Loading...
HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 19North Woods Block 16 Lot 19 #051-064-30 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S(JL)Ot� aaT' PID Number. 051'06_q-30 Name: arid•y Mc A -Pees, Wastewater System: ❑ New ❑ Upgrade Add rHS' I'f Slow. L C 67-56 ABSORPTION FIELD Phone: 27,L,50_0 Nn. of Bedrooms O Deep Trench (tQ ShB(low Trench ❑Bed C] Mound O 011ier LEGAL DESCRIPTION Soil Filling Da total Depth from oigb.al grade. iKGPD/Sq FI Q Lel''/L Slock: SubdNklon: a911 16 � rAPlh to pita' bollom from lskiiinal rens Graval depth henoath pipe or h S Ft n township nange: section- rill added show ori inAl inde: g g O FI Gravel len ll, ^/ g • 5 Ft. WELL: ❑ New ❑ Upgrade Gravel widltl Number Olanes Orslanaebeleer," Ft ` Ft Classification (Private. A.B.C)- Total DWIV CAud total abserpllon eras C Pipe malerlAl• rt. 75,51 SO Ft 1q5T1V Fq to Or111eC Filled $nlia Wale, Lave,: Inslalle c SYSrc.as Date Installed' •� /y� Q Q• `W Ft. K Yield.Vump Set at. I Cas.rp Ilr.gnl Aleve Grouts TANK GPM Ft. Ft. SEPARATION DISTANCES 1(septit 011olding ❑STX P. To rtOm Septic Abaerpiwn Lin "owing W fcmlba.e M�'{nulaelYrer: -fly In gallons. /� lank Field 6UIbn Tank it'..,Lines /7ri G/1 �/84CoTh^ — L/l/O Well er— �� �� � Malmial' C��iLV I e✓ Number of Companmenls Surf c Walere 100+- TO`{- LIFT STATION Lot Is v% Size In gallons' AIAn. rer: Line alk Foundation /. , 16 V �69 ` VVV VV "Pump on' I",l at: Tu 'leve {11gh wAler alarm al• eWlain orain D /' e f� �1 tnJ yl I`ump Makr el Electrical Inspections pedotmed by: nemarks: f-XfJTiNC SCArrc_ TANK BENCH MARK PJMPkr� CR�tN[.p �- R6ANOoN�a Location and Desedptlon: o P o✓n oT `di lw O i n Q %t Assumed Elevelba: O EN AL S i S ENGINEERIN 17034 Eagle Rlyer Loop Road, NO.M Inspections performed by:EaglaRiver. Dates: lsl ,/Laalrs9grzz 2nd -7 x0'00 i ,.....w .............:. r"' �eec� IIOUN COWAN WAN Department of Health and Human Services approval ++ Reviewed and approved by: Dale: '3�' 00 lt>>P;�"'-"� 72-017 rna. 9/911 MOA 25 PERMIT No. SW000224 PAGE 2 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 • Anchorage, Alaska 99519-6650 o Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 19, BLOCK 16, NORTH WOODS #4 P.I.D. No. 051-064-30 SEPTIC AREA LOT 20 NEW 1000 GALLON STEEL SEPTIC TANK off\ DBL1 & DBL2 DV (DIVERTER VALVE) LOT 18 SAERPI� SCALE: 1' - 40' p ROBERT G COWAN 4C�Jlti� CE -8801 PERMIT NO. sw000224 PAGE 3 OF 3 municipalityof Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Ataska 99519-6650 o Telephone- 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 19, BLOCK 16, NORTH WOODS #4 P.I.D. NO. 051-064-30 STI ST2 98.4' FINAL GRADE 94.5' NEW 1000 GALLON SEPTIC TANK A B FCO 16.5 30.0 ST1 18.5 48.5 CO1 ST2 23.0 54.0 MTl CO2 biT2 CO1 = 97.0' DBL1 27.0 58.0 6BL2 28.5 59.0 CO2 = 97.3' Dv 31.0 61.0 FINAL GRADE C01 71.0 100.0 MT1 79.5 93.0 CO2105.0 98.0 MT2 103.5 97.0 CO3 1 70.0 ss.o COI = 93.7' SR CO2 = 93.7' MTI = 89.5'-/bIT2 = 89.6' c��P " 5�+ ,,4 ye 0 % Of WATER FOUND ® 83.5' • 82.0' B.O.H.` ROBERT C. COWAN hk CE -8801. J? S f c� MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000224 Legal Description: NORTH WOODS UNIT IV BLK 16 LT 19 Design Engineer: 0003 S & S Engineering Owner Name: Randy McAfee Owner Address: 21464 Snowflower Loop Chugiak , AK 99567-5642 7/Jo �d7� fpm Date Issued: Jul 12, 2000 Expiration Date: Jul 12, 2001 Parcel ID: 051-064-30 Site Address: 021464 SNOWFLOWER LP Lot Size: 21830 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of., Disposal Field n Septic Tank Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: i-.4 1 —0-0 Date: %— / 2 - 00 S& IIID ROBERT C. COWAN, P.E. June 21, 2000 CML ENGINEERS (907)694-2979 FAX(907)694-1211 HEALTHNJTHORITY MUNICIPALITY OF ANCHORAGE APPROVALS Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER 6 WATER MAMDOENSIOHS REFERENCE: Lot 19, Block 16, Northwoods #4 SEWER 6 WATER INSPECTION It is requested that you issue a permit to install a septic system upgrade to serve the existing three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location ENGINEERINGSTUDIES ANmwpoREPon,e of the test hole is located on the attached site plan. At the time of excavation 5/22/00, water was not found. After seven days of ground water monitoring, water was found at 14 feet. WELL INSPECTION SFLOWTEST We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent SITEFANS properties. If you require additional information, please contact us. ROAODESIGN Sincerely, rag AL SOIL TEST Robert C. Cowan, P.E. RCC/bjj PERCOLATION TEST .. Enclosure RECEIVED STRI CTL,RAL. MECHANICAL Jul, 28 2000 INSPECTION$ 01 ANI.FVvr,ifC pµjNtGPALIn nrlW,KWE `•AL ONSITE WASTEWATER DISPOSALSKTEM DESIGN 17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 1 " = 40' ' DESIGN I SITE -PLAN o40F V 0 A c0 q N000 o' A A n e o ' r O m 0 �--� Cyt --z i'r7 m mro w L7mm-D � yNNNN� � H�Hy Cp{ y A l J \_R`\ �cl OC) xD spa° / � •\ no nO a� Zm