HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 2 LT 13North Woods Phase 2 Block 2 Lot 13 #051-821-13 MUNICIPALITY OF ANCHORAGE .--'.! r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION --t (.41 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEW,Q� GE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME j..L0 /��y—/�-- r ``�.4)) P PHONE EW UPGRADE MAILING ADDRESS U P6, Pax ND , l , 1 LEGAL DES �PI 11 / �p,J�tLia., 11 0 . �ij`L rfJ LOCATION //` e�� NO. OF BEDROOMS SEPTIC TANK DISTANCE TO:! Well ti--- Absorption area /� Dwellin i PERMIT�.Q�6/0� f Manufacturer 71t Ma�tq�/�� /'� ,.0 —11 No. of coartments Liq, Icapayilons yy IF HOMEMADE: Inside length Width Liquid depth 0 �' J22 0— 4 DISTANCE NCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well �'� 1� Foundation 0 Nearest lot line f PERMI=,N Of'b /, No. of lines,--- Length of e b line �ld' �n�-- Total lengyjlgya lines /.F n" r Trrrenc width, y' '......... Distancj%b tween lines cp Top of tile to finish grade / Material beneath tile// (co inches Total effective absorption areja ,.pGQnI /700 zytcY' SEEPAGE PIT Length Width Depth PER IT 0. J/v 4t:/?4S0 Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J L.1 CI/ 1. g �/j_ N Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER PIPE MATER ALS q P.C- . / v SOIL TEST RATING INSTALL,ER nI REMARKS r/(� ^ dr e yz" S 311 APPROV.D DATE LEGAL ct,....__ 1 --.,;(9 --(e-,-, 72-013 (Rev. 3/78) mur4IoIF1FIL_Iyy ov. FiriovioRn-AnnE: DEPARTMENT Ce -HEALTH AND ENVIRONMENTAL 9TE 14 * 825 'L STREET, ANCHORAGE, AK. 99501 2E4-4720 1:711"4—!SI-T P."PM PERMIT NO. ( 830106 ) APPLICANT STEVEN L. SKAGGS P. a BOYD. CHUG I AK LOCATION LEGAL LOT 13 ELK 2 NORTHWOOD 11''' 0 g3 644(.4.Se LOT SIZE -999999 SQUARE FE TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING <SQ FTSBR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CREEP -TEA= -4 1.__E-ENGTFA== 11...7?7" OPFWEEL,.. CREEP -TEA THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). MEE 11-PEENCF-fl waol-FA i OIDO -PEEEE'T_ THE GRAVEL DEPTH IS THE. MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION IN FEET). PEQUIPED, 7=7;E:PTIC: 7-PliV4K 1 2= iiiCi oFIL_t_or4 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 'TWO R::> FIPEZ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TC' PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150. TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. - SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ENkt:MBP JLE487 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3 I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE sEMODELED TO INCLUDE MORE THAN .-ig-DRoovia SIGNED: HPPLIC•4 STEVEN L. SKAGGS ISSUED BY fse4e,197, 8):A1 S ---37 3 667 10--&Q-L/ POUCH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOW1ES, MAYOR D1 I'ARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (Permit #: 821059 January 31, 1983 TO: Permit Applicant Subject: Lot 13 Block 2 North Woods Subdivision Phase 1I A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 • MUNICIT717-111-IW oF FING-AncsilE DEPARTMENT HEALTH ANE:' ENVIRONMENTAL ODTECTION 825 'L' STREET, ANCHORAGE: AK:. 99501 264-4720 fSEEWEEFZ IREIRMIT PERMIT Na ( 821059 ) APPLICANT STEVEN L SKAGSS CONST PO BOX D CHUGIAK 99967 A88-2831 LOCATION LEGAL L1382 NORTHWOODS II LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS Etml1-1-1= -4- L...1a14-413T1-1= L7 Ot-F2!~1a1.- IDIIPTF-1= THE LENGTH DIMENSION IS THE LENGTH IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE E:ETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). 171 -IEE 17FZ EE1',41 1-1 1.,11 I C>11-1-4 I E.:: 0112:i F=EEEE ir. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL E:ETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. moD <0_-> 19Rna BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-EIRMIT EXF•IF:E_P-75. CIECEMBER: 131_,82 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED • APPLICANT STE'v'EN L 5KAGVt0NST ISSUED BY DATE_ -3qX-2 4 (1 h7-/ • O & E EN(. LEERING & DEVELG. MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name* ,Q Mailing Address' ` ` 8 e K JD, Cif u � /<' ' '<. 