HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 3North Woods #3 Block 12 Lot 3 #051-732-12 rerunratpaury or Anchorage • y Development Services Department Building Safety Division On-Site Water 8 Wastewater Program, 4700 South Bragaw St. `� ~ P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 On-Site Wastewater Disposal System and/or Well Ins pection Report Paa° 1 or 3 Permit Number. SW050151 PID Number. 051-732-12 Nam.: LINDA BEACH Wastewater System: ❑ New ■ Upgrade Addreee 22909 CREEN GARDEN DRIVE • CHUGIAK, M. 99567 ABSORPTION FIELD Phone: No. of BWroome: (907) 688-3335 3 ■ Dep Trench D Shallow Trench O SW aMound DOther LEGAL DESCRIPTION '°l T^ w °� can alp rasa Brock tot SubdMeton: 0 8 ao/so n 9 MAX R 12 3 NORTHWOODS J3 oen a ..pip.o.mn n.e. W.%M rade G; daww.m m e►los SEE DWG. Township: — Range: — sectlon: — R 6+ n eee.e sew. e,gneh r� ase R WELL: SEE DWG. n 50 n •"" e""° / New ❑ Upgrade 4w. or r� aweww. o.hw.w res 2.5 e+..neahee A,9,C Cad T«� — T.ral as.wgbn er.x R PM m.r.rNt R srw. waw t..rt 600+ sa R, D 3034/ F-810 rira n owner GEG, Lt]d. �`` 7/1-7/2005 cawro rrge Asa aw.e: �X �Qip( -? n TANK SEPARATION DISTANCES To ■septlo DHolding 0S.T.F-P. C! Other s4Pt a AD tion From Tank flNd stair" � s.... u�°"�',,. ANCHORAGE TANK m 1000 Well — — — — 25'+ e.ewwe STEEL Nwnow a eanearmwMe 2 Surface water 1000+ 1000+ — — — LIFT STATION Lot Une 5'+ 100+ — _ _ Ms• to °a.- Yemr..e.w: Foundation 5'+ 10'+ _ _ _ en 6"`i ec a: wA.r Harp ML- :Curtain CurtainDrain NONE KNOW Mww Oi6Ud ewv.eea M.rn..d or Remarks: THE OLD SEPTIC TANK WAS BENCH MARK COMPLETEIY ABANDONED PER UPC. tA.elbn ens u..,,rs.c BACK DOOR THRESHOLD 4 Aft we ENwlbn: 100.00 R ENatNEER7 QF F:. • .�g044 Inspections performed by: GEG, Ltd. �*�' Dates: 1st 7 1 2005 / / p......... ....... .......: * 2nd 7/5/2005 3rd 7/6/2005 t7 %j . . . ......mesa:' �0 Development rvices Department Approval °a, E-79 3 .` O�dp�°dp Reviewed and approved by: ate: t.«. ,yo,1 p��r..00 10 PERMITNUMBER: SWO50151 AS -BUILT DRAWING SW0 r A I 4TH/ EXISTING DRNNFlELD ABANDONED IN PLACE )R FUTURE USE CRAVTTY FLOW COULD NOT BE NIEVED FROM NEW TANK TANK PARCEL ID NUMBER: 051-732-12 LOT 4. BLOCK 12: NORTHWOODS S/D/3 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS MI L llooll NaA owt nl • bcmwaL r pwrAn. In . la[ Oali11•.laN . •SIC •w{•.�, ...... .......... PREP FOR PHONE NUMBER: LINDA BEACH PACE NUMBER: .. ... ............ 907 688-3335 2 OF 3 Q a eY mess. LEGAL DESCRIPTION: pRAyyN BY: QC —7 53 O o� NORTHWOODS SUBDIVISION #3: LOT 3, BLOCK 12, .A.L O{. ``* R TYPE OF WORK: wrE: O�p.,,�/g�� q,�°o AS—BUILT FOR SEPTIC SYSTEM UPGRADE 7/8/20054400 '�� 1R«. oiAUI 60 61.9560 73.3290 71.5873 68.3914 W 67.9563 74.5486 74.1515 41.6626 61.95 4TH/ EXISTING DRNNFlELD ABANDONED IN PLACE )R FUTURE USE CRAVTTY FLOW COULD NOT BE NIEVED FROM NEW TANK TANK PARCEL ID NUMBER: 051-732-12 LOT 4. BLOCK 12: NORTHWOODS S/D/3 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS d GENERAL CONTRACTORS MI L llooll NaA owt nl • bcmwaL r pwrAn. In . la[ Oali11•.laN . •SIC •w{•.�, ...... .......... PREP FOR PHONE NUMBER: LINDA BEACH PACE NUMBER: .. ... ............ 907 688-3335 2 OF 3 Q a eY mess. LEGAL DESCRIPTION: pRAyyN BY: QC —7 53 O o� NORTHWOODS SUBDIVISION #3: LOT 3, BLOCK 12, .A.L O{. ``* R TYPE OF WORK: wrE: O�p.,,�/g�� q,�°o AS—BUILT FOR SEPTIC SYSTEM UPGRADE 7/8/20054400 '�� 1R«. oiAUI PERMIT SW0 N�151 AS -BUILT DRAWING PARCEL ID NUMBER: SW050151 051-732-12 HAL GRADE - 97.54 Plil TOP OF TANK AT INLET - 93.35 TOP OF TANK AT OURET - 93.31 j� NEW 1000 GALLON `) A� °- 9.8 I SEPTIC TANK I �1 OF BUNG AT OUTLET - 92.39 -FINAL GRADE 2,40 93.01-95.58 AIZORIGINAL GRADE - 94.11 HIGHEST POINT) RT OF PIPE - 91.19 s� `BOTTOM OF 1 - TRENCH -83.11 L-RELATNE ELEVATVON OF BOTTOM OF TEST HOLE - 79.11 (TEST HOLE DRQ GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS •••••• ••••• ••••••••.:... =I L VAM .WD. V M I"- MaCkw . Mt MM11 � MOIL pgrovyjn • w per, o • 4 w.—r�y-- PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .•••• ...... ............ LINDA BEACH 907 688-3335 3 OF 3 • T e LEGAL DESCRIPTION: DRAWN BY: OQ Mo, • , CE- 9),3 NORTHWOODS SUBDIVISION #3; LOT 3, BLOCK 12, R.A.L.4�p s ' •�'!2,��000� p �Oi1oo'od� TYPE OF WORK: DATE: Q prof no PROFILE AS—BUILT FOR SEPTIC SYSTEM UPGRADE 7/8/2005 Permit Number: SWO50151 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 995196650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jun 02, 2005 Expiration Date: Jun 02, 2006 Parcel ID: 051-732-12 Legal Description: NORTH WOODS UNIT 3 BLK 12 LT 3 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 022909 GREEN GARDEN DR Owner Name: LINDA BEACH Lot Size: 43919 SQ. FT. Owner Address: 22909 GREEN GARDEN DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567-5438 This permit is for the construction of: Q Disposal Field E✓ Septic Tank Holding Tank E] Privy E] Private Well El Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by catling (907) 343-7904 ( 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: Date: ^' Issued By: �,�� Date: 1 Al Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ok.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. /757 232-/A Permit Number Property owner(s) LINDA BEACH Day phone 688-3335 Mailing address (1) 22909 QRFFN CARDEN DRIVE * CHUGIAK. AK, Mailing address (2) Eff,05 I. RAP Lei Z KIM Kel Legal description (Section, Township & Range) N/A Lot Size Y39/ 9 Acre � Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. 1 further certify that this application is being made fora Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: Date of Payment: Receipt Number: 744, Waiver Date of Payment: Receipt Number: GA,RNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS May 24, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Northwoods Subdivision #3; Lot 3, Block 12, To whom it may concern: The existing 3 bedroom house is served by public water and and a private septic system. The septic is currently in the state of failure and needs to be upgraded. We are proposing to install a new 1000 gallon septic tank and a deep trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the area of the drainfield is a 10-15 percent slope running approximately southeast to northwest. In short there is no slope concerns. We are unaw of any adverse impacts this installation would have on adjacent wells or septic systems. If you have ai questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 0 Fax: (907) 338-3246' Website: gamessengineering.com oor/ LOT 16, BLOCK 1: /(NNORTHWCOONCOSERSN/D LOT iS, BLOCK 1: / NORITIWOOOS S/D / (NO CONCERN) / / / � � ►gni i � Lha 14, BLOCK 1; NORTHWOODS S/D (NO CONCERN) / / LOT 13, BLOCK 1: NORTHWOODS S/D (NO CONCERN) / LOT 2, BLOCK 12: NORTWOODS S/D /3 (NO CONCERN) 3 BE HC LOT 1. BLOCK / I I NORTHWOODS S/D2/3 I (NO CONCERN) I I 1T 7, BLOCK MHW00DS S, (NO CONGER LOT S. BLOCK 12: NORTHWOODS S/D /3 (NO CONCERN) LOT S, BLOCK 12: NORTHWOODS S/D /3 (NO CONCERN) VA '�'� LOT 6, BLOCK 14: y." I I I OLENN VIEW ESTATES (NO CONCERN C%� L GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS C Tp011 p10. •1R 101 • MUGMLG Nf M001 . �Iql( -SIT • AY M . pY1L• .w PREPARED FOR: PHONE NUMBER: PACE NUMBER: LINDA BEACH (907) 688-3335 1 OF 3 NORTHWOODS SUBDIVISION #3; LOT 3• BLOCK. 12, R.A.L. OF WORK: DATE SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE 5/23/2C IK". V 1M) NUMBER OF BEDROOMS:3 GALLONS PER DAY (CPD): 450 PERCOLATION RATE/S:13 MIN.ANCH PROPOSED APPLICATION RATE 0.6 MINIMUM DRNNFIELD SO.FT.:563 MAXIMUM DEPTH:B FEET WIDTH: 2.3 FEET LE4CTH:50 FEET M.OA APPROVED SAND FILTER: N/A EFFECTIVE:6 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT-- 600 ARFAD LAT 2. BLOCK 12: NORTHWOODS S/D /3 (NO CONCERN) EXISTING SEPTI: TANK TO BE COMPLETELY ABANDONED INSTALL FLOW EXISTING DRAINFIELD TO BE USED AS A RESERVE SITE — 4 7HI 1-m IX W / H fJ� h'1�u PROPOSED 1000 GALLON SEPTIC TANK LAT 4. BLACK 12; NORTHWOODS S/D/3 - ate. GARNESS ENGINEERING GROUP, Ltd. p, 4 CONSULTANTS& GENERAL CONTRACTORS �.