HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 9North Woods #3 Block 12 Lot 9 #051-732-18 (Rev ub/u2/18) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201205 PID Number: 051-732-18 Dwelling: W Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade Name Nadine Thompson ABSORPTION FIELD ❑ Deep Trench ❑Wide Trench E] Bed ound Site Address 23055 Green Garden Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot North Woods Unit 3 12 9 Fill added above original gre, Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total a orption area Number of trenches Dist. between trenches From Tank Field ft Stat Lift Tank Line Ftz Fl. Well n/a I TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1094 Gal. Surface water 100'+ Material Number of compartments Lot Line 5.0'+ NA Plastic 2 Foundation 7,5'I LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Whitters Drainfield CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 350.3 ft Inspectio v, 7/30/2020 7/30/2020 Location and description 3rd 7/31/2020 2nd 4", NW Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF Akq6, Conditional Approval: Date �� :.4 T� / L �_ - Steven R. Ponnone `��¢ Septic Sy P . CE 8149 ^ste Appro L i Date 9'-11-2000 Note: this approval does not include well permit requirements. (Rev ub/u2/18) J (i) VJ O n O O ho II 4�j :;7 \ \ \ doPROF f ,� \ e .r9sF\ e\ � Fti� y \I \ \ cn cn I II �I�ITEg �n- �II �u L11� IG v � r, NOTES: PANNONE ENG SVC LLC (C.t. io8s� P.O. BOX 1807 PALh,�ER, AK 99645 """",, OF,.A( h, REVISIONS DATE 8/5/2020 RECORD DRAWING PHONE (907) 745-8200 FAX (907) 745-8201 -='�E - �p '.... sf '4 SCALE NORTH WOODS UNIT 3 812 L950' NADINE THOMPSON/� a ` 27 .5 COUNTY ROAD 19 = ................ s St— R. ft-- ; ', �''. CE-8149 50' P.I.D. NO 051-732-18 DRAWN ACP PERIAIT N0. WATERLOO, IN 46793 p err . �_ OSP201205 SITE: 23055 GREEN GARDEN DRIVEo'= SHEET CHUGIAK, AK n„l 3 OF 3 m m U) nn�� D n n n cJ s �J z y OOmx A m < I cfJ "{Do ZLZatn O `� � 0 z Z 0= D £ z A-p-I0C� 0 m O �mOZ m c�O i Z _t m MA '- Z O D :Em > O Z O (n � m o D r I 02 r W n Em rn � O , a � O a o -71 11 of m K n n n 0 (n 0 o o to z O m m o D o"c�D 0 N - Ln m O iP K m a fel m M n rn o w W rn D \ rn o D ('o cn a N J o} / \ 00 •J O) N -- N Cn � co�0)C14owcn ""`..... �E`OF A(q''i REVISIONS DATE 8/5/2020 RECORD DRAWING PHONE (907) 745-8200 FAX (907; 745-8201 ?'" S4y''y n (A NORTH WOODS UNIT 3 B12 L9 NADINE THOMPSON alt l r .. ... �� ....s / / / / / / \ i -'• C -i Z -0 z�m z� z\ ( FTI T p D C/-) 0 (n 0 o o to z O m m o D o"c�D Q U)D o O O Ln � Ln m O iP K m a fel m M n \ O_ o \ D D 1 - O O Z - �\ �� cn� \ vicznm 0 CO \ I D n -I I / r \ >1> DD K:mm1 \ n mm \ P, \ M 4 r = m \ mo i r0 \ i 1 OOM o L all, \ ( \ 1 D O \ ( \ m J o} / \ 00 \ \ O_ o \ D D 1 - O O Z - �\ �� cn� \ vicznm 0 CO \ I D n -I I / r \ >1> DD K:mm1 \ n mm \ P, \ M 4 r = m \ mo i r0 \ i 1 OOM o Z- 1 ( \ NOTES: PANNONE ENG SVC LLC (C.1. 1088). P.O. BOX, 1807 PA5JER, AK 9964.5 ""`..... �E`OF A(q''i REVISIONS DATE 8/5/2020 RECORD DRAWING PHONE (907) 745-8200 FAX (907; 745-8201 ?'" S4y''y SCALE NORTH WOODS UNIT 3 B12 L9 NADINE THOMPSON alt l r .. ... �� ....s P.I.D. NO 051-732-18 DRAWN ACP 2745 COUNTY ROAD 19 % St—R.�noo •, CE -8749 WATERLOO, IN 46793c OSP201205 SITE PLAN SITE: 23055 GREEN GARDEN DRIVE b " ~ ' �{ SHEET CHUGIAK, AK nn 2 OF 3 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://vvww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201205 Work Type: SepticTank Upgrade Tax Code Number: 05173218000 Site Legal Address: NORTH WOODS UNIT 3 BLK 12 LT 9 G:1459 Site Mailing Address: 23055 GREEN GARDEN DR, Chugiak Owner: THOMPSON NADINE A Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date S, „ 1,�„�y£'.,+3h f kms. r; f, Department Lot Size in Sq Ft Total Bedrooms: 7/7/2020 7/7/2021 27858 ❑ Disposal Field ✓❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 Received By: Issued By: ' Date: 7//,, ` 4 �, Date: 7 7 Z6 a D UNIMPALIT OF ANCHORAGE P �Y Community Development Department � Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 051-732-18 Property owner(s) Nadine Thompson Day phone Mailing address 2745 County Road 19 Waterloo, IN 46793 Site address 23055 Green Garden Drive Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) North Woods Unit 3 B12 L9 Legal description (Township, Range & Section) Lot Size 27,858 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank MUpgrade ❑X Duplex (D) ElHolding Tank F-1Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: $ Waiver Fees: Date of Payment: (5 7-61ZO Date of Payment: Receipt Number: O78g3G- Receipt Number: Permit No. Q5P2.01 Z05 Waiver No. Permit App_-'-:. :....:c: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201205, Rebecca Carroll, 07/07/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201205, Rebecca Carroll, 07/07/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201205, Rebecca Carroll, 07/07/20 ~ JNICIPALITY OF ANCHORAGE K°� St B3 01 \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 2644720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE "NEW S}L+ S% eVe.t Q9gS Q3 GESS 28❑UPGRADE MAILING ADDREC) PA'(. BO LEGAL DESCRIPTION Noh�N°°ds D� li 9 LOCATION NO.OF BEDROOMS 3 a5 �c'irS rte 1'— J DISTANCE TO: WeiW welt Absorption area Dwelling / PERM T NO.1 �N/d 4 el COY IUs L weir 2 Manufacturer Materials [' No. off ompartments w� mc H Liq. capacity in gallons ((JJ IF HOMEMADE; Inside length Width Liquid depth d Y DISTANCE TO: Well Dwelling PERMIT NO. . oz _ z F Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well W cll Foundati n Nearest lot line PE(�iM1T NO. ,W rilb IU t VLJAA 11r lines Length of each line Total length ; �ines Trench width Distance betsvtynflines 241 12— / C77inchesf Im tile to finish grade - Materialbeneath lila Total effective absorption step H7 �A per. inches 6 3 [] Length Width Depth PERMIT NO. W U a f wd Type of crib Crib diameter Crib depth Total effective absorption area UJ a DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J i DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER S PIPE MATERIALS pvc• o ; SOIL TEST RATING 140 n'/b INSTALLER SK " -35 REMARKS EXe*"✓a e M ✓ [ O✓ems r7lere is / %r -f '4t /ews7' 'o Over eijf)re led co re } 1 R APPROVED 61 DATE LEGAL 6-l1-83 Norte wopdsJI: 6•I� �-'9 72-013 (Rev. 3/78) ►15Pec4td by '(� a� ,,�NNICIPALITY OF ANCHORAGE o Department Health and Environment, otection 825' L Street, Anchorage, AK. .99501 �• } 264-4720 Permit # * * * HANDWRITTEN PERMIT W/OR ON-SITE SEWER PERMIT Applicant: a Mailing Address: Location: iU Cr"r AWo0 S Phone Number: _ Legal Description: L -/ r► Z N or'�^ d Woo P Type of Soil Absorption System Is: Trench: Drainfield: u/ Maximum Number of Bedrooms:_ ze: a 0 0 0 a' — Seepage Bed: `Holding Tank: Soil Rating(sq.ft/br) / v 1. 5 'Twp.- •c — The Required Size of the Soil Absorption System Is: DEPTH � LENGTH . GRAVEL DEPTH 6 J. WIDTH 3 The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ ( O 0 0 GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *.* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 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 codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha 3 bedrooms.' (�(� Signed: L. e . Issued by: �J 'Q_Q' Applit Date: SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Amhaa9a, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST SOILS LOG ❑ PERCOLATION TEST syy���"yy�� r PERFORMED FOR: �S DATEPERFORMED: AA L3 LEGAL DESCRIPTION:I�,7�1-�C�J�./ E3IL..L�Il ID LO� 1 PERFORMED 72008 (6/79) WAS GROUND WATER _ No ENCOUNTERED? IF YES, AT WHAT DEPTH? PERCOLATION RATE TEST RUN BETWEEN MUMCIPALITY OF ANCHORAGE i Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section �-Fax: 907-343-7997 Parcel I.D. 051-732-18 Certificate of On -Site Systems Approval . � Expiration Date:3�2 1. GENERAL INFORMATION Complete legal description Northwoods Unit 3 B12 L9 Location (site address) 23055 Green Garden Drive Current property owner(s) Nadine Thompson Day phone Mailing address 2745 County Rd Waterloo, IN 46793 Real estate agent 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DiSPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ l a, SQ U)U 16 '-, Waiver Fee $ _ Date of Payment /2020 Date of Payment Receipt Number 0 8 7 28 E Receipt Number, V COSA # S C2 d'l Lf ( 5 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of. the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Phone (907) 745-8200 Date `7.0- L', OF System #1 Approved for bedrooms � ' 'Stever: Pa r'•*onncne � kig, %C v1.