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HomeMy WebLinkAboutNORTH WOODS BLK 1 LT 4North Woods Block 1 Lot 4 #051-731-77 c� LL u. c c CO CO M r til p3 a w aoi 3 N c'') ❑ ❑ a o �- a s .0 o a N m ° cn -0= : `m CD O o w Lo U : CD r 3 m o a IM N N L r U O i M N — El ❑ a � ❑u u o Q) O W o a� v a �. aNi S m O cO X W o J �do� � Z �_ `- o �° _ Z ° W o � o pl6 •. Cpl( Roo �- t ❑ -a n � c)co X Z o o :� >LLI 000 o p W w °N' n` -o = CO W C� �•. ❑ m co m m Z r W 1-- 0 F- ' Cr7 E LU s 0 cj ❑ v! N N O o z ,r, O T LL o Q o 0 a� O z m ~ m a Q Q Z O �' Y �' :� Z w J J m o d > on° cn Q a ¢ LU ~ Q ¢ O s 3 w ❑ Q r o o Q Q" U� U) z 1 O ❑ v o = c �) 0. co Q. m ❑ Q ❑ ❑ � a @ 10 Z Q CLL O L W Z W m Q 7 N O R1 (� Q 3 Q U) O LL C7 F- F- m � Z12 m 1112 m _m Q a m o J z ` WO 5 X Q a L o + z .5 .� W rn o coJ N L -D Q M o c N D z x ° V)❑ co Q Q .0 L) w G C C7 E O r 2 m O z > F- �� _ cn '3 z Z � � � � ° o O a ° Oi ElLLJ ❑ LU m -2 O t� LU � m > Q F- Z w d p z \ o 00 U-> z V .� O X o N Q z z _� X x x x 1 w I--- -� � J- a ❑ O ¢ W W W W z � N Q � m Q O a Q + + co Lu Z LO "' o U) _ U 0 �' ~ z a O O U r 2 �- ai D F- d U1 ❑ z O ('3 a z Q cn z o ❑ �n W O F y LLU U 0 O �, o z o> Y zz °� J Q _ _ +� zz (D 0 C > OL }. U) dQ 45 v N Q .N o. = Q a, � d o 'a c N zY a`� o y a .0 3 E - �� N o�0a0 O a o LL ; L aQiQ N d ❑ z ``� in N a W J w z f°- W N o ti in a� vai c U U) Q 0 PERMIT NUMBER: PARCEL ID NUMBER: OSP231387 051-731-77 PC, RECORD DRAWING I - - - - - - - - - - - NORTHWOODS -DRIVE KEY BOXY — — — — — — — — — — — — -------------------------�---- ' :. ----------- ASSUMED WATER LINE LOCATION L-"'e"'� \1 cu CL < A B I C__j FCO 27.3 1 8.9 - MH 44.6 15.6 64.3 ST1 4 7d.7 15.0 61.3 DBL1 50.0 W 15.7 59.6 DBL2 50.8 , 16.2 j226 59.2 C01 57.6 61.8 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. NORTHWOODS; BLOCK 1. LOT 3 — — — — — — — — — — — — 15' UTIL. EASEMENT 1] ----------- dJ EXISTING 2 -BEDROOM HOUSE (SEPTIC SIZED FOR 3- BEDROOMS) EXISTING 1981 DEEPTRENCH TYPE DRAINFIELD. PASSED ADEQUACY TEST ON 10/3112023 NOTE: PER THE CONTRACTOR, THE OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC. PER THE CONTRACOR, THE OLD TANK WAS FILLED WITH - - - - A CONCRETE SLURRY. LAMPERT ESTATES; LAMPERT ESTATES; BLOCK 2, LOT 3 BLOCK 2, LOT 4 -INSTALLED NEW FOUNDATION CLEANOUT (FCO). PLUMBING IN CRAWLSPACE WAS REROUTED PER THE CONTRACTOR —NEW IM -1060 INFILTRATOR TANK NORTHWOODS; BLOCK 1, LOT 5 —INSTALLED DOUBLE CLEANOUTS (DBLI & DBL2) Q A N SCALE: 1"=40' 40' T LAMPERT ESTATES: LAMPERT ESTATES; BLOCK 2, LOT 5 BLOCK 2, LOT 6 11 Tp %ffARNlrjz5N 11!lNk`xllNj'"r_jj7ElRlfN (_xl GRO'll u Ltdf ........ ............. ENGINEERING o SALES v CONSULTING N., 0 io 3701E TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA PHONE (907) 337-6179 -WEBSITE: gamemengineen . ng.com ............ ............ PREPARED FOR: PHONE NUMBER: PAGE NUMBER: e re Ga ss i Ar JANICE SHIPMAN 907-229-5544 20F3 ##' A•c PROJECT/LEGAL DESCRIPTION: DRAWN BY: 'j .3., NORTHWOODS; BLOCK 1, LOT 4 J.L.M. .... (Z TYPE OF WORK: DATE LICENSE via ESS\ RECORD DRAWING OF SEPTIC TANK UPGRADE 3/15/2024 #AECC884 WIL 04 31 Is/ Zf FPERMIT NUMBER: OSP231387 RECORD DRAWI 1 V G PARCEL ID NUMBER: 051-731-77 TOP OF TANK @ INLET= 94.27 - r INLET INVERT OF PIPE @ INLET= 93.71 — uICII TOP OF MANHOLE LID = 98.94 FINAL GRADE = 98.23-98.27 STI NOTE: PER THE CONTRACTOR, 2" TOP OF TANK @ OUTLET = 94.27 OF INSULATION PLACED OVER TANK 1060 2 -COMPARTMENT INVERT OF PIPE @ INFILTRATOR SEPTIC TANK OUTLET = 93.44 GARNESS ENGINEERING GROUPLtd ENGINEERING SALES CONSULTING , I 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, ALASKA 'PHONE (907) 337-6179' WEBSITE: —.9am ssen9ineering.c PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JANICE SHIPMAN 907-229-5544 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: NORTHWOODS; BLOCK 1, LOT J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 3/8/2024 C.