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Home My WebLink AboutNORTH WOODS BLK 1 LT 3Northwoods Block 1 Lot 3 #051-731-78 mspecnon Mepon_i-1-ie.aoc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131064 PID Number: 051-731-78 ❑ New 21 Upgrade Name: Andrew Sensabaugh ABSORPTION FIELD ❑Deep Trench 0Shallow Trench El Bed ❑✓ Mound Address 22444 Northwoods Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.6GPD/SF 2.O Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.5 Ft. Gravel depth beneath pipe 0.5Ft, Subdivision Block Lot North Woods 1 3 Fill added above original grade 1.0 Ft, Gravel length 150 Ft. Township Range Section Gravel width 5FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Llft Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 Ft' 3 1 OFt. Well N/A N/A N/A N/A N/A TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1000Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 43 4.1 N/A N/A Steel 2 NA Foundation 10.0 48.3 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A I Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to drainfleld 3034 Isabelle Construction & Excavating, LLC Drainfield 3034 comer 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection dates: 1° 10/18/13 2nd 10/21/13 Location and description 3" a" Garage Door Threshold COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date TH �" Vteven 'A. "Man Gme Approve A!4!Jr f ¢ �.•. CE s143� -.1311"-- Ar W �li e D bate /� �Ata�t. mspecnon Mepon_i-1-ie.aoc | 15' ULOT 3 T N0RTHW0ODSDQyVE \ E A 13 C FC 18.4 38.4 T2 35.7 31.5 DCO 37.5 30.5 C2 69.5 40.9 69.9 41.1 83.4 49.3 83.9 49.6 ILEASE ENT ITY , 3BR OUSE (E) DECK, TI NEW 10OOg SEPTIC TANK 1 OOOg SEPTIC TANK (E) CO ABANDONED PER CODE a DRAIN FIELD (E) IN FAILURE 'ABANDONED PER CODE \ ` � | \ | �| SEPTIC AREA � TH1 3\x��|``�``�INSTALLED LEV[LWAN|FOLD SEPTIC AREA ( (PE- ' ", ` 4 wuwUPGRADE DR�R DRAIN \ � ` ``— J ` �|� 21� .8 (JEA) 50LFxO.5'EDx5'YY,2.V'TD � *cu—`- ABANDONED PER CODE ._ .` L SEPTIC AREA (E) A— SEPTIC AREA (E) SEPTIC AREA (E) PANNONE ENG SVC, LLC OF A4. DI a/t205 /2 013 —8218 FAX (907) PHONE (907) 272 NORTH WOODS, BLOCK 1, LOT 3 ANDREW SENSABAUGH Steven R. P�V6nW PERMIT NO. 22444 NORTHWOODS DRIVE CE 8149 OSPI31064 N0RTHW0ODSDQyVE \ E A 13 C FC 18.4 38.4 T2 35.7 31.5 DCO 37.5 30.5 C2 69.5 40.9 69.9 41.1 83.4 49.3 83.9 49.6 ILEASE ENT ITY , 3BR OUSE (E) DECK, TI NEW 10OOg SEPTIC TANK 1 OOOg SEPTIC TANK (E) CO ABANDONED PER CODE a DRAIN FIELD (E) IN FAILURE 'ABANDONED PER CODE \ ` � | \ | �| SEPTIC AREA � TH1 3\x��|``�``�INSTALLED LEV[LWAN|FOLD SEPTIC AREA ( (PE- ' ", ` 4 wuwUPGRADE DR�R DRAIN \ � ` ``— J ` �|� 21� .8 (JEA) 50LFxO.5'EDx5'YY,2.V'TD � *cu—`- ABANDONED PER CODE ._ .` L SEPTIC AREA (E) A— SEPTIC AREA (E) SEPTIC AREA (E) PANNONE ENG SVC, LLC OF A4. DI a/t205 /2 013 —8218 FAX (907) PHONE (907) 272 NORTH WOODS, BLOCK 1, LOT 3 ANDREW SENSABAUGH Steven R. P�V6nW PERMIT NO. 22444 NORTHWOODS DRIVE CE 8149 OSPI31064 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALLED NEW 1000g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS OBSERVED AT A DEPTH OF 8.5' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 8.0' FEET BELOW EXISTING GRADE. ) INSULATION -R FABRIC 0 DRAIN PIPE W/ 1/8" HOLES 18" O.C. N ROCK 6" ABOVE PIPE INV -93.7 -93.2 -93.2 -92.7 ON/ SM 8/13/2013 SECTION DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 16-30 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 750 SF SYS. TYPE: WIDE TRENCH 0.5' E.D. MIN LENGTH: 150.0 LF USE: (3EA) 50 LF X 5' WIDE, 0.5' E.D., 2.0' TO TOTAL AREA: 750.0 SF LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC NOTES: PC1L`I19O1`IL' ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTH WOODS, BLOCK 1, LOT 3 ANDREW SENSABAUGH 22444 NORTHWOODS DRIVE DESIGN DETAILS CHUGIAK, AK 99567 ►�1:�:3:�111:ID� CU COPPER DIP DUCTILE IRON PIPE w m TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. RIGID INSULATION z o DCO "4� o DV FILTER FABRIC o z " o 0 fl n m o w 0 DRAIN ROCK 6" ABOVE PIPE INV f ORIGINAL GRADE FG FINISH GRADE i 4" 0 DRAIN PIPE a 3 10009 SEPTIC 94.5 TRENCH SEE DESIGN q TANK PROFILE DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 16-30 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 750 SF SYS. TYPE: WIDE TRENCH 0.5' E.D. MIN LENGTH: 150.0 LF USE: (3EA) 50 LF X 5' WIDE, 0.5' E.D., 2.0' TO TOTAL AREA: 750.0 SF LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC NOTES: PC1L`I19O1`IL' ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTH WOODS, BLOCK 1, LOT 3 ANDREW SENSABAUGH 22444 NORTHWOODS DRIVE DESIGN DETAILS CHUGIAK, AK 99567 ►�1:�:3:�111:ID� CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE H�4.ol�i. „1/25/2013 *. 49 TH •.:*7/ NTS .... . .. P.I.D. NO Steven R. Pannone 051-731-78 PERMIT N0. OSP131064 X96.•. CE 8149 �s r (��FROFESSION� Sheet ��""� 3 OF 3 Mu ity of Ancho Development Services Division On -Site Water and Wastewater Program vaent s Z y v N Department *** VARIANCE/WAIVER REVIEW **** Waiver#: OSVI61011 COSA#: _ Permit#; OSP131064 PID#: 081-731-78 Legal Description: North Woods, Block 1. Lot 3 Engineer: PES Applicant: Andrew Sensabaugh Your request for a waiver of the. required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ® The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property: ❑ Adjacent properties are not affected by this waiver. .. ........ ................. ..■.... ......................................mean, Waiver is Granted'. X Waiver is not Granted: Date: Gr l Approved by Name of Reviewer ..:.:.....rrm...■...,....■........... .......................... ........... ..N- Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePpaneneak.com March 26, 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P O Box 196650 Anchorage, Alaska 99519-6650 Subject: North Woods Block 1, Lot 3 Lot Line Waiver Request Ladies and Gentlemen. Waivers. We request a waiver to 4.1' to the lot line. The absorption field had to be place inside the 10 foot offset. Granting this waiver is not likely to affect the health and safety of this lot or the surrounding lots now or in the future. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131064 Tax Code Number: 05173178000 Work Type: Septic Permit Effective Dates: April 26, 2013 to April 26, 2014 Design Engineer: RN%W0'4Q Subdivision: NORTH WOODSo Site Legal Address: NORTH WOODS BILK 1 LT 3 G:1459 Owner/Address: SENSABAUGH ANDREW L 2564W STONEBLUFF DR WASILLAAK 996540766 Site Mailing Address: 22444 NORTHWOODS DR, Chugiak Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: G-3-13 6/-7/3 1011-9113 20128 3 Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage /A; 001 IZ:ov Y/,;,/ - 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By Col rev:sas ' IIvk %� k. (20a Nevisas -`lto lu Aw.,d /bid) CG3 rev:Ses !'ke �rtear desI kl. COLI rtvr'Ws Cc7s .-TP+04 WIA✓I;YOdl91• MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWERANELL PERMIT APPLICATION Parcel I. D. 051-731-78 Property owner(s) ANDREW SENSABAUGH Day phone Mailing address 2564 W STONEBLUFF DRIVE, WASILLA, AK 99654 Site address 22444 NORTHWOODS DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS BLOCK 1, LOT 3 Legal description (Township, Range & Section) Lot Size 20'128 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) SingleFamily �,{ Absorption Field Initial F-1 (SF) LTJ Septic Tank Upgrade X (w/wo ADU) Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (?O3 VT VZS S +1eeV1,t1ee0 be fmv%%A0vte. owner or Permit/Rush Fees: 1530• ` Date of Payment: hea Receipt Number: �1ct Permit No. 1�S0131064 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. Co3 Pannone Engineering Services u.c Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve0aanenaak.com September 4, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: North Woods, Block 1, Lot 3 Permit #: OSP131064 Septic System Upgrade Permit Change Order Ladies and Gentlemen: I am writing to request a change order for OSP131064. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. A 1000g septic tank will be installed. The design will be changed to utilize 3ea 5'W trenches instead of a bed type drain field. This lot is served by a class 'A' well that is located over 200' from the proposed drain field. The surrounding lots are served by the same water system. There are no wells on surrounding lots within 200 feet of this system. There was an un- used well on Lot 3, of Lampert Estates, Block 3, just to the south of this lot. That well has been abandoned per code. 1. Soils. One test hole was excavated in the area of this drain filed by Pannone Engineering Services in July of 2013, and groundwater was encountered in the test hole 8.5 feet below the ground surface. One test hole was also excavated by Arc Terra in April of 2013 in which ground water was monitored at 6' below ground level in June of 2013. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.6 gallons/day/square feet should be used for a conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes from the east to west at approximately 5% in the area of the proposed drain field. There are no steep slopes in the vicinity of this system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 C0.1 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 200 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 NORTHWOODS DRIVE 15' UTILITY EASE ENT LOT 3 313R HOUSE (E) DECK 10OOg SEPTIC TANK (P) W1 DCO 10OOg SEPTIC TANK (E) ABANDON PER CODE DRAIN FIELD (Q IN FAILURE ABANDON PER CODE TH 13 -1 1 0 '(AFC TERRA) 0.0 SEPTIC AREA (E) s �' I SEPTIC AREA J 10.0 INSTALL LEVEL MANIFOLD TH1 (E) I \� (PES) UPGRADE DRAIN FIELD (P) 10. 0 (3EA) 50LFxO.5'EDx5'W, 2.0'TD 10' UTILITY EASEMENT I WELL ABANDONED PIER CODE 7 SEPTIC -AREA (E) SEPTIC AREA (E) SEPTIC AREA (E) NOTES: PAMONE fNG SVC, LLC "A 1"�� Date 10/22/2013 CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 Scale PHONE (907) 272-8218 FAX (907) 272-8211 .... . ... .... .......... ...... .... 1"=50' NORTH WOODS, BLOCK 1, LOT 3 . I.D. NO 051-7 1-78 ANDREW SENSABAUGH 22444 NORTHWOODS DRIVE Steven R. Pannone CE 8149 PERMIT NO. OSP1 31064 PLAN CHUGIAK, AK 99567 klk�, ftFMES9 Sheet I 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK WITH 500g LIFT STATION AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS OBSERVED AT A DEPTH OF 8.5' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 8.0' FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. D INSULATION ER FABRIC 0 DRAIN PIPE W/ 1/8° HOLES 18" O.C. N ROCK 6" ABOVE PIPE INV 10009 SEPTIC TRENCH SEE DESIGN TANK PROFILE DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 10009 PERC RATE = 16-30 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 750 SF SYS. TYPE: WIDE TRENCH 0.5' E.D. MIN LENGTH: 150.0 LF LEGEND W WATER LINE/ WELL RADIUS — SS USE: (3EA) 50 LF X 5' WIDE, 0.5' E.D., 2.0' TD TOTAL AREA: 750.0 SF NEW SEPTIC �...14 il CU GM/ SM DIP DUCTILE IRON PIPE TH TEST HOLE FC 6/13/2013 T# s SECTION CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. 0 DCO DOUBLE CLEAN OUT -15.0 DIVERTER VALVE FS arWWc 3F BFG BELOW FINISH GRADE OG SON FG oa '0 0 �3 �o r o wo z RIGID INSULATION z jz z FILTER FABRIC o z 0 E DRAIN ROCK 6" ABOVE PIPE INV O Z R 0 DRAIN PIPE n 10009 SEPTIC TRENCH SEE DESIGN TANK PROFILE DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 10009 PERC RATE = 16-30 MPI SOIL RATING: 0.6 GPD/SF AREA ROD: 750 SF SYS. TYPE: WIDE TRENCH 0.5' E.D. MIN LENGTH: 150.0 LF LEGEND W WATER LINE/ WELL RADIUS — SS USE: (3EA) 50 LF X 5' WIDE, 0.5' E.D., 2.0' TD TOTAL AREA: 750.0 SF NEW SEPTIC �...14 il CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE NOTES: ��\\ Date PANNONE ENG SVC, LLC pF AG `�l 9/4/2013 CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 r '��•""'•qt4 (� PHONE (907) 272-8218 FAX (907) 272-8211 j*49 � TM �yrr scaNTs A ... .... .. . ..... P.I.D. NO NORTH WOODS, BLOCK 1, LOT 3 051-731-78 ANDREW SENSABAUGH I S'te'ven 'R. ''a'nnone % PERMIT NO. 22444 NORTHWOODS DRIVE CE 8149 j OSP131064 DESIGN DETAILS CHUGIAK, AK 99567 �1>t`r' ••• PSG sheet kk �SSIO� OFE�+ \�"`_� 2 OF 3 TEST HOLE ORGANICS OR/ 1 OL ORGANIC NETTIME WATERTIME LEVEL READING SILTS 2 7/26/13 11:20 3- 5.30 — 45 4- 777F71:30 5 8.08 2.78 3 GM! SILTY GRAVEL g SM AND SAND 7 8 8 10 _Q 11 12 13 —� 14 15 BOH 16 17 16 DATE PERFORMED: 7126113 8113/13 CO3 SOILS LOG - PERCOLATION TEST SLOPE X TH 10' UTILITY EASEb 7126/13 WAS GROUND WATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -13.0'- DEPTH TO WATER AFTER MONITORING? -8.5'- DATE: 8/13113 SLOPE 13-1 C TERRA) TH X READING DATE CLOCK NETTIME WATERTIME LEVEL READING NETDROP 1 7/26/13 11:20 -- 5.30 — 2 777F71:30 10 MIN 8.08 2.78 3 11:30 -- 5.30 — 4 11:40 10 MIN 7.75 2.45 5 11:40 — 5.30 — 6 11:50 10 MIN 7.71 2.41 PEROLATION RATE 4.1 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS; Test hole excavated by ISABELLE CONSTRUCTION & EXCAVATING LLC.. Perc hole was presoaked. Test run for one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL �7G1�U�ID7LIINNES�I7N�TEFFECT ON7THE �rDATE OF THIS TEST. NOTES: Date PAMONE ENG SVC. LLC �� OF AC l kl 8/26/2013 CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Scale Scale *: 49 TH ••*+� NTS �...... -. P.I.D. NO NORTH WOODS, BLOCK 1, LOT 3..sr-731-78 •teven •i�. annom• ANDREW SENSABAUGH ePERMIT N0. .