�o � System #2 Approved for bedrooms r � � - Lu Disapproved ' ,0FESSIOI pp y�� Conditional approval for bedrooms, with the following stipulations: '111))))))1)'' � p Original Certificate Date: 0 2 �ZCi2U The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Northwoods Unit 3 B12 L9 Parcel ID: 051-732-18 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Community Well B. TANK DATA Age of tank (S) 7130120 years Tank type/material 5ap'� `' Measured operating fluid level in septic tank n/a Q Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Bed Which system tested (date installed) 8/11/83 V ALL standpipes present per record drawing Total measured depth from grade 5.3 ft (max) Measured depth to pipe invert from grade 4.8 ft (min) ❑ N/A — pressurized field FR Monitor tubes go to bottom of effective. If not, state depth into effective N Code -required soil cover over field ❑® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 1000 gallons Comments/Deficiencies: Located Bed Installed CO's and MT. COSA Checklist yellow sheet Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/312020 Results 0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time 120 min Final fluid depth 0 in Absorption rate >450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date NO E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well Septic Tank/Lift Station on Lot > 100' ❑ Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' (❑ Yes if No 7.5 ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓❑ Yes if No Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No Water Service Line > 10' ✓❑ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No 5.0 ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ED Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Q Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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. COSA Checklist yellow sheet ������� OF Al- 49H.. :. ...... Stever R [Jannor)e- CE 8149 Ile ft ft ft ft ASBUILT—NO CORNE , RS SET THIS DATE. / HEREBY CERTIFY THAT | HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY- AND INDICATED. IT IS THE RESPONSIBILITY OF THEOWNER TO DETERMINE THE EXISTENCE OF ANYEASEMENTST COVENANTS, OR RESTRICTIONSWHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULDANY DATA HEREON BE USED FOR CONSTRUCTIONOF FENCE LINES, OR FOR ESTABLISHING BOUNDARY LINES. S.UJ&RD ASSOCIATES LAND SURVEYING 694-082 D R A7W!N: \ Municipality of Anchorage •. Development Services Department Building Safety Division J On-Site Water and Wastewater Program 4700 Bragaw Street s A IT, 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 Parcell.D. COSA# NP021015 Expiration Date: C-1-0-7— Complete -1-D7 Complete legal description WPr'�1 tVoeds 1r-3 Lo%- 9 i Rock— Location (site address) -2 3 06 &Me -t" C CL4eUn Dr-. Current Property owner(s) 0 e i�9a.n Day phone 317 - (0861 Mailing address -P.O- -RQ>( X0.2770, fincG, •. t)K 9`)9_3o -,A -7-7o Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 01� Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System al 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 Onsite 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 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. l 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 Eagle River Engineering Services Suite Address Fagle 13w;AK995= Engineers Printed Names her R. X ood F���9L1;L•ii�1:�� ✓ Approved for __ bedrooms. Disapproved. Phone V111- T115 Date 5/_76/y6 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ���� ,,/ G/ Original Certificate Date: �e )Rev. 11105) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: -nee-1hw0,^dV- # 3 , Lof 1. G.tk /a- Parcel ID: 0,5/ - :Z .3 Z — 1i A. WELL DATA Well type A Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform mg/l If A, B, or C provide PWSID # 2�1 Qo t Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG g.p.m. iies/100 mL Nitrate mg/L B. SEPTICMOLDING TANK DATA Well Log (Y/N) Wires properly Casing he jgMTabove ground) in. ft. Other bacteria oolonies/100 mL Date of sample: _ Collected by: Tank Type/Material s-ca-r'e- / S -1--A P Date installed tlOf ll,100 3 ` Tank size 1 000 gal. Number of Compartments J -L._ Cleanouts ON) V&.4— Foundation cleanout! N) Depression over tank (YQ �21Q High water alarm (Y& tit o Date of pumping 511510fo Pumper 7y' , s :13AMPi2 5 C. ABSORPTION FIELD DATA Date installed x/ 11 f Sl3 Soil rating (g.p.d.e or 140 System type 99,00-1 Length 3S ft. Width 19, ft. Gravel below pipe 0.5 ft. Total depth r R Eff. absorption area feag_W Monitoring tube +a" Depression over field -Aa Date of adequacy test Mom Results ®'Faiq . For _-J_ bedrooms Fluid depth In absorption field before test _0 _ in. Water added].0 gal. New depth� in. Elapsed Time: _LS- min. Final fluid depth 0 in. Absorption rate >= 4 So g.p.d. Any rejuvenation treatment (past 12 mo.) (Y)U& type) r "gnc /, moow} If yes, give date n/C_ D. LIFT STATION Date installed "Pump on" level at —in. Datum Size in gallons 'Pump ott" level at_ in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic-serilike line containment areas Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit On adjacent kris On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 46 Property line 't 5" Absorption field y S' Water main *IDS Water service line tto' Surface water Inn' Wells on adjacent lots -rtno SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '--It) ' Building foundation * S ' Water main +"I n ' Water Service line r l o , Surface water + 100' Driveway, parkinglvehide storage 50 Curtain drain + 50 ' Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in � *' conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name UhriS- 42ke r 9 • Wood i cidtl47bPttERIt Date 51 Z 611e, CE. � , COSA Fee $ � 3 D Date of Payment 5-26–n6 Receipt Number O 33 (Rev. I IM) Waiver Fee $ Date of Payment Receipt Number • �,ysr 69•si ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Q/ao�.v�s'�facP.avr-zu-to�'��.f'/z AND THAT NO ENCROACHMENTir&IST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TD DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING aOUND- ARY LINES. SEWARD & E SCALE yo GRID, 414%1 -*%s9 11141f 6 s% Oqwlaluiaaal Al .... ..... r i (g, 1h r n FBr1 oua. Mark E.w,.d ' 1 dl9'JdA,'jJ DRAWN= .Off 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 I.D. k 05-1 132-' � a HAA N 114 96'05'2 2 1. GENERAL INFORMATION Complete legal description Lot 9; Block 12; North woods" Subdivision 3 Location (site address or directions) 23055 Green Garden Chugiak, AK Property owner Estate of Dotty Prowse Day phone Mailing address c/o Remax of Eagle River 16600 Centerfield Dr. Eagle River, AK Lending agency Day phone Mailing address Agent Virginia Kohfield/ Remax of Eagle River Day phone 694-4200 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' Individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (R«. 1/70 Hoed MOA 621 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I f urther 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 FirmS & S ENGINEERING Phone G� y — d 9 20 77034 a Eag River Loop oa o. Address Eagle River, Alaska 99577 Engineer's signature � `fir Date ) -Lja (9 C 6. DHHS SIGNATURE Approved for --:3 bedrooms. Disapproved. Conditional approval for Additional Comments By. r ,,I R0:jRT,C.IFO'MA:+, ; c • C°-seo1 / `' min •� ' f�` !. bedrooms, with the following stipulations: Date / 2 - M — 9� CAUTION 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 courtesyto purchasers of homes and their tending 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. 72-075 IA". 1M) Swk MOA 021 iwAICIPAtItY of ANCMORNoti ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEC 0_�s 19 DEPARTMENT OF HEALTH & HUMAN SERVICES R C /' E V96 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health `Authority ((Approval Checklist Legal Description: L—ftroi t)L4-1Z ljt -tI \Loni3 Parcell.D.: 6U 732 A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) Total depth Sanitary seal (YM) Date of test Date completed Cased to FROM WELL LOG Casing height (above ground)'' i Wires properly protected (YM) i ..AT INSPECTION Static water level / Well production / g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Tff- C� B. SEPTIC/HOLDING TANK DATA Collected by: Other bacteria Date installed �- P3 Tank size OoO Number of Compartments Z CleanouMON)- Foundation cleanout &I Y Depression (Y Q r' High water alarm (YM) �J14 Date of Pumping /.? -.2 - 71 Pumper Tl- f✓M/"-) 4 C. ABSORPTION FIELD DATA Date Installed / `/ d 3 Soil rating (g.p.d./M or Witidrm) IVB / System type .61-'Q Length Sr ' Width /9-1 Gravel thiclmess below pipe G Total depth 3.5- f Effective absorption area 636 Monitoring Tube present JVN►_y _ Depression over field (Y&__d_-) Date of adequacy test //'1J -i6 Res all) 64S For 3 bedrooms Fluid depth in absorption field betore test (in.); O ' Immediately atter gal. water added (in.): G ` Fluid depth 6 (ins) Minutes later: Absorption rate = y4 0 t g.p.d. Peradde treatment (past 12 months) (Ya Al • +JC /"? / ✓Ld If yes, give date ~/• 72-026 (Rev. 3/98)• D. LIFT STATION Date installed Manhole/Access(Y/N) High water alarm level at' _ Cyel sed E. SEPARATION DISTANCES Size in gallons "Pump on" level at* 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots. Public sewer manhole/cleanout Sewer /senfie serV ce linf a Lift station SEPARATION DISTANCES FRO SEPTI OLDING TANK ON LOT TO: Foundation S r f off" level at' Property line /o 1%4- Absorption field GI ' Water main/service line /o r f Surface water/drainage /-)v el- Wells on adjacent lots Zoo I -A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /0 Building foundation S Water maintservice line /o i Surface water /Do r� Driveway. parking/vehicle storage area Jo It Curtain drain .w'o tif, Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certNy that I have determined thru field inspections and review of Municipal records in conformance w , HAAHA guide nes In effect on this date. Signature 7 Engineer's Name /► J 6 t.t r C . Co u,qv i Data HAA Fee $ 3 % Date of Payment Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number 'tad r t =�4 ROGERr C. COWAN �? CE-8C°O1 =�4 ('*11 r�, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date May 27, 1986 t. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 9, Block 12, Northwoods #3 T15N, R1W, Sec.4 Location (address or directions) Green Garden St. (b) Applicant Name Dorothy Prowse Telephone: Home688-4119 Business 862-6207 Applicant Address SR3-208 Chugiak, AK 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderU; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Alaska Pacific Mortgage Telephone 694-7780 Address POB 100420 Anchorage AK 99501 Carol Sherrod (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: pickup by engineer 2. TYPE OF RESIDENCE Single-FamilyU Multi -Family❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ CommunityU Public ❑ Note: If community well system, must have written confirmation from the Stale Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite M Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11,84) n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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. l 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 FirmTelephone —�ENGINEERING SERVICES Address FdGL"IVER AK -995 Date P. 0. BOX 773294 694.5195 Z. Engineer's Seal �. lovis A. 6W ra �. e1 GE 6736 v`� PiOFC$Sh:w.. i J / 6. DHEP APPROY�LA_ CCf. Approved for 1,� �� bedrooms by � --�Zf•Z1T _ Approved Disapprov Conditio _ Terms of Conditional Approval CAUTION Date �K ) The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MLRJIUFALITY OF ANO40R MUNICIPALITY OF ANCHORAGE (MO DEPT. OF HEALTH 8 ENVIRONMENTAL PROTEC710N HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1994 MAY 2 71986 264-4729 Legal Description: RECEIVED. y A. WELL DATA Well Classification fi - N r fz wnoc(/ If A, B. C, D.E.C. Approved (Y/N) Y Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground _ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot _ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole — Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Depth of Grouting _ Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) _ ; On Adjoining Lots On Adjoining Lots — —To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Date Installed SAF 3 Size ,54/ No. of Compartments a Standpipes (Y/N) y Air -tight Caps (Y/N) i Foundation Cleanout (Y/N) y Depression over Tank (Y/N) y Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 1446 ; for Holding Tank High -Water Alarm (Y/N) A-"4 Temporary Holding Tank Permit (Y/N) !!Z4 Separation Distances from Septic/Holding Tank: To Water -Supply Well