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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 6MUNICIPALITY 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241091 Work Type: Septic Upgrade Tax Code Number: 05173134000 Site Legal Address: NORTH WOODS BLK 3 LT 6 G:1459 Site Mailing Address: 22540 MC MANUS DR, Chugiak Owner: BURSELL AARON Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: Delmrtri7etlt 6/4/2024 6/4/2025 20000 Q Disposal Field 2 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 d Received By: i Issued By: — Date: Date Zoe 2 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-731-34 Property owner(s) AARON BURSELL Mailing address 22540 Site address 22540 M( Day phone 907-715-7619 US DRIVE, CHUGIAK, AK 99567 US DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTHWOOD; BLOCK 3, LOT 6 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of 13rooms -_ 2.. (PEPTIC SIZED FOR 3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field FRI Initial ❑ Single Family (SF) MX (w/wo ADU) Septic Tank MR Upgrade MR Duplex (D) M Holding Tank M Renewal M Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: 2 TO 1 SLOPE WAIVER FOR DRAINFIELD / BED WIDTH Distance: 0'/ 25' I 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) P!7!01ush Fees: SAS — — Date of Payment: !al)610-9 Receipt Number: 001,92a Permit No. k�giver ees: Date of Payment: Receipt Number' 0 12,2 4 Af�s V Waiver No 10 t9 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241091, Curtis Townsend, 06/04/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241091, Curtis Townsend, 06/04/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241091, Curtis Townsend, 06/04/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241091, Curtis Townsend, 06/04/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241091, Curtis Townsend, 06/04/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241091, Curtis Townsend, 06/04/24 McMANUS DRIVE_ — — 8510M N EAST 100.00 10' Utility Easement -------------- Lot 6 �C b Lot 5 Lot 7 SCALE: 1 "= 30' ® `20.3 deck N 1,0`# -20. Aar ° • CD- 21.1 0 15.6 c, 9) O AM'`��� °S (/) cv rn 1 Story Frame House "' 00 ° th .-57 f O 9 57.0 r00,"$ e: K _ 21.3--1 ff , : lizabeth L. Walatka .' °` 0 o ��F • Alff 8036 - LS Jq- o (Z ®pFE5Si0NA� c J Septic vent (typ) a �- