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Home My WebLink AboutWOODBOURNE BLK 1 LT 13Woodburne Block 1 Lot 13 #015-351-19 Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT I"Iermit Number: OSP181342 ling: N Single Family (SF) F1 Duplex (D) IMNIMV Page of PID Number: 015-351-19 Multiple (SF and/or D) Project: M New Upgrade Deep Trench ❑ Shallow Trench R Bed R Mound Phone INumber of Bedrooms Soil Rating Total depth from original grade 5 0.4 GPDlSF 13 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision WOODBOURNE Block Lot 1 13 3 Ft, 10 Ft. Township Range Section Fill added above original grade Gravel length V, VARIES 0.85 – 1.55 Ft. 94 Ft. r v width t Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 3 Ft. Ft. To Septic Absorption Lift Station Holding, Sewer Totalb n area absorption a tio Number of trenches Dist. between trenches From Tank Field Tank Line 1880 Fe 1 Ft. Well 100'+ 100'+ 200'+ NA NA TANK lZ Septic 0 S.T.E.P. El Holding 171 Other Manufacturer Capacity Surface Water 100'+ 100'+ 100'+] NA ANCHORAGE TANK 1 2000 Gal. Material Number of compartments Lot Line 5'+ 10'+ 51+ � NA STEEL 2 — NA — Foundation 10'+ 10'+ 10'+ NASTATION Manufacturer Capacity Curtain Drain NA *50' NA NA Anchorage Tank 2000 Gal. Remarks Diverter valve in STEP to original and on level at Pump off level at High water alarm - at — new fields. Septic tank decommissioned per rp 44 in, 42 in. 48 in. LV4iV. Installer Northern Excavation Inspector First Water Consulting Services Inspection M dates: 1 10/2/18 2" 10/2/18 3'd 10/4/18 4" 10/5/18 Conditional Approval: Approve_i A t, Report-9-1-12.doc r-U111P MaKe ana moaej Franklin 2445040117 — 1/2HP Electrical Inspections performed by MOM IPE MATERIAL House totank 3034 Tank todrainfield 3034 Drainfield _3034 CO/MT 3034 CH MARK (Assumed elevation) 100 ft Location and description Date Date 10-11^1 Engineer's Stamp c 0, % 4?H ............ I MICHAEL N. ANDERSON1 . N, Permit No. O.S.P.1.81.342.... Page: �.... of .... Municipatity of Anchorage 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 Legal Description: WOODBOURNE BLOCK 1, LOT 13 PID No.: 015-351-19 .0000 2J250,74 MH 100195 r MT MT /- FINAL GRADE GRADE 101pz4 0.0 0RG/0L FILTER FABRIC 15 — 89 98.89 Gm/sm 2000 GALLON SEWR ROCK STEEL STEP 1.02 \0&9 DRY SEPTIC SEC'nON80.89 Jami va, —T44 qv'le ,`"""ry MUNICIPALITY OF ANCHORAGE ill C n On-Site Water&Wastewater Program PO Box 196650 4700 Elmore Road ` Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �y http:/lwww.muni.org/onsite `- �s / 1)(•luirtmcnt HhCH pH HVE On-Site Wastewater Disposal System Permit Permit Number: OSP181342 Effective Date: 9/27/2018 Work Type: Septic Upgrade Expiration Date: 9/27/2019 Tax Code Number: 01535119000 Site Legal Address: WOODBOURNE BLK 1 LT 13 G:2741 Site Mailing Address: 8200 GINAMI CIR, Anchorage Owner: ALA ANCHORAGE LLC Lot Size in Sq Ft: 106339 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 5 This permit is for the construction of: 0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 500 gallon STEP tank shall be a minimum of 5 ft from any deck or stair support. Received By: � Date: Issued By: Date: ' .%' Qt e MUNICIPALITY OF ANCHORAGE Community Development Department O Phone: 907-343-7904 p Develo ment Services Division � Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-351-19 Property owner(s) ALA ANCHORAGE LLC Day phone 907-575-8872 Mailing address 814 W 2ND AVE., ANCHORAGE, AK 99501 Site address 8200 GINAMI CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) WOODBOURNE B1 , L13 Legal description (Township, Range & Section) Lot Size 106,339 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (E)all that apply) Absorption Field Initial (1 Single Family (SF) (w/wo ADU) Septic Tank L?f Upgrade rir Duplex (D) C Holding Tank n Renewal I IMultiple Dwellings ❑ Privy n (SF and/or D) Private Well n Water Storage n THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Si r• ► property owner or authorized agent) Permit/Rush Fees: 50 Waiver Fees: Date of Payment: 9/25714 Date of Payment: Receipt Number: It.2.309.51 Receipt Number: Permit No. O3Pigl3cl2 Waiver No. Permit App_9-1-12.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 September 24,2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Septic Upgrade Permit Legal: WOODBOURNE BLOCK 1, LOT 13 To whom it may concern: This is a request for a septic permit on the above referenced lot the old system has failed. Test holes were excavated and the results are attached for your review. It is proposed that a pressurized deep trench be installed with an effective depth of 10 feet. No water was measured in the test hole during or after the excavation. The tank will also be replaced at the same time and a diverter to the original field installed. The slope at the proposed trench is location is 10-15%, but then flattens out with no cut banks within 50 feet. The lot and area is served by private water and this system will not impact any of the neighboring properties due to the lot layout. Please call me if you have any questions. Sincerely, /41171— Michael N. Anderson, P.E. 4661 Natrona Anchorage, AK 99516 Phone 727-8864 __ 0 ORA/lyq q2 4 ,W 288 56 E?VT NO WELLS W/IN 100' OF PROPOSED SYSTEM. GIN' 1,— M f.. ; DEGOIJMISSION D0SRNG t C. N. ST. PFRCOOEdt N b ' INSTALL NEW EXST 1500-GAL / - ST. 5' FROM DOSTINC FIELD &10' FROM FOUNDATION W/08L, COs kDIVER / r) /DOSTING i FIELD O x 8 DECK 470" O O �� Op 4:. FROM GRADE j Z i\ INST * m1) MT 5�lV- . 