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HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 15Northwoods #2 Lot 15 Block 1 #051-811-02 Municipality of Anchorage Page 1 of Z• 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 SW 940/72. PID Number. OS/P//0Z Permit Number: Name: AJOgTtf1/00 AS' _TAic.. Wastewater System: gNew • Upgrade Address: M-rtchu/l' ABSORPTION FIELD -PRe.ae:No. /4/0CDeep N07 GE AC..., q96-43 of Bedrooms: Trench ❑Shallow Trench ❑Bed 0 Mound ❑Other 7 LEGAL DESCRIPTION Soil Rating: O. 46—GPD/Sia. R. Total Depth from original grade: �' Lot: Block: Subdivision:Depth /S_ / /cNo,�-,t7•JoaJs 'Z. to pipe bottom from original grade: ..? Ft. Gravel depth beneath pipe S Ft. Township: Range: I Section: ^—'—" Fill added above original grade: �• to i/•/Ft. Gravel length: /CC R. WELL: ❑New ❑Upgrade Gravel width: ..Ft. Number of Distance beteenlines: Classification (Private, A,B,C): EXIST C0.41/YJCMJ/TY Total Depth: Ft. Cas o: Ft. Total absorption area: /l?l)0 SQ. Ft. Pipe material: FP/O ?e77 -F. /4Sr�+ /"3o3" p.. 1' C. Driller: Date Drdlle Static Water Level: Ft. Installer: / 6.D S-7)4,22- CVA -AS r Date installed: q - /o -9e/ Yield: GPM. Pump Set at: 1Casing Height Above Ground: � Ft. Ft. TAN K SEPARATION DISTANCES OSeptic 0 Holding 0 S.T.E.P. To From Septic Tank Absorption Field Litt Station Holding Tank Public/Private Sewer Lines Manufacturer: T /Jf-0 tr / A -Ad - Capacity in gallons: /QOC WeI Well' ZOO '-i- 200 206 +- ZS t sr t- Number of Compartments: Z Water -r boo',.- /Cb 'd - LIFT STATION Lot Line r /Or- , /O 77•- Size in gallons: I Manufacturer: '_^ Foundation // , 2/ / "Pump on" level at: "P off" level at: High water alarm at: Curtain Drain E- K.AJC3 WN Pump Mak odel I Electrical Inspections performed by: .UDA. Remarks: BENCH MARK Location and Description: T$m - TOP c P rOk D4-7760 kuA-L.L 41— 3-7',mow P cO Assumed Elevation: /OO • OO Ft E L f. OF �1+.�, kp �� w2z 4 S & S ENGINEERING 17034 Eagle Rivet U. Inspections by: Eagle River, /4a IOW Dates. 1st P -/(0'g`'' `ft •" � f GG as performed 2nd P-/� �r y w„, mom• ROBERT C. COWAN r Department of Healt • Hu ervices approval Reviewed and approved by! % ' Date' a” - CE -8801 ` i�F:, �1 111***'... 72-013 72-013 (Rev. 9/91) MOA 25 Permit No. Page Page 2 of 2 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 ORTHWOODS SUBD.#2; BLOCK 1, LOT 15 PID No.: 05181102 C01 002 E1NAL. / 98.3 NEW 1000 GAL SEPTIC TANK B ECO. C01 CO2 CO3 C04 C05 C06 MT1 MT2 18.5„ ,1.0.0. 21.5 17.0 22.5 23.5 20.0 32.0 67.5 83.0 31.5 31.0 72.0 83.0 64.0 80.0 69.5 80.0 X91.3' 98.3' (C05) GRADE - 904' (C05& C06) 95.0' (C06& MT2) 98.3' (CO3) 96.7' (C04& CO .MT1.) 90.4 (CO3& C04) 85.4' 85.4' (MT2) (MTI) .7.H_9'.,..N.O...,WATER.. E.O.IIN.D..... NEW 1000 GAL SEPTIC TANK NEW TRENCHES T 3 BDRM :HOUSE Co 0 C05 SCALE 1" = 40' 72-013 A (1/93) * DBL Co PROPERTY SERVED BY COMMUNITY '€ WATER SYSTEM. NO WELLS WITHIN. 200' OF SEPTIC SYSTEM. N ENGIN ER'S SEAL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 I s/ gla,, al/ kiv ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940172 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:NORTHWOODS INC OWNER ADDRESS:709 W. INTERNATIONAL AIRPORT RD. ANCHORAGE, AK 99518-1123 PARCEL ID:05181102 LEGAL DESCRIPTION: NORTH WOODS PHASE II BLK 1 L T 15 LOT SIZE: 49158 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/13/94 EXPIRATION DATE: 6/13/95 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: RECEIVED BY: ISSUED BY: CJA-4164 L UM DATE: DATE: ,_ Petty/11p kt3 R/VER, ALN HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. May 18, 1994 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Northwoods Subdivision; Lot 15; Block 1 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue a permit to install a septic system to serve the proposed three bedroom house on the referenced property. 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 checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. This property is served by a Community Water System. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincer LSU/jk er, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 0 0 11 F -d Vl Q cr C/2 Q 0 00 z J w 00 N w w E z cc cc O EDGE OF ROAD U 4114 \\ \\ 1:4 0 0 0 GSd NVH1 3d1-lryrySyy NI 3`30JNV1-10tlHD z Nb119 1S 1NOI1V d3S 0 w O Ea mo \\ \\ 0 O O, V 41 0-, . 0 Z " 0 0 0 % O U 0 > > X nfa rC C_7 0' 0 o . a 0 0 a H �rz Nz CC I- 0z LA 0-0 M aQI- o Ct U T Z Q 0 a� on - o U W x N W v) LL 0a Uw W W m W CC D Z CCQZ 0L._ DJ 0Zs 00 Z aQ (.D 11-1>- >- UjJX Z? O �H F -d0 �) w Z Z wJv)C- M � WW>- >mi -- O mew �—zcc MJ V)En Ct DZ W� V) Ow 4v)� �Owo U 1J-1 .±- U0Z ~zwa w0U) V) -.1 M-Ctw z} WZ5 w >-v) o ix O co JW L W > • 0 Uz0 �wU z www . Oa 0>� >- >- v)Q F= 1 -O W O F- 0 a_ sQ O Vld 31IS TWOS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MAMUTAL SPECIFICATIONS REFERENCE: Northwoods Subdivision; Lot 15; Block 1 GENERAL: 1. The scope of this project includes the installation of a 1000 gallon septic tank and two leachfield trenches to serve the proposed three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. Page Two Northwoods Subdivision; Lot 15; Block 1 May 18, 1994 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Northwoods Subdivision; Lot 15; Block 1 May 18, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Page Four Northwoods Subdivision; Lot 15; Block 1 May 18, 1994 Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ( /TE_ TH0'ros e.c:vv 4\iy LEGAL DESCRIPTION: 1--1�/gf/ 1061271 44/61 0.i DEPTH (.FEET) N 2- 3- 10- 11 - 12- 13- 14- 15- • 16- 4 17- 18- 19- 20 - DATE PERFORME -C/' Township, Range, Section: GSRNDy &aaust.. COMMENTS 'Cl3ek.'17 tib S R. S ViAtIgN IEPRIRia SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? NO S L 0 - P E Depth to Water After / / Monitoring? ��� Date: 5/6/” % SITE PLAN 1' N cE312. TC_ Pfj.)7v Reading Date Gross Time Net Time Depth to Water Net Drop 7 .r/S pn„ — S Yy " '— %2S /Omer. r;3k" IA„ .LS /0 ,• 6Yr" 3g„ LIS to " 6 ata Vv.':.(1 t0 ^ 65/g �yn 8:6S.? &,*, 10 •- 6'/i 'la" PERCOLATION RATE "l t) (minutes/inch) PERC HOLE DIAMETER ND FT TEST RUN BETWEEN PERFORMED BY 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI 72-008 (Rev. 4/85) b ERTIFY THAT THIS TEST WAS PERFORMED IN N THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: T-wei wy2 7`y LEGAL DESCRIPTION. :(�t�/�/ Ak0-1406PS DEPTH FEET) 2- 3- 4- 5- 6- 7- 8- 9- 10- 11 - 12- 13- 14- 3 r 9 4 i f r 15- 16- 17- 18- 19- 20 - (ENGINEER $ SEAp DATE PERFO r ED: Township, Range, Section: 6ii,k ` 5 77 .sm'Jt) 6.12.8.44%L pa,sea 1--(opp7a COMMENTS G-+ S & S ENGINEERING SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L 0 P E Depth to Water Alter Monitoring? DIV Date: SITE PLAN 1 t-] N S/ 7� Reading Date Gross Time Net Time Depth to Water Net Drop Si6/9Y Uriazev ?:to?GA — 3 %y'' _ 2.o lO.uir. 1,(3A° 30 /0 0 e/3/y '' 3/8 yo /U a 5V" 4 : SG 10 " St/2'" 348 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 5 ND b FT 4,, PERFORMED a y1�7034 Eagle River Loop Road No. 204 Eagle Liver, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN T ON THIS DATE. DATE e •` �_'-� Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 051-811-02-000 Expiration Date: 'g"- 3d —( 1. GENERAL INFORMATION Complete legal description North Woods Phase 2 Block 1 Lot 15 Location (site address) 22541 Whispering Birch Cir. Chugiak, AK 99567 Current Property owner(s) Jeremy & Cera Jondrow Day phone 907-444-8039 Mailing address 22541 Whispering Birch Cir. Chugiak, AK 99567 Real Estate Agent N/A Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) (1 Duplex I I Multiple Dwellings (Single Family and/or Duplex) • 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well (l Individual Individual Water Storage Holding Tank ❑ Community Class Well ❑ Community n Public Water System [ Public Sewer (l Waiver/Variance request for: Distance: Received by: ,q n� Date: 71 Cl /I COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ J L-{O - tanQ Waiver Fee $ Date of Payment (o- a5-8 ckt05e Date of Payment Receipt Number a a ( C (v Receipt Number COSA# 1?.9T 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 Alaska Rim Engineering, Inc. Phone 745-0222 Address 9131 E Frontage Rd. Palmer, AK 99645 Engineer's Printed Name Norman K. Gutcher Date 6/19/2018 .f CSF A re i® ., -(,.�,..,.o.,,� « , ilk oir co 1: ; 9T4 1 ?"° ' ' 6. DSD SIGNATURE `O ;�y '..., lak, System#1 Approved for 3 bedrooms �� �v s ^d°m n K.Gutcher c. G,•p CE-4919 �� Issif System#2 Approved for bedrooms 8 , G., ;.•c.,r., Disapproved t�k?eo PROFESS\O'� � Conditional approval for 1/ bedrooms,with the following stipulations: � iv 0 \ G 1� IS a ecucS OLD ,A vve�t U uk e / 1 0 ' ( S e y'Jfi C.'-f� c I S 2 -j OP :fit: ANCy0, / G�.S��PN© -. �� R\ PRGPG --::\ • . , �--- // n-12 Original Certificate Date: 9 -24-CC, B . 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 r , - 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 1 Lot 15 Parcel ID: 051-811-02-000 A. WELL DATA Well type A If A, B, or C provide PWSID# 213001 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 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 9/10/94 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping J f I l Pi` Pumper 1-Da01\'\Cl\ Vil)MV.k1`>� C. ABSORPTION FIELD DATA Date installed 9/10/94 Soil ratingi z 0.45 gpd/ft2 Dual Trench (g.p.d./ft or ft /bdrm) System type Length 2X50!=100 ft Width 3 ft. Gravel below pipe 5 ft. 10.75/11.67 1000 2 Total depth ft. Eff. absorption area ft Monitoring tube Y Depression over field N Date of adequacy test 8/30/16* Results (Pass/Fail) P 3 For bedrooms Fluid depth in absorption field before test 7 in. Water added 624 gal. New depth 21 in. Elapsed Time: 24 hours min. Final fluid depth 9 in. Absorption rate >= 534 g p d Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date *North trench found to be surcharged. Tested south trench only. D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >200' On adjacent lots N/A Absorption field on lot >200' On adjacent lots N/A Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line N/A Holding tank N/A Animal containment areas N/A Manure/animal excrete storage areas N/A SEPTIC/HOLDING TANK ON LOT TO: Building foundation >10' Property line >5' Absorption field>5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots N/A ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >5' Curtain drain none known Wells on adjacent lots N/A F. COMMENTS This system has two trenches. The northern trench (closest to the road) is failed. The southern trench was tested and found to be operating satisfactorily. G. ENGINEER'S CERTIFICATION ��.O ALgs 14 1 certify that I have determined through field inspections and s_4.; •..�f- � review of Municipal records that the above systems are in a�1= Y . 17 ,/I conformance with MOA COSA guidelines in effect on this date. Norman K. Gutcher yy � � Engineer's Printed Name .�• K•�y�•- �� � Norman K.Gutcher � Date 6/19/2018 II a:.• CE-4919 ,:�zi 1�TF 4,.i 9 `%� PA0FESSO...... COSA canary sheet_2-6-15.doc m.d Parcel I.D. 051-811-02-000 1 Certificate of On -Site Systems Approval Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Expiration Date: 3*t7 1. GENERAL INFORMATION Complete legal description North Woods Phase 2 Block 1 Lot 15 Location (site address) 22541 Whispering Birch Cir. Current Property owner(s) Thomas Hawkins Day phone Mailing address Real Estate Agent PO Box 671566 Chugiak, AK 99567 Laney Stapley Day phone 350-7984 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request for: 3 r TYPE OF WASTEWATER DISPOSAL: 0 Individual 0 ❑ Holding Tank 9 ❑ Community ❑ Public Sewer 0 Distance: Received by: t,rt._.' a L COSA to be released to the engineer, Wf eiwise requested by the engineer. Date: COSA Fee $ 5 -f3%S" O ' c° Date of Payment 9 /X /J°((I 3250 Receipt Number ;�J IO',(`1 `� COSA # OSC.I Co I "( I 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 an 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 Alaska Rim Engineering, Inc. Address 9131 E Frontage Rd. Palmer, AK 99645 Engineer's Printed Name 6. DSD SIGNATURE -763/4 System #1 Approved for 7) bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for By: S Phone 745-0222 Date 006, ``°°a\i\►tli►fll .5=4.. 9ry y /71/.0 Mary L. hreves I ¢': '/cJ'T••• CE 9351 F •• dear bedrooms, with the following-9 Att EggS0',,,a� 1111\0®\\\44° ;l ( tOFAtVC/(470% rf, _`cl S\fE. � O ON. ND I; WPCE WP�5R o=- gTE PM �_ PROGR 9'�>Z���'a Ett,,„ GAL& Original Certificate Date: 9'2-9'( 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 c 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 1 Lot 15 Parcel ID' 051-811-02-000 A. WELL DATA Well type A If A, B, or C provide PWSID # 213001 Well Log (Y/N) Date completed Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) T Depression over tank (Y/N) Date of pumping ' 37'30 'C 6 Pumper 4 £ ' S Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ft. g.p.m. in. Collected by: N Date installed 9/10/94 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA- Date installed 9/10/94 Soil rating (g.p.d./ft or ft2/bdrm) 0.45,gpd/ft2 Length 2X50'.