•. CE 8149 j 22444 NORTHWOODS DRIVE � c OSP131064 SOILS LOG CHUGIAK, AK 99567 �11s� ••••• `r sheet 3 OF 3 Col o Q►RCTERRq ".. m 3 ARC 1 ERRA g CONSULTING, INC 212 E. 51" Ave, Anchorage, AK. 99503 N . Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Andrew Sensabaugh Date Performed: 04tuAlzuio Project: North Woods Block 1 Lot 3 TEST HOLE # TH 13-1 Depth (Feet) SEE ATTACHED SITE PLAN - ORG/OL FOR HOLE LOCATION 1- SM/GM B.O.H. 14- 15- 16- 17- is- 19 - HOLE PRESOAKED 20- PRIOR TO TESTING Was Ground water encountered? NO What depth? NA Depth to water after monitoring? 11.25' Date? 4/10/2013 1046/3//3 Reading Date Gross Time Net Time Depth to Water Net Drop 1 4/10/13 1:00 6" - 2 1:30 30 min 48/16" 18/16" - 3— - * -1:31 _ 6" 4 2:01 30 min 48/16" 18/16" 5 * 2:02 6" - 6 2:32 30 min 49/16" 17/16" 7 8 9 10 11 12 * Water Added Percolation Rate 21 (min/in) Pere Hole Diameter 6" Test Run Between 4 feet and 5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. r MUNICIPALITY OF ANCHORAGE r� 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 � 94 -NEW 6 Q'3 ❑ UPGRADE MAILING ADD S l./s til I LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS o DISTANCE TO: Wel I D r A sorption area / f Dwelling r S PERMIT NO. �O 6 z HZ w Manufacturer Mat i No, of cympartments W N Lig. capac'tytin g &ns (J (/ U IF HOMEMADE: Inside Ienath Width —_ cue Liquid depth dDY OISTANC Well Dwelling PERMITNO. Z S?Fa- MjAutsciurer ater;al CiquidcapanPy]ngallom�- I W = DISTANCE TO: W r 13Q�'T 10 Foundatio Nearest lot line ' -�- �J t PERMIT NO. u. Z No. of fires Leng t of each I/nq Z 0 Total length of lines Trench width a O Distance between es ~ I- Top of file to finish grade t nc Material beneath the J 'CTs Total effectivetsorp� � 81area +^[lies 7 7 W Length Width 1 Depth PERMIT NO. ; i H W i Type cib Cnb meter Crib de t Total efl stye absorp on area to DISTANCE TO: Well Builtling foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. i WI . i DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS :1,3b3 (( I I SOIL TEST RATING — + 00 INSTAL ER / r REMARKS if,?34,3 41 T1 11 0 0 _3631, I I I I PQ PHOVED DATE LEGAL ]onto t .. ^not rNICIPALITY OF ANCHORAGE T•. Department o� Health and Environmental-_otection 825 L Street, Anchorage, AK. 99501 264-4720 I I:Is L -1&-V ti HANDWRITTEN PERMIT R= ON-SITE SEWER PERMIT Applicant�L. Sk4Qgs Cr0[�S7`. Mailing Address: Po - 6o C ra Location: 9btiuL4:004 -vo('" Phone Number: cor 3 �- /�o� .2 Legal Description: Lot Size: Or 000 Type of Soil Absorption System Is: Trench: L�'Drainfield: Seepage Bed: Holding Tank: Maximum Number of The f DEPTH Bedrooms: Soil Rating(sq.ft/br) oV_00J Required Size of the Soil Absorption System Is: f LENGTH. GRAVEL DEPTH O WIDTH I 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). i * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /000 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 M 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 feel 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. I certify that: (1) (2) (3) * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 * * * I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. I will install the system in accordance with codes. I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that edrooms. Signed:Issued bv: Ap icant g� Date: SWP/024(1/81) y O & E ENG VEERING & DEVELO V1ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: SOIL LOG Earl Ellis i688-2280 Tel. No.' ' I Mailing Address: <6U• I-NOf- 77r . {mak. Cts-b % Legal Description: LOT 3 � K AJn�e-r-AJulcbO `�"A,0 Depth (feet) Soil Characteristics 0- 2- 3—M 2 3 4 �--7V�,>— S�nr�a w/C�cG'Gtcts s FA Our r-f'o.>7 uN� �-No 10 11 _ CO F -14J -72r to x•12 — +n)C:Nr'�2G1G -.�w Fr/�� 13 14 _ 15 16 Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit_ Drain Field 'wh Fti-w r o ,tai Jv� I J.3LorJ� I /Zo JI�o�L-rx�woa0 PLOT PLAN PERC.TEST, 9rc--- lei Ati,� i„»sJ of F3_! @.zs_ fusa'i L �,, T - Performed b . u �5 �*+�'� Date: /�l / 9 g) Municipality of Anchorager3o On-Site Water & Wastewater Program(907) 343-79042016 3 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 051-731-78 Expiration Date: ^�J 1. GENERAL INFORMATION Complete legal description NORTHWOODS; BLOCK 1, LOT 3 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 22444 NORTHWOODS DRIVE *CHUGIAK AK ANDREW SENSABAUGH Day phone 2564 W. STONEBLUFF DRIVE *WASILLA, AK ANNA THOMAS Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: 202-3420 TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® Public Sewer ❑ WaiverNanance request for. Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA# Distance: — Date: T 6 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 =ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality ofAnchmage and industrypmctices. The reporfedresutts describe the condition of the systemrs on the deters of evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quaRyof construction (materials and workmanship), and the water usage of the /amity utilizing the systemrs. These condifions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemrs. therefore, GEG makes no warranty (express a implied) regarding the future performance of the well orsepik system. GEG makes no repres mfalion whether air alternative well or septic system can be installed on the property in the event either of the current systems fait. The content of this report is forthe sok benefit of the persoNpady who retained GEG. Reliance upon the information pmvked in this report by any other person orparty, including but not limited to subsequent property purchasers, is not authorized. In short GEG disavows any legal duty to anyone other than the persoNpartywho paid for this report. 6. DSD SIGNATURE 0 System #1 Approved for Z bedrooms. System #2 Approved for bedrooms. Disapproved. 337-6179 Date 6 d /6 Conditional approval for bedrooms, with the following stipulations: .1 l OF 1ninTFR Ai`4p The Municipality or Anchorage Develop, emit Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10/12112) If more than 1 septic system Is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: NORTHWOODS; BLOCK 1, LOT 3 Parcel ID: 051-731-78 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE R', PUBLIC If A, B, or C provide PWSID# Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG Coliform _�' colonies/100 ml. Vinic: ug./L. B. SEPTIC/HOLDING TANK DATA g.p.m. Nitrate mg./L. Date of sample: Well Log (YIN) _ Wires properly protected Casing height (ab R ATI CT Collected by: in. TankType/Material SEPTIC/STEEL Date installed 10/18-21/2013 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 ofpumping ! Pumper ` 5 L-4 m✓J�L1 G% C. ABSORPTION FIELD DATA BELOW EXISTING GRAD Date Installed 10/1 B-21/2013 Soil rating 6._p._d_Aborftlbdrm) 0_6 - System type MOUNDED SHALLOW TRENCH Length 150 ft. Width 5 ft: Gravel below pipe 0.5 ft. Total depth *2.7+ ft. Eff. absorption area 750 f? Monitoring tube YES Depression over field NO Date of adequacy test 5/3/2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 687 gal. New depth 5 in. Elapsed Time:.., 30 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date INTRODUCED WATER INTO MIDDLE TRENCH ONLY, NORTH AND SOUTH''} TRENCHES REMAINED DRY THROUGHOUT TEST D. LIFT STATION PUBLIC Date installed Size in gallons Menhole/Access (Y/N) "Pump on" level at in. "Pump ofr level at in. High water alarm level Datum Cycles tested Meets alarm & requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Ilft station on lot On adjacent lots Absorption field on lot— Public ;sewer mainSewer service line An-Imal containment areas On adjacent lots Public sewer manhole/deanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots **100'+ PVT & 200'+ PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: *4' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots **100'+ PVT & 200'+ PUBLIC F. COMMENTS *WR#OSV151011 **COULD NOT LOCATE WELL ON LAMPERT ESTATES; BLOCK 2, LOT 3 & 4 (22441 LAMPERT CIRCLE & 22453 LAMPERT CIRCLE). "NO TRESPASSING" SIGNS ON LOT, WELL LOCATION WAS NOT PHYSICALLY VERIFIED, HOWEVER, WELL WAS DECOMMISSIONED TO CODE PER 1992 COSA BY TOBBEN SPURKLAND, P.E. G. ENGINEER'S I certify that I have determined through tied inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in etfact on Nlis date. Engineees-Printed Name JEFFREY A. GARNESS Date (Rev.11105) F11161111,040 PON 8t+ IAm cow I'"(ANpAfA°1e�°. --------------------- afto mmomomia NORTHWOODS DRIVE ax fwD SETMW 100.40" NW 00' 00"E ' 15' UTIL ESto T- A6+A ■IIILWa.Y'Ie.ot GRAVEL DRIVE .24.5' 20.0'., .... w AT V In N T rn 4 w EXISTING - P' N a HOUSE 56.5' 'o 4 2 Zj g SHED � PHI o.S S894 54, 24"w 744.40' UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR OONSTRUC'DON OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY OWY FOR THE COST OF THE SURVEY. THE SURVEYOR TAKES RESPiNSOUiY FOR INITIAL USTED DISTANCES. PREVAIL OVER SCAUNG.. REPRWUCTION MAY CAUSE ERRORS IN .SCA-£ LWTsam SURVEY TYPE SYMBOLS ASPHALT FOU18MA90Ii AS-MT } RAL BTRUmm AS-8ULT SET REBAR DRAINAGE O FOUND REBAR .e e-a. FWOGD FENCE a ° CONCKTE P-OT:AtAN .... As-eULT...... WRtCy ... T01VVAlmr � ASSUMED MEI+..-I}--+A—)E METAL FENCE. MOD DECK t NO CMMS 91 PLOT PLANS & LOT SURVEYS NOTES IT IS THE RESPONSU 31UTY OF THE BUILDER OR OWNER, PRIOR TO VERIFY. PROPOSED BUILDINO GRADE RELATIVE ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE VA" B£ SHOWN, FENCES, WELLS. SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS. CONSTRUCTION, TO TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SLOW SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. '.. THE EXISTENCE OF ANY EASEMENTS COVENANTS. OR RESTRICTIONS WHICH .DO NOT APPEAR ON THE RECORDED SUBDIVISION PIAT. MAY PREVENT ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTED. Prepared by SURVEY CERTIFICATION '*ayaay +� Robert E. Johns, Jr. & Assoc. PLAT PUN Surveyors nr elk I Aw Mlw.eb •nyM ' . Professional Land I Ir m. wne w «Wbn.a • «9w W aaa.n 1700 Brink DAw.. ANU7tORACE, ALASKA 94504 YM M W Olw aN b IM Md «.fryAr w..b. rm i Ssste: I Rea Lot sF, Rec Pest FP* No .w�.r wm4anu r 48th"� e ....� U e 1 40 FOUNDATION AS- BN-T y4 K.�. 4 ndwt 6. b t, A�.CY SWM u«.i , � � ....I . «.» . i ,�t :.... .. .....N Dots p5131116 Drawn by REJ Check b . .FMK n»... / rnb.b.. mA aw.+lbn r t e.tia * ROBERT £.JOHNS JR t x «» t iA '1.• Dste D nwn 08!31116 mid` 1459 w D 16-191 _ 0 4127—S ens Led DescriptMn: FINAL STRUCTURE AS-BUILT m r s' 4,'; f•� '' Rte 'r'�o L+,�� LOT 3 BLOCK 1 Manaesf s..hwe h..en tee4ional �«�:.«'••,,••��•• �taaaa,�s*s .NORTH WOODS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 4 S1-'7 3 1- 78 COSA # O a 0,3 R O Expiration Date: R — l ST — OJ GENERAL INFORMATION Complete legal description `nor -4h Mfoe) 1— L 3 B 1 - Location Location (site address) a q q y -YJ er-f1, m ern G1_ Ar, (I, ,,u;, a h . Current Property owner(s) r,,L- (Alord Day phone ,;t - ,ice 1'1 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone I r_;1,dj4 :incl6lorn Day phone _ 0LI - 9 'I �< C-atGxf i dr+rl Ple-CIV O 11,111 Old (T -U nni HiW, r= -f2 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 1. r Individual Water Storage ❑ Individual Holding Tank El Community Class _ Well Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for' a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in gfffe�eQct a�t the time of installation. Name of Firm j ,A2 £ ((.( 1) %e—V//,I .Y Phone "_4v Address &4g, 4 S && P`,%� &"!P Engineer's Printed Name JMoff/J E. S. DSD SIGNATURE JZ Approved for .3 bedrooms. Disapproved. C Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; Al/ o_,L� Original Certificate Date: (Rw. 7105) 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: koR11.4Wooss !bT 3 gLk i A. WELL DATA Well type J, Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE RE: Coliform ob Ar ug/L If A, B, or C provide PWSID # Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG ft. 00 mL Nitrate mg/L date of sample: B. SEPTIC/HOLDING TANK DATA Parcel ID: 05'1-731-7E -P(A L I L WATT --_l2. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above und) in. AT INSPE -� ON Other bacteria Collected by: fi# colonies/100 mL Tank Type/Material Date installed L Tank size 1, QQo gal. Number of Compartments a- Cleanouts (DN) (Aon Foundation cleanout 6)N) Depression over tank (YfbQ ttl{Z High water alarm (Y(I Date of pumping -.1/14 /D 6 Pumper Tim S f ume1*r) C. ABSORPTION FIELD DATA Date installed 6 11 JF I f Soil rating (g.p.d./ft2 or /lxJr ) J.00 System type -n-.r nrG, Length 1iZ- ft. Width 3 ft. Gravel below pipe 1ZI '4' ft. Total depth/.I- ft. Eft. absorption area 21ft: Monitoring tube Lkl. Depression over field .72& / i Date of adequacy test 2f�of Results (Fail) -aa4.,J_ For -3_ bedrooms I Fluid depth in absorption field before test _Q_ in. Water added gal. New depth in. Elapsed Time: /min. Final fluid depth in. Absorption rate >= q5-0 Id. 9•P. Any rejuvenation treatment (past 12 mo.) (Y/N & type) . ,, nerig la.-,o,A )r, If yes, give date I — 'X SE'b' &;,MW%fW) S D. LIFT STATION Date installed "Pump on' level at _in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at _in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /seofiale-rvice line containment areas ManholelAccess(Y/N) High water alarm level at Meets alarm & On adjacent lots On adjacent lots flal -PtA 6i -I (— t/ J%k TEY2 Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation + S I Property line -f '; I Absorption field 1 Water main +10 ' Water service line t 10 Surface water I OU' Wells on adjacent lots + a.00' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -r 10 1 Building foundation -* 10' Water main -r 10, Water Service line I-10, Surface water 1100, Driveway. parking/vehicle storage + a.0' Curtain drain 4.✓mayWells on adjacent lots + oO' F. COMMENTS J -r 6,LJ vd6Nn �tSedtr,c,c_ • ,T"VC1rt7' To Sie)rvw\ or G. ENGINEER'S CERTIFICATION (7.5') AATrfkkTHAJ T'S I certify that I have determined through field inspections and i review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. i Engineer's Printed NameC�NA-) E. ��ly Date F/� COSA Fee $ y3a Date of Payment 01 1a6 Receipt Number 0146 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number JOHN E. WOOD CE -4630 wkeS *,�10 r I lfll\ LL LVVI IIIU VU•UI 111 VIIIILIIV II\VI LI\I II:J ITA 11V. LOJOUIOUIIIIUU01 Ie r• IJ I ', • •I.• il.o i /-STY to, /lad It ,' 4 .sc.L 2 ti t�� upr(c ` o S/17. n 1 . PCS •-. o. IA'IO � 10 569.59' EASEMENTS OF RECORD, OTHER THAN THOSE SHO.'/%4 ON THE RECORDED AI e.fn PLAT, ARE NOT SHOWN HEREON, v SNLD � �1• 7 , 4' I/ANt•}, �RtNer,.11l� f i •. No Cornwl Sol Tlnl 0.10 2z"79" z"7 vilify Inel 1 Ir.e vrvoyed the I011e•-In0 O..vfl)•0 Prepefly. Lal-.-eloc• AIaRr/% wa�pf $��• Anelle,eo, reead.nd 0001#.� Ale1Re, SW IMl IM W'*'* nW1T6 Idy•ted thween Irl •e114.0 IM d•OOerly IIne1 end do not 1f.erbo w eflcf O•Ch On IN property HMe f4jo l thame• 041 M Urveoyefnenw on oroVwly Iylry edlecerll Ihwelo enpe,ech an 01i Or.fnf• In Orwl'on end met Ihwe we 00 r0•dneyl, irenlf U4n hnel or 01her V,1,01# q.#Wm,nt{ On 1e.4 ►Open t•t•ol h hd.p1W ►.woon Anellereal, A4lte 31 OCY, 1994 IT. SCALE I' •40' toe+ No. I/n OF 4 C re [/ 4 T� ` HfMII N,tderw Y, ••. W. 1 ioF'1 rl .' t4 e,rN_WcoD5• 0P -WE 10 ^_' 1 gA5r.• 100.00 I ', • •I.• il.o i /-STY to, /lad It ,' 4 .sc.L 2 ti t�� upr(c ` o S/17. n 1 . PCS •-. o. IA'IO � 10 569.59' EASEMENTS OF RECORD, OTHER THAN THOSE SHO.'/%4 ON THE RECORDED AI e.fn PLAT, ARE NOT SHOWN HEREON, v SNLD � �1• 7 , 4' I/ANt•}, �RtNer,.11l� f i •. No Cornwl Sol Tlnl 0.10 2z"79" z"7 vilify Inel 1 Ir.e vrvoyed the I011e•-In0 O..vfl)•0 Prepefly. Lal-.-eloc• AIaRr/% wa�pf $��• Anelle,eo, reead.nd 0001#.� Ale1Re, SW IMl IM W'*'* nW1T6 Idy•ted thween Irl •e114.0 IM d•OOerly IIne1 end do not 1f.erbo w eflcf O•Ch On IN property HMe f4jo l thame• 041 M Urveoyefnenw on oroVwly Iylry edlecerll Ihwelo enpe,ech an 01i Or.fnf• In Orwl'on end met Ihwe we 00 r0•dneyl, irenlf U4n hnel or 01her V,1,01# q.#Wm,nt{ On 1e.4 ►Open t•t•ol h hd.p1W ►.woon Anellereal, A4lte 31 OCY, 1994 IT. SCALE I' •40' toe+ No. I/n OF 4 C re [/ 4 T� ` HfMII N,tderw Y, ••. W. 1 ioF'1 i Municipality of.Anchorage Development Services Department Building Safety Division . Onsite Water & Wastewater Program r 4700 South Bragaw SL P.O. Box 196650 Andwrage,'AK 99519.8650 www.d.anchorage:akus (907) 343-7904' CERTIFICATE OF HEALTH AUTHORITY. APPROVAL FOR ASINGLE FAMILY, DWELLING' ` Parcel I.D. 051-731-78 1. GENERAL INFORMATION HAA# HA 1 Expiration Date::_ Complete legal description NORTHWOODS SUBDIVISION: LOT 3. BLOCK 1. Location (site address or directions) 22444 NORTHWOODS'DRIVE • CHUGIAK AK 99567 I Current Property owner(s) LINDA JONES Day phone 688-1253 i Mailing address 22444 NORTHWOODS DRIVE • CHUGIAK. AK 99567 Lending agency Mailing address Day phone Real Estate Agent PEGGY GONZALEZ w% DYNAMIC REALM Day phone 261-7618 Mailing address 3111 "C' STREET * ANCHORAGE, AK -99503 I Unless otherw1se requested, HAA will be held by DSD for p/ckup. i 2. NUMBER OF BEDROOMS: ►3 3. TYPE OF WATER SUPPLY: *THE SEPTIC SYSTEM IS SIZED FOR 3 BEDROOMS. THE HOUSE IS ONLY A 2 BEDROOM RESIDENCE. TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class "A' Well N Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) 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) 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 less than 30 days old. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $810.00 at, or prior to ciosing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Health AuthorityApproval 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 wafor supply and/or was Iowa ter 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUITE 213 ' ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A GARNESS. P.E. Engineer's Comments: In conducting this evaluation, AMNC, Inc. attempted fo provldo a thorough, conscientious engineering analysts of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results dosonbod 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 fife 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 lamiy 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 meyguarantoe that there are no hidden defects or encroachments. AWWQ, Inc. can therefore not provide any warranty or future estimate of howlong the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the solo benefit of the owner fisled above. Anyrellanco upon or use of lhls report by any other person or party Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing Date 337-6179 S12_'1101 ON-SITE : WATER AND WASTEWATER • PROGRAM „un Attachments: HAA Checklist Septic System Advisory Well Flow Advisory l� Manitenance Agreements Supplemental Engineers Reort Other By, o0"t/ v Original Certificate Date. 17L — Quw. +groom Municipality of Anchorage Development Services Department O"ite wow & Wastewater Program 47W South Bragaw SL P.O. Baht 196850 Anohorege, AK 695198850 www.aanelara6e1k.ue MM 343 -TW HEALTH AUTHORITY APPROVAL CHECKLIST i i Legal Description: NORTH WOODS SUBDIVISION, LAT 3. BLOCK 1, Parcel ID: 051-731-78 A. WELL DATA PUBLIC WAT E R wen type -A- K A, B, or C provide PWSID/F213001 Web Log (Y/N) Date ccrnpleted Sartilary seal P1opeM protected (YM) Cased to R Casing height (above ground) in. FROM WELL LOG AT INSPECTION Data of teat Statle water level it R W ctlon g.p m. g.p.m. WATER SAMPLE RESULTS: I Conform coloniesM00 ml. Nitrate mgJL. on 10D ml. Date Collected Hy: B. SEPTIC/HOLDING TANK DATA Tank Type/Materkd STEEL Date Iristaiied 6/18/81 Tank size 1000 gal. Number of Compartments 2 Cleanout (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO Ngh water alarm (YM) N/A Date of pumping 3/23/01 Pumper JR'S PUMPING i C. ABSORPTION FIELD DATA TME oe sarsrONLY A S Date instaned 6/18/81 so raft (g,p dJft%r1� 200 System type TRENCH Length 42 R. Width 3 R Gravel below pipe 8 fL Total depth 12 R Ef - abaorptlon area 672 fe Montto ft tube •+YES Depresslon over field NO Date of adequacy test 3/23/01 Results (Pass/Fan) PASS For'3 bedrooms Fluid depth in absorption field beforeteat 63 in. Water added 708 gay. New depth 89-5 In. Elapsed Time: 1210 min. Flea) fiukt depth 72 in. Absorption rate >w 450+ g.p d. AnY reluvena110n treatment (past 12 mo.) (YM S type) NONE KNOWN If yes, give date — **SUMP ONLY EXTENDS 89.5' BELOW THE INVERT D. LIFT STATION Date in stalled Size in gallons 'Pump on' level at n. E SEPARATION DISTANCES High water alarm level at in. Cycles tesMd Meets elarm 6 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot Absorption geld on krt Public sewer main Brie PUBLIC WATER On adjacent Lg Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption geld 5'+ Water service Brie 100+ Water main 10,+ Water service one 10'+ Surface water 100,+ Wells on adjacent Ift 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: property Brie 10'+ Suliding foundation 10'+ Water main 10,+ Water service Brie 100+ Surface water 1001+ Driveway. parldrp/vehide storage 20'+ Curtain drain NONE KNOWN Wells on adjacent lots-1-00L±— F. Ns200'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION I car* that I have determined through Reld Inspections and review of MuMdpal records Nat the above systems are In conformance with MDA HAA guidelInes In effect on Nis date. Gamess: Engineer's Pame JEFFREY A. GARNESS Date r,201 HAA Fee S 30D LO Welver Fee S Daae of Payment L j - fl - O N Data of Payment Receipt Number 014 19 Receipt Number (Rev. UMM - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section �9 P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 / CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.#-b5�'731=78' HAA#_ HA940590 1. GENERAL INFORMATION Complete legal description Lot 3; i3tocii 1; Mckth Woode Subdivision Location (site address or directions) 22444 Noathwooda V4i.ve Chug alz AK Property owner Tom Haztett Day phone 688-2444 Mailing address 22444 Nowthwoodd Uhive Chua•iak AK 99567 •;Lending agency Day phone Mailing address' Agent -' -Tom Stiiafeman/ DYNAMIC PROPERTIES Day phone 261-7655 Address 3111 Or" cinocf Suite 100 ••. Ancho4 e,' AK `;99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 f 3 . TYPE OF WATER SUPPLY Individual well - - — Community well Public water r' IL NOTE: If community well system, provide written confirmation from Stafe ADEC es - Ing to the legality and status of system. a ' -'4. - TYPE OF WASTEWATER DISPOSAL:*-- = _ _. '•., 4;C' • ' ' ' . ;•`��;+ :' Individual on-site XXX _ _. _ Holding tank >_: .... ' " - ., '... :•� , -. ,. Community on -site• - Public sewer „ NOTE- ; If community. wastewater system, provide written confirmation from State AD EC attesting to the legality and status of system in!: - !:, •> > ;•: z a1 NKl cz? cel ;- T2'*j In". IM) front MOA <21 �. .... .. .�. .' _. ..--.,. - r •:'S_a,Wr 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 verity 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 -f 41 ENCrN j exj C_ Phone 6 C1 y - ;Lq 7 Address 17o 3Y C4cc.c <,,/fA L4o' /?,0 4c ff/Vt%, ASC, g9•r`77 Engineers signature �� '—� /7t— Date /o Ak-% C I�:0A ROURT C. COWAN CE•8801 +rte ... .._ - , 6. DHHS SIGNATURE i`aaaaz>o�� Approved for �� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By:. ' � Date 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 theirlending institutions in ordertosatisty certain federal and state requirements. Employees of DHHSdo 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. Cf Municipality of Anchorage AL O Department of Health and Human Services IN HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t-.,- 3 Li 1 N o,,� 1. SLParcel I.D. A. Well Data Well type /k If A, B, or C, attach ADEC letter. ADEC water system number_ 2/3 00 / Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (YIN) Wires property protected (Y FROM WELL LOG Date of test Static water level Well flow SEPARATION DISTANCES FROM WELL TO: Septiclholding tank on lot 7e o 14- PECTION A z R,� y z� �. g.pr c . ..� A O <b � b P N g N On adjacent lots = m Absorption field on lot z+o rf ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Other bacteria DaCollected by: i B. SEPTIC/HOLDING TANK DATA Date installed 6161 Tank size /oo o Compartments z- Cleanouts (94) Foundation cleanout (YO �% Depression (Y N High water alarm (Y19) .