99A-6 7 Legal Description. L' oT ! / GO�, A/D2TN YVe c LD S 6/ gdJ P//.ksc EK,EJ/ 2, 5K4 c s &ici.s,-77 Tel. No 6Se -,2 ff'3/ Depth (feet) Soil Characteristics 0 1 ML 5/Lr 7-P 50/4_ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 P42c. i T Sol S / L 'T `.' 6/2.44 v e CC - 4A/ -4A/ v a 5.4/4L L. 44 L E/v1Es c,� S4N PLOT PLAN Alb 5-e4LO PERC. TEST 5� ,!/^r//.v S© 4/5,2. / Ground Water Encountered: Yes No iZ If yes, what depth e Proposed Installation: Seepage Pit___ Drain Field Comments' (1JJ ) f'`, s.. /4974".7. 1..°...°..°••• :... r. 02073.1% _ Earl P. Ellis : W e 4i '•� NO. 1745-E J .44.4.'‘.#q�el?OFESSI 1,18.. ft Performed by: Date. /7 pZ /5 ix. a •G Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-821-13 Expiration Date: « 3 1 —1, 1. GENERAL INFORMATION Complete legal description NORTH WOODS PHASE 2 BLOCK 2, LOT 13 Location (site address) 23215 NORTHWOODS DRIVE, CHUGIAK, AK 99567 Current Property owner(s) MATTHEW McCOY Day phone Mailing address 23215 NORTHWOODS DRIVE, CHUGIAK, AK 99567 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: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System z WaiverNariance request for: TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank Community Public Sewer Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 52. (o.. OD Waiver Fee $ Date of Payment tD 13 /2-0/ (C Date of Payment Receipt Number 06a3gReceipt Number COSA# "SC -1 (0l20h 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 6/2/2016 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: OE Af1/4 49 x of KENNETH M. DUFFI ' 15/00 ON-SITE �0 WATER AND 5' • WAS T EWATFR z cc\ PROGRAM c�: S• �ic41y- �"l��nCFc'' r Original Certificate Date: —,S9-1 �Q The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.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: NORTH WOODS PHASE 2 BLOCK 2, LOT 13 Parcel ID: 051.82113 A. WELL DATA — PUBLIC WATER Well type If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Y Wires properly protected (YIN) Total depth ft. Cased to _ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate _mg/L Arsenic: _ ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Date installed 3/29/1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) 11 High water alarm (YIN) N Date of pumping 5/3112016 Pumper JRs C. ABSORPTION FIELD DATA Date installed 3/29/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 280 System type BED Length 50 ft. Width 34 ft. Gravel below pipe 0.5 ft. Total depth 5 ft. (Measured 5131/16) Eff. absorption area 1700,ft2 - Monitoring tube Y Depression over field N Date of adequacy test 6/112016 Results (Pass/Fail) " PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 6 in. Elapsed Time: 1380 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Size in gallons "Pump off' level at _ in. Cycles tested - PUBLIC WATER Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 104 Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS Vacant system presoaked per code prior to testing. Water main 10'+ Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M.DUFFUS Pate 612116 COSA canary sheet2-6-15.doc 0 2 Parcel I.D. 051-821-13 4 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval ///�� Expiration Date: 6 1 1. GENERAL INFORMATION NOYn Weals5 Pk&SE a Complete legal description Block 2, Lot 13 Location (site address) 23215 Northwoods Dr. Current Property owner(s) Michael & Diane Lindberg Day phone PO Box 299021 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank 9 Community Class Well ❑ Community ❑ Public Water System E Public Sewer ❑ WaiverNariance request for: Distance: Received by: 2si..