„100.,ft: Width System type Dual Trench 3 ft. Gravel below pipe 5 ft. Total depth ''O7y"5. fit. 'Eff. absorption area 1000 ft- Monitoring_ tube Y Depression over field N Date of adequacyt%st 8130/18". Results (Pass/Fail) P Fluid depth in absorption field before test 7 in. Water added 624 gal., in. Absorption rate >= 534 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date For 3 bedrooms New depth 21 in. Elapsed Time: 24 h°9rs4rnin, mInal fluid depth 9 `North trench found to be surcharged. Tested south trench only. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump Off" level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift statio Absorption field on to Public sewer main Sewer /septic service line N/A Animal containment areas N/A SEPTIC/HOLDING TANK ON LOT TO: Building foundation >10 Water main X10' N/A On adjacent lots N/A in. On adjacent lots N/A Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas N/A Property line >5' Absorption field >5 Water service line Surface water >100' %s. Wells on adjacent lotse .a i`'Y r ✓' ABSORPTION FIELD ON LOT TO: Property line >10 Water Service line >101 Surface water >100 Curtain drain none known Wells on adjacent Building foundation Water main >10' >5' ng/vehicle storage F. COMMENTS This system has two trenches, The northern trench (closest to the road) is failed. The southern trench wad tested and found to be operating satisfactorily. G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name 4 t. t1l L. r ' 5 Date %�. /JO l COSA canary sheet 2-6-15.tloc ��t��\1�llflt 0 z -L ed 0 1 r=D 1 00 m Dm$ 0m m 0 0) 0 0 z m m 2 z 0 mp =2o Amo m2 - 1 Ati =0l• :TWOS -100 Note: this lot is served bycommunity water system. N a 0 g1 6E r• 0 A A'voZ''N •ST 1 • 0 A 0, m mm 10' A m • O `LD, m O. N� N go o ti 0 0 m N y In 41'01`.0) o1D n ng o a- n- 0 co µ j 0< O d 7 N m W ry O° p d3 6' O N O p .Z1 S•N p .pi m N CP O �p 0 0 a w a ' NN • oo00)0- opnO= COO 0 ay 0 n0=-0 S ys-� mm' • <�� p w N m O D 3 a 3� m w x ',I@ � m S -. N S 01 p m g a 5= ma0 N• 0, 5'Nm O J▪ i a - 13 CP ct24�— • � nm m d nx P) 0 0 3 0 0 rn • PI ■ • • • • siva SIH1135 S2i3N21OO ON r 0 1 Ob O� r 0 8444T w A a A Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650G -- Anchorage, AK 99519-6650 www.muni.orgionsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I . D. 051-811-02 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address COSA# Q 5e)) I) Expiration Date: 5 / 3 `" / NORTHWOODS S/D #2; BLOCK 1, LOT 15 22541 WHISPERING BIRCH CIRCLE * CHUGIAK, AK * 99567 OLIVIA LORENTZ Day phone 230-2578 22541 WHISPERING BIRCH CIRCLE * CHUGIAK, AK * 99567 Day phone Day phone Unless otherwie requested, COSA will be held by DSD for pickup. . NUMBER OF BEDROOMS: 3 3: TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site III Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 1 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 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!r wastewaterdispdsal system is (are) safe, functional a dadequate 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 JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of fhe sysfem 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 person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for Phone 337-6179 Date 9-/Z91') ,00�oop4 o�OFA bedrooms, with the following stipulations: .............. Y • • • • ON-SITE 4"• WATER AND • r"= WASTEWATER :• PROGRAM sed* \' By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory %1:1-_1Advisory Arsenic .Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11/05) Original Certificate Date: / - / r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NORTHWOODS S/D #2; BLOCK 1, LOT 15 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level ft ft. Well production g.p.m. g.p.m. WATER SAMPLE RES PUBLIC WATER Parcel ID: 051-811-02 If A, B, or C provide PWSID# Well Log (Y/N) Sanitary seal (YIN).