-� Alarm tested (Y/N "/ t Date of pumping Pumper T -•Z, ,SSI r7 L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots 2-.,:) r 4 —Foundation S" To property line /0,-/., Absorption field /o/ Water main/service line �� 14 - Surface water/drainage /OC3 10P - 72-026 d- 72.026 W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Manufacturer Size In gallons Manhole/Access (Y/N) Vent (YIN) 'Pump on" level at High water alarm levet Meets MOA electrical codes (YIN) SEPARATION D. ABSORPTION FIELD DATA LIFT STATION TO: at I adjacent lots Surface water Date installed (, D / Soil rating (GPD/Ftz) 7--G llxle— System type Length �L r Width 3' Gravel thickness E' Total depth 11 ' Total absorption area 1072 Cleanout present&)_Depression over field (Y/NP J Date of adequacy test 7-4-9-f Results (passtfaB) Osr-s s for .7 Bedrooms Water level in absorption field before test After test 1 Pe jid treatment (past 12 months) IIQ °� �8 Yes, give date `tlr�2�' OG L-t1za,o—ff)At.- I'lsP6 .-n6A Io,7 6ccf SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot r't,( On adjacent lots Zo' r Property line To building foundation Zo 14, To ext ting or abandoned system on lot On adjacent lots 3o r h Cutbank Water main/service line 00 Surface water / / oo 14- Driveway, parkinglVehicle storage area 70 j Curtain drain Ia,4g- " t a E. ENGINEERS CERTIFICATION I cer* that t have checked, verified, or oonlormed to all MOA and HAA guidelines in Signature 74 /< e ✓ , Engineer's Name ' eo /?f e % C ( e wd Date IO /a 9 I q'/ HAA Fee $ �-5� Date of Payment / -7 Receipt Number 72-028 rM' Bade Waiver Fee $ Date of Payment Receipt Number CE -8301 n� FC....,. .tea this Inspection. MUNICIPALANCHORAGE • 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 Parcell.D.lt IQL-131-210, 1. GENERAL INFORMATION Complete legal description Lot 3 HAA N VA C101 tirlhln 6 Location (site address or directions) 22444 Northwoods Drive, Chugiak, Alaska I Property owner Steve and Karen Parker Day phone 248-3535 hm 561-1500 wk Mailing address P -O- Pox 221583, Anchorage, Alaa_ka 99522 1 Lending agency Day phone i Mailing address I Agent ProokP — rFNTURY 21 /mr.ONTAr. RFAr. F-SrAT . Day phone F96-9600 Address 11901 Business Boulevard, Suite 103, Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well Community well xxx 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 xxx Holding tank Community on-site Public sewer i NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(R".1/91) Front MOA621 i 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t 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. l furtherverify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on isite 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 S & S ENGINEERING phone ape oad Na: 204 Address Eagle River, Alaska 99577 Engineer's signature Date 2— 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. a Conditional approval for Additional Comments bedrooms, with the following stipulations: e 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 -WS M v. 11911 8a k MOA R1 i, Municipality of Anchorage AL Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I T 5 hue- ( 0"'I ooOS �%a A. WELL DATA Well type If A. B, or C, attach ADEC letter. Log present (YIN) Date completed Parcell.D. ADEC water system number _Z13�j Driller Total depth Cased to Casing height Sanitary seat (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level T r Well flow-� g.p.m. g.p. Pump level 'C �o A . IT7 ' SEPARATION DISTANCES FROM WELL TO: L3 1 Septic/holding tank on lot On adjacent lots N n T Absorption field on lot �%r ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Tank size / [JOD Compartments 2 CieanoutsX%N) Foundation cleanout (Y6cp_*_d_ Depression (YINP High water alarm (Y/N) /A- Alarm tested (Y/N) Date of pumping Pumper�s� QI X i Fc. o• SEPARATION DISTAN ES FROM SEPTIC/HOLDIN� TANK TO:-r_"v1E o/- /1./ S L-4- -C ,1 /ff / Weil(s) on lot On adjacent lots Oyyl _> - Foundation S bf} 1 Topropertyline � Absorptionfieid �b � ' Watermain/serviceline� � 1 Surface water/drainage I 1 +_ 1!5';> 1 -f- T GtsASS `e-' e NoT 72-026 (Rev. 7191) Front e,J,/ r:oT 3 /A'1.4 Pnzl-es �, _. /"! OSS) CONTINUED ON BACK PAGE C. LIFT STATION - Date Installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer — Manhole/Access (Y/N) - "Pump off" levet at Cycles tested — r SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date Installed ("A Soil rating �d �/� System type r Length `AZ Width 3 Gravel thickness t3 Total depth �2 Total absorption area Cieanouts present&77N) V Depression ever field (YLS'jL Date of equacy test 2- -T-93 Results/it) �S for 3 �)Z bedrooms Peroxide treatment (past 12 months) (Y45P A_ WoLJJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 2 62Mr—/IAL� /\�b Well on lot �o�a, On adjacent lots 2oD d Property line 1 To building foundation '� t % To,e 'sting or abandoned system on lot 'd' On adjacent lots �( � Cutbank�Watermain/service line ,,�vt� Surface water ov f 4 Driveway, parking/vehicle storage area �2 t� Curtain drain /I(_ Igg E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in S L 5 ENGINEERING Signature 17034 Eagle River loop Road No. 204 ap a River, AI-Sku 99577 Engineer's Name Date HAA Fee $ /70 Date of Payment Receipt Number n-we(Ray. 3191) Back MOA 21 — /U — Sk Waiver Fee: $ Date of Payment Receipt Number R ROGER J. No. f of this inspection. Sc' i • �� n � � O � n L S WALTER J. NICKEL, GOVERNOR IUuI►J (('jjU"ll`JJ DEPT. OF ENVIRONMENTAL CONSE111ATION i ANCHORAGE DISTRICT OFFICE (907) 349-7755 800 E. DIMOND BLVD., SUITE 3-470 I ANCHORAGE, ALASKA 99515 December 15, 1992 ' Mr. Roger Shafer S & S Engineering SUBJECT: Northwoods Subdivision Class `A' Public Water System, PWSID 213001 Dear Mr. Shafer: have completed a review of this office's files concerning the monitoring status of the above -referenced Class 'A" Public Water System and found the following: i 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on December 3, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on April 21, 1992. This does meet the provisio6s of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on July 1, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on June 2, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class W Public Water System is in compliance with other provisions of the State Drinking Regulations.' If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, �Wc Michael Lu Environmental Eng. Asst. II �F11 panted on rec,cled pane, by C.O. r`, MUNICIPALITY OF ANCHORAGE DIVISION OF EIVIPONMEN`IAL HEALTH DEPARTMENT OF HEALTH AND CW1RO1NZENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICA1 1. General Information (a) Legal Description ( I-4to block, Application Date , section, tcwrship, range) Location (address or direction�ss) /+ O�u� O►J NV P e. oat G� 3-t1To..,. 