•••.• ••• •• •• .... .......... VDI L MOR llY 10= 101 • Nomar. NI MlOt • ROI[ puy= SIT • W (pW} M • gulp w� yrll PREPARED FOR.- PHONE NUMBER: PAGE NUMBER: •• . ...... .......... UNDA BEACH 907 688-3335 2 OF 3 Q eY ness: LEGAL DESCRIPTION: DRAWN BY: OO o, CE -79 ��� NORTHWOODS SUBDIVISION #3: LOT 3, BLOCK, 12, R.A.L �� e,�' y/le!yyr. tl o TYPE OF WORK: LUTE: 404000 AOQ�o4�i' DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE 5/23/2005 IN FRO TANK FINAL FABRIC FILTER 9' GRADE GARNESS ENGINEERING GROUP, Ltd. p* ."4 CONSULTANTS & GENERAL CONTRACTORS . m1 L Rc V*% VJM 101 • rocraL we aeas • nd[ 6�)vr�iw • sa horlsss.uw . snnn ....,.ice... 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • • • . . • • • • ... ........ LINDA BEACH 907 688-3335 3 OF 3 of y A. Ga ess. LEGAL DESCRIPTION: DRAWN BY: QO ° CE -79 NORTHWOODS SUBDIVISION #3; LOT 3. BLOCK. 12. R.A. 0 ''ewe '• 1,�}��5�a��a`d� TYPE OF WORK: DATE: 40Q400� sTO� PROFILED OF PROPOSED DRAINFIELD UPGRADE 5/23/2005 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS& GENERAL CONTRACTORS SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: NORTHWOODS SUBDMSION •3; LOT 3, BLOC PERFORMED FOR: LINDA BEACH TEST HOLE #1Lv DEPTH TO GROUNDWATER •. DRY I I 111111111 5/23/2005 � — 6- — /.� HHH • 30 Imo.' .4'd IIIIIIIII 2 1/2- 3 1:28 — 6- lillll� 4.6.0. • 1:58 30 1 4- 2- DEPTH TO GROUNDWATER GATE DRY 5/13/2005 DRY 5/23/2005 12:58 — 6- — DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/17/2005 1 12:58 — 6- — 2 1:28 30 3 1/2- 2 1/2- 3 1:28 — 6- �- 4 1:58 30 1 4- 2- 5 1:58 — 6- — 6 2:28 30 4- 2 - PERCOLATION RATE 15 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS COMMENTS: PERFORMED BY GEC, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WASERFDRMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 24 D f �1 f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW _ I ❑ UPGRADE MAILING ADDRESS � {'� 1't t" LEGAL DESCRIPTION )n L - LOCATION NO. OF BE;AOOrJS M We area / Dwellin PE IT U DISTANCE TO: ` ,Absorption 11a- Y F Z Manufacturer Mate 'al No. of compart is w�r7 vwy- y Liq. ca acit in goons Inside length Width Liquid depth IF HOMEMADE: - ❑ �' JaZ DISTANCE TO: Well Dwelling PERMIT NO. 2 F Manufacturer Material Liquid capacity in gallons ❑ We Foun pn Neares lot line �l w= DISTANCE TO: r ��- Lu u Z No. of lines Length of a line Total lent o Ines Tren w44dt V) 6, � Distance between I' es F Z w & t inches HTop finish Material beneath tile effe area of tile to grade ❑ inches Length Width Depth PERMI NO. w C7 Q h- Type of crib Crib diameter Crib depth Total effective absorption area w° w y Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W � Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS , SOI L TEST RATI NG INSTALLER Ex- 05 A F1 f • J X REMARKS r. •�!/ d •� isSuZcLf r ' /4c 9a I e QiOen -� � � P /✓ �v O£S/f✓/ S2 S'9 � oAe& ^ /-',61.f A-1-1 / t S tln E e The*& � oe SM -�- APPROVED DATE LEGAL 72-013 (Rev. 3/78) M{ MUNICIPALITY OF ANCHORAGE Department"f Health and Environment' ''Protection 825 L Street, Anchorage, AK. j9501 264-4720 Permit # # # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT Applicant: Mailing Address: Location: Phone Number: Legal Description: L_ S� �Z—R�,nQ�� 'Lot Size: Type of Soil Absorption System Is: Trench: JVr_ Drainfield: c/ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) a,&� The Required Size of the Soil Absorption System Is: , DEPTHLENGTH V�d GRAVEL DEPTH ��r WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE 1660 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department.. will 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. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bed oms. Signed: /� ;rte C- �� ( Issued by: Applican �_� � 6_3Date: SWP/024(1/81) I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST 9 SOILS LOG l PERCOLATION TEST PERFORMED FOR: Sievert .SR 913 . DATE PERFORMED: 7/)1.I8 LEGAL DESCRIPTION:. D 1 Ai. � N,r. tAwa8 77M E+dzvk%'�n 7 SLOPE SITE PLAN I F � T f L a14 A1, `t7 i. ) � e 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS the? ,Y.', a»11jy"gi-wae1, (j m, .1 AP114 WAS GROUND WATER ENCOUNTERED? NO L 0 P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop �3 lu n0 a !O �,1�� , am a J44 .06 7/J1/93i rola OL .�a to m;nao ---139 . 4q. mOE +14.10ia0a 711i181 14 +nlAs .50 C". lao 33t `t 7/i i183 i i�oa 10 mins. a J7 cr 0 d✓� iHa0 �'711'L-"3 incl ] 10 and Ad. 045, p- QU �7��1�83 I' 76;6! I) J Al;ii :, l ( Off_ PERGOLA ON RA E in ,� L (minutes inch) TEST RUN BETWEEN 0`a FT AND �� FT AA;aA S% 8'3^-0aI /.1 s / PERFORMED BY: P—ele -'-tSO ti CERTIFIED BY: 72-008 (6/79) DATE: 7 ° - % Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-732-12 1. GENERAL INFORMATION Expiration Date: T O y— Pe Complete legal description North Woods Unit 3 B1ock 12 Lot 3 Location (site address) 22909 Green Garden Drive, Chugiak, AK Current Property owner(s) Coffman Day phone 727-5555 Mailing address same Real Estate Agent Viki Kaas, Homes Unlimited Day phone 727-5555 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: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Received by:�.-_�Gr�/ Date: COSA to be released to the engineer, unless otheVise requested by the engineer COSA Fee $ 5 Date of Payment gb3i1 �. Receipt Number O 1 qui c. COSA# bsCI til! (P 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 4/11/2016 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following By: Original Certificate Date: The Municipality of Anchorage Devlopment 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 COSA blue sheet 9-1-12.d.c X Nitrate Advisory Arsenic Advisory Other s If more than 1 septic system is on the lot: COSA Checklist # of Structure served bythis system Certificate of On -Site Systems Approval Checklist Legal Description: & ,r f h 06,,& V%. T 6 1z 4 3 Parcel ID: t051732 f 2 A. WELL DATA PC- tA114T6R Well type 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) in. FROM WELL LOG AT INSPECTION Date of test. Static wafter leve( ft. ft Well production g p.m. g.p.m. WATER $AMPLE RESULTS; Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material 0AIC- fi dR. a 7aA/ff-/ 1j-! �L'c Date installed Q5 Tank size gal. Number of Compartments _ CleanoufiQY/N) Foundation cleanout (YIN) 4 Depression over tank (Y/N) N . High water alarm (Y/N) IV Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed 7 rys Soil rating (g.p.d./f:2 or fe/bdrm) DESA � _. System type 7-kOda# Length +S�Q AL- - Width 2 s ft. Gravel below pipe t ft. Total depth 9. 5 ft Dff.'Vsorption area (¢2+fl? 'Monitoring tube v Depression"over field - ( Date of adequacytest 1l ; - Results (Pass/Fail) P. For 3 bedrooms Fluid depth in absorption fi¢tdaefore test 0�0 , in. Water added y5Q gal. New depth fl�' in. Elapsed Time: Final fluid depth 60 in. Absorption rate >= 4610 g.pA. Any rejuvenation treatment (past 12 mo.) (YIN &type) If yes, give date D. LIFT STATION IVA Date installed Size in gallons Manhole/Access (YM) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm &'circuit requirements? r E. SEPARATION DISTANCES WELL ON LOTTO: pu &IC. w.47-gA Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manholelcleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOTTO: Building foundation �'+` Property line /4 `t Absorption field Water main el Water service line / d f Surface water 1r04 r r Wells on adjacent lots 2 0o r ABSORPTION FIELD ON LOT TO: Property line %O f Building foundation AQ Water main /D 01'. Water Se[vie line �t Surfacewater ' �0� �'° Drivg�ay, parking/vehide storages ram .. Curtain drain,( as %Cr 2L*Welis on adjacent lots Z O Q If, F. 'COMMENTS G ENGINeFITS CERTIFICATION certify that l have determined through field inspections and „�t�,,.