}•..• 1 W 4t .....:..r } . . ........................... I ♦, in -1- .•.}�niffrey A. Garhess:i t ir ♦7 53 • AV LICENSEEVA SS� ♦` •® MECC884 ®®®O®4 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231387 Work Type: SepticTank Upgrade Tax Code Number: 05173177000 Site Legal Address: NORTH WOODS BLK 1 LT 4 G:1459 Site Mailing Address: 22508 NORTHWOODS DR, Chugiak Owner: ALASKA TRUST Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 11 /16/2023 11 /15/2024 20127 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: C, &_�-3 Issued By: OkA Date: Date: 3 Development Services Department j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 051-731-77 Property owner(s) JANICE SHIPMAN Day phone Mailing address 22508 NORTHWOODS DRIVE, CHUGIAK, AK 99567 Site address 22508 NORTHWOODS DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTHWOODS; BLOCK 1, LOT 4 Legal description (Township, Range & Section) Lot Size 907-229-5544 Sq. Ft. Number of Bedrooms 2 (SEPTIC SIZED FOR 3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ Septic Tank ElUpgrade ❑ (w/wo ADU) Holding Tank ElRenewal ❑ Duplex (D) ❑ Multiple Multiple Dwellings ElPrivy El and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2-2-5— Date of Payment: Receipt Number: Permit No. S f Z s t 387 Waiver Fees: Date of Payment: Receipt Number: Waiver No, GADevelopment ServiceslBuilding Safety\On Site Water and Wastewatefforms\Client FormsTermit Application.doc go] Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231387, Curtis Townsend, 11/16/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231387, Curtis Townsend, 11/16/23 NORTHWOODS DRIVE 0 0 co co EAST 100.00 Water valve 5' Utility Easement Q) LOT 4 zt= ca < deck deck 2 9 36.0 1.2— 36 0 . Lot 3 13.7 13-7 c, c, cD I Story Frame 9 ( 0 s .6 Cl) CN House g N (0 Lot 5 C14 —27. 49.7 C\1 deck C14 M 0 Septic vent (typ) 0cr_ 0 Z Wood fence (typ) Z SCALE: 1"= 40' N89059'29"E 100-00 Lot 4 1 Lampert I Estates Lot 5 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 4, BLOCK 1, NORTH WOODS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 31 st day of October 2023. EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED Engineers and Surveyors ., `B E 1 666 PLAT ARE NOT SHOWN HEREON � - 1, � 4--, 907-248 UNLESS OTHERWISE NOTED. FB 23-3, pg 39-40 1 1 ' This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. F A4 AM 49th •1 00 00- 4'. 00 %bizobeth L. Wolatka o ow 8036 - LS AW NORTHWOODS DRIVE— 8509A CY') EAST 100.00 Water valve 15' Utility Easement --------------- C� LOT 4 CL W < deck 0 1.2- 6 36.0 Lot 3 13.7 c, I Story Frame 9 CID (6 House M —27. C14 49.7 CO (0 Lot 5 C14 C'� 13.7 deck 0 a C2 3 deck 6 .0 Frame me c� Story F a c,6 for IS c,q House c) 27. 0 49.7 0 1 I CNJ 0 Abandoned & o Septic vent (tYP) F_ Manhole F - w I cr_ 0 0 Z Wood fence (typ) _T I N89059'29"E 100.00 Lot 4 1 Lot 5 Lampert I Estates OF • A4 Is 49th Poo . ..... ... . izabeth L Walotka ;k' AW 0,. 8036 - LS• j. •AW AW AW _T REVISED 3-28-24Add venr RECERTIFIED 3-20 24 CORM NE AS -BUILT NO CORNER SET DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASKS Standards of the following described prop": LOT 4, BLOCK 1, NORTH WOODS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 31st -day of October . 2023. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREONEngineers and Surveyors FIB 23-3, pg 39 UNLESS OTHERWISE NOTED. _& ZIBE 1 907-248-1 666 -40 Il This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaomracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shelf only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a Violation of Federal Copyright law. Unless grow negligence Is discovered, the liability extent of the preparer is firnited to the amount of fees collected for services in preparation of this product MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL. PROTECTION ENVIRONMENTAL. ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT s— NAME`+ A�a CJ J s� 16 � �j P - d3 4- �,�,�- F PHONE � ' 9!f EW ❑ UPGRADE MAILINGAD ESS , e ° LEGAL DESCRIPTION ��� LOCATION � d ocl N0. OF BEDROOMS v _ Y DISTANCE TO: Wel Absorption,a e r Dwelling PE T O L? I- Q w I.- Manufacture Mater No. of co rr��ar; ments �C N Liq. capac'ty in gallons IF HOMEMADE: Inside length ate. Width Liquid depth 11� jaz DISTANCE TO: Well Dwelling PERMIT NO. 0-2< Manufacturer Material Liquid capacity in gallons D w= DISTANCE TO: Wel �t� Foundation ��14n Nearest lot line^ PER O. er J W z FZW � No. of line Length of,4ag„h Irne (jFCJ Total leppth of lines eat, Trench Va �j inches - Distance etween lines _ Q F O Top of tile to finish grade Material beneath the alf inches Total eff ve absorption area Z76 p Lu C9 Length Width Depth PERMIT NO. Q l- as w Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 15 SOIL TEST RATING INSTALLER REMARKS q4 4s. -at APP VED DATE ` LEGAL ro-u iz trsev. j rtsl 6'/ y 'L ':'T REET.. F!P,II; HI?RAGE. AK. 9. JF'2Gel P -:10 10 9" -rt -`-' °. ':. I '. E.- ..amu ��_'-._ E^"1 E--- Fz: F* E_:7 1 I _T PERMIT NO. 810,1661 g I APPLICANT STEVEN L. S6'.:FGGS CONST. PO };rlX D 9 56-7rSSI;.8:=I—: '=' .I LOCATION NORTHt�•Irll D.:.� DRIVE- L EIut-IL. L 4 B 1 NOR FFIHru=lD:v ,_De--' LOT 'SIZE 20000 SQUARE FEET 'TYPE 1� OF .CII!_ ABSORPTION SYSTEM I S . TRENCH `tea, r,ff-j> IMUM NUMBER OF BEDROOMS _a SOIL. RATINIG '_O FT'BR?= 250 J]Ct UC�S�Y' THE REQUIRED 'SIZE OF TETE: 5 -OIL ABSORPTION :SYSTEM IS: ._-a EZ F'—T'[[--3 --_:' .1-22" E._ 9— ✓i Ng C—H T H _ �.- e 5 n'' C -i FRE._ _ T—'- F. � �== e FE �_ �'"'-'d �. THE I._EP' GTIH L:F I MEP:1:.=; I rIP••1 IS THE LENGTH �I P•4 FEET:: OF THE TRENCH OF. DRA I NF I ELL:. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GRi il_!NI-) AND THE BOTTOM OF THE EXCAVATION (Ir-4 FEET). THERE IS P'.ICI SET WIDTH FCIR: TRENCHES. THE GR!= %)EL DE:PTI-I IS THE: MINIMUM ! EPTH OF I RAVEL BETWEEN THE OUTFF=IL_L. F'IF'E AND THE BOTTOM OF THE E: ?C:I= VATI ON (IN FEET). F' EE_' Q_ n k.3 31- Ems_ IE -r Wim; : " E' 1 nr "I & _- =r 1 E _ n:_� M � s , 1 E._ s_ > �°••.� PERMIT APPLICANT HAS TF -IE" F'E:_-F'CIP'-ISIEIILIT4' TO INFORM THIS DEPARTMENT DURING THE INSTALLATION IP'dSPE E TI[IN OF ANY WELLS ADJACENT ACE' NT 'TrI THIS PR:rIP R TY FIP' D THE NUMBER OF RESIDENCES THAT THE WELLWILL SERVE. —Q-- a " S `� E " _ E P G _ p__" _F E 11_11 i "E "_ ^ F—T F-! EE E_" IE= C! LJ . E, In;HI_ "FILLINIG '_IIS ;ii•dY_Y_c;FEP'1 I.;IiTHOUT FitIAL_ IP•-I=,FiECTI"� N AND APPROVAL BY 'THIS r)r--P tRTMENT WILL BE SUBJECT TO PROSECUTION. P,11 P'1I P'1L!M DISTANCE BETWEEN g:.! WELL AND ANY ON—SITE °SE I IF 13E DISPOSAL :y', STEM IS 100 FEET FOR: F! PRIVATE WJEL L OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING G UPOI --1 THE TYPE.' GF' PUEIL I ( WEL.L.. M_T..P•,IINUM DISTANCE FROM A PRIVATE WELL. TO A PRI' ATE SEWER: I It4E IS 25 FEET FIND 'TCI H COMi°11_IP•1I'T',' SEWER: LINE IS 5 FEET. OTHER: REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRFdMS ARE AVAILABLE To I N__;i !f',:E PROPER: INSTALLATION. I CERTIFY THAT 1: I AM FAMILIAR WITH 'THE REI_!I..F I REMEP'd T FOR 'LIN—SITE 'SE14ER , AND i...lELLS' AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. AGE. ..I: I WILL INSTALL. TFIE SYSTEM IN ACCORDANCE WITH THE CODES. ERETFP: E��TEP9�TREQUIRE I RE E�LFRrEPEPIT I F THE' UN