�C - Date: &/2 6/ 13 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ CACIO / wi 4 - t` -&k S\n Waiver Fee $ Date of Payment Col (D i (a3 f i \ Date of Payment Receipt Number CfoLA 1 G Receipt Number COSA # OrDCA J1 eanCI 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 Pannone Engineering Services LLC Phone Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for By: (907) 272-8218 Date 6/25/13 - reqN. 4 i' jIr. 49 TH ..0 9+) a IP r * 0/ • • Steven R. Pannone • I+}�`Sl. CE—8149 �1 �OFESSIONP��.' bedrooms, with the following stipulations: \-cYtkttt `OF jo.,. ON-SITE WATERPRO `• AND "� WASTEWATER d S- )j & DSER�7) Original Certificate Date: C" -2- 6— (�i The ity Fr Anr jacfe Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet ( 1.. c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: N rthJvoods #2, Block 2, Lot 13 Parcel ID: 051-821-13 A. WELL DATA Well type AWW U If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) FROM WELL LOG AT INSPECTION in. Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA 1 Tank Type/Material Sep 1-. C /S'E'EP./ Date installed 3 t72 ? /9 3 Tank size le 00C3 gal. . Number of Compartments o2 Cleanouts (YIN) / C Ye $ Foundation cleanout (Y/N) reS Depression over tank (Y/N) /VD High water alarm (Y/N) Date of pumping eh -40' 13 Pumper s Pu -vv 1 �S 0 C. ABSORPTION FIELD DATA Date installed 3/29/83Soil rating (g.p.d./ft2 or ft2/bdrm) 280 SF/BR System type Bed Length 50 ft. Width 34 ft. Gravel below pipe 0.5 ft. Total depth 5.5 ft. Eff. absorption area 1,700 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/25/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 3 in. Water added 483 gal. New depth 6 in. Elapsed Time: 110 min. Final fluid depth 3 in. Absorption rate >= 450+ g,p.d. No Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in. Size in gallons Manhole/Access (Y/N) "Pump off' level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: 9136-- Septic tank/lift station on lot'f Vie Absorption field on lot - A 0 u On adjacent lots in. On adjacent lots "err Public sewer main -7 Public sewer manhole/cleanout�9� Sewer /septic service line 25*- Holding tank 11/- 41-9941 Animal containment areas - Manure/animal excrete storage areas*eel-- SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Water main 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Water Service line 10+ Curtain drain 50+ F. COMMENTS Property line 5+ Water service line 10+ Building foundation 10+ Surface water 100+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ G. ENGINEER'S CERTIFICATION I certify that 1 have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 6/25/13 COSA brown sheet 10-10-12.doc 14 l'1416 Steven R. Pannone • 4 /tl` o tr4- E-8149 �� i1 lt, �OFESSIO � JUN -25-2013 15:02 FROM:JR'S SEPTIC PUMPING 9073449821 TO:2728211 P.1'1 JRs Pumping PO O Oox 773415 Eagle River, AK 99577 (907)694.6454 Billing Information Pannone Engineering Po Box 100217 Anchorage, AK 99510-0217 (907) 272-8248 Off [J9.b_ Ite_Infonrtatio.n.... .... Dan 23215 Northwoods Drive Chugiak, AK 99567 (907) 272-8218 Job Description: P.0, Number Terme: Salaarep. Mop Book; Cross Streets: Job Comments: 1000g Net 30 Dawn Service Agreement Number, 038801 Order Date: 19 -Jun -2013 Service Date: 24 -Jun -2013 Technician: Mike Tax °%: 0 Job Type: Repeat Map Grid: 15 - - Whispering Birch Drive Last Service 11-17-2006 1000g pumped & checked tank Additional. Location Comments: Diagram: smiegrarnst14688.brng Corner lot on left of Voyles/Sheltering Spruce -white w/aqua trim, #'s on mailbox 3 bdrm septic in front & visible tank access to left of house at ground level Service Type Septic Sery 1000K Qty Price Each 1 $205.00 Tax? No Gallons Planned; 1000 Gal. Actual: Hose Length: Double Tank: 0 Pump System: CO Baffles Inlet: 0 Baffles Outlet: 0 Extension Actual $205.00 Estimated Charges: Actual Chargee: Nontaxable Total 5205.00 Taxable Total Tax Total Grand Total 50.00 50,00 5205.00 Customer agrees to the terms and conditions shown, THIS IS A BINDING AGREEMENT. Signe an aturI d Title o/ Customer Rapresentative Accepted by JRs Pumping Date l' v ' 'Pr Date Accepted For your added convenience we accept; Dlcover, Visa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. 530.00 For NSF Checks Returned. { QF -A•1 .®•'' arca••' * **4 9TH 'r, s e rcara No, 3143-5 o. bks..,...._':.; •11...14",44r � it 30:00' 30.00' a1"�+a •;,9 Ili ln�kofi£: ie • tor tit 1-1/2" Aluminum p 4f 0, '0 LOT 13 BLOCK 2 NORTH WOOD SUBDIVISION PHASE (82-204) I Split Level Wood Frame House on Conc. Found. 