fa°° r To Building Foundation To Property Line r(o To Disposal Field F I To Water Main/Service Line +/v To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11164) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �� ¢�'B/e Type of System Design Date Installed 5 & 3 Length of Field 3S Width of Field Depth of Field 3 y Gravel Bed Thickness 6 Square Feet of Absorption Area 3 Standpipes Present (Y/N) _Y Depression over Field (Y/N) Al Date of Last Adequacy Test Results of Last Adequacy Test . Abr.. A A- — 3 Jtr C' Separation Distance from Absorption Field: To Water -Supply Well To Property Line To Building Foundation 5 / To Existing or Abandoned System on Lot tiZ-- ; On Adjoining Lots — 3� To Water Main/Service Line r& To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course Izw To Driveway, Parking Area, or Vehicle Storage Area Comments 127e i Jfi. T« b♦ r /.✓rfc /4.0/ /z+ 6. /✓.T, D. LIFT STATION N1 Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access(Y/N) "Pump Off" Level at '• Check Permitted Bedroom Rating Against HAA Request '• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed — Date 7 Company — CiPGu^ MOA No. Receipt No. _1%f ck8,1 Date of Payment s' Amount: $ ics .cb Page 2 of 2 71-026 11 UK .:.. `........_ ;... ;: Iv�'•�> Engineer's Seal t ;u,.,..%./.fes. ,...• •... • .. (+;�1 Louis A. Cutara C <r,S, cssr�5 EAGLE RIVER ENGINEERING SERVICES Lou Buten P.E. P.O. x Eagle River, Alaskalaska 9 9 9577 Telephone (907) 694-5195 May 27, 1986 Mr. Steve Morris Civil Engineer, On-site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 REP: Lot X9, Blk 12, Northwood. #t3 Dear Mr. Morris: The enclosed application is submitted for issuance of Health Authority Approval for a 3 bedroom home on the above referenced lot. As the home is located in Northwoods subdivision the required installation of ground water monitors was provided. The enclosed site plan shows the position of the monitors with relation to the absorbtion bed. We are pleased to report that there was no water within 4' of the bottom of the bed at any time during the monitoring period 5/15/86-5/23/ The adequacy test demonstrated that the bed absorbtion rate is adequate for a 3 bedroom home. The monitor tubes are left in place for future inspections. This report applies to the observed conditions on this dat only. If there are any questions or if additional information is required please feel free to contact me at 694-5195. Sincerely, Lou Butera, P.E. Encl: HAA application site plan EAGLE RIV!") ENGINEERING SERVICES INC. P. O. Box 773294 EAGLE RIVER. ALASKA 99577 Phone 694.5195 JOB L07` 5 �''// /2 /1/, waw(i 93 SHEET NO. OF CALCULATED BY DATE 'S� 2S/ff CHECKED BY DATE SCALE /,= rn W, ozi7 r_ a... r MUL y � I . T I , —i—_— I_ A es _._soe a rio� �I I -- r ! I Y y _ 6� _i G"� j •:r '�' __ _ I —'. � - ---___... P..y..—..._-. _._..... ... S"r^, :-'louie �A. Dutew -•k �r-. : ._ F ..� ! I ' � j I I 1 I I I '�iP,• I CE -6736- I •"�^,_._----�-I --i.- V 7. —,- r I --obs •rre.o( .CN_ y .f.i ... - --_ — I- -+--/— jI ; o. tio"V e. rn W, ozi7 r_ a... r MUL - APPLIC^^T FILLS OUT UPPER HAL' ALY Properly owner JkUP+_l /S�r('S Phone Mailing Address100.. k— Zip Code 9eJ Buyer Date Address Inspector Zip Code Lending Institution Inspector Phone Address - Zip Code -iLa'AcL(LUCI e- k k- s", L Realty Co. d Agent TH DEPT. N H`_PRO 1. ENVIRO�v1LNTAL ROTEC110N Phone Address Zip Code RECEIVED Legal Description ��.. 9+ ��•� �� / /��f� r pAnse ZrT 3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ' Street Location ( ) CONDITIO L APPROVAL' DATE Type Residence BY Ingle Family Soils Rating ❑ Multiple Family No. of Bedrooms Well To Absorption Area ❑ Other Septic Tank Size Water Supply Well to Tank ❑ Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. C/Community For wells drilled prior to that date• give well depth (attach log if available). ❑ Public Utility Sewer Disposal IR Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank ' NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE -iLa'AcL(LUCI e- k k- s", L TH DEPT. N H`_PRO 1. ENVIRO�v1LNTAL ROTEC110N SEP 7 ist�,� RECEIVED 3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIO L APPROVAL' DATE BY Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank rxon OM