E.' - E R RESIDENCE IS REMODELED TQ INCLUDE MORE THAN 4: BEDROOMS. Nt5APPLICAr- STEVEN LlhPFidl33I_i5 COr-.IST. e 9 •l ISSUED 'ATE Russell Oyster 694-2774 Performed for: O & E ENG AEERING & DEVELOi-MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Mailing Address: Legal Description: Depth (feet) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ?6. Soil Characteristics C A -„r,0, c� '60 v iJ Cr ¢-Jf>j--jr eo-40'6 illf) Aef Earl Ellis 688-2280 Tel. N o. c7 57 Ix, - 16 Ground Water Encountered: Yes— No ✓ if yes, what depth Proposed Installation: Seepage Pit— Drain Field Comments: Performed by: PLOTPLAN Date: --24/ O & E ENG�.,JEERING & DEVELOE�JIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis --694-2774 SOIL LOG 688-2280 Performed for: Name: 5,e5ol,1764,ef IAVILAq o7- 14 Tel. No. Mailing Address: 310006, S-7-,> /V��t-10e- 4-(5;= > 14 Legal ©ascription: ZO'i -9• /, Alt) %ei7�yyC90n .5-616 D, Depth (feet) \,\ Soil Characteristics 0 N sYZ_7- 5e e- 2 v 3� 4 �e&c,-S r 5 6 A4 7 8' 4&/,,2. 9�1� 10 11 12 13 14 15 16 Ground Water Encountered: Yes No � If yes, what depth Proposed Installation: Seepage Pit— Drain Field— 'F ield Performed by: PLOT PLAN / PERC.TEST Z4 -S7- ge 117,A"71 d �i /ih Zo 70/e �- -� 1Q, 0 �a CZ ®6 /� EObn4 °CO GG C3�aO tlk."-" Earl P. Ellis e N v PLOT PLAN / PERC.TEST Z4 -S7- ge 117,A"71 d �i /ih Zo 70/e �- -� 1Q, 0 �a CZ ®6 /� EObn4 °CO GG C3�aO tlk."-" Earl P. Ellis e m �_ N v- r - C) CY) 0) C) M M ti [- C) O (3) G) a) X Vol (13L�'I O LL �F q�, o � U m a) y�r CO L�L W✓/ 0 0 Q U) co rr^D o6 vJ L E o Q� a) v) 00 LO N O N LO c) ai Q C 0 Q x W LO G) rn Y Q M � U ry Y 0 J C0 00 0 U) O 0 O O Ory = f— O O o0 Z o LOC: N N Q U) U U) U 0 cu 0 J () N 0 O O Q Q m 0 L c� LD U) a) U) U) c O O X L u 0 0 0 Q � Q u N (� ++ CU i+ U, o -� s E ~ O ~ O U O O a ca N Q �^ cu a O O O to N E N = � O U > C Q. O M a) Q .Q Q. E a) N v v CU CU 0 u) N Q . O O O 0 CL O > cc 0 = N O �•+_— a) CU ca U E 0 V � z Q x O U) � T Q Lo ._Lb Y > U LL Q m o (D fn U 7 0) L Q Z U) O Y W O Q y' = U Q I— O U H H Q v f - CD m i t O O m m z o c co��r1 G O z LO O z Z LLIca 0 a_ T U) In 0 t s >>' i �! LL z3 'rte a 3 S ti r _ mss: a� k3dl �J r1 4-- z o c co��r1 G O z LO O z Z LLIca 0 a_ T U) S n 4-- 0 O CFD O U L :t:f z o c co��r1 G O z LO O z Z LLIca 0 a_ T U) 71- 4-- 0 O O L :t:f V1 W O U) m Q � O OU >, N (n a) LL _ p ❑ N _Q U ❑ CD V Li L —CD o �' ❑ N ami CD U) ❑® W = a) .n LU N 0)cn W o i- C a) V (n`n d U m V) 1:1 mi 0 LLJ '~ LL aEl ) (� -i- L^l ❑ to Q. V, L U) H ❑ o > o CD 2 O m N ❑co0m L as -0 > LLJ ❑D ElU m o Q ini a) [0 El El N O o Cl p L N a p O n w s O El ❑ ❑ d U' o 0 LL _ ❑ ElE LUQ o N ❑ U) 1 H N p ; V/ .� .^^ V/ Q (1)> � En Z �i_ o o LLI W L, U LULLI ❑ _ LL = Q)y-' cn ¢ Z s O L i U 0 Q � 2 U) Li LLLLI O O ~ z a U o _0 .� O 1}- F}- w to Q Q Q > N M to CD LI m 0 IT 0 a� LL m E C a) m 0 a) n ❑ Q O U 0 a 0 U Cn MOY- - g Legal Description: NORTHWOODS; BLOCK 1, LOT 4 Parcel ID: 051-731-77 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 LL DATA ❑ Well log I with Onsite (or attached) Date drilled I depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing heigItest above ground) Date of flow for COS Static water beginning of test ft. B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/15/1981 ❑Q ALL standpipes present per record drawing Total measured depth from grade *13.1 ft (max) Measured depth to pipe invert from grade *4.2 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of tes gpm Water storage tanme gallons Well d' ' cted for coliform test? F-1YesNc Coliform bacteria is Negative itrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date T STATION ❑ Require tenance Age of lift station Lift station al Adequacy test date 10/31/2023 