4, ykk e nil /j/Cry Ab �„�� ' 1 e j.,..„...*_ le 10.'1 I / J � I 1 0'8 ,g,�YA NELL Y` / u 1112 �, �" 1 1 / MT , 35' — ., i i , P 10' UTILITY EASEM N89'55'15"E 398.65' Septic Design Prepared for 40:1111:`\\ ALAANCHORAGE LLC �� 9F ` <q�1 WOODBOURNE BLOCK 1 , LOT 13 oj`� �� y ,A 8200 Ginami Circle, Anchorage, Alaska / * 49TH * Michael N. Anderson, P.E. DATE: 9/24/2018 / Ili L N. ANDERSON j No. CE 44 4601 Natrone Ave. DRAWN: First Water Cons. Srv. 1 7c 7 ,, Anchorage, Alaska 99516 N • VII 9 ssiovw" i (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 50' \�`__f DESIGN CRITERIA: 5 BDRM X 150 = 750 GPD ❑UND OVER S❑ILS = 750/0.4 = 1875 SF 10 _ RADE 1875 SF/ (2 X 10' ED) = 94' (1) TRENCH 11, FILTER FABRIC 13.0' DEEP1,25.0 PIPE -3.0 •=" 10.0' EFFECTIVE 2.0' WIDE 10' 94' LONG SEWER ROCK INSULATE TANK IF LESS THAN 4' OF COVER, -13'0 INSULATE TRENCH IF LESS THAN 3' OF COVER. 2.0 PRESSURIZED HOLE SPACING SEPTIC FIELD SECTION 30 HOLES-USE 3/16TH HOLE AT 3.1' SPACING PER HOLE M in DECOMMISSION EXISTING I\ Z S.T. PER CODE & C\1 INSTALL NEW 1500-GAL W S.T. 5' FROM EXISTING 00 1, ; ro FIELD & 10' FROM Q FOUNDATION WI DBL. o W COs & DIVERTER. / n EXISTING � / CVM /FIELD 0 X/ • • / / O o 4� DECK <30' O O �`� *co FROM GRADE 0 \ INSTALL a Z MT , SppSTEP AALDIV.� �/d. ,t•/.. .4„, 15 2s A J4,` " Ni 4 , GO ff,,,t ; 17' 40/ 1 It /4s ® A/�9 10_15% _..:_g:__lw.___c-..Of 1 cqI 0'6 61 Pyex\PPy oWELL 1 TH2 r, °� 10 1576 Pi 5-10 MT g 35' 44. /; Septic Design Prepared for ��_N ALA ANCHORAGE LLC �,'�� OF ALA‘1 • tS' `� WOODBOURNE BLOCK 1 , LOT 13 %\ Yy � 8200 Ginami Circle, Anchorage, Alaska / * 49TH * 7.0 Michael N. Anderson, P.E. DATE: 9/24/2018 ` MICHAEL N. ANDERSON j No. CE 9469 4601 Natrone Ave. 1 04, DRAWN: First Water Cons. Srv. 4,/,v,„„,.Anchorage, Alaska 995169Ip �, (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 40' � -`__f QF 4, ?.,, Municipality of Anchorage DillEER�s 4 . Development Services Department y�•�• ( " '� On-Site Water and Wastewater Section x 9 T C ,�, 4700 Elmore St. '> P.O. Box 196650 Anchorage,AK 99519-6650 �a ��s-,= www.munl.org/onsite / �s (907)343 7904 rl v•. MICHAEL N. ANDERSON•;4� ; •^�•• CE• 946 ��. Soils Log - Percolation Test �tlt"�FO‘kiP'ti.•••.' ,,P�• `��" � � Performed For: '/� � A nrtL�)l�'�G.-E L�(' Date Performed: Legal Description: t a D DG0LAQivg 1311 L 13 Township. Range, Section: 17"/ l / Slope Site Plan ,/ r7 Depth (Feet) 1- 2- �� , 0 L- SEE 144 A✓ 3- 4- 5- &Al ISW\ 6- 7- 8- WAS GROUND WATER 9 i-r ENCOUNTERED? NO 10- DeCi Nish-- L f/1! IF YES,AT WHAT DEPTH? L 1 C I Depth to Water After 0 I P • 11- -to Monitoring? D�� E r 12- Date' `,/2-1/& 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop `� 15- f i i/,g 3e /so/rel G if D 11/lo 16- (P " ;3�G 17- I fi/i(go 18- 19- - RO i-I 20- PERCOLATION RATE £/0 (minutes/inch) PERC HOLE DIAMETER 0 if TEST RUN BETWEEN Y FT AND 5 FT COMMENTS EVE-SD 41e--:En P0/012 m '7z .i- 4LL l'E4O/VLS —71, E Vim PERFORMED BY: I /u/'v Y/ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72<--//'C R�eNA-No, Municipality of Anchorage �"`•-(ENctNuR:s SEAL).. Development Services Department ':'(�'•••• ��! On-Site Water and Wastewater Section `x ;49TH • •1. i, •i f f 4700 Elmore St. ;%"r �� --4i P.O. Box 196650 Anchorage,AK 99519-6650 / i, F. ..i.-- www.muni.orq/onsite / r (907)343-7904I • to -,;:,„.... MICHAEL N. ANDE SCN .•`, lr s... CE 94 .' i Soils Log - Percolation Test 10‘,,‘P.. Q k,(D '••• . '\,,,,." 1�,PR�t -6°- �l .,...,_ Performed For Atli .q n,4G��(,� LLL_ Date Performed: -6°- Legal Description: 1,4./0 00 101g2 Ve 1311 L 1 3 Township. Range. Section: Slope Site Plan VI 2-- Depth Depth (Feet) 1- Sr- PO A) X6/0 L2- 3- 4- 5- 6- j ,14 7- 8- WAS GROUND WATER 9- ENCOUNTERED? NO S 10- IF YES,AT WHAT DEPTH? L Depth to Water After D P 11- Monitoring? /_QY E - 12- Date: '/21)1`b 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- 7/2///€7 0 ex/n (a 2 a 16- ' ' C'''' / 4S/,, 17- ,/ 6' '' / / s//4 18- 19- ---•` 130'4 • 20- PERCOLATION RATE l (minutes/inch) PERC HOLE DIAMETER �}�� pTEST RUN BETWEEN FT AND 5- FT COMMENTS PPE-�l)4 &, f'/'IOvt "71) 7LS7 4,0i v -f TD ''1fE %fi&'17' e /, PERFORMED BY: I f1�ki— CERTIFY THAT THIS TES WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9 23 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE • +.rrl DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \ j 825 L Street - Anchorage, Alaska 99501 Telephone 254.