Loading...
HomeMy WebLinkAboutRAVEN WOODS BLK 1 LT 4Raven Woods Block 1 Lot 4 #015-232-12 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: SW PID Number:yiS23y/Z Name: Wastewater System: anew ❑ Upgrade Address: ABSORPTION FIELD Phone: No. of edrooms: eep Trench ❑Shallow Trench ❑ 8ed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: � Total Depth from original grade: , • GPD/Sq. Ft. Lot: Block: S bdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Wd 3 — Ft. P Ft. Township: Range: Section: Fill added above original grade: Gravel length: 0— I Ft. .5 Ft. __� WELL: L�lNew 11 Upgrade Gravel width: ' Number of lines: I Distance between lines: Ft. –� Ft. Classification Private, A,B,Ci: Total Depth: Cased To: Total absorption area: Pipe material: b�30.y}2 r'/ a�cr Zo o Ft. ISI Ft. %r!C% So: Ft. —W- G. I• f? piller� �� Date filled Static Water Level: Installer. II_ fYr r�i13 Date install /(O FL Yield.mp el Set at:Casing at I Height Above Ground: TANK GPM C% Ft. Z Ft. SEPARATION DISTANCES Septic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manu acturer r (� Capacity in gallons: From Tank Field Station Tank Sewer Lines //\ Z5;�17 Well �/i/�� 7 ��5;7' / )I.GZ/ Maters lt� ♦ Number of Compartments: Surface / I� f > i� � � > 1501, LIFT STATION Water Lot yI/If ��y/ / / ), �,Lf Size in gallons: Manufacturer: Line / / / Foundation ICJt > 2� I / / "Pump on" level at: "Pump vel at: High water alarm at: Curtain `' / / / Pump Make 8 Model lectrical Inspections performed by: Drain l BENCH MARK Remarks: Location and Description: - Assumed Elevation: Ft r00% ENGINEER'S SEAL ej �v M, r� Ja v — `A q➢ Nyp qa 46 Inspections performed by:, lef/O_ Dates: 1st e 2nd y�Mto ®� s'° cc, E. Anderson ba v 4381-E 8 � Department of Health a Hu ervices approval `�'<�P^•.meas",!V.fw°' ���r°:,m�''�a. Reviewed and approved by: Date:'� Z / 72-0131Rev. 9/91) MDA 25 Permit No. 5'�J'}01S I- Page Z of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650_ • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ��,VPXIZ GdU;z� PID No.: flI5232IZ I �Oy (r � to K rr-,k,Wno,i E. And ,son 1381 e I„,g4,':;pi GN 4 (il% fi PpF� s;o� Permit No. �v1^( O ih'� Page 3 of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report f F�OF ALASKA Swot 401 4 DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER .WATER WELL RECORD,. - LOCATION OF WELL CONTRACTOR INFORMATION: REMARKS: B _4 _ PLEASE MAIL WHITE COPY OF LOG; -.TO: Date < - DNRIDIVISION OF WATER '* PO BOX 772116 At `+'I E RIVER AK 99577-2116 BOROUGH SUBDIVISION LOT BLOCK. -. <-" SECTION OTRS - SECTION TOWNSHIP RANGE MERIDIAN ON ❑E OS ow LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM: casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole: ft Depth of casing: / ft 17 1,2 �y BOREHOLE DATA: Depth M?ter;31 Type s^d Color' From To - `e DEPTH TO STATIC WATER LEVEL: //� a'' ft below �E) top of casing El ground surface Date: `2 f METHOD OF DRILLING: 2r air rotary ❑ cable tool ❑ other USE OF WELL: El domestic ❑ irrigation ❑ monitor ❑public supply ❑other CASING STICK-UP: ft. Diam: in. to 8/ft Casing type: . -.Lin. to j V ft G WELL INTAKE OPENING TYPE: ❑ open end ❑ screened ❑ perforated open hole Depths of openings: to ft f SCREEN TYPE: Diam: in. SlotJMesh Size: Length: ft 166 GRAVEL PACK TYPE: �� Voiume used: Depth to top: - - GROUT TYPE: Volume: FC) gZ Depth: from ft to ft DEVELOPMEN1� METHOD: rim Duration:_ PUMPING LEVEL AND YIELD: ?