Om •po9G c ti OC) 00 O Al d C V O C) I N I O O f� A � A c� l FOFy I N OIO (n Ow o -m Cr ON.ZI rnll3 II O II z A O p �cl OC) L O "oma C7 O .4in N ri O n � C V O C) I N I O O f� A � A c� l FOFy I N OIO r Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED LEGAL DESCRIPTION: NNL ���/� �� /t- IOFEET) DING f7 n���j 1 'r 2 3- 4 4 5 p 6 7 8 9 �p 10- 11 0 11 12- 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS 21314 15 1617181920 COMMENTS C GM vileloobw .tb Q 4 U WAS GROUND WATER A,D ENCOUNTERED? O S IF YES, AT WHAT ^. L O DEPTH? P E Depth to Water ARer Lig aI'�Q Monitoring? DitE 15-16 111 C DATE Township, Range, Section: o OF R A ROBERT C. C RME ITE PLAN , v "r ®=mmm '�'�-�- ET*� 090275A MUM mwww tom PERCOLATION RATE (mmutevmch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 4 FT 5 & 5 ENGINEERIN4 �1 PERFORMED BY: 117034 DpI�,,.,,v,�.� Rover1 / �f'`— CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WFP09kFSTATE'Ae1TJV1v1WWAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72.008 (Rev. 4195) S& HEALTHALITHORITY APPROVALS SEWERS WATER MAINECTENSIONS SEWERS WATER NSPECTION ENtlNEENNGSTUgES ANDREPORTS WELL INSPECTION S FLOW TEST SITE PLANS SOIL TEST PERCOLATION TEST ST RLICT LIRAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 11G ROBERT C. COWAN, P.E. CMLENGINEERS (907)694-2979 FAX(907)694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 19, Block 16, Northwoods #4 June 21, 2000 GENERAL: 1. The scope of this project includes the verification of the existing 1000 gallon septic tank and installation of a new 1000 gallon tank if necessary, and installation of a new trench to serve the existing three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 18, Block 10, Horthwoods 04 June 21, 2000 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCHIDRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Papa 3 Lot 19, Block 19, Horthwoods 94 June 21, 2000 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: �.. 'ys.r. a . W Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Pe90 4 Lot 19, Block 16, Northwoode 64 June 21, 2000 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to cant' out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER 72-013 (Rev. 3178) 4 14 MUNICIPALITY OF ANCHORAGE 1 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 [}1tvW L . S\cP cc IQST• Q Z13 ❑UPGRADE ES MAILING ADDRS 7R C %A %N\—, LEGAL DESCRIPTION L— 0 4 _v OOV LOCATION NO. OF BEDROOMS Well Absorption aread. Dwelling PERMIT NO. Use DISTANCE TO: FF SITE Z\ 3102. Manufacturer n £ Material STTELiqcapacity No. of compartments in gallons IF HOMEMADE: I^side length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Material Liquid in Manufacturer capacity gallons O W DISTANCE TO: Well OFF ;%m Foundation / Nearest lot line PERMIT NO. Z u.No. of lines T7 Length of each line Tatal length of Imes Trench width Dist nce between lines � P < 2 \ �x inches Top of tile to finish grade `1 Material beneath tile ToAl effective absorption area -I_( O ( 00 _ IlUr•a I f_- I !- AL I'TY t1F F: rV4 1ivRHGE i ' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION I _ 825 'L' STREET, ANCHORAGE, AK 55501 264-4720 ANCHORAGE 6.94-21331 : EAGLE RIVER C0 t-4 I TE caLJEF:Z.' F'EF<M I T PERMIT NO. 831027 APPLICANT: STEVEN L. SKAGGS CONSTRUCTION PHONE: 688-28 1 Q I(o ADDRESS. PO BOY, Dnn N24., [�X CHUGIAK, Al. 99567 C ,J) LEGAL DESCRIPTION -'SUBDIVISION: NORTHWOODS IV BLOCK: -1-07- LOT: 19 LOT SIZE 0 SQ. FT. TOWNSHIP: - RANGE: - SECTION: - MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING = 159 159 159 (SQ.FT. /BR) LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - "i'FZ:ENCH GES I Gr -4 WIDTH = 2. 5 FT. LENGTH = 60.0 FT. ! NOTE ! - >75 FT. REQUIRES TWO TRENCHES TOTAL DEPTH = 7.0 FT. GRAVEL DEPTH = 3.0 FT. GRAVEL VOLUHE = 25.9 CU. YDS. TANK SIZE = 1, 000. 0 GALLONS (TPJO COMPARTMENT TANK) C:EG GE_• I CEr_4 IJIDTH = 19. 0 FT. LENGTH = 38. 0 FT. TOTAL DEPTH = 5.0 FT. GRAVEL DEPTH = 0.5 FT. GRAVEL VOLUME = 26.7 CU. YDS. TANK SIZE = 1,000.0 GALLONS (TWO COMPARTMENT TANK) L -i I GE GF;cF-i I t•J F I ELG GES I 113 t-4 WIDTH = 5.0 FT. , LENGTH = 56. 0 FT. TOTAL DEPTH = 7.0 FT. GRAVEL DEPTH = 3. 0 FT. GRAVEL VOLUME = 36. 2 CU. YDS. TANK, SIZE = 1, 000. 0 GALLONS (TWO COMPARTMENT TANK) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I CERTIFY THAT: 1. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE AND THE STATE OF ALASKA. 2. I IJILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES AND HAVE RECEIVED A COPY OF THE CODE SUHMARY AND DIAGRAM ATTACHMENTS WHICH IS PART OF THIS PERMIT. 3. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM PERSONNEL DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPtRTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. IF A LIFT STATION IS INSTALLED, AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED. AS-BUILTS CANNOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT. THE ELECTRICAL WORT: MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: STEVEN L. "GGS CONSTRUCTION ISSUED BY;DATE: 11/15/83 ----------------- PERFORMED LEGAL DESC 1 2- 3-g 4- 5 6- 7- 10- 11 71011 7H 12- 13- 14- 15- 20 2131415 20 SOC .OG ti. .. ( MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2641720 1 SOILS LOG — PERCOLATION TEST n I k4ii (J� DATE PERFORMED: /1/ z0—T3 IN: �I�rt/1 �/✓�O S #q (M) Brown 50-f (6/1) SiI j Gravel G re ✓ gold, Jr. WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? A=4 9ci SLOPE Reading Date Gross Time Net Time Depth to Water Net Drop LD 10,2 v %3 130, -- �r: -(N o y:s 014.5 -- 2L 3:D I 0,Z 3o � 3: ( z �O 0. 4 0 2 + L -1Z -- 0, g8 S% Z Z. /O 01 ,Z 414 2.0 s 3z to v.gs6 0 /9 PERCOLATION RATE FT AND L,..3 FT PERFORMED BY: (/ //YN Gree „ CERTIFIED BY: 73-008 (6/79) DATE: ' ALASKA NIUMOfIUTAL COnTROL SMICCS, InC. Enynecrinq 6 Enuironmenlal Studies +►wkrgvqurr OF q FNVlR0Pr 10 PAC TgL p pUC7/pNE 1v January 13, 1984 RECEWED Department of Health b Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Robbie Robinson Dear Robbie: On December 1, 1983 our company inspected the sewer system located on Lot 19, Block 16, Northwoods Subdivision Phase IV. All the standpipes were above ground and capped. The well is located over 200' from the system. The lot is served by a Public well and is approved by Alaska Department of Environmental Protection. Sincerely, Tod She Structural Engineer Approved by: 1200 West 33rd Auenue, Soc B • Anchorap, Alaska 99503 9 (907) 276-1361 n r E OF RBILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTALENTALL CONSERVATION Telephone: (9on 274-2533 Addma: 437 E. Street Suite 200 Anchorage, AK 99501 April 5, 1984 To Whom It May Concern: According to records on file in this office Northwood Subdivision (Phase IV) Water System is in compliance with the State Drinking Water Regulations. Sincerely, James C. �Allen Anchorage/Western District Supervisor JCA/msm cc: Alaska Environmental Control Services 1200 W. 33rd Avenue Suite B Anchorage, AK 99503 (XI nj3-)j*8 tre' 9 add �310N�H i .1daa N W �bC� j0 G£ QL Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 5^ ETY Certificate of On -Site Systems Approval Parcel I.D. 051-064-30 1. GENERAL INFORMATION: Expiration Date: lam" ^S4 " 2021_ Complete legal description NORTHWOODS 94, BLOCK 16, LOT 19 Location (site address) 21464 Snow Flower Loop *Chugiak Current Property owner(s) Gregory Gallagher Day phone 830-6972 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNadance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 Waiver Fee $ Date of Payment �1 a 20.2 Date of Payment Receipt Number 600 7(oG Receipt Number COSA # Os C122 1 3 5 1 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. Name of Firm: Gayness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE K System #1 Approved for -3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Date: 2s5 1 ZZ bedrooms, with the following stipulations: - f e , ` n p,_1TY op 6i, #A`84 SITE o WA ER VVAS7-__ ,AND Jm A7- �o PRpG� ER -o AM JJ/JJ���T S RVICES�J I) t��Zlll��l 4D I t 14-- Ef 14- Original Certificate Date: - l 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other iL e -_p'fir— ta•Ytk RopJg06/t l0 v / COSA Checklist Legal Description: NORTHWOODS #4; BLOCK 16, LOT 19 If more than 1 septic system on lot: COSA Checklist # of AWWU 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) Date of flow test for Cas- Static wate at beginning of test ft. B. TANK DATA Age of tank(s) 22 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 0 9 Standpipes/foundation cleanout per record drawing Date of pumping -9" I )- �- i y �-_ Parcel ID: 051-064-30 Structure served by this system Well production at time of test Water storage tank Well disinfected ❑ C bacteri mg/L Arsenic ug/L Collected by Date of Sample gallons test? ❑ Yes ❑ No is Negative ❑ Nitrate less than MRL (ND) ❑ Arsenic less than MRL (ND) C. LIFT STATION ❑ Required maintenance completed Age of lift station yea Lift station material D. ABSORPTION FIELD DATA TRENCH MT1/MT2 Which system tested (date installed) 7/20/00 Adequacy test date 6/30/22 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 7.16 ft (max) Fluid depth prior to test 40.5/36 in Measured depth to pipe invert from grade 3A ft (min) Water added 486 gal ❑ N/A - pressurized field New depth 47/44 in Monitor tubes go -to bottom of effective. If not, state Elapsed time 120 min depth into effective 3.95'& 3.54' ❑ Code -required soil cover over field Final fluid depth46.25/43.25in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) Gallons introduced N/A oallons If yes, enter date - Comments/DeflclencleS: DRAINFIELD 85%-90°h FULL UPON ARRIVAL "WATER NEVER APPEARED IN CLEAN OUTS THROUGHOUT TEST - WATER USAGE INSIDE HOME WAS LIMITED DURING RECOVERY PERIOD - DRAINFIELD IS APPROACHING THE END OF ITS USEFUL LIFE - AREA AROUND MT1 HAS