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION NAME REPORT PHONE NEW rf �i IC�11P AI�iA )[4 MAILING ADDRESS ❑UPGRADE LEGAL DESCRIPTION I vd LOCATION NO. OF BEDROOMS DY F-2 DISTANCE TO: Well /OO Absorption ar9� Manulxturer Dwellmq / p 1 T I bro _ hf al Material J No. of compartments 11 Liq, ca c • In a;,llons Inside length IF HOMEMADE: g Width Liquid depth dOZ DISTANCE TO: We11 Dwelling PERMIT NO. S=H Manufacturer Material Liquid capacity in gallons W = W 2 DISTANCE TO: Well '%' Foundation/O/ Nearest loyly+ PERMIT N 66 76 No. of li 'y Len h f eacb,r ! sy'7 e� I � Total lent f ,4 97ys Trench rgyry `inches �?us ix Distancayy n lines � F- To of the to finish grade __,�J Material beneath file f p �� Total lllept. g�pt,on area W Length Width . Depth PERMITI NO.S V n n W Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well 8u1 ding foundation Nearest lot line _1 Class Depth Driller Distance to lot Ie PERMIT ND. W i DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER OD W 0, LL PIPE MATERIALS SOIL TEST RATING INSTAL ER s REMARKS Q I LEGAL / zR .v APPH D DATE slc_lell� P 72-013 (Rev. 3/78) Fl r-a'= H r-i F., F=t in E DEPARTMENT p5• HEALTH R!d_o Etd':+IF:OFJt•1ENTRL!"aiTECTIOtJ '� • 825 STREET, ANCK'RAGE, AF;. 9�. _ gl rn'n a •ea 264-4720 1 . C'r'1—E I TE _ EI•_IEF: F•EF:t•i I T PERFIIT NO. ( 82067) �-Q% D APPLICANT BARBARA GRRGhJEP.. SF-F-- BOX 75-R J�� 8 'iCATIOhJ C4y_1 LEGAL L13 61 W7O0 AAA DBUF,'NE LOT SIZE 999999 SQUARE FEET d TYPE OF SOIL AB_,ORPTION SYSTEM IS: TRENCH ;cid i'lA`{Ih1Ut'1 NUMBER OF BEDROOMS_ c c -6;L SOIL RATIN, (_O FTrBF:)= 250 p� THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C�EF"TH= 11 L_EZ"i TH— y _; ,�F:H•ti•EL_ C�EF'TH= r THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DPAINFIELD. THE DEPTH OF R TRENCH OF: PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E)•:CA'•iATION (IN FEET). THERE IS NO SET WIDTH FOF: TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETIJEE!J THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F1EID L-1 I F:EC. _.EFJ - I Cr4K : _rf E I EE= ytZ C-10 rFjLLCor4 PERMIT AF'F'LICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS F'ROFEP,T4' AND THE MU'IEER OF RESIDENCES THAT THE IJELL WILL SERVE. -- T1-10 •` I f4EF'Er'T I Cit -JC Ft RE F1 t_t I F:EC• BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AFF'F:0';+AL BY THIS DEPARTMENT 14ILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY OM -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR: A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE T4FE OF PUBLIC WELL, MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER: LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F E:F=:t•1 I T E: ;F� I F<:E`= C•Ei:�EZIME E:F=: ZZs 1r.0;` I CERTIFY THAT 1: I AM FAMILIAR !•WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I !JILL INSTALL THE SYSTEM IM ACCORDANCE WITH THE CODES. =: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE t•JORE THAN 5 BEDROOMS. SIGNED: APPLICANT BARBARA GRRDNEF. ,n ISSUED EY------- r - -- _ RTE-- ' 0 �✓ � CA-- ---- ----- V4. 0 ., r1 Ll r4 I C I Pt�L I TY OP F=1r40Ht7R1=40E DEPARTMENT ( 'HEALTH AND ENVIRONMENTAL. JTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 I.IELL Fl r4 E> CD v4 I TE '>ELJEFT F}ERt7I T PERMIT NO. ( 8103£5 ) APPLICANT BARBRA GARDNER SRR BOX 75A ANCH. ctqs o"1 349-1134 LOCATION GINAMI LEGAL LOT 13 BLK1 WOODBURNE SUB LOT SIZE 87120 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING CSQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LIEF='TH= 11 LEt�IGTH= irEHkrEL pEp•TH= 7 THE LENGTH DIMENSION IS THE LEFJG H <IN`FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REQU I REL7 ESEF=>T I C TRr.IFC *_12!E:= GRL_LOrJS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO <,2> fRF;Ra REQIJ I FZEC� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ONS15ITEfSEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO°')E+0 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. 4 \d MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER. LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. F`ERM I T EXF=' I RES} FCrECEMF3ER 31r :I,so01 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. SIGNI I SSUI V4. 0 Performed for Legal Description: This form reports: GR"'i-ER ANCHORAGE AREA -15M-0— C---� Depanment of Enrironmenul Quality 3330 "C• Street Z Anchorage, Alaska P9503 LOG — PEROLATION TEST Date Performed SLLY Soils log u Percolation ter, Depth Wit] -µ� 1 X/rel ;A7 f jR' SO Feet moil$ Dr.N No1We11 IY)- _ Bra,.4, �,Fq r1� ML) w/ror�? I i• i i i I 1 I 2— I I I I I I 1 I I I I I I I I G.r I Q( r FZ rhe�rr k (�vuQ I I t I I I ,-4�.— 6_ l Gd7 � • mk> I 1 i i i i I I y �Lt. rO �,r C.lc�iL.s �w l f(GL✓ DP.rtG�Y ilw Aak g_ / . F -AZ 15,Q°'�•:�4. . .....i. ..I .................... PZCL37*Wt sEr j 20 — Was groundwater encountered? Reading Date �f Gross Time Pmlatlon"%te`� 30 Proposed installation: Seepage Pit Depth of Inlet 41 COMMENTS: AL NOM : G Ovo f-m%jla .tr l�►wr=.