5.3' Wood Deck & Stairs -N Conc. Pad - I Asphalt Driveway 60.0' 0 a Riser Pipe0 0 Deck 26.2 2,1'01.91 r Cont. 2.1'x13.7'1t Cant. , A� 26.2 Conc. Wolk & Steps Stairs Conc. Po (Typ') 15 Tei.. & Elec. Eosemer 106.91" 50'00'00"E 11,5' 11.9 SCALE Z hear 30' 15' 30' Wire Fence LOT 12 Upper Level Wood Deck 7' x 12' Wood Shed on Conc. Slab 8.9 SHADOWY SPRUCE DRIVE hat an accurate survey of the following described I hereby certify t property LOT 13, BLOCK 2 NORTH WOOD SUBDIVISION PHASE II (82-204) was mode on June 21, 2013 and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto:,; that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing. Anchorage Alaska, this 25th day of June 2013 Utility Pedastal (TYPO 60' 5/8" Rebor (TYP-) PREPARED FOR: PANNONE ENGINEERING AS-BLILT DWN. JSP DATE 6/25/2013 GRIP NW 1559 NW 1560 FILE NO. 1323' F.B. :2d13 PG. 25 JOB NO. 1347 KARABELNIKOEF SUR VEYIN G rge7i 3$,_9,3. Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051 - 821 —13 1. GENERAL INFORMATION Complete legal description MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MAR 3 1998 RECEIVED HAA # A.W1SrX1-1ii Lr /3) Bk -2 (17*61,JboOS i Location (site address or directions) Z 3 Z- / 5- Nom—f74IAX,0 PS 402. /14M4-. c 4 -,,,mow 1 Ate' Property owner Mailing address Lending agency Mailing address Agent Address Day phone 242.-9 38 Q, o goy b 7! Q C -c.%1 , Are, ,c75-67 Day phone • Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 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 X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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 •f this inspection. Name of Firm 337-6/71. Address Engineer's signature .Go953 :Fa 6. DHHS SIGNATURE . Vd Sq • ^••9.194.•' �•°;pF gto�a\°v"' X Approved for 3 bedrooms. ,k'bArbsibP4, Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments Date 4 - 6 -- CAUTION CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 521 MUNI EPALI?Y Qt ANCHORAG E ENVIRQ�r�yENTAL SERVECEs QIVISIQ Municipality of.Anchorage MAR 3 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division R ���r�n��i 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) r3?L41O N Health Authority Approval Checklist Legal Description: 1.1041— 13) 134Z.) .T} Nb'2}-wt O1S Parcel I.D: A. WELL DATA We •e If A, B, or C, attach ADEC letter. ADEC water system number 2 00 Log present Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected(Y/N) FROM WELL LO AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA (, ») Date installed 3/i67/$ 3 Tank size I Number of; Compartments Z Cleanouts (Y/N)/S Foundation cleanout (Y/N) yds{' Depression (Y/N) MO / Date of Pumping 21251, t Pumper J • Q S ' C. ABSORPTION FIELD "DAA 00 el -,,J —OUTS Date installed 3/241 93 R Total depth 4.S Soil rating (g..p.&1fi or ft2/bdrm) Z ,O System type Length Width 31- Gravel thickness below pipe lS1 Effective absorption area 11x70 Monitoring Tube present (Y/N) 7 Depression over field (Y/N) iNO Date of adequacy test 2/Z5198 Results (Pass/Fail) PMS For .3 bedrooms % Fluid depth in absorption field before test (in.); E)(j Immediately after 3 gtal. water added (in.): 5 Fluitl depth �� (ins) Minutes later: 8'4'r Absorption rate = 4� 't" g.p.d. Peroxide treatment (past 12 months) (Y/N) No^'e- KApi,J"/ If yes, give date ` A.!/A 72-026 (Rev. 3/96)* D. LIF TATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" 1 - - "Pump off" level at* *Datum C ed E. SEPARATION DISTANCES TION DISTANCES FROM WELL ON LOT TO: Septic/holding tank o Absorption field on lot Public sewer main Sewer On adjacent lots On adjacent to ublic sewer e/cleanout Lift station ne SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation 514- Property line � Absorption field Water main/service line l0 i' Surface water/drainage ) DOf {" Wells on adjacent lots 12 P /981 /AU,. @.EParig- 2-Z O } SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1O + Building foundation tO 'f' Water main/service line 10 ff-' Surface water Curtain drain I O'- - 12..,aow4 Wells on adjacent lots 2 -VD'+ i I o0 4-' Driveway, parking/vehicle storage area 5 F. ENGINEER'S CERTIFICA ION 1 certify that I h. de in: in conforma - � r Signatu e Iry / �1 uideli I f Engineer's Name fie u «-rTA-eµ£e F A inspections and review of Municipal re tiiarthe es in effect on this date. e�_,' J c t A. �. s Date 3 30/9 6 ®• c"'% • icE /� 3 • Y �...