SLIGHT DEPRESSION (SEE PHOTOS). SEE EMAIL FROM OWNER REGARDING NO FREEZING ISSUES 1w�nrQ�AG- o -j -711 �ZZ e` S�OrFis-,^�� /fir !.lBSU2i�;�a l COSA Checklist yellow sheet 3 L4 so &Po-8sc�0;rov 0 r up VJwss 0 E. SEPARATION DISTANCES AWWU 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 > 9� ❑ Yes if No ft es if No ft Neighboring Tank > 100' ❑ Yes if No ft Private S eptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' E] Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 0 Yes if No ft Animal Containment > 50' El Yes if No ft Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes Manure/Animal Excreta Storage > 100' ft Co ewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Yes Absorption Field > 5' Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALLATION 1983 RESERVE BED WAS NOT TESTED OR EVALUATED. MT FOR 1983 BED NOT LOCATED. IaSJ�—r-LAL b -t. G. ENGINEER'S CERTIFICATION Q�o�60�40� OF'�°�� 1 certify that I have determined through field inspections and review 'S�4GU of Municipal records that the above systems are in conformance with p y ° MOA COSH guidelines in effect on this date. * • : • . t • 49 .... A. , .. _ _ ,I• ....... �.4 COSA Checklist yellow sheet ,j' .J vQ09. f r y A. ar ness., G�� —795 Z,�i7G� e aprt(essi00°oo #AECC884 DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221381 Subdivision: Northwoods #4 Block 16 lot 19 907-343-7904 Fax: 343-7997 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 22 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. Ma�lirg Address P O Box 196650 *Anchorage, Alaska 99519_'665p*www muni org Municipality of Anchorage ® Development Services Department i,; .;``... �: ........... Building Safety Division s,A F F. T Y On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate of On -Site Systems Approval # OSC221381 During a recent adequacy test on the septic system for Block 16, Lot 19 of Northwoods #4 subdivision, 40.5 inches of standing water was observed in the absorption field. This indicates that approximately 90+% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval • • • Municipality of Anchorage On-Site Water&Wastewater Program (907)343-7904 5 A s [ V CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-064-30 Expiration Date: 3 ^�3- 19 1. GENERAL INFORMATION Complete legal description NORTHWOODS S/D#4; BLOCK 16, LOT 19 Location (site address) 21464 SNOWFLOWER LOOP, CHUGIAK,AK 99567 Current Property owner(s) BRIAN COOK Day phone 351-4440 Mailing address 21464 SNOWFLOWER LOOP, CHUGIAK,AK 99567 Real Estate Agent PETE CARPENTER Day phone 854-8404 2. TYPE OF DWELLING: IN Single Family (w/wo ADU) ❑ Duplex n Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I I Individual On-site Individual Water Storage (1 Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System I Public Sewer n WaiverNadancerequest for.. N/A Distance: - Received by: Date: / ��46 COSA to be released to the engineer,unless otherwise requested by the engineer. ((( COSA Fee$ Waiver Fee$ Date of Payment � Date of Payment Receipt Number 0 2-061 c5,G Receipt Number COSA# US 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD, SUITE 101 *ANCHORAGE,AK,99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 4 0/f 5 Engineers Comments: In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the ,��n�7�11 Ill guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the 4 44,........0, S_ 0 , ♦• ♦ condition of the system/s on the date/s of the evaluation.Separation distances were measured to readily identifiable features. 10'•P.\\•,. l 'e. ♦♦ Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic ♦ \ • •,•/J •`•�'•.,`�♦♦ systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during .•• `�,� the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system's.These i *: 49 , ./ i'‘ •' * ♦♦ conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the I • 7 • system's;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. # • GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the v .. r.. .} v current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the �, • e . G a ess• .= information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ♦♦ %/� �C47 E 795 authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. •J'J'•�. t• ;'� ,,,, .. . ...... .. 