7 vcN 6u'4r- //-- //�� (b) Applicants Name S/�t t /vEilSaN Telephone Applicants s2 �r 'eo ?6z (c) Applicant is (check one) Buyer [1-1 ; Other (d) Lerdirg Institution Address i Lending Ins Gu�/ I/ns�5�t� . O.mr/builder (explain -IN AZvL11yn ; ✓/ Telephone _ r (e) Ictal Estate Co. b Agent /UTA=�%t J1 9�� d�✓�� `^ �� Addresses ! Telephone 2. Type of Pesiderce Single -Family Multi -Family Other (describe) 2 ' Number of Bedrooms � 3. Water Supply C1 /��^ k Individual Fkll Camunity, Public C�4-/7J > Note: If community well system, must have written confirmation f±on the State Department of Envirormertal Conservation attesting to the legality and s Is the well adequate for the nkmiber of bedrooms specified in this HAA ( 1 4. Sewage Disposal i OrsiteyH;� Public Ccrmnity Holding Tark i Is the wastewater disposal system adequate for the nunber of bedrooms (Y (Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, Tests, Data and Information I certify h ve checke , verified, or conformed to all MOA HAA Guidelines in effect on da nspection. Signe Datey/—017� Name Firm Telephone Address #H8: £ GINEERING Uri Signed by .,., C•�. Date ( ENGINEER SEAL) 6.DEEP Approval Approved for 3 bec�oaas Fly r J v A. s ! a�i.� Approved M Disapproved Q Conditional Terms of Conditional Approval Date I The Municipality of Anchorage Department of Fbalth and Envirer:mantal Protection does not guarantee the ccr:tinued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system W safe and func- ,ticnal for the number of bedroa s and type of structure indicated.. +' (DHEPP SEAL) 7. Mail the the ollowing address: KB2/d5/s [Page 2 of 21 n L 3 i MUNICMI IT OF ANCHORAD! MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY, APPROVAL (HAA) CHECKLIST -FEBRUARY 1984 pMAR ?. 9 100AA. WELL DATA / u L ( AtUIVED Well ClassificationS ,AC, D.E.C. Appr Well Log Present (Y/N) Da , B,leted ield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height.Above Ground Sanitary Seal on Casing (Y/N) I Electrical Wiring in Ccnduit (Y/N) .Depression Around Wellhead (YIN) Separation Distances from Well: To Septic/Holding Tank on Lot IAOn Adjoining Lots I To Nearest Edge of Absorption Field on Lot T On Adjoining Lots To Nearest Public Sewer Lire To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line onLot Water Sample Collected By Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Instali Size %t No. ;arpartments Standpipes Y _ Air -tight Caps (Y Foundation Clearest ) �� Depression over Tank Date Last PprVed Pumping/Maintenance Contract on File ( for Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (Y/N Separation Distances from Septic/Holding Tank: To Water -Supply Well elf h' L-/ G To Building Foundation To Property Line To Disposal Field To Water Main/Service Line To Stream, Porti, Lake, or Major Drainage Course Comments SP th Q I ?42 ` int (Page 1 of 21 1 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in tics ttrata Z Q� Type of System Design Date Installed 04d J Length of Field Z width of Field Depth of Field Z ^�7 Gravel Bed Thickness Square Feet.of Absorption Apea L7 / 7/ Standpipes Present Y Depression over Field J Date of Last Adequacy Trost ,3 Z Results of Last Adequacy Test C C 1 Separation Distance from Absorption Field: ID To water -Supply wall G / C To Property Line To Building Foundati ZO7,L- To Existing or Abandoned System on Lot w s Cn Adjoining Lots c5�0) To water Main/ rvice Line ,• �l L 4 To Cutbank(if sent) r V— To Stream/Porxi/Lake/cr Major Dr inage Course To Driveway, Parking Area, cr ehicle Storage /Area / /lf % /'�%� 7 Cawents ?fid x. �DK t D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at I High water Alarm Level at Tested for Electrical Codes(YM) _- C, nt Cements Dimensions Manhole/Access (Y/N) ' "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify th ve check -ad, verified, or conformed to all MOA HAA Guidelines in effect on the da of ion. Signe Date d C ax^-ERi1!C .. MOA No. brm KBl/d5/s �Y.di1E [,,y�69? a,7J T;o. i4ii-c C L't'd � .�.^s✓,•i (Page 2 of 21 2-15-84 I r1 ,. INSPECTION APPOINTMENTS DATE RECEIVED STREET L ATION TIME TIME TIME DATE DATE Cwt DATE ❑ One ❑ Four ❑ Other INSPECTOR INSPECTORS INSPECTOR I MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 90501 ENVIRONMENTAL P ,CTECTION X11/ ENVIRONMENTAL SANITATION DIVISION JUN 2 6 1981 Telephone 264-4720 p CE1I `\�, FF REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER 11Gi1 NM D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be protested. Please allow ten (101 days for processing. 1. PROPERTYOWNER LC. f1 PHONE MAI LING ADDRESS I t PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE. j MAILING ADDRESS I 3. LENDING INSTITUTION PHONE. MAILING ADDRESS 9. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET L ATION 6. TYPE OF RE DENCE NUMBER OFsBEDROOMS qrJ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY E�'Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL' ' ATTACH WELL LOG. A well tog is required for all wells drilled m--�COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM <13 INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I 72010 (Rev. 6/79) 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑SepticTankor ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL - - 4. DISTANCES W ELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lo[ Line Absorption Area to nearest Lot Line 5. COMMENTS 1{d APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac com ❑ DISAPPROVED ny certificate) DATE BY 72010 (Rev. 6/79)