•' �• k9C�PR •...4,6:�0V010 HAA�.r .s Fee $ 30(9.o 0 Date of Payment 3 -31- 9Q Receipt Number 03 5---`f 6 (a) 2s_3 ) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Alaska Water & Wastewater MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MAR 3 1998 7320 East Chester Heights Drive — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers March 30, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Reference: Lot 13, Bk2, Northwoods S/D #2. To whom it may concern: RECEJVF,) The subject 3 bedroom residence is served by a private septic system and a community well. Per Municipal records the septic system consists of a 1000 gallon tank followed by a 34' X 50' (1700 ft2) bed. Both were installed in March 1983. According to the HAA guidelines, drainfields installed in 1983 were required to have a monitor tube and at least one clean-out. According the installation inspection report (1983), neither a clean-out or a monitor tube were ever installed during construction. It is our understanding that the house had been vacant for approximately two weeks prior to our evaluation. The septic tank was pumped by JR's pumping on the morning of February 25, 1998. During our evaluation, it was noted that only one 4 inch diameter PVC pipe was located in the general area of the bed. The pipe was measured to extend 53 inches (4.4 ft.) below grade and was found to be dry. For the purposes of performing an adequacy test it was assumed that this pipe was a monitor tube. Water was added to this tube at an average rate of 2.54 gallons per minute for 155 minutes (394 gallons) which caused the liquid level to rise to 5 inches. It should be noted that the liquid level rose to the 5 inch level immediately after the first 33 gallons was introduced and remained at that level even after an additional 361 gallons was added. After approximately 14 hours (845 minutes), the monitor tube was checked and found to be dry. From this data, it was determined that the drainfield meets the (Municipal) absorption requirements for a three bedroom dwelling. These results are based on the following assumptions: 1. The 4 inch dia. tube is in fact a monitor tube located within the bed system. 2. The monitor tube extends to the bottom of the sewer rock (bottom of the bed sys.) and 6 inches below the invert of the distribution pipes. In order to confirm these assumptions it would be necessary to install a clean out in the bed and verify that the monitoring tube is indeed in the drainrock and is set at the proper elevation (six inches below the distribution invert). NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this septic system. If you have any questio , please feel free to call me at 337-6179, or 244-9612. Sincerely, 17 Je', A. �: ess, P.E., M.S. Pri cipal MUNICIPALITY OF ANCHORAGE D DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL t_ �j g OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date December 31, 1987 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13; B.2och 2; Non.hwood6 Subd4iv.L Lon z Location (address or directions) (b) Property Owner A!abfza Hou6ting Telephone: Home Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY/Lynda Barmen Address P.O. Box 771699, EagCe Riven, A2a6fza 99577 Telephone 694-5500 (e) Mail the HAA to the following address: or: Check here RI, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING/694-2979 170_3_4__Eagte Riven Loop Road, Sate 204 Eag.Pe R.ivm, A.P.a4ha 99577 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3 ondened by Lynda Barmen 3. WATER SUPPLY Individual Well 0 Community 0 Public G(1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite RI Public 0 Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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DIVISIO A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) 1S3 HEALTH AUTHORITY APPROVAL (HAA) 1 2 l .