_gz ft after 2 hrs pumping_gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION] 1J YES ❑ NO CONTRACTOR INFORMATION: REMARKS: B _4 _ PLEASE MAIL WHITE COPY OF LOG; -.TO: Date < - DNRIDIVISION OF WATER '* PO BOX 772116 At `+'I E RIVER AK 99577-2116 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 919 (2 DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940184 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:THOMPSON WESLEY P & JULI-ANN OWNER ADDRESS:12921 AVO CIRCLE ANCHORAGE, AK 99515-3740 PARCEL ID:01523212 LEGAL DESCRIPTION: RAVEN WOODS BLK 1 LT 4'' LOT SIZE: 111792 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/21/94 EXPIRATION DATE: 6/21/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 7?W4,,DESIGN ORIGINAL:SY SU13MITTED BY THE ENGINEER WAS TO H:6 P`kET Or_T_l=ct WITH A TOTAL DEPTH OF 12.0 FT. 9.0 FT. OF EFFECTIVE GRAVEL. RECEIVED B ISSUED BY: REVISED WITH D'cq' /7 DATE: &/ y / %y DATE: L/ JCC e?cl6✓tc-/-,^ �4-/P,eli A�Jf June 06, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTHAUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 ILI Street P.O. Box 196650 SEWER &WATER Anchorage, Alaska 99519-6650 MAIN EXTENSIONS REFERENCE: Ravenwoods Subdivision; Lot 4; Block 1 SEWER & WATER INSPECTION Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. ENGINEERING STUDIES AND REPORTS Test holes were excavated and percolation tests performed. The approximate locations of the test holes are located on the attached site plan. The monitoring tubes within the test holes have been WELLINSPECTION checked and found to be dry. & FLOW TEST This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed SITE PLANS septic system. If you have any questions, or require additional information for your review, pl contact us. ROAD DESIGN Since ly, SOILTEST e Shafer, P.E. PERCOLATION / TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 . _:, � �;ty A a aC)a au4 pNi P s 0 x s z, �> WN ® a z �}A e Z Kia a O F F Z c a=o b tI- w q 's ZF OK o0ii; 3 (IVoa IlVal Sa3ddVa1 w z o �o Oz w z U O O �3a <¢ Z aN zaO U ON ol..d U Q W Wm =W W ... - �z er aZ JWMJ VIJw �V)� w h O z <—V;m O J M,�w"-Z� `� IAWa zo 0 w Q �� 100' WELL RADIUS a Viz 0 S. C) �Omtw�W� J VZU—wi~wm�'l p o o aW U D � V) Q w o U F Fo 0- dw 1\ Vt Z ^ /� moo �1 o r.w O 0 U Oao � ��� V� i i 11 z z w uou > z \\ Em o Ljj Hado Q ¢ u o w�3o w zxo z Z- O N �Wyy W Z W m00 V) a py N.I� Q VNtO �.-cONV Ul�U] "� a F Wa �P.d W Q J O SCJ UW O � Z06 zN� a w E z E, w 4 3 m oaa P, Kr x w El 6 � a � &r � WP 31tl03 NVId HIS .09 = „L _ Y e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:, 1` • '�7�UN �/P• DATE PERFORM LEGAL DESCRIPTION: ��l✓N y�. S L ` i g 1 Township, Range, Section: e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:r`�✓'J""�_ DATE LEGAL DESCRIPTION:?AUeN LJpJO.0 S/0,j_1,&wnship, Range, Section: 1 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 011& S,,-.0 y C4.v /TrtAOF OfXl Sir—zy SA'Npy t,,, �Fi=w FwE SA*D QDLK�,7 Tff2wbN-cSu.7 m � v. �f �1A,tL SILY�Q SF}Nli w�SrcT Eagle River, Alaska 99577 PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4/85) WAS GROUND WATER n ,D ENCOUNTERED? 'v S IF YES, AT WHAT L O DEPTH? p E Depth to Water Ager Monitoring? Dale: S A 9 Reading Date Gross Time Net Time Depth to Water Net Drop 3 — a✓8 " _ :SS /Omw 3sit =/S `IJ SMrN Y" 3I ' s:a5 ISr..eti �s �'s" PERCOLATION RATE TEST RUN BETWEEN r. /inch) PERC HOLE DIAMETER 6 SFT CERTIFY THAT THIS TEST WAS PERFORMED IN THIS DATE. DATE: • Municipality of Anchorage ff; On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval L / Parcel I.D. 015-23212 Expiration Date: 1. GENERAL INFORMATION Complete legal description RAVEN WOODS; BLOCK 1, LOT 4 Location (site address) 6266 TRAPPERS TRAIL ROAD *ANCHORAGE 99516 Current Property owner(s) LAURA & RYAN NOFZIGER Day phone 907-782-9767 Mailing address Real Estate Agent Day phone _ 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 _ 4. TYPE OF WATER SUPPLY: Individual Well ❑X Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: N/A TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by:��— COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment g X211 S Com, Receipt Number COSA # oSCl 5 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK 99507-1259 I Engineer's Printed Name Jeffrey A. Garness Date 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 systems on the datals 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 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 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. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short GEG disavows any legal duty to anyone other than the persoruparty who paid for this report. ,. Y OF , S. DSD SIGNATURE J� ON-SITE O� i TER D G> _ System #1 Approved for bedrooms J� WASTEWAT m System #2 Approved for bedrooms ER Z o PROGRAM Disapproved l p Conditional approval for bedrooms, with the following stipulations: SERJ}GEf?O\`` By: Original Certificate Date: The nldplt y o n - ge 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheer 31-12.doc 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: RAVEN WOODS; BLOCK 1, LOT 4 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 9/29/94 Sanitary seal (YIN) YES Total depth 200 ft. Cased to 181 ft, FROM WELL LOG Date of test 9/29/94 Static water level 161 ft. Parcel ID: 015-232-12 Well Log (YIN) YES Wires properly protected (Y/N) YES Casing height (above ground) 12'+ in. AT INSPECTION 7/29/15 I&I Well production 4 g.p.m. 3.38 g.p.m. WATER SAMPLE RESULTS: Coliform Z?r colonies/100 ml. Nitrate 0 b mg./L. Collected by: GEC. Ltd. Arsenic: NP ug./L. Date of sample: 24/15 B. SEPTIC/HOLDING TANK DATA TankType/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/NYES Depression over tank (Y/N) NO Date of pumping 7 W Z Jl-!5- Pumper owt- 5 C. ABSORPTION FIELD DATA Date installed 9/9/94 Soil rating (g.p.d.Vo /bdr 0.8 Date installed 9/9/94 Cleanouts (Y/N) YES High water alarm (Y/N) N/A p0 (-P1.f6- System type DEEP ,TRENCH Length 50 ft. Width 4 ft. Gravel below pipe Total depth *14.16 ft. Eff. absorption area 900 fe Monitodng'tube YES Depression over field NO Date of adequacy. test 7/29/15 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 54 in.. Water added622 gal. New depth 71 in. Elapsed Time: 150 min. Final fluid depth 66 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump ofr' level ' . High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field *5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main NIA a Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ASSUMED. NO CLEANOUT AT BEGINING OF TRENCH; HOWEVER DOUBLE CO'S AFTER TANK WILL ALLOW FOR ACCESS TO TRENCH FROM SEPTIC TANK. TRENCH IS ON A 30% SLOPE. NO DAYLIGHTING OBSERVED. CONDITION HAS EXISTED FOR ALMOST 21 YEARS. G. ENGINEER'S CERTIFICATION I certity4hat i have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date a bs& (Rev. 11105) S 0�_ 60 Cb £31,3 ANIS N VA fill HELL ----- -- - Pd iP;RO)TE7CnVE VVELL RADIUS ILD 7 1,3 CANIT HOUSE DETAIL 1:2 4�: Z Municipality of Anchorage°<G On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-232-12 Expiration Date: a 1 `� 1. GENERAL INFORMATION Complete legal description RAVEN WOODS SlD; BLOCK 1, LOT 4 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 6266 TRAPPERS TRAIL, ANCHORAGE, AK, 99516 WESLEY THOMPSON Day phone 6266 TRAPPERS TRAIL, ANCHORAGE, AK, 99516 Day phone 2. TYPE OF DWELLING: sn' Single Family (w/wo ADU) L11VI1 I i ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) MAY 2 0 2014 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 345-4928 TYPE OF WASTEWATER DISPOSAL: Individual Well N Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ W aiverNanance request for: Received by: O Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52__°_ I ` Date of Payment Receipt Number COSA# OSCI7I �� Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below/ verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance ofthe system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the yea(, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this repents for the sole benefit of the owner listed above. Any reliance upon or use of this report by any ofherperson or party is not authorized, nor will it confer any legal right whatsoever 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditional approval for M -r bedrooms. bedrooms. 