Results FXrPass Fluid depth prior to test 65.25 in Water added 484 gal New fluid depth **76.5 in Elapsed time ``$0 min Final fluid depth **73 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) *96 in Effective depth used **62.5 in Effective depth remaining **33.5 in Comments/Deficiencies: *8.9'(106.5") OF EFFECTIVE MEASURED IN SUMP. 8' OF EFFECTIVE PER INSPECTION REPORT. **30" BELOW INVERT AT END OF ADDING WATER. **33.5" BELOW INVERT AT RECOVERY READING TIME. COSA Checklist June 2022 3111 rj V . m i 1L LP E. SEPARATION DISTANCES Frit .vate Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift n Lot > 100' Community Sewer Manh anout > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if ft P ' ewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No � Tank > 100' ❑Yes if No ft Neighboring Absorption Fields > Animal Containm _ 0' ❑ Yes if No ft U Yes if No ft Manure/Animal Excreta Storage > Main > 75' ❑ Yes if No ft ❑Yes if ft MR N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' rwC Yes if No ft Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' 5_1 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Naive of Futn Gayness Engineerinq Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s, of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 =4T y* orness.: vJp�9 1` £F 31MV? V S� LICENSE �\1Qa pro f es s-o"o< #AECC8& 3/121/24 Municipality of Anchorage Development Services Department IL Building Safety Division -° On -Site Water 8 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. 051- �45 (- -4 q- 1. GENERAL INFORMATION Complete legal description COSA# Moo 3. ( Expiration Date: a — a 0— O q Location (site address) 22508 NORTHWOODS DRIVE • CHUGIAK, AK 99567 ❑ Individual On-site 0 Current Property owner(s) JANE KNIGHT do RON KMIECIK Day phone C/O AGENT Mailing address Lending agency Mailing address Real Estate Agent Mailing address 22508 NORTHWOODS DRIVE ' CHUGIAK. AK 99567 Day phone MARGARET NELSON w/PRUDENTIAL JACK WHITE Day phone 273-7332 3801 CENTERPOINT OR. 11200 • ANCHORAGE, AK 99503 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 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class A 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 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I venthat my investigation, based on procedures outlined in the Certificate of On -Site Systems Appzval Guidelines for this application, shows that the on -V water supply and/or wastewater disposal system is (are) safe, functidnal and adequate for the number yyf�bedrooms and type of structure indicated herein. I further verify that based on The ti informatio l oif5ined from the Municipality of Anchorage riles and from my investigation and inspection, fbe aasite vr supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal Nsf5te 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 JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines S Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readilyidentiliablo 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 lost 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 3 bedrooms. Disapproved. 337-6179 Date 19106 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other • ONSITE WATER AND WASTEWATER PROGRAM By: Original Certificate Date: ' -0 O (Rev 11*5) 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 SUBDIVISION, LOT 4, BLOCK 1 Parcel ID: 0 6—I — % 31. % A. WELL DATA Well type GLASS A Date completed _ COMMUNITY WELL If A, B, or C provide PWSID# 213001 Well Log Sanitary Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate mg./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/ STEEL Tank size 1000 gal. Number of Compartments 2 properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Collected by: Date installed 6/15/1981 Cleanouts (Y/N) Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 2/2008 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA er ow EXISTING GRADE Date installed 6/15/1981 Soil rating 6ii2yor ft'/bdrm) 250 System type TRENCH Length 60 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth *13.08ft. Eff. absorption area 960 ft' Monitoring tube YES Depression over field NO Date of adequacy test 2/14/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 29 in. Water added 540 gal. New depth 45 in. Elapsed Time: 120 min. Final fluid depth42 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — PRESOAKED WITH 1000 GALLONS OF WATER ON 2/13/2008 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N1 "Pump on" level at in. "Pump off level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic COMMUNITY WELL On adjacent On Public sewer manhole/cleanout Holding tank areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 59+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ 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 Welts on adjacent lots 200'+ 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 COSA guidelines in effect on this date. O '•.Je Engineer's Printed Name JEFFREY A. GARNESS Date 21Igboy$ COSA Fee $ % �, d, fl h + / 7 5 1 U Date of Payment * � / / C l0 8 Receipt Number 9-70 q.! (Rev. 11105) Waiver Fee S Date of Payment Receipt Number 'vS�p41 Aness;' CE -79 3 `FQ 2�1.9�R�•��ao of LLOT_ RECEAT/F/Eo 3 a p C3 MI Sm MW ..- OF t- "11 I c : LL u' '• 151192 1, \�OPE SS10NAI Ji . Lot.4 ; Biock_. -- Anchorage Recording Precinct,Aiasko (79-X5). S89'591 a90W LOT SURVEY CERTIFICATION LEGEND Ihereby catity"ihave surveyedffwwDpertyft" wAdescribed 0aBross capped mmunerdrecovered twecn,ad Ihd the knprovemerda sihatd ttwom ore wItW the prop- 0 1 Iran pipe ad/or rebar recovered arty taws orad do rot overlap orenaooc i on odocrf property and that no a e 2x2 hub 8 tack rseavad kWoromenn an od*W property overlap or encroach an thepremises • 1 Wxad'rebor set ttas survey in gAsrbn and that them are no modwaye, unary Grathe or or vtslble Indl hereon. -iE-- jEESCCE.LINE (APPAM LOCATION) easememe on said property except as otd I LO; 5 s Scale /- ?^/ Date �/ Prepared by: RegRmWUMON ndSuu 30 (907)779-6200 W W. Eighth Am Anakyugi, Aosta 9930/ Ref. F. S. No. Property_of:..JAV5 . KNIGHT �?CrS C/: Z4 :3Z 1R0NALD KM/ECIK .rJ VlY• .. .. t .. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ik 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. # 051 73177 HAA # 1. GENERAL INFORMATION Complete legal description rot 4: Block 1: North Woods SubdiviEion Location (site address or directions) 22508 Aorthwoods Drive Chugiak, AK Property owner Rebecca Leonard Day phone 'Q3-3895 Mailing address P.o. Box 6702014 Chugiak, AV 091-67 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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) MOA N21 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 furtherverify 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 5 & 5 ENGINEERING Phone Address Eagle River, Alaska 99577 Engineer's signature 6'<<y -.;-O 7`% Date y_// C / `r C OF 'e! R03ERT C. COWAN •f•2 Bf % CE-Seol +ti 6. DHHS SIGNATURE Approved for 13� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: NUTIC 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 v91) 9111 MOA 121 s MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 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. # OSl 73 t 77 HAA # 0 W)(rr;) 1. GENERAL INFORMATION Complete legal description Lot 4; Block .1; North -Woods subdivision Location (site address or