6. DSD SIGNATURE LICENSE'1 �rO�ESS�vuove'' \• • System#1 Approved for S bedrooms. System#2 Approved for bedrooms. Disapproved. pF Af�CyU�c Q� \ - . Conditional approval for bedrooms, with the following sti 1atirs PND Z"' o PS�OGRP`� c P �ap4zspnrr C,2"C: By: 1l ,�.., I� f�� Original Certificate Date: LI S ^/ The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations 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. ATTCHMENTS: , COSA Checklist Nitrate Advisory Septic System Advisory S,. Arsenic Advisory Well Flow Advisory Other (Rev.10!12/12) If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: NORTHWOODS SID#4; BLOCK 16, LOT 19 Parcel ID: 051-064-30 A. WELL DATA PUBLIC WATER SYSTEM Well type PUBLIC If A, B, or C provide PWSID# Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protecte. N) Total depth ft. Cased to ft. Casing hei. -.ove ground) in. FROM WELL LOG 1 SPECTION Date of test Static water level .. ft Well production g.p.m. g.p.m. WATER SAMPLE RE - S: Coliform colonies/100 ml. Nitrate mg./L. Collected by: enic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA vi Tank Type/Material STEEL Date installed 7/20/2000 a �- 1000 Ili t Tank size gal. Number of Compartments 2 Cleanouts (Y/N) YES -A.,- Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A `4 o Date of pumping 4/11/2017 Pumper JR'S PUMPING _ V *BELOW EXISTING GRADE.6.9'DEEP AT MT1 WITH SLIGHT DEPRESSION AROUND THIS STANDPIPE. C. ABSORPTION FIELD DATA APPROXIMATELY A 5-6 FOOT DIAMETER AREA WITH A 1-1.5 FOOT DEEP DEPRESSION CENTERED 1 AROUND PIPE.DEPRESSION MOST LIKELY FROM OLD TEST HOLE IN THIS AREA. Date installed 7/20/2000 Soil ratingp.d./�'or ft2/bdrm) 0.6 System type 5-WIDE Length 75 ft. Width 5 ft. Gravel below pipe 4.1-4.2 ft. J Total depth *6.9-7.5 ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 3/23/2018 Results (Pass/Fail) **PASS For 3 bedrooms ***47.75/ ***54.25/ Fluid depth in absorption field before test 43 **'* p p in. Water added 461 gal. New depth 50 in. ***47.25/ Elapsed Time: 1380 min. Final fluid depth 42.5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **DRAINFIELD 90%FULL.2000 5-WIDE DRAINFIELD SHOULD RECEIVE ADVISORY LETTER.THE 1983 BED TYPE DRAINFIELD WAS NOT TESTED OR EVALUATED.THE 1983 DRAINFIELD IS CONNECTED TO SYSTEM WITH A DIVERTER VALVE.DIVERTER VALVE SET FOR FLOW GOING TO 2000 DRAINFIELD. ***MT1/MT2 -NOTE:FILLED SYSTEM TO COMPLETELY FULL.4.25"OF LIQUID IN CO1 AND 5.5"IN CO2.LIQUID LEVELS CHECKED 405 MINUTES AFTER STOPPING WATER WITH A 5"/5.25"DROP IN MONITORING TUBES WITH A SLIGHT TRACE AMOUNT OF WATER IN CLEANOUTS. '***DID NOT ACCOUNT FOR HOUSEHOLD USAGE DURING RECOVERY PERIOD.TANK NOT PUMPED.OWNERS USE WATER SPARINGLY. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circui - •uirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATER SYSTEM Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/se. ervice line Holding tank • imal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ PVT&200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ PVT&200'+ PUBLIC F. COMMENTS .• , OF ,84' �441 G. ENGINEER'S CERTIFICATION `P:• '•�S/r.1. ' 1 certify that I have determined through field inspections and •.• . • review of Municipal records that the above systems are in :11111F • • conformance with MOA COSA guidelines in effect on this • • re •• ess: �� date. • �'�':/ CE— 73 Engineers Printed Name JEFFREY A. GARNESS �•V.4 4 .•.•a , �,,.c.;5-4 Date f 3b/(g LICENSE • ,'1llII •`lisiv' •' #AECC884 (Rev. 10/12/12) <Or) Municipality of Anchorage • Development Services DepartmentBuilding Safety Division S A f F r On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate of On-Site Systems Approval # OSC 181124 During a recent adequacy test on the septic system for Block 16, Lot 19 of Northwoods #4 subdivision, 43 inches of standing water was observed in the absorption field. This indicates that approximately 90+% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval C Municipality of Anchorage -- Development Services Department / Building Safety Division On -Site Water and Wastewater Program s , 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051- 06 H -so COSA # Or 012 Expiration Date: 5�_ / �2_ — / 0 1. GENERAL INFORMATION Complete legal description Lot 19; Block 18; Nonhwoods subdivision #4 Location (site address) 21464 Sunflower Loop Chuglak, AK 99587 Current Property owners) Maiya Yde Mailing address Lending agency Mailing address Day phone 301-1548 Day phone Real Estate Agent Susan Bickman Day phone 240-0385 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑� TYPE OF WASTEWATER DISPOSAL: Individual On-site ✓❑ Individual Holding Tank ❑ Community On-sfte ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm S s S engineering Phone 6942979 Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer S. DSD SIGNATURE Approved for _�� bedrooms. Disapproved. 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: Original Certificate Date: (R. 11*5) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 wwW.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE A (SYSTEMS APPROVAL CHECKLIST .sf Legal Description: /2 i '�i� ; 've)r_TN k)r&bS 4,11 � Parcel ID: -0,5-1-060-30 A. WELL DATA Well type 61MrnV171i(/ Date completed Total depth ft. If A, B, or C provide PWSID # Sanitary seal (YIN) Cased to ft. FROM WELL LOG Well Log (Y/N) Wires properly Casing heigve ground) in. ME Date of test Static water level ft Well production g.p.m. g.p.m. WATER SAMPLE RESULT . Coliform onies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arse ' . ug/L date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank TypelMaterial 136PTle,I Date installed6 Tank size /Coogal. Number of Compartments 0? 