��u�� aN P . If yes, at what depth? Net Time 1 Death to water I Net Drop �Jlcwlrant 2.40 ':k7 (,?Q �, I Drain Field X xo bottom of it or trend 1S-/ o4. P r� (00% M -W DRILLING, Inc. �, .O. Box 4.1224 • 1310C International Airpc,,. Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Bob Groeneweg Location (address of: Township, Range, Section, if known; or distance main road of Welt Do_ mecri c Lot 13 Block 1 Woodbournp Subdivision Size of casing " epth of Hole 101 Leet Cased to 7 OO 7 feet Static water level 55 ft. (above) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ). Describe screen or perforation N/A Well pumping test atm S gallons per (116 (minute) for 1 hours with 1 or)% Et, of drawdown from static level. Date of completion SPnremhPr 17 r 19 1 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO_2 Casing —2TO_5 Or an c f411 --5—TO IR Sand gravpl IS TO 19 Sand —15—To 98 Si 1 t•y r1 ay –3-$—TO_62_ Water grairpl 7 GPM _fi.Z_TO—RI Silty hard an MUNICIPALITY OF ANCHORAGE i —81 --TO 94 171 all ENVI., '. J! .I .. A . ' .c, : TO 101 --SaAdu_STnt6' "aYet�uyr•�nj�t 13CI 2 195 TO -- RECEIVED TO TO TO TO TO NWWA Qertified Contractor Cert1ic(dc No•.:144 & 87? I —CUSTOMER ..77... ..��a.S.—�,j:�T—T �.y.�.....=w_c.�.,v�.+.��•.�: .1••: rte- .. M -W DRILLING, Ina P.O. Box 4.1224 • 1310C International Airport Road (907) 2744611 ANCHORAGE, ALASKA 99509 DRILLING LOG LAS sss$ Well Owner Bob Groenewep /9Rr t Aim Vie. o/ne.- Use of Well T12• i Location (address of: Township, Range, Section, if known; or distance main road 7 13 ai].00i: 11tJn!6•ri\Y^(.' A•.i•-7 i_•r:_a•i nn Size of casing--GL'--Depth of Hole, feet Cased to 1 L feet Static water level ft. '(above) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated (' ). , Describe screen or perforation %* I A Well pumping test at 7 S gallons per (Boor) (minute) for ~ours with + f)"` ft. of drawdown from static level .2 Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness . TO % O C-a+n( Q.:% TO 3 Om- nni r: l 3_,Z—TO3.;—_Lb / 6,2:!::�_TO :- 33 '3__TO—,G� �_ ATO io 0 79,:_�TO s.+ 9� 9aLTO. I->-- Z9 _)TO TO TO TO TO / conA O 2—STATES �_ Silt.+�nl aV _'[•later o�e:.nl 7 rr/.r' C r •Ci l t� 1,-rA ne-, 17 n �. Z 74 � W NVVWA CerHficd Contractor Q Nos. 973 t7 O 2—STATES Tom' 104, 700 SF m 104,176 Sf / ' fN O I o.Olo'' 9e \ O ►� - 4y --- � /oc, as :f c ISO .I_ F — mow-- �_�.. -•� �. _ fir✓y fTV \ . wG�ae�-••..j•-Y1-...r^�j :- •-aa..."•�.. •t�...�.��+amu.. ;�ti•.��y`Y��'�'l�yp: .� 10. .' 5�j�f p Ali, a N BG•L?'70"E 1-45. r50' GINAAv1/ �6o.t•�6• c.. 1 E4, f, / t • LCT hom _Soma.-.i.dCAL._ p�lU - •� f G 6f{ }31iN'(]' GrC(� _ '73•f A'Dl/G}}lILT. - (•oi fnd. 3$`BC % S' 6t/iw• purr/ iMd �V/�tL //✓ 'c0 -n' 6GO.oe•.c�. o�..s..l in LChaj_ v -T e A Itti C) (Y) CD (3) r- r - (Y) M 'IT Nt C`7 co N O Q Q (n U` U) sL 0 0 m co U 4- m 4 0 0 O r� LO cY) i 0 m U (B rn m Y J Q) r � Ycu L- 0 m L U W Z ry O U m � 0 0 z O CD o N 00 n U U U U m � 70 ca m J CO W Q Q 06 U) W Q W 0 U) U W D 2 w 0 (V C O a� Q O Q c O U U O O (U LO 0 (L) O (z ca O N U) U N C 0 M 'L N cu 0 N C (u E O An, N N O LO �i cu Q () cu U (ll U (B C M I 0 0 0 n. (A m a fu O 3 _a. 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Date of flow test for COSA 5/3/2024 Static water level at beginning of test 18 ft. Well production at time of test 2.1+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.27 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/23/24 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA* Date of pumping 5/1/24 *FLOAT LEVELS Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station 6 years Lift station material STEEL Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/02/2018 ALL standpipes present per record drawing Total measured depth from existing grade 18.3 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 5/1/24 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 5/3/2024 Results Pass Fluid depth prior to test 13 in Water added 1000 gal New fluid depth 23 in Elapsed time 1440 min Final fluid depth 8 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 120 in (MOA 10’ ED) Effective depth used 8 in (Final Fluid Depth) Effective depth (ED) remaining 112 in Comments/Deficiencies: Approximate total measured depth from existing grade. ED per visual observations, measurements & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/7/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 5/7/24 MUNICIPALITY OF ANCHORAGE r +ftw Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner Street Address��Cj Septic Tank: *Sludge levelinches *Pumping: required es no •Pumesping completed no Lift station. t` 2y 20�� -Pump basket cleaned es no •E -Effluent filter cleaned a no AP -Control floats cleaned yes no *Proper float settings confirmed e no -Operation satisfactory & no Alarm System: -Dedicated electrical alarm circuit aesno -Audible and visual alarm inside dwelling es no -Alarm system operation satisf cto not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations es o •Weep hole functional es no -Manhole, lid: Functional Es no Insulated es no Properly Secured e7no. Other -All manufacturer required inspections and maintenance completed @ no Comments: Qualified Maintenance Provider: Technician 1-0. C- r- Y W. l�e �� /1" Date of maintenance vir `1 1 Company Sp j( Signature Date & Parcel I.D. 015 -351 - E Municipality of Anchorage G On-Site Water and Wastewater Program (907) 343-7904 S A F E T Y _.7 CERTIFICATE OF ON-SITE SYSTEms APPROVAL Expiration Date: / 8 Id Complete legal description WOODBOURNE BLOCK 1, LOT 13 Location (site address) 8200 GINAMI CIRCLE, ANCHORAGE, AK 99516 Current Property owner(s) ALA ANCHORAGE LLC — Day phone Mailing address Real Estate Agent 814 W 2 ND AVENUE, ANCHORAGE, AK 99501 2. TYPE OF DWELLING: [Z Single Family (w/wo ADU) F-1 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well % - 0 Individual z Individual Water Storage F71 Holding Tank F71 Community Class Well El Community 0 Public Water System El Public Sewer F-71 WaiverNariance request for: Distance: Received by: Date: 10bolIg COSA to be released to the-e-ri`g�ir, unless otherwise requested by the engineer, I COSA Fee $_ v� (a 1? .0 Date of Payment 0 /Q Receipt Number COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # As certified by my sea[ affixed hereto and on of the validation date shown below. | verify that my inveoUoation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this app|iootion, shows that the on-site water supply and/or wastewater disposal system is (are) aafe, functional and adequate for the number ofbedrooms and type of structure indicated herein. | further verify that based on the information obtained from the Municipality ofAnchorage files and from my investigation and inopeotion, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations ineffect atthe time ofinstallation. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/5/2018 DSD SIGNATURE System #1Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the'folk}Vvngstipulations: 11 Y U11-1 Amn Original Certificate Date The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approva|(COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered inthe State ofAlaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. {}[)8AChecki5t X Nitrate Advisory Septic 8Vst8OO /\dViSO[y �_ /\[seOic/\dViso[y Well Flow Advisory {]the[ COSAo��-12.doc If more than iseptic system is on the lot: CDSACheck|kst #o__ Structure served by this system Legal Description: WOODBOURNE BLOCK 1, LOT 13 Parcel ID: 015-351-19 VVeUtype Private If A, B`urCprovide PVVS|D# Date completed 18/178y01 Sanitary seal (Y7N)y Total depth _i{M_ft, Cased to1{XL7_ft. FROM WELL LOG Date of test Static water level Well production 711981 91 WATER SAMPLE RESULTS: Coliform _NEG colonies/100 mL Nitrate _3.88mg/L Arsenic: _ ND ug/L Date of sample: 9/1712018 Tank Type/Material SEPTIC/ STEEL I 5-Tr_F Tank size _ 2000 gal. Number ofCompartments 2 Foundation cleanout (YYN)y Depression over tank (YYN)@ Date oypumping Pumper Wires properly protected (Y/N)y Casing height (above ground) _24+in. AT INSPECTION 9/1212018 21 ft. g.pm, Collected by: First Water Consulting Date installed '1010412018 Qeonouta(YYN)\,___ High water alarm (Y/N) Date Soil rating m*2 /bxnm)0.4_ System type DEEP TRENCH Length 94 fL Width - 3 tL Gravel below pipe 1{_ft. Total depth 13_ft� Eff.absorption area 1880 ft2Monitoring tube ly Depression over field y0 Date ofadequacy test Reau|hs(Peae/Rai|)For bedrooms Fluid depth inabsorption field before test in. VVobarodded_____ga\. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >=g.p.d. Any rejuvenation treatment (past 12moj(YYN&type) |fyes, give date_ Date installed Size ingallons _20KK}_ Manhole/Access (YYN)y "Pump on" level ed_44in. "Pump off' level ot_42in. High water alarm level cd_48_in. Datum Cycles testod2Meets alarm & circuit requirements? y Septic tank/lift station onlot Absorption field onlot 1001+ Public sewer main Sewer /septic service line. Animal containment areas SEPTIC/HOLDING TANK OWLOT TO: Dnadjacent lots ' Onadjacent lots Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 'Building foundation Property line _5+ Absorption field Water main Water service line Surface water Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line _i8,+Building foundation _1ly± Water main Water Service line _jU'+Surface water Driveway, parking/vehicle storage _1{yt_____ Curtaindran Wells onadjacent lots _j8O,+___ JIM011 910411111M G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above ayob*nns are /n con/bnnannawith MOA C[)GAguidelines /neffect onthis date. Engineer's Printed Name -MICHAEL N. ANDERSON, PE Date 10/05120118 COSA canary sheet-2-645doc Municipality of Anchorage • 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. 