� a3 CHECKLIST - FEBRUARY 1984 264-4744 RECEIVED Legal Description. . tu.1-_. Z L.rn- t2, t3��•2 If A, B, C, D.E.C. ApprovedefiN) Well Log Present (Y/N) Date Completed Cased to 1,-3 Total Depth Static Water Level Depth of Grouting Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) c:-.7'-1 To Nearest Public Sewer Line ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results CommentsG1r3 iPi t�1'l�t'C\ Wt9t 2c-,{�1 1D 2.-4',G=0 B. SEPTIC/II-GLOW TANK DATA Date Installed 3" '0.2, Size 1�� Standpipes 6'N) y Air -tight Caps¢9N) Depression over Tank (YL Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) No. of Compartments »/f Separation Distances from Septic/Htrtding Tank: To Water -Supply Well To Property Line (� r "� To Water Main/Service Line 1 c� Course Foundation Cleanout(PN) Y �ate Last Pumped f- ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field r t2. To Stream, Pond, Lake, or Major Drainage Comments T� S l s� t-- ) P ' f €71—c -1 Page 1 of 2 72-026 (Rev. 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z.e,c7 ' -- Type of System Design fl - Znl - `t='3 Date Installed Length of Field �4f Width of Field Depth of Field Gravel Bed Thickness 4� tt Square Feet of Absorption Area \ 1 CD(7 Standpipes PresentON) Y Depression over Field (Y6) Date of Last Adequacy Test k - ' ` - Results of Last Adequacy Test - � - -77 Separation Distance from Absorption Field: To Water -Supply Well 7�f7 1't` To Building Foundation 2v To Property Line To Existing or Abandoned System on Lot 1---) As ; On Adjoining Lots 3c l� To Water Main/Service Line 1-1-1-.3(A To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course \tom "- To Driveway, Parking Area, or Vehicle Storage Area 2/7I Comments D. LIFT STATION 0/pc Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumpin les during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all IvjOA ar}d HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date / L/ SY 17034 Eagle River Loop Road No. 204 Comparut eagle River, Alaska 99577 MOA No. 8? c-'�3 Receipt No. '=2-O0/-O0/L 1-- 12-ge Date of Payment Amount: $ Page 2 of 2 I / V 72-026 (Rev 8/861 Back Sciftni (u7 F DEPT. OF ENVIRONIVIENTAI, CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 "C" STREET. SUITE 1334 ANCHORAGE, ALASKA 99503 DATE: 1-5-88 PWSID #: To Whom It May Concern: 213001 STEVE COWPER, GOVERNOR According to the records on file in this office, the LITIES/NORTHWOODS 563-6775 CHUGIAK UTI - Water System is in compliance with the State of Alaska Drinking Water Regulations, Sincerely. Ronald S. Klein Environmental Field Officer APPLIrti NT FILLS OUT UPPER HAS ONLY Property Owner tJa(/r'i ,B{.11 I de e.3 Mailing Address P. 0 . Zox /2 e 2. e.A ("r a ki Ia,3k , Zip Code �Y J �U7 j Phone 1 8X ` 9a3? Buyer Address Date /( J Zip Code Lending Institution - - Address .. Zip Code Phone Realty Co. & Agent Address Field Notes: tt \-. -(" _ Zip Code Phone Legal Description .1,01 /3 43/o(4. Street Location Uo uaj czar . ,27 ,��^^�� ik)(71 (.)0QC7 S . 1A --O Phase ..�,[... 'Type f Residence Single Family ❑ Multiple Family No. of Bedrooms 'CONDITIONS OF APPROVAL oo BY:Ii,i 0 Other Water Supply 0 Individual 1 Community Public Utility Date Sewer Installed Well To Absorption Area Well to Tank ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal AIndividual 0 Public Utility O Holding Tank Year Individual Installed: 1n:3 When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time i Date Date Date Date ..,////./11,1 sc/,C41M•.J9, , Inspector Inspector Inspector Inspector Field Notes: tt \-. -(" O "Municipality Environmental LJ [aV APR "Dept. tf Se of of Health flE UU �J 1983 Mncharag3" & Protection" r ( ,) APPROVED BEDROOMS ^l ( ) DISAPPROVED �j ( ) CONDITIONAL APPROVAL' DATE,,, 'CONDITIONS OF APPROVAL oo BY:Ii,i Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72-023 (3/32)