11 '' Cleanouts&) y6`� Foundation cleanout(ON) Yes N Depression over tank (Y& O High water alarm (Yra) �Jo Date of pumping 8/a Pumper �J F� S �t7MPln16 7tJC� . C. ABSORPTION FI LD ATA �•. Date installed O Soil rating (g.p.d./ft? or ff/bdrm) �• System type - l>7�>xy �� N FYI r � Length 75 ft. Width S ft. Gravel below pipe 4 ft. Total depth r9' ft. Eff. absorption area JL0fe Monitoring tube qrs Depression over field Date of adequacy testu2 `J 00 (Pas Result Fail) �S For, bedrooms n ^ Fluid depth in absorption field before test 3G in. Water added gal. New depth in. p " q50+ d Elapsed Time: f 1)min. Final fluid depth') in. 1 Absorption rate >= g•p• Any rejuvenation treatment (past 12 mo.) (Y& type) )() If yes, give date D. LIFT STATION IQ Date installed 'Pump on" level at _ in. Datum Size in gallons 'Pum eaet-8t = in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 0/11 C 1n.,7?Ve1rf 0,0�V�� Septic tankAift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer /septic service On adjacent lots sewer manholelcleanout Holding tank areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I r i r Building foundation S * Property line 5 f Absorption field 5 r r r Water main /0+ Water service line Surface water /GYM r Wells on adjacent lots / 'f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r /D r Property line /0 t Building foundation /p + Water main 4 r / Water Service line /Or'f Surface water IM Driveway, parking/vehicle storage /0+ r r Curtain drain 6.04 Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined thro gh field inspections and x•• r:. f: �! review of Municipal records at t abov ms re in conformance with MOA COS uid nes n ffe this ate. I ••••«• •., r r ,'r•W �. i. 55410. • �, �i Engineer's Printed Name Date a+�& �i t 7711 6�199;l h\ LA'S" _ COSA Fee S t/ Waiver Fee $ Date of Payment /nJ r-� Date of Payment Receipt Number (l2rJ RS 1 / Receipt Number (Rev. 11105) Municipality of Anchorage Development Services Department .� Building Safety Division L' ' 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. COSA # %0903 Expiration Date: 7 - --215 - 0 7— Complete legal description Njor- bwood% ILL4 , !- tcl G lb Location (site address) ), t q L 14 Sviow-f-lotnftr LP. Current Property owner(s) dorrAmn J�"ToA Vtu,ut Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Lie,a Covtvtcr Day phone .244 -o� Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System 131, TYPE OF WASTEWATER DISPOSAL: Individual On-site [, Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Eagle River Engineering Services Phone VI q - 5 r -IS' 1042 1 VFW Rd., Suite 201 Address Fanta Rivnr AK 899;77 Engineer's Printed Name Chris -hp iw t4. (Awd Date -7 J�e�jOb 5. DSD SIGNATURE Approved for _3 bedrooms. Disapproved. 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 Engineers Report Other By: � W Original Certificate Date: —7 (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/onsde (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: \i0r43riwood5 it= N L IOf B 13 Parcel ID: A. WELL DATA Well type L2wr""ni 4y If A. B, or C provide PWSID # _ Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly protected Y Total depth ft. Cased to ft. Casing height a ground) in. FROM WELL LOG AT ECTION Date of test Static water level ft ft. Well production 9 P.M. 9 P.m• WATER SAMPLE RESU Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL ic: _ ug/L date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material _ pe I ehlC/ S-IA" Date installed -7 / a-•f 100 Tank size 1. 000 gal. Number of Compartments .2- Cleanouts ON) V&i= Foundation cleanout ON)'7l" Depression over tank (Yo 14 High water alarm (Y" LTU Date of pumping 906/vS Pumper -To is C. ABSORPTION FIELD DATA Date installed -7%'1 00 Soil rating (g.p.d./ftZ or t1° - r+n) o•(o System type bra i n Length '15 ft. Width ft. Gravel below pipe ft. Total depth 9 ft. Eff. absorption area „]fO ft' Monitoring tube U LS Depression over field -(Q„ Date of adequacy lest i / L /0 b Results a , Fail) —Pet S-s For .3 bedrooms Fluid depth in absorption field before test g2 3_ in. Water addedJ+5'o gat. New depthd8 in. Elapsed Time: Amin. Final fluid depth A- in. Absorption rate >= qso g.p.d. Any rejuvenation treatment (past 12 mo.) (YO& type) ` 04n t "Q-0e) If yes, give date An I'd D. LIFT STATION Date installed 'Pump on' level at_ in. Datum _ E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump off" at _ in. High water alarm level at in. Cycles tested Meets alarm 8 circuitrequ)wmmants? / - \ VV SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septiic aerice line containment areas On adjacent lots 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 t S Property line -ts , Absorption field '' S Water