•m•°°•"tib{° &� revipw of Municipal records that the above systems are -in <g ' '•'9�+J conformance with MOA COSA guidelfnnQsy in effect on this date. Engineers Printed Name (S�il/C, eM a .e ° »...» Date + i�/ !�/ �O r..' e,� 6 W Eng �o PE 56 COSA yellow sheet_2-6-15.doc - - - ASBUILT-NO CORNERS THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: i✓onrf/ sr�crzA.rloOd ur-mat' sorb ��� iz AND THAT NO ENCROACHMENTS. EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY ONS WHICH EASEMENTS, DONOT APPEAR ON HE RECORDEDOR ISUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA E USED FOR OF FENCE LIINNESNOR FOR ESTABLIISHI GUCTION BOUND- ARY LINES. SCALE -- - i .140 s 4 DATE: �`L 0 -F -A l 4 k e GRID: i...LHK* t lulu iyry � ... ...: , FBSI Duena Merk Seward •"'� 4,••. DRAWN; Municipality of Anchorage Development Services Department Building Safety Division 5 On -Site Water & 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..'>�' I - 7-3-Z-12- COSA# -05 C- / 0/223 1. GENERAL INFORMATION Expiration Date: 9-Q=2- 11 Complete legal description NORTHWOODS UNIT ##3 B12 L3 Location (site address) 22909 GREEN GARDEN DRIVE *CHUGIAK 99567 Current Property owner(s) LINDA BEACH Day phone 688-3335 Mailing address Lending agency Mailing address Real Estate Agent Mailing address SAME Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3- 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 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 samples. (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 iry seal al�ixed i"teteto and as of the validation date Shown balow, l 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 _ GARNESS ENGINEERING GROUP, Ltd. 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 of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of 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 report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other erson or art is not authorized nor will it confer an le al right whatsoever Phone 337-6179 Date �J-2=3401 OF°gyp Q a ....... ,�s��o •..-y�l ""�.��fft�v� A�ra�ss � • . . �•• �-7953 ••' v �OQ�pr o f e s s�o�oo p p Y y V g t 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory N;1tra Le Advlsar j' OF,q�c-�.r. J ON-SITE c WATER AND : �= WASTEWATER bedrooms, with the following stipulations •, PROGRAM UrvT Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other f%' �i�. , Original Certificate Date: T� :j By:— (Rev. 11/05) Municipality of Anchorage °25..6R @v • Development Services Department ¢...-......- ' Building Safety Division On -Site Water & Wastewater Program 3 R t Y Y 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NORTHWOODS #3 L3 B12 Parcel ID:0.6-/- %3 A. WELL DATA a 133r,o Well type PUBLIC If A, B, or C provide PWSID# A Well Log (Y/N)— Date completed Sanitary seal (Y/N) Wires properly prote (Y/N) Total depth ft.Cased to ft. Casing he' (above ground) in. FROM WELL LOG INSPECTION Date of test Static water level A. Well production WATER SAMPLE Coliform colonies/100 ml. Nitrate mg./L. Other bacteria Ars ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material DEEP TRENCH Collected by: .colonies/100 ml. GEG Ltd. Date installed 7/7/2005 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping / O Pumper r C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/1-7/2005 Soil rating (g.p.d./ft2o 2/bdr 0.8 System type DEEP TRENCH Length 50 ft. Width 2.5 ft. Gravel below pipe 6+ ft. Total depth 9.5 ft. Eff. absorption area 600+ ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/13/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test22.534in. Water added 716 gal. New depttf!-. sin. Elapsed Time: 330 rein. Final fluid depth41/47-51n. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Anim.ment areas On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main 10'+ Water service line 10'+ Surface water_ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 5'+ 100'+ 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 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION A,5—OF A v 1 certify that 1 have determined through field inspections and * ;' • ,� O review of Municipal records that the above systems are in D conformance with MOA COSA guidelines in effect on this date. OO f r ..A:. S.:.. Q Engineer's Printed Name JEFFREY A. GARNESS OQ�'�s •, CE 795 � 2 iv 0 '• •• •, Date 40ey "°ro f essiorooa COSA Fee $ q0 Date of Payment Vlo Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS. EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING SCALE: /'>so DATE: GRID= y`v /s�sy FB: s"a- 741 DRAWN. 94-0829 At Ar * JH I• Duane Merk Seward p( 6 >p 22 10 02:58p Betty Van Boven 907 688-0993 p.1 SANffARY PUMPERS 20627 UPPER BOWERY LANE CHUGIAK, AK 99567 907-688-4602 CUSTOMER'S ORDER NO. PHON= DQTE�. NA's1E ADDRESS^ 1 E1. .L 4 r -A SOLD BY CASH C.O.D_ CHARGE I ON ACCT. MDSE. RET'D. PAID OUT QN PRICE AMOUNT r� a e e i TAX RECF;VEU 8Y TOTAL All claims and returned goods Thank You! rJIUST be accompanied by this bill. 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 401 - CERTIFICATE OF HEALTH. AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # D5/732/Z HAA # H A 9 4- a S3S 1. GENERAL INFORMATION Complete legal description l GOC.,L'/2 A/D/2Ti'1JW0DhS Location (site address or directions) ZgDy 62_�Al S.4?eQ61X/,sT PE7,rRS Cgf k� A< Property owner MY&ZYK15, T/til Ag&RIVS Day phone 69j8- 6/23 Mailing address729D9G',2F�iV�.4.21 it/ST ,P�' E -K A< 44W Lending agency Day phone Mailing address Agent — Address 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 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 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 MOAN21 - Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L2 2 Parcel I.D. OS/73Z/Z No W 14140405 X118AP A. Well Data Well type A If A, B, or C, attach ADEC letter. ADEC water system number%JH(: M= 2/�0 Log present (Y/N) Date completed Driller Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION M� CNV /�MFNTq S°'"gNcNo :?� R"Ices �kSUk g. P -M . c/ 0 1994 SON tD Septictholding tank on lot goo./- / O _;On adjacent lots :906 / d Absorption field on lot 0 60`r' / ; On adjacent lots 2420 f 4 Public sewer main —AIA Public sewer manhole/cleanout /VA Sewer service line %VA Petroleum tank /V>Q WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Collected by: Other bacteria _ Date installed 7��:0 Tank size /600 6"-44 0 Compartments 2 2 Cleanouts (Y/N) 0 Foundation cleanout (Y/N) Y d Depression (Y/N) High water alarm (Y/N) NA Alarm tested (Y/N) NA Date of pumping 7/2/94 Pumper CIIPs PUMP/NG SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot NA On adjacent lots NA Foundation !3 /0t To property line /071/0 Absorption field / Water main/service line /Vit Surface water/drainage NA / ,4s t�6SEI2VEA oR MEAr~P oN X/Ir 72-026(3=)6Fmnt Aq,0" DF/fIS F/GES CONTINUED ON BACK PAGE 3 PER oWAf FR MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M� i DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel 1. D. # `� 1- l ti - \ HAA # W �1 / 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Black 12; Nvnth Woodb 03 Location (address or directions) 220 Gneen Ganden Dative (b) Property owner C2a.in & Gany €tetche2 Telephone: (home) Business Mailing Address 220 Gneen Ganden Dkive (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and AgentRixzflp�n),�D€RTT€�—AMI. �3 Awi4 te6o Address 12212 QZd Glenn Highway Eagle Riven, Ah 99577 Telephone (e) Mail the HAA to the following address: (or check here Wxif hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 294 Easle Rive., Ala*a 99577 2. TYPE OF RESIDENCE Single -Family INX 3. WATER SUPPLY Individual Well ❑ Number of bedrooms 3," Community d(x Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site 1XX Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 MUNICIPALITY OF ANCHORAGE (MOA) He uthority Approval (HAA) • �tS� Op AN t 3 T - FEBRUARY 1984 M� app ES; $43-4744 p,�,�MENj tNv« 1g�� Legal Description: 40t 3 