015-351-19 COSA #_ 7. GENERAL INFORMATION Expiration Date: Complete legal description Lot 13 Bk 1 Woodboume Location (site address) 8200 Ginami Circle. Anchorage AK 99516 Current Property owner(s) Alan Maki Day phone 344-6463 Mailing address Lending agency 8200 Ginami Circle Anchorage AK 99516 Day phone Mailing address Real Estate Agent Claire Ramsey mamic Day phone 261-7600 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Welt ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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 Onsite 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 seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102954 Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test. I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines &. 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. •��aa The operational life of all wells and septic systema depend on the local soil condition, ground water •••••`t OF aaa4 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�0 there ano hidden defects or encroachments. PES can therefore not provide any warranty for future '^ i are performance nor give any estimate of how long the system will continue to meet the operational 0 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed Ack Steven R. nnone m above. Any reliance upon or use of this report by any other person or party is not authorized nor will it a��n, CE 8149 confer any legal right whatsoever. 5. DSD SIGNATURE �aaaaa••• ✓ Approved for S� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory PROGRAM Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: � (r""� . / Original Certificate Date: 2 (Rw. 11A5 �l/77� Municipality of Anchorage ' Development Services Department Building Safety Division On-Ske Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsits (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 13 Block 1 Wood mma Parcel ID: 015351.19 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 9N7H981 Sanitary seal (YM) T Total depth 181 fL Cased to 100.7 fL FROM WELL LOG Date of test 911711981 Static water level 55 ft Well production 18 g.p.m. WATER SAMPLE RESULTS: Coliform _L_cokmies/100 mL Nitrate '14 mg/L Arsenic: A& mgn bate of sample: 41M B. SEPTICIHOLDING TANK DATA Tank Type/Material Greer Steel Tank sae _ISDO gal. Number of Compartments j Well Log (Y/N) Y Wires properly protected (YIN) T Casing height (above ground) 12+ in. AT INSPECTION 4 11 312 0 0 8 20 ft. 3.1 g.p.m. Other bacteria __L oolonies/100 mL Collected by: Laura Pannone Date installed O15J1982 Cieanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) WA Date of Pumping AMMM6 Pumper A+ Home Services C. ABSORPTION FIELD DATA Data installed 8!5!1982 Soil rating (g.p.d./ft2 or fe/bdrm) 250 System type Deep Trench Length 34181 ft Width _ 3 ft. Gravel below pipe 7 ft. Total depth 1U ft. Eff. absorption area Mf Monitoring tube Y Depression over ffeid 1N Date of adequacy test 411312009 Results (Pass/Fail) Pass For I bedrooms Fluid depth In absorption field before test IE in. Water addedZU gal. New depthMI in. Elapsed Time: 1412 min. Final fluid depth YM in. Absorption rate >= 750 g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed `Pump on, level at_ in. Datum /v S" `Pump E. SEPARATION DISTANCES / I t SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot 100+ Absorption field on lot 100+ Public sewer main 100+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (YIN) High water alarm level at In• Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent kits 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manureianimal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation It Property line 10+ Absorption field S Water main 100+ Water service Ilne 25+ Surface water 100+ Wells on adjacent kris 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ r % Water main 100+ Water Service line 25+ Surface water 100+ Driveway. psftVh ehida ". 8, 25+ Curtain drein None Observed Wells on adjacent lots 10+ F. COMMENTS ' _ ___.. .__ .. ..__�______..._�. �u.��... r.1.w MIA. N.w.�lha ba}-✓ G. ENGINEER'S CERTIFICATION 1 cet* that 1 have determined through field inspectlons and raview of Municipal records that the above systems ere In �,� conformance wiM MOA COSA guldellnes in effect on this date. r �1" $te Ve; R.7cr( Engineer's Printed Name Steven R. Pannone P.E• +� �^m- ce 8149 Ieee` 'W <e 7 f Date eeoo^�� r- Kt COSA Fee S T 3 Date of Payment �J--2 �- 6 Receipt Number e (Rev. 11105) Waiver Fee S Date of Payment Receipt Number S VT VLI KC e - r 00000vppp VA OA e - r - Municipality of Anchorage Development Services Department �' ° " i` Building Safety Division - �� Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-351-19 HAA# HA 0/0039 1. GENERAL INFORMATION Expiration Date: 'i /2 — 0/ Complete legal description WOODBOURNE SUBDIVISION; LOT 13, BLOCK 1. Community Class Well ❑ Public Water System Location (site address or directions) 8200 GINAMI CIRCLE ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KATHLEEN RICHARDS Day phone 257-0110 c/o MIKE MESSICK w/ REMAX Day phone MIKE MESSICK w/ REMAX OF ANCHORAGE Day phone 257-0110 2600 CORDOVA STREET ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well M Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site M 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 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 j 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.) Certificates are valid for one year for properties served by Class A wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in 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 Author tyApproval 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 myinvestigalion 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 ALASKA •WATER do WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date Engineers Comments: In conducting this evaluation, AVWW, ina attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results dosaftd the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily Identifiable tea tures. The operational fife of all nulls and septic systems depend on the local soils condition, groundwater /owls Chet 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 tost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Ina can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of Ne ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner fisted above. Any reliance upon or use of this report by any other person or parry Is not authorized, nor will It confor any legal right whatsoever. 5. DSD SIGNATURE _)L Approved for S bedrooms. Disapproved. Conditional approval for bedrooms, with the tllowing stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory _ Manitenance Agreements Supplemental Engineers Reort Other Po By: �!�. Original Certificate Date: 2 — /2 'OI (Rr. rz9o) Municipality of Anchorage J ' Development Services Department Building Safety Division Onsite water 3 Wastewater Program 4700 south eregew SL P.O. Box 168650 Anchorage, AK 99519650 W W W.ci.andwrage.ek.us (907) 943-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WOODBOURNE S/D: LOT 13, BLOCK 1. ParcellD: 015-351-19 A. WELL DATA Web type PRIVATE If A. B, or C provide PWSID# N A Date completed 10/17/1981 Santry seal (Y/N) YES Total depth 101 % Cased tp 100.7 fL FROM WELL LOO Date of tog 10/17/1981 Static water level 55 fL Well production 18 g.p.m. WATER SAMPLE RESULTS: Well Log (YM) YES Wires party protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 10/10/2000 23 fL 3.47 g.p.m. Coliform 0 coloniss/100 mi. Nitrate 3.46 mgJL, Other bacteria 0 cotonles/100 ml. Date of sample: 2/1/01 Collected by: - AWWC. INC. B. SEPTICIHOLDING TANK DATA Tank Type/Nlaterlal STEEL Date installed 8/5/82 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (YM) N/A Date of pumping 12/8/2000 pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA �MONRORING TUBE EXTENDS 58.5 BELOW THE INVE ELQWINVERT Date installed a/5/82 Soll rating (g.pAJRV /bd 250 System typo TRENCH Length 115 R Width 3 1t Gravel below pipe 7 ft. Total depth 12.5 +/- R Eft. absorption area 1610 ft' Monitoring tube 'YES Depression over field NO Date of adequacy test 12/11/2000 Results (Pass/Fall) PASS For 5 bedrooms Fluid depth In absorption field before WW-745"in. Water added 792 gal. New depth 55" in. Elapsed Time: 1056 min. Final Auld depth -15-1 in. Absorption rete u 750+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN if yes, give data - D. LIFT STATION Date installed Size in gallons "Pump on' level at—in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 1000+ Absorption Heid on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent bis 100'+ Public sewer mantwle/deanout N/A Sewer /*spite service One 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption tleld 5'+ Water main 10'+ Water service One t 0'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 109+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 1000+ Driveway, parkbVfthide storage 50'+ Curtain drain NONE KNOWN Wells on adjacent lots-1-00:-+— F. ots100'+F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field inspections andL W.f ; , review of Municipal records that the above systems are In ...... . confbrmance wilt► MOA HAA guidelines in effect on this date. — Engineer's Printed Name JEFFREY A GARNESSOF�7953 (V °� • E Dais 7-/G G/ °�jD�ofas* oil Fee S _ Waiver Fee $ Date of Payment o Date of Payment Receipt Number Receipt Number titm.12MM �/ MUNICIPALITY OF ANCHORAGE' ��66 • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services y ' 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 I.D. # 015- 351— t o HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) f32�0 G iv�n�w. i G7i r Propertyowner CzDay phone 2(P&^9237 Mailing address Lending agency Day phone Mailing address Agent C% ' r a.Hns t,& UU!