main + I o ' Water service line + 10 Surface water + t o o Wells on adjacent lots + too ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line +-10, Building foundation + (0' Water main r I o ' Water Service line t I o' Surface water fi too' arkin ' Driveway, y p gNehictestorage,�Q_ Curtain drain + S o ' Wells on adjacent lots +100 ' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. B Engineer's Printed Name Lillnod '• (1T Date COSA Fee $ q-30 — Date of Payment ��a4l0,(Q Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ASBUILT SEWARD h ASSOCIATES LAND SURVEYING 694- 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALEt.1� FOLLOWING DESCRIBED PROPERTY' I ` �� OF Atq DATE] ....... AND THAT NO F.NCROACHMENTSIEXIST EXCEPT AS`P.•'' S 0 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID EASEMENTS, COVENANTS OR RESTRICTIONS y<viy6o�� WHICH DO NOTIAPPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 1� •• Dyenn Mlr4 S.wd ANY DATA HEREON BE USED FOR CONSTRUCTION. �� 1; '• 1S-6918 OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. BOUND--DRAWN: I ,O/1�f °� L n taw •*' Municipality of Anchorabe Department of Health and Human Services Division of Environmental Services 1 ' On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. O Sl - 0 6 y - 30 HAA# Expiration Date: 1. GENERAL INFORMATION Location (site address or directions) 21464 Snowflower Loo Current Propertyowner(s) Randy McAfee •T. Day phone688 -4 6 2 7 Mailingaddress 21464 Snowflower Loop Chugiak, AK 98567 Lending agency Day phone Mailing address Real Estate Agent Remax/Charlotte Schlosstein Day phone Mailing Address 2600 Cordova, Suite 100, Anchorage, AK 9� Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by:1 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: 257-0106 R/rt-/00 Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Q Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family cn-site wastewater disposal and'or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or 6 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7_.=5.-ev Ci M, 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 Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection• the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances. and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No,204 Phone L� 1 `i 0L c) 7% Address Eagle River, Alaska 99377 Engineer's Printed Name J20R i •e r C cO w.4.✓ Date / __L/00 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the following stipulations. Maintenance Agreements Supplemental Engineer's Report Other By: ((� �. (J Original Certificate Date: G%' /✓�-0 b Expiration Date: 9 - / !�-- O Reissue Date: 75 0,5 (Rev 31 CV Municipality of Anchorage RE C E I V E D • Department of Health and Human Services Division of Environmental Services On-SIte Services Section 825 `L' Street Room 502 SEP 14 2000 P.O. Box 196650 Anchorage, AK 99519.6650 ww (907)343-4e.ak.us 1811NWMMOFAN04MAM (907) 343 4744 �AL t8 DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ALWO Date completed Total depth Date of test Static water level Well production WATER SAMPLE Coliform / If A, B, or C provide PWSID # Sanitary seal ft Cased to ft FROM WELL LOG ft g.p.m RE S: :olonies/100 ml Nitrate _ Date of sample: Collected by: B. SEPTIQUOLDING TANK DATA W#II Log Wires properly protected height (above ground) AT INSPECTION III 9 -p.m mg/I Other bacteria colonies/100 ml in. Tagk Type/Material ZALe1f'Mh -'-- Date installed Tank size Id" gal Number of Compartments Z Cleanouts X�LFoundatipn cleanout -Y -Cf Depression over tank 60 High water alarm Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed _r%�j v v Soil rating p.d./ or ft2/bdrm) System type 5Nkwyz uJ �LL�vey Length �Si ft Width ft Gravel below pipe —14-Lft i Total depth _46�_ft Effective absorption area_2�2—t ft2 Monitoring tube e5 Depression over field /VSO Date of adequacy test N&W �41% Results (Pass/Fail) 955 For :3 bedrooms Fluid depth in absorption field before test -0- in Water added '— gal. New depth —=- in. Elapsed Time: -� min Final fluid depth in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 11d*Ak- 16,WW If yes, give date — 72 M (Rev. 01W 0. LIFT STATION Date installed _ "Pump on" level at 111 E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: in High water alarm level at in Meets alarm & circuit requirements A6f�+L Septic tank/lift station on lot On adjacent lots Absorption field on lot Public sewer main Sewer /septic service Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /0 .f— Property line Absorption field t Water main Water service line /0 �f Surface water /OV d - Drainage /0-2 Wells on adjacent lots N SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O -'•' Building foundation/0 i r Water main /O Water Service line /0 f Surface water /0-b Driveway, parking/vehicle storage---L�.O- Curtain drain Alter e- Wells on adjacent lotsN A F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name P06#47- C. Co.