isloc 2- Prior*L000ri s 5-h 3 A. WELL DATA r v�+ V V 011 Well Classification-j`Itt`oS Well Log Present (Y/N) Date Completed Total Depth Cased to Static Water Level Casing Height Above Ground Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Pump Set At Yield Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Z 00 t ; On Adjoining Lots Z 00 To Nearest Edge of Absorption Field on Lot 2 O0 f ; On Adjoining Lots Z 00 + To Nearest Public Sewer Line IJ/A To Nearest Public Sewer Cleanout/Manhole X)lq To Nearest Sewer Service Line on Lot S t Water Sample Collected by ; Date Water Sample Test Results / Comments �� A tbA_ C '1e�1 E G A Dn ro UW t' B. SEPTIC/HOLDING TANK DATA Date Installed _ - I&-V3Size 1000 No. of Compartments Standpipes (Y/N) 4—Air-tight Caps (Y/N) 4 Foundation Cleanout (Y/N) T— Depression over Tank (Y/N) bi Date Last Pumped % V 7 -1 a Pumping/Maintenance Contact on File (Y/N) N�� ; for Nh Holding Tank High -Water Alarm (Y/N)Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Or To Water -Supply Well 2 r'>0+ To Building Foundation (� To Property Line (O I t To Disposal Field r To Water Main/Service Line (� t To Stream, Pond, Lake or Major Drainage Course Comments 6" hGpumocd 10N S Ges 5 O UMIP �� 72-026 (Rev. 7/88) Front Page 1 of 2 Tip - , - ;-D" I i � I t+ DEPT. OF ENVIRONMENTAL CONSERVATION AlICIIMAi=17, 'JESTER`] DISTRICT OFFICE 3601 C STREET, SUITE 322 A.IC=n.?AGE, ALAS7A 40503 ;ay 24, 1990 PP7SID: 11213001 STEVE COWPER, GOVERNOR 563-66775 According to the recora's on file in tris office, the ChuUiak i_Ttilities/Northwoods Deer '-Torn +`TateY Syste:a is in compliance with the State of Alaska Drinking 4Jater Regulations. Sincerely, (2111 V: -RA E. CRAIG Environmental VEC:bas Fiel officer Time APPLI(f'--NT FILLS OUT UPPER HA�7. ONLY Property Owner Phone Baltic Builders Time P • O. Bax 4-2412 Anchorage, A.laskztil, CAg509 688-2831 Mailing Address Date Date Buyer Inspector Address Zip Code Lending Institution Alaska Mutual Bank Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code (3 APPROVED BEDROOMS Legal Description Lot 3, Block 12, Northwood's Subd..* Phase III Street Location Marshall Street Type of Residence -) �(� 3 9 Single Family DATE ! El Multiple Family No. of Bedrooms 3 ❑ Other BY: Water Supply ❑ Individual Soils Rating ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. X Community Well Log Received For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility -2—((0 —..S Well to Tank Sewer Disposal ® Individual Year Individual. Installed: 1983 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF 1!=/.Lill ?. ENVIRO\.A--NTAL PROTcCTION NOV RECEIVED (3 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' -) �(� 3 DATE ! �i-{ ,,� S BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size -2—((0 —..S Well to Tank 72.023 (3102) y ALASKA 6I01ROW11TAL COnTnOL SRUS, Inc. 6ngineerinq & 6nuironmental Studies November 4, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On October 31, 1983 our company inspected the sewer system located on Northwoods Phase III Block 12, Lot 3. All the standpipes are capped and protrude above ground level. The finished grade looks good and surface drainage is away from the septic system. The well is a community well and did not require our inspection. According to Mr. Bruce Erickson of Alaska Department of Environmental Conservation, the community well is up to standards at this date and no water sample is required. AW 49 e ee:am . .fweef fees•.. r,$ �p eo.o e•eee y..... i Leroy C. Reid, Jr. 0 No. 251-E MUNICIPALITY OF ANCHORAGE PVT. OF '. ENVIRO\:v�': NTAL PROTECPON RECEIVED 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 276-1361 Time Time Time APPLICNT FILLS OUT UPPER HAL`' "ONLY Property Owner g '� Phone Mailing Address (1, *;I% -,7� /, /_.