-u �¢ Day phone 61 z9 S 5 � Address 52-0( C S Unless .otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 'TYPE OF WATER SUPPLY: Individual well Community well ' Public water 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 �_ , 4-; 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.' 72025 (Rw /91) From MOA R7 1 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ordinances, and regulations In effect on the date of this inspection. Name of Firm I o �O� �`^ Sov rbc a.�nv R-1=• Phone L7'9 —3 §4 Address Engineer's signature Date Z�r o /q 11 . +��Rt o a� O:...;4; Vis!? lr�)T�� e < Tbbln orurklcnd . _ .. �� •' Cr -:125 :' V�� 6.' DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval. for bedrooms, with the following stipulations: Additional Comments M Date 3 94- • The Munlcip',ality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. n -M (PWA ) 8. uoA m ® Municipality of Anchorage AL Aicm Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LA 13 13IG 1 Parcel I.D. Q 15 — ZS I - I q A. Well Data UCi°C°Q ou r N e_ Well type 1R If A, B, or C, attach ADEC letter. ADEC water system number N / �- Log present (Y/N) —Date completed 4/17/8 f Driller "- it/ Total depth lot Cased to Iy0. 7 Casing height 3 4!5 It Sanitary seal (Y/N) Wires property protected (Y/N) ,ice FROM WELL LOG Date of test On l e i Static water level 55 Well flow 16 g.p.m. Pump levell t;e 4"_1 SEPARATION DISTANCES FROM WELL TO: ATI SPECTION ltolqq -< 2 ENVIRONMENTAL MUNICIPALITY OF ANCHOkAUt SERVICES DIVISION L' g'?'TP3 1 1994 RECEIVED Septic/holding tank on lot 1 1 D ; On adjacent lots > i o >] Absorption field on lot 133 ; On adjacent lots 7 10-0 Public sewer main N/A Public sewer manhole/cleanout N/A Sewer service line i -5o Petroleum tank N 10 WATER SAMPLE RESULTS: Coliform Nitrate �2. � 3 Other bacteria Date of sample: 2 /a /9L/ Collected by: S B. SEPTIC/HOLDING TANK DATA C, L&/V/fY p /acrf Date installed 815-180- Tank size / 50,y Compartments 2 Cteanouts (Y/N) _Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) r N/t4 Alarm tested (YM) Date of pumping Ft -b 114 k} Pumper t A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Ifo On adjacent lots 7 t C%CD Foundation 1.3 To property line i t o Absorption field 5 Water maintservice line i C� Surface water/drainage N l o 7229(3S3)•Front CONTINUED ON BACK PAGE C. LIFT STATION N/ Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on" level at 'Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed (S iS16 2 Soil rating (GPD/Ftz) 2 5 y System type ' Length 115 Width 73 t781 Gravel thickness % Total depth Cl Total absorption area 1(o I U Cleanout present (Y/N) Depression over field (Y/N) N1 Date of adequacy test 2hobu Results (pass/fail) for `5 Bedrooms Water level in absorption field before test J�40 After test Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 13 7 On adjacent lots % I C-0 Property line ID To building foundation .95 To existing or abandoned system on lot N /A On adjacent lots n� 50 Cutbank ? tiy Water main/service line 'Sy Surface water / l / O Driveway, parkingIvehicle storage area �> S-0 Curtain drain N %O E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eNecl•8 i'the &.1te, of this inspection. .r .. ..... 1a Signature �I _ Engineers Name 16WeviJ V �� p�•��NTu ri nSp'v'rl!ca1 'y Date '••......•••' o, HAA Fee $ 00 Date of Payment a2 - Receipt Number c� -,r4 7.2 „? 8 72.026 (M)' Back Waiver Fee $ Date of Payment Receipt Number, to C CZ]T..'1L.� Time APPLIr,NT FILLS UPPER HAS ONLY Properly Owner I. 6�yn e- a' L34 T' 6 W /OUT Phone Said /10 q,r Mailing Address — Zip Code Buyer /Q /r, h Y- Y"' 4 r -1 Date . Address S / h G — / ' Zip Code Date Lending Institution %irS7 /V �%in.al .�n,..Il a � �h �. Phone Address Zip Code Inspector Realty Co. d Agent Inspector Phone Address Zip Code Legal Description LT /3 Q•k / f .1� U O d orti ✓ri C Sw ��^ Field Notes: Street Location OF ANCHORAG el Type of Residence ENVI.: Single Family JCI J 1962 Multiple Family No. of Bedrooms ❑ Other APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Water Supply Individual D `i� ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. 0 Community 6 QQ>� �,� /O- — r y For wells trilled prior to that dale. give well depth (attach tog If available). ❑ Public Utility B. Seww��er Disposal Soils Rating Date Sewer Installed Well To Absorption Area /00 r IndividualYear Z SO Individual F v 'LI Public Utility Septic Tank Size / 13,00 When Connected to Public Utility:�� ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. to C CZ]T..'1L.� Time Time Time Time aL1.rr e �_4, O Date . Date Date Date — 1-Sca Inspector Inspector Inspector Inspector Field Notes: OF ANCHORAG MUNICIPALITY ENVI.: JCI J 1962 u RECEIVED APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( 1 CONDITIONAL APPROVAL' /O- — r y DATE B. Soils Rating Date Sewer Installed Well To Absorption Area /00 r Well Log Received O K Z SO r -s- F v Well to Tank /o 4 / Septic Tank Size / 13,00 )]NJ CM