337-6179 Date S l0yrs bedrooms, with the following stipulations: �wtiv����(�OFt I�C�frrr�� �� ON-SITE WATER AND :o WASTEWATER oz `v ROGRAlvi 01) Original Certificate Date: a �?- The Whicip0lity or Agjok6rage 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 ofAlaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other A ' 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: RAVEN WOODS SID; BLOCK 1, LOT 4 Parcel ID: 015-232-12 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 9/29/1994 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 200 ft. Cased to 181 ft, Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/29/1994 4/23/2014 Static water level 161 ft, 156 ft. Well production 4 g.p.m. 3.79+ 9.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.69 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 4/23/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 919-10/1994 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping +" Z'41' 14 Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA ITELOW Exisrwc cRAOE Date installed 9/9-10/1994 Soil rating ( .p.d./ r ftlbdrm) 0_8 System type TRENCH Length 50 ft. Width 4 ft. Gravel below pipe 9 ft. Total depth `14.3 ft. Eff. absorption area 900 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/23/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 53 in. Water added 615 gal, New depth 66 in. Elapsed Time: 120 min. Final fluid depth 58 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off" level at a er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/I'rft station on lot 1001+ On adjacent lot; Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manholeldeanout Holding tank 100'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field •5'+ Water main N/A Water service Wells on adjacent lots 1001+ 10'+ Surface water 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 17+ Building foundation 10'+ Water main N/A Water service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 104 Curtain drain NONE KNOWN Wells on adjacent lots 1004 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 COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date ch TJ iy (Rev. MUM) LOT 8 �� LOT 5 l — — N e0VaDO-E 372.64— — qO' UTILITY EASEMENT LOT 4 M 12.2'x23.8' 2.566 ACRES $ ( SH£ LOT 9( f 8 M SEPTIC i z CLEANOUTIWELL7— E ASPHALT FPRO7TECT�IIVE 0 1 > 1 LOT 3 RADIUS // .0'x28.1 ;ANT. 5'x 10.s' ;ANT. H,)USE DETAIL STALE 1:40 PLOT PLAN AS BUILT X SCALE i" = 100° GRID SW 2738 Project No. L14040AI Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 fax � kenBiongsurvey.com �� ACq�V j jonothanolangsurvey.com G,� ,....., I hereby certify that i have surveyed the following described property: ®�iV^;°''�r-'�� LOT 4, BLOCK i, RAVEN WOODS SUBDIVISION (PLAT # P-583) Q�'C�; jt Anchorage Recording District, Alaska, and that the improvements situated thereon are w'):' 9TH within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed {{(( premises and that there are no roadways, transmission lines or other visibleE..G.........;J. easements on sold property except as Indicated hereon. KENNETH G. LANG' LS -5202 Dated this the 3 Day of UJA! , at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, �ti �`S510NAt• covenants, or restrictions which do not appear on the recorded subdivision plot. MUNICIPALITY OF.ANCHORAGE / r • DEPARTMENT OF HEALTH R HUMAN SERVICES, Division