directions) 22508 North woods Drive iak, AK Property owner Rebecca Leonard Day phone Mailing address P.O. Box 670284 Chugiak, AK 99567 Lending agency Day phone Mailing address Agent Day phone Address MUNICIPALii'i car hi��•i7�"''`"e Unless otherwise requested, HAA will be held for pickup. ENVIRONMENTAL SERVICES DIVISION 2. NUMBER OF BEDROOMS, 3 r) 0 1996 JXI3. TYPE OF WATER SUPPLY: Individual well RE C- 1\ 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 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigatiop and inspection, the on-site water supply and/or wastewater disposal system is in compliance ith all Municipal and State codes, ordinances, and regulations in effect on the date of this ins ection. Name of Firm Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. S & S ENGINEERING Conditional approval for Additional Comments Loop Road No. 204 bed u Phone 6 `f 7 / Date 'Y /, o l `I 6 bedrooms, with the following stipulations: 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 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 k21 MUNICIPALI I Y Ur AN( -hof„ {U ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES ;F:`d 199 Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-Lj �4 Health Authority Approval Checklist Legal Description: , 4 ?::"L- l �0 > �oppS Sf�o Parcel I.D.: 65-1 231 7 7 A. WELL DATA /� Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Nitrate g.p.m. Casing height (above Wires properly cted (Y/N) of sample: Collected by: B. SEPTIC/HOLDING TANK DATA AT INSPECTION Other bacteria g.p.m. Date installed &-81 Tank size /600 Number of Compartments Z Cleanouts�l) Foundation cleanout Depression (Yap di High water alarm (YJN) f -11A Date of Pumping 4'Y -9L Pumper TI-, /UM/-,J4-'�4 C. ABSORPTION FIELD DATA Date installed '8/ Soil rating (g.p.d./ft2 or ft2/bdrm) 2S 4k System type f � C/ Length %0 t Width 3 Gravel thickness below pipe Total depth 13 Effective absorption area !o Q Monitoring Tube presen A5N_X Depression over field (YQ W Date of adequacy test it -s" -9C Results as ail) For bedrooms Fluid depth in absorption field before test (in.); S H Immediately after Gla gal. water added (in.): 3L n Fluid depth Jb " (ins.) Minutes later: -766 Absorption rate = 0-d i g.p.d. Peroxide treatment (past 12 months) (YZJ�) Addy-iIf yes, give date 4 D. LIFT STATION Date installed Manhole/Access (YIN) High water alarm level E. SEPARATION DISTANCES Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main service line "Pump off' level at* On adjacent lots n adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM S HOLDING TANK ON LOT TO: Building foundation 5-t Property line /° t f Absorption field Water main/service line /° Surface water/drainage /so t ` Wells on adjacent tots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 7o t 1 Water main1service line /b t Surface water 400 t d Driveway, parking/vehicle storage area Curtain drain tJI-J G rt,fid ,UJ- Wells on adjacent lots 2,06 14, Property line >L /O F. ENGINEER'S CERTIFICATION $- PC,(— 1 ,)5I'k c noJ 9 i -PL' ,Q 09 6 /, s-/ 8 / I certify that I have determined thru field inspections and reviely ofillfunicipal in conformance with Ad A U—1 guideh es in effect on this date. Signature Engineer's Name RI 0136 Z 7— C. COwAi� Date � //a r G G HAA Fee $ A-0- 6D Date of Payment 7_ /Y Receipt Number 1 1=;7-Z Rev. 8/95 OSS: ]naa.wk.doc Waiver Fee $ Date of Payment Receipt Number are yo ROBERT C. COWAN f �� I� CE -8801 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division (� 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 y Health Authority Approval Checklist Legal Description: Ze7 `� ��a�� / X/or2Z kt%ooi5 Parcel I.D.: A. WELL DATA Well type AIf