✓g.✓ Date_ 1.6 )- /00 HAA Fee $ ®a Waiver Fee $ _ Date of Payment Data of Payment Receipt Number © (033JReceipt Number. 72-028 (iW. 01i00)• y ` ■oeev� c. cu..... ygf\� CE -8801 MDNICIPALM OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPAIMENT OF HEALTH AND ENVIROWNTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Description (include Location (address or directions) Application Date "11S1R4/ block, subdivision, section, township, range; ( b) Applicants Nang S7-s7(IG � Knc�� S Telephone / �� .� /.; Applicants Address Pn t4, rlr rC' i ,�K o7.TL•7 (c) Applicant is (check ore) Lending Institution Cwner/builder ; Buyer other f:Ej (explain); /�i•r�T/'r^��n�^/f�r�. c�.�%arc. (d) Lending Institution Telephone Address (e) Real Estate Co. s Agent Address Telephone 2. Type of La silence Single -Family EET Multi -Family Number of Bedream Other (describe) 3. tinter Supply Individual Well Community F4 4 Public Note: If c<mnmity well system, must have written confirmation from the State Departrn nt of Envirorzental Conservation attesting to the legality and status. Is the well adequate for the number of bedroans specified in this HAA ATIIN) 4. Sewage Disposal onsite [:a Public Camunity Holding Tank Is the wastewater disposal system adequate for the number of bedrooms /N) (Page 1 of 21 2-15-84 r, r 5. E^gineering Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MDA HAA Cuidelines effect on the date of this inspection. Signed %//•�% - = c/ Date Name of Firm f�F��S Telephone ,S"L:/—�U�1��? AddressiJi�i�/i!�2 .GiF '4.1dL$ Rk Signed by Date (ENGINEER SEAL) 6.DHEP Approval Approved for 3 bedroom . jkpprovedrE:j Disapproved Terms of C.crditional Approval _ ay C. Reid, Jr. No. 2251-E _. B1' Date Conditional The Municipality of Anchorage Department of Health and Environmental Protection not guarantee the continued satisfactory performance of the water supply and/or wastewater disposal system. This approval indicates that, as of the validation shown above, based on the data and information furnished by an engineer register the State of Alaska, the water supply and wastewater disposal system is safe anc ticnal fcr the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 of 21 2-15-84 r'1 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 6 HEALTH AUIMRITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 -84 APR 610 84 a /vck ► (P ItIO2 A. WELL DATA RECEIVED Well Classification C d) '7 If A, B, or C, D.E.C. Approve ) Well Log Present (YDate Completed IV(A- Yield Total Depth, N A Cased to )VIA Depth/ of Grouting 1-114 Static Water Level (A Pump Set At L)4 Casing Height Above Ground Allk Sanitary Seal on Casing (Y/N)_ Electrical Wiring in Ccnduit (Y/N) Depression Around Wallhead (Y/N) Separation Distances frau Well: To Septic/Holding Tank on Lot OJIA- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot N�1F ; On Adjoining Lots %} To Nearest Public Sewer Line N%,+ To Nearest Public Sewer Clearcut/Manhole PU44- To Nearest Sewer Service Line on Lot Water Sample Collected By IV/k Date Water Sample Test Results A)JA Camlert:s B. SEPTIC/HOLDING TANK DATA Date Installed Size /0c) No. of Compartments -2- Standpipes ZStandpipes 6N) Air -tight Caps &N) _ Foundation Cleanout 1) Depression over Tank (Y Date Last Pumped /V& Pumping/Mairtenanee Contract on File (Y/N) A)& ; for N/* Holding Tank High -Water Alarm (Y/N) w t* Temporary Holding Tank Permit (Y/N) A6F Separation Distances from Septic/Holding Tank: To Water -Supply Wall Ai0 To Building Foundation .21 To Property Line ^ JLe1 To Disposal Field t' To Water Mair/Service Line > 80' To Stream, Pond, Lake, cc Major Drairage Course A)1A CcgMnts K 4ubmG vu Qc.J of ht"T S 6e lu d Ax"si kip 5 I"5 Goch CA) [Page 1 of 21 2-15-84 Soils Rating in Absorption Strata /SY.d Type of System Design ed Date Installed �z/,Q3 Length of Field f13 Width of Field /R Depth of Field S� Gravel Bed Thickness Square Feet of Absorption Area 77V4f Standripes Present &N) Depression over Field (YA Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Property Line (o To Building Foundation .253 To Existing or Abandoned System on Lot W% On Adjoining Lots i , iv( To Water Main/Service Line >AU To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course IVI To Driveway, Parking Area, or Vehicle Storage Area ILIU Cements kEA, 6a -L c -Ad aju�ujAll ayLt to eQ ire d a: 4,o4,o D. LIFT STATION Date Installed A)(A- Dimensions W&+ size in Gallons 'IIA Manhole/Access (Y/N) Ali{ "Pump On" Level at A.11j¢- "Punp Off" Level at High Water Alarm Level at *V/2f Vent (YM) W�jf Tested for �1i¢ Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) YU�s4 Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all in effect on the date of this inspection. Signed Date S/$ Ar : ' '••?q 1� ConpanY f#ECS 61 MOA No. KBl/d5/s [Page 2 of 21 Raid, h. 2251E 2-15-84