of Environmental Services On -Site Services Sectiomr P.O. Box 196650 Anchorage, Alaska .99519-6650 343-4794 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING SZ 3 Z. i Z. Parcel I.D. # 015-7— HAAS 1. GENERAL INFORMATION - Complete legal description LOr . ' SuB�IJISIOnI r. Location (site address or directions) ZO I APPgft5 �I�- �oAA TIZ Property owner C w rJ C -Po, mr, -N C. Day phone 305 Mailing address' 1>0, i3or, /12313 AniCA4on466- Aft- 9'Y511 Lending agency &1A,- Io^I4A_ &,Mw of ALACfo Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well X7CX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX -A, 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 systema 72-M(Rev.1/91) Front MOAN21 - 5. STATEMENT OF INSPECTION BYE ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigationof 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. 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 Firm %�NA�7LSe� � Grn1cra4N6 Phone -3 q,4 VSs I Additional Comments bedrooms, with the following stipulations: 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 theState of Alaska. The DHHS does this asa courtesyto purchasersof homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before ia.certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-M(R v.1V81) Be* MOA#21 ® Municipality of Anchorage AVM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ��/ / At✓ylyV Parcel I.D. O/SZ32/Z. I Sr{ps,p. A. Well Data (� Well type h r, V;tA, �\ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Z/o Driller -� a. If Total depth lob Cased to /S/ Casing height Z Sanitary seal (YM) r Wires properly protected (YM) / FROM WELL LOG AT INSPECTION Date of test: —T Static water level Well flow Y g.p.m. Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/boldit tank on lot / -;On adjacent lots-;. > /SD Absorption field on lot a /S] ; On adjacent lots Public sewer main > Public sewer manhole/cleanout > / n ;/v - sewer v - Sewer service line /22 Petroleum tank /Vbf WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/Y6 TANK DATA Date installed —Tank size It ZSp Compartments Cleanouts (Y/ N) y Foundation cleanout (Y/N) _Depression (Y/N) High grater alarm (Y/N), Alar tested (WN) Date of pumping���kPumper rte' ' SEPARATION DISTANCES FROM SEPTIC440EBttCr7ANKTO: Well(s) on lot ? I`?.�/ On adjacent lots Foundation > /S / To property line %3%� Absorption field f -Water fRoWservice line 757 Surface water/drainage > 72-026 (area)• From CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical i "Pump on" level SEPARATION DKfANCE FROM LIFT STATION TO: adjacent lots D. ABSORPTION FIELD DATA "Pump off" Level at tested Surface water Date installed 9/,� 94 Soil rating (GPD/Ft) - $ System type �— Length Width 7' Gravel thickness , `� Total depth 73 Total absorption area 7SO 5•C Cleanout present (Y/N) / Depression over field (YM) Al Date of adequacy test —Results (pass/fall) [ �� for i"Bedrooms Water level in absorption field before test /� After test Peroxide treatment (past 12 months) (Y/N) If yes, give data SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot � /S7' On adjacent lots -' 15-0'f Property line ;-9Z., To building foundation > 30 To existing or abandoned system on lot r � On adjacent lots gyp® Cutbenk N`�if� Waterfneirdservice line > $ r 1 � Surface water Driveway, parking/vehicle storage area Curtain drain Nle/ E. ENGINEER'S CERTIFICATION t certify that I have checked verified, or conformed to all MOA and HAA guidelines itf this inspection. A L VV �r 4111 _ 0* 49M Signature y En inser's Name A t C.OACL. Ait a 2S onl d� i g C '• 4381-E • �'/ Date �Zif lq�i ®�19 �'`•:.. •�a�� i�l�,p�+U ESS�aN�a "+svaar>� HAA Fee $ Waiver Fee $ ' Date of Payment Date of Payment Receipt Number 41*1 5 Receipt Number 72-026 (3/93)` Back -