A. B, or C, attach ADEC letter. ADEC water system number Log present (YIN) Total depth Sanitary seal (YIN) Date of test Static water level Well production WATERS LE RESULTS: Date completed Cased to FROM WELL Nitrate g.p.m. Date of sample: Collected by: B. SEPTIC OLDING TANK DATA ��\Ac)- (�j 73/ 7'7 yin eight (above ground) properly protected (YIN) _ AT INSPECTION Other bacteria �o O I g.p.m. Date installed & -J'/ Tank size /000 Number of Compartments a, Cleanouts6()/N)--V- Foundation cleanout (Yo /J Depression (Y& High water alarm (YIN) /V/,+ Date of Pumping q- 2/- Pumper�CCiJIiOi C. ABSORPTION FIELD DATA Date installed 61 - cp/ Length 60 I Width Soil rating (g.p.d./ft'` or ft-/bdrm) Asa 3 System type fr ehGLj 3 Gravel thickness below pipe 8 Total depth 13 Effective absorption area 96 D Monitoring Tube presen (Y )__y Depression over field (Y4@ /\j Date of adequacy test "/-S- 9 (.o Results Pass ail) g a,:Z� For 2 bedrooms Fluid depth in absorption field before test (in.); 8 " Immediately after &Oa-bgal. water added (in.): 310 11 Fluid depth o�0 (ins.) Minutes later: 3&0 Absorption rate = -1/6-4 g.p.d. Peroxide treatment (past 12 months) (Y& `lone- know +? If yes, give date nle - D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm Cycles tQat6d E. SEPARATION DISTANCES on" level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot _ Public sewer On adjacent lots On adjacent lots Public sewer manhole/cleanout MUNICIPALITY OF ANCHOMGE VIRONMEN,TAL SERVICES DIVISION 11r;�IQI 199G RECEIVED Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTI HOLDING TANK ON LOT TO: Building foundation s i Property line /D Absorption field Gi Water main/service line h . f Surface water/drainage /DO Wells on adjacent lots 6200 _ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /0 Water main/service line / t Surface water Driveway, parking/vehicle storage area .5'D _ Curtain drain Ll one- 1✓noui n Wells on adjacent lots a -DO Property line /D F. ENGINEER'S CERTIFICATION or Pe'_ t n'%OF ��'�ie I certify that I have determined thru field inspections and review ofs%lunicipal recorjl�q� il}q.nhni+¢„rV�t�uS nr'e in conformance wit NIA A� guideC es in effect on this date. "4� n b 5t Signaturea"t� s� rti..•. I Engineer's Name r` e n ��� T ( ��7 wA �� tv' Date °'.� CE .8801 � wAO HAA Fee $ 3 © 0 • m a Date of Payment _ `y A, e / C1 6 Receipt Number 1 -7 7 0 `j 9 M Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number -- DATe RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME NUMBER OF,BEDROOMS sSINGLE FAMILY ❑ One C1 Four El Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY DATE DATE \ DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI®SPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P. OTECTION • ENVIRONMENTAL SANITATION DIVISION A id 6 1981 Telephone 264-4720 pDe ,, // [� LLTILE REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SPEC EA YS DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER i PHONE ,IEy L)ClI lCL 11 1 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION �LJ/�/ / IC�-r (K. f , 1 J 11r' STREET LC� ATI 0 1S ,, _ 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS sSINGLE FAMILY ❑ One C1 Four El Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ ,JNDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled fes` COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE. DISPOSAL SYSTEM 1/i- INDIVIDUAL/ON-SITE** r YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified _ PERMIT NUMBER DATE INSTALLED (--Q— INSTALLER ❑Septic Tank or ❑ Holding Tank SizeIf Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS " APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE ('- BY 72-010 (Rev. 6/79)