____ Wires properly protected (Y/N Cased to ft. Casing height (ab• - •round) in. FROM WELL LOG AT I CTION Coliform colonies/100 ml. Nitrate mg./L. Collected by: enic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/16/1994 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO Date of pumping 8/9/2010 C. ABSORPTION. FIELD DATA Date insta6ett '`8/416/ 1994 (2 0 50') Length 100 TOTAL ft. *10.3/ Total depth *11.5 ft. Eff. absorption area 1000 ft2 Monitoring tube YES Depression over field NO For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 1120 gal. New depth 26 in. Pumper Soil rating Width High water alarm (Y/N) SANITARY PUMPERS N/A *BELOW EXISTING GRADE r ft2/bdrm) 0.45 System type DUAL TRENCH 3/3 ft. Gravel below pipe 5/5 ft. Date of adequacy test **4/23/2011 Results (Pass/Fail) PASS Elapsed Time: 1183 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN **NORTH TRENCH WAS SURCHARGED. TESTED SOUTH TRENCH ONLY. If yes, give date D. LIFT STATION Date installed "Pump on" level at in. "Pump off' level Datu E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent Tots Public sewer main ' • • sewer manhole/cleanout Sewer /septic service line Holding tank ntainment areas Manure/animal excrete storage areas Size in gallons Manhole/Access (Y/N High water alarm level at in. Cycles tested Meets alarm & circuit requirements? PUBLIC WATER SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line *10'+ Surface water 100'+ Wells on adjacent lots 200'+ PUBLIC, 100'+ PVT. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line *10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ PUBLIC, 100' + PVT. F. COMMENTS *ASSUMED BASED UPON KEYBOX LOCATION SHOWN ON 1994 DESIGN DRAWING. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date t''`l 21/1/ Q�600 9F „ .,9s;pt ss; fessiot S4. COSA Fee $ q/0- /0 Waiver Fee $ Date of Payment 5. //° / / 1 Date of Payment Receipt Number b co(,,Co 30 Receipt Number (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division • On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650'' • ., • - www.ci.anchorage.akus (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL _..• FORA SINGLE FAMILY DWELLING Parcel I.D. (O.S 1 -'J /- 0.2_ • 1. GENERAL INFORMATION Complete legal description No cLTi74. aol->S HAA# . A 'o3.o./_,JL- :. . Expiration Date: 14-= 1 g - o �- [�I (b\-- lS" Location (site address or directions) • Current Property owner(s) P'Mvt - n��%-r.nYkaa6trt-PS' Day phone LCa Ssr.- Lt Mailing address . Q', _ t. • tZ Lending agency , Mailing address Real Estate Agent Day phone Mailing Address F. Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: .n. 3. TYPE OF WATER SUPPLY: • Individual Well Individual Water Storage Community Class Well Public Water System - 3 _- 1' Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer 9a5-1> The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HM) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 .Poc.GG- S i I.vc. &ex Phone(907J 74'6—io 7.,3 Address 9990 E. PuA'FiA., 0.2�.s�Mc=.e, A,•• 99644 -- Engineer's Printed Name .47o"c"'$�- �t 'u�-% Date • 1 `1 - O 3-. QF Az It • ' I i 5. DSD SIGNATURE 1/� .I• w 7 KE�1lFl.' .ji CE8tJ6 :,,.. Approved for bedrooms. jaji •i•••••'• Disapproved. '‘....0~4 Conditional approval for - - bedrooms, with the following stipulations: Additional Comments QP\`Vi of 4NCil/ • 2• ON-StTE c' t • WASTEWATER • PROGRAM • • • �.- ` s•- • •• J.1[;°P+,L-1jr Cr • 1))111)1 ! 1) )1►'' Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:/7faid/. / d Original Certificate Date: ` - - 1 - 0 3 (Rev. O1O2) 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.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L ?;-469: .✓"e'-'44dam47s "1•41"4' 44.Z A. WELL DATA Well type _ Date completed Total depth ft. If A, B, or C provide PWSID # Sanitary seal (WN) Cased to ft. FROM WELL LOG Date of test Static water level ft Well production g.p.m. WATER SAMPLE RES Coliform colonies/100 mi. Nitrate mg./I. Parcel ID: OS'/ -R 1(-O a Well Log (Y/N) Wires properly protected (YM Casing height (abo , ound) in. AT IN ION ft. g.p.m. Other bacteria colonies/100 ml. nic: mg./I. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sar®rs e/Syz t.. Tank size /oo o gal. Number of Compartments Z Cleanouts (WN) )' Foundation cleanout (WN) y Depression over tank (YM) �✓ Date of pumping 'x/'1/03 Pumper /ri c M' " Date installed gV/ d/9-4/ High water alarm (YIN) A11.7 C. ABSORPTION FIELD DATA Date installed °P/'44r1/ Soil rating Length X04.f ::.•1°4 ft. Width r ftzlbdrm) ft. System type. . �. F:doVey Gravel below pipe ft. Total depth /1 ft. Eff. absorption area i000 ft' Monitoring tube Y Date of adequacy test t1/1%/0 3 Results (Pass/Fail) P.ors /S/ Fluid depth in absorption field before test a in. Water added4Zgal. Elapsed Time: g 7' ;alw Final fluid depth a in. icrz Any rejuvenation treatment (past 12 mo.) (Y/N & type) Depression over field A/ For 3 bedrooms 161/ New depth 6 in. g.p.d. Absorption rate >= If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off" level at _ in. High water alarm level at in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: P P Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent Tots Public sewer Public sewer manhole/cleanout er /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /'Z 14-74 Property line 76' 2;64 Absorption field 5— Water main Ai" '4« Water service line ,4s—'4,47 Surface water , Ac ry Meets alarm & cite ' quirements? Wells on adjacent lots ��A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7�74 Building foundation Zz;`;i Water main Water Service line 2-5-'7/1 Surface water /4 Driveway, parking/vehicle storage f 1‘,/-P1 Wells on adjacent lots A..''� .11o .t�1' .�ls'C aJ• J Curtain drain i c`/' c/ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name �a�e'-'°-r �'e6yi-/t- Date 'l' (t-1 ' d -))' ow •otA� •S'i''f f •49TM .. : �y r' •. . KENLEY w«8176IA •. '• ` HAA Fee $ 3 3 S 11/447 Date of Payment Receipt Number 3�7° (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ,••••••=1/141IIII. L 411•111•M•••••• m G) mr- 4 • Pga kt.. III L[77.11.7 45 ;c/ILr�ATt is - . pwr ficAlt1 1044 argia alLks1 iiii 144 -a --0. --( a . r .-'4fON i • . ,.. 4.! . .liati * • .4111••••••••11 su•Hiat.. airian a wed Millita lir,r,..i - FA , „g if wn: Jen sum* gmailleille Or% alrea slim is esTdbillitatli "wai twins illowliMen id leiland a OF ii•astrisilakg delipesS tit Ned1/1011,1d1 fir wan winks wag aurdlounlins, eskillifilitirlf daftridbe alawbumai akiNaliailli , is am wimisals. Stemimifter.11411161091% ShleaSSII14111 INFIBillheallik. Alt, Millter 411 EMP1140111111011111-09M1111111.4 alba = idbassiiir - tio. war eavalisime Afars ors inala - .. • - - - * Irg 0 ESOlgaint *the oausiligailimeltiOraWa , . 7470, A eviais • wilitinal9 • • tar 45 mial. Zit SC 111111011 • maga - i- ..,:eivitgacialoweffL. PM.Se Rai. NIL • . SCA LAE MD 132- 2b4 firz.-.40 Pr • ••••• m G) mr- Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# /9-606%JS 9 - Parcel I.D. 051-81-102 1. GENERAL INFORMATION M �hs Expiration Date: Complete legal description Lot 15, Block 1, Northwoods S/D /12 Location (site address or directions) 22541 Current Property owner(s) John Holman Whispering Birch Day phone 688-5274 •• Mailing address 22541 Whis.erin• Birch Chu iak AK Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 Sev. 01/001' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Phone 9`1-3`i 77 Engineer's Printed Name /v DGz 1.r C . C o,,,,,y,✓ Date 6 //i/°6' Fac04 f• `.f .ENG1VEER'S ' 6. DHHS SIGNATURE I, ^>,\ ROBERT C. COWAN jc,u Jt, ' •• CE -8801 /4? 9 Approved for 2 bedrooms. Disapproved. 1t;�?,; Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: � / Com, �c �� Original Certificate Date: Co -2 O - o C Expiration Date: "/ - 0 - 0 c Reissue Date: 7'5-025 (Rev. 01 OOP Ktt..tIVtu JUN 19 2000 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES' uNICIPaunoFANC viRf NMENTAL SERVICE Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 / Health Authority'A//001996416- Approvalpr'o"Checklist �1 Legal Description: L6/ /� r R-4/ 7 / v• � ,0g 2- Parcel I.D.: 067 et /'© 2- A. WELL DATA Well type Log present (Y/N) Date completed Total depth Cased to Casing height (- , •ve ground) Sanitary seal (Y/N) Wires prop= y protected (Y/N) FROM WELL LOG AT INSPECTION If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Nitrate g.p.m. g.p.m. Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed V no `T Tank size /0-0U&Numbergoff Compartments CleanoutaN) > ;c Depressiones(Y1 Aft t High water alarm (Y/N) ///l Pumper v t s Foundation cleano Date of Pumping Q -7/S C. ABSORPTION FIELD DATA Date installed Soil rating i Length /0 --or Width Effective absorption area /aer Date of adequacy test 67t4.1) Fluid depth in absorption field before test (in.); --0" Immediately afte or ft2/bdrm) 0,45 - System type D&- 7 4C%' Gravel thickness below pipe C 7. Total depth /0 Monitoring Tube presenN) i;S Depression over field (/ I A/0 Result- (Pass/' ail) 455 For 771a0 bedrooms ,/� gal. water added (in.): Fluid depth c3//(ins)Minutes Peroxide treatment (past 12 months) (Y/N) NeW4 iniA/ If yes, give date ~� later: .g4 --Absorption rate = -71-4 g.p.d. 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjace. oto Size in gallons Absorption field on lot Public sewer main Public sewer manhole/cleanout On adjacent lots Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5 /it Property line Absorption field S /171-- Water main/service line 4- 'm Surface water/drainage /0d ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: t� / > / Property line / 9 Building foundation /d Water main/service line /0 /9- Surface water /ere /4— Driveway, parking/vehicle storage area /o / (- Curtain drain Nenl6 /lJ✓rw Al Wells on adjacent lots F. ENGINEER'S CERTIFICATION A/ %4 I certify that I have determined thru field inspections and review of Municipal recor bot fha ab44 ms are in conformance with MOA HA/ idelirys in effect on this date. F '4C. fi��gr ec Signature y/�//(�/J c �pA...._� I Rr{ r c .,. 4 Engineer's Name POS/a,27- c. Cawnu Date G/1%/ot> f -r°i 10 -' % ROBERT C. COWAN r ,,t .4 pdt�• %rl., CE ' -8801° a it HAA Fee $ Waiver Fee $ j'—o 0 Date of Payment Receipt Number b'J t 72-026 (Rev. 3196)* Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O_S / — f / — o Z HAA# 1. GENERAL INFORMATION Complete legal description Loy/ 1—$ lock 1 'No271- We otzs sig Z Locati�n(site.address or directions) Z2- -SW/ le(" c-ire- Propertyowner„ M172. G ef;2AC141/5 A 14ANSDay phone Mailing address Lending agency Day phone Mailing address Agent Co (-IA) 7a c" i-31 CicaA,,Aroith Day phone S62 --S-s"47'Z Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 'J 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 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 of this inspection. Name of Firm & 5onJ CX a J G Cyr Phone 2 72— 9Zt 8 Address d'• b. ax '4 2dzs , AN cN- qk A -/u Engineer's signatur Date C r /7c0 / 4 6. DHHS SIGNATURE Approved for ��EG bedrooms. Disapproved. By. L � IR 4.�4�Q * 4• 901 Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 1Z-5. 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 921 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICERECEIVED Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 47 4� 97 Health AuthorityApproval Checklis Municipality of Anchorage pP ibept. Health & Human Services Legal Description: L /s t^$ I ' N o2TN° W nom,s4r - A. WELL DATA Parcel I: D.: 0 -SI — f8/( --©2 Well type A If A, B, or 0, attach ADEC letter. ADEC water system number / 3Oo( Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG 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: Collet:ted by: B. SEPTIC/HOLDING TANK DATA Date installed 4//0/ 9 4 Tank size /o00 Number of Compartments 'V Cleanouts (Y/N) Foundation cleanout (Y/N) f Depression (Y/N) vt2 High water alarm (Y/N) Date of Pumping "ll /2cf % 4` Pumper C. ABSORPTION FIELD:DATA'•. Date installed 9'//alSoil rating (g.p.d./ft2orft2/bdrm) 0'4 System type Length / on Width Z, Gravel thickness below pipe Total depth /6Z It Effective absorption area /000 Monitoring Tube present (Y/N) `i Depression over field (Y/N) N Date of adequacy test il1ZZ/4'- Results (Pass/Fail)ni AsS For .3 bedrooms Fluid depth in absorption field before test (in.); 'DRY Immediately afterS/Ogal. water added (in.): Z" %u if Fluid depth Y (ins) Minutes later: /'/0C) Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 4/0 If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level - * *Datum ested Size in ' level at* "Pump off" level at* E. SEPARATION DISTANCES ^A SEPARATION DISTANCES FROM WELL ON LOT TO: 'NA Septic/holding tank on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Lift station r /septic service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ,/ Property line S01 Absorption field Water main/service line 4O1 Surface water/drainage / 00' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: t Property line /2Building foundation Z ( Water main/service line uv t Surface water / dc.) Driveway, parking/vehicle storage area 2S Curtain drain /t7cprt Wells on adjacent lots 2ce F. ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal reco in conformance with �MOA �HAA guidelines in effect on this date. Signature__ —Pe=a"'��1 Engineer's Name i[2J C raRPd etWeNt2tP•CL Date ///27-14-- s�.w.»seep l40.. ow, iIeven R. Pannone d+ •yy CE= 8149 r 444' '�F9<r.°Stl f2.�N`\ %4o e� HAA Fee $ 3 CC) CL) Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number �o . 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES.':, Division of Environmental Services On -Site Services Section . .. .0. Box 196650, Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY , APPROVAL FOR A SINGLE FAMILY DWELLING = -3 Parcel I.D. # / - 811 ' ('7 HAA # I4 r 1 cl el 0'"4R 1. GENERAL INFORMATION Complete legal description Lot 15; Block 1; Waad4 Subdi.o.i3.ion #2 Location (site address or directions) Wh.L petLng Bitch C-.ncee Chug.Lah, AK Property owner NORTHWOOVS INC. Day phone 244-5126 Mailing address 709 W. Intennati.onat A.inpont Rd. Anchonage, AK 99518 Lending agency 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 Community well Public water ad.avu. c t� -• • r.. ,„ NOTE: If community well system, provide written confirmation from StateAbEC attest= ing to the legality and status of system. r., 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 MnA t21 STATEMENT OF INSPECTION BY ENGINEER As certified by my 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 of this inspection. DHHS SIGNATURE Approved for. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional.Comments • Dat94y 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 works t,<' 72-025 (Rev. 1/01) Back MOA N21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:1-0:T 1S '&tom -1 NO Pra 0 arcel LD. ///��� �] / A. Well Data Well type r ` If A, B, or C, attach ADEC letter. ADEC water system number f✓ / Log present (Y/N) Date completed Driller ✓ Total depth Cased to Casing height ° ►++ Sanitary seal (Y/N) Wires properly protected,(''/N) _fg g FROM WELL LOG AT INSPECTION irri 's Dv aDate of test r't v ® ff'-.' O Static water level < A rrI CO m Well flow g.p.m. g.p.m. a' 0 0 Pump levels �/ " Z rr SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ?� Absorption field on lot Zoo 4-,.s ; On adjacent lots ; On adjacent Tots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING, TANK DATA Date installed q — '0 --ct L1 Tank size 100 0 Compartments z Cleanoutst( N) 1 Foundation cleanout Y )1 7 Depressionl(Vita) High water alarm Mg)A ' Alarm tested (Y/N) ,S14, Date of pumping 4I a� - = N e -‘.-i Pumper '! SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot god On adjacent Tots 0'1h Foundation /1 / f / / To property line /o Absorption field Water main/service line /d Surface water/drainage / o o ' 4- 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump o " at High water alarm level Cyc - - ed Meets MOA electrical codes (Y/N) SEPARATION DISTAN of D. ABSORPTION FIELD DATA UFT STATION TO: On adjacent lots Surface water Date installed cl -1 b - 1 �k Soil rating (GPD/Ft2) 0 YS- System type it/ -i Length /00 Width 3 Gravel thickness Total depth // Total absorption area /o o ©Y Cleanout present N) V / �/ Depression over field (Y Date of adequacy test ti/A. - "4i./ Results (pass/yip " r a for J Water level in absorption field before test !/4- After test '/ Peroxide treatment (past 12 months) (Ye t" If yes, give date .17 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Zoo r I- On adjacent lots /d Property line /0 f To building foundation 2 / ' To existing or abandoned system on lot '1/a On adjacent lots 70 / Cutbank 5 / Water main/service line /a r 25 Bedrooms 4 - Surface water /coo Curtain drain '�/AA Driveway, parking/vehicle storage area E. ENGINEERS CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in eff Signature Engineer's Name /C" 88j47 C. co 'no. ) Date / o /.”( HAA Fee $ L5CerPda Date of Payment l�^�� ) Receipt Number 72-026 (3/93)' Back 's inspection. Waiver Fee $ Date of Payment Receipt Number