(' . Zip Code f'' C Inspector Inspector Buyer Field Notes: Address j U L 2 11983 Zip Code Lending Institution Phone Address ( ) DISAPPROVED Zip Code ( ) CONDITIONAL APPR IAL" Realty Co. & Agent DATE Phone Address Soils Rating 7 Zip Code Well To Absorption Area Legal Description Ia',7 Well to Tank Street Location - h Type of Residence Single Family - ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Ll- ebmmunity For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal P-11dividual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: j U L 2 11983 ( APPROVED BEDROOMS 2 �J 'CONDITIONS OF Aemoluwn l Pr N:,ti!cn� ( ) DISAPPROVED ( ) CONDITIONAL APPR IAL" DATE BY: Soils Rating 7 Date Sewer ined Well To Absorption Area Well Log Received Septic Tank Size ((J G t7 Well to Tank 72023 (31821 C. ABSORPTION FIELD DATA Soils Rating in Absorption StrataQ �7 2 S �—Tr�l— Type of System Design !&CL Date Installed - / h - QZ3 Length of Field f Width of Field / Depth of Field Gravel Bed Thickness t z Square Feet of Absortion Area q j 8 Statndpipes Present (Y/N) u Depression over Field (Y/N) rJ Date of Last Adequacy Test Results of Last Adequacy Test _4S k+ I J{ftC, SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Z oo 't To Property Line To Building Foundationr� 1+ f To Existing or Abandoned System on Lot N ((A ; On Adjoining Lots D 7'f" To Water Main/Service Line / O t To Cutback (if present) Z A To Stream, Pond, Lake, or Major Drainage Course &)1A To Driveway, Parking Area, or Vehicle Storage Area _ / 6 t Comments_T_7�17 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent (Y/N) _ "`Check Permitted Bedroom Rating Against HAA Request" I certify that f have checked,verified, or conformed to all MOA ar inspection. Signed _ Company Date MOA No. Receipt No. v2/ �I/ 1,2,10 9 Date of Payment _ 6o - = — 2(p Amount: $ 70 r cyn v Receipt No'_ Pumping Cycles during Adequacy Test. t'Nr� date of this Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ineer's Seal 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. 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 of this inspection. Name of Firm Address Date Telephone I i N�i.... ... e. e.e• hobwf A. Shafv Ib 1457-E 6. DHHS APPROVAL / Approved for ._,Z—__ bedrooms by – Date. " Z, Approved --Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze 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. 7/88) Rack Page 2 of 2 C. LIFT STATION CA64) Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump 'on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Soil rating (GPD/Ftz) System type j5E2 Length D Width �8 Gravel thickness 6; © Total depth ,30 34 (D Total absorption area 90 d) Cleanout present (Y/N) Q Depression over field (Y/N) /v Date of adequacy test 7�9l,1 Results (pass/fa) ��4 S for .3 ilBedrooms Water level in absorption field before test _% After test Peroxide treatment (past 12 months) (Y/N) _ Al IT If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot_ NA On adjacent lots NA Property line /0 7 - To building foundation f3. $ Q To existing or abandoned system on lot NA On adjacent lots 33f O Cutbank NA Water main/service line N4 Surface water AIA Driveway, parking/vehicle storage area 579 Q Curtain drain NA E. ENGINEER'S CERTIFICATION l certify that /have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineers♦ /r i �` Date HAA Fee $� Date of Payment Receipt Number 7,.-�) -7 -7 n-026 (3/93)' Back 3 S Waiver Fee $ Date of Payment Receipt Number_ % X ROBERT W. WRIGHT P•f� mac/ h CE - 8156 • s 9Y- 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, ordi .Ines, an4 regulations in effect on the date of this inspection. Name of Firm _�ie/CST— .4 L�4Sk''4 �/S/� cT!/C-� Phone'6 2.30 AddressG N•C�EiC�RY ZW1-,eweC'�2y4r' .4K 99�- 04 Engineer"� s signature Date,t� A 6. DHHS SIGNATURE "ROFESS0' Approved for ._....bedrooms. 10�8�9� Disapproved. Conditional approval for bedrooms, with the following stipulations: By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their 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 engineers work. .. 7225 (Rev. 1/91) Back MOA N21