderto 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. M= Mw. usil Bart MOA m .;tCEIVtL Municipality of Anchorage U6 1 1999 DEPARTMENT OF HEALTH & HUMAN SERVICE Environmental Services Division WNICIPAUTY Of 825 L Street, Room 502 - Anchorage, Alaska 99501 KWNggg VWCEs Dtvlsl Health Authority Approval Checklist Legal Description: L0T' i.l 13>•6c•c y Nu.¢;Nwco4 J Parceil.D.: OS'/-7i1_o`% A. WELL DATA l0Ul3Lr e Well type If A. B, or C, attach ADEC letter. ADEC water system num Log present (Y/N) Date completed Total depth Cased to ng height (above ground) Sanitary seal (YM) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. 9•P•m• WATER SAMPL SULTS: Coliform Nitrate Other bacteria D,0 of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed � / A 101 of Tank size / 3 J O Number of Compartments Cleanouts 49N) Y t J Foundation cleanout &N) Y E- S Depression (Yv r '� High water alarm (YO k c Date ofPumping ^y �� - ^'t "� Pumper C. ABSORPTION FIELD DATA., Date Installed / �" 9 Soil mting dJ1t' r tt°lbdnn) a 0 System type I. A. S. F. � ... • � s. 'To rqs Length 3 6 Wldth 10 Gravel thickness below pipe o. J r Total depth a.r,..., 1 Effective absorption area 36 0 F, Monitoring Tube present &N) Yt ss Depression over field ?(�Y(O fu Date of adequacy test 4A Results (Pass/Fail) For / bedrooms Fluid depth in absorption field before test (in.); Immediately Fluid depth 72-026 (Rev. 3196)- (ins) Minutes later. (Y/N) (in.): Absorption rate = a.p.d. If yes, give date D. LIFT STATION Data installed f I q Size in gallons I✓ 1,4 Manhole/Amass &N) W, S "Pump on" level ar y , "Pump ofP level at' ,f'f . J_ High water alarm level at' At H• S " .Datum T aP ° nA,v Nom! Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: f V AL. r c w.f-r t.f Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /simbeital0oe line _ On adjacent lots _ ie latent Ift Public sewer manhole/deanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation S Property line ) g S ' Absorption field ;I 0 4 r � Water main/service line } Surface water/drainage BOO t Wells on adjacent lots aO0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ) l Building foundation 9 Water main/service line 10 4 Surface water ) o O r+ Driveway, parking/vehicle storage area Curtain drain N cr 4 k M r ww Wells on adjacent lots F. ENGINEER'S CERTIFICATION I cerft that I have determined/thru field inspecdons and review of Municipal records rmjlVlip ms are in conlomrance withAL.. guidelines irr effect on this date. Signature A• Engineer's Name /16054A7-- C. COwRN Y� 3 / / q q \ toewf C. COWAN � Date, ti CE -8801 HAA Fee 6 3Po ' Waiver Fee $ Date of Payment o� �'�r� —/�� Date of Payment Receipt Number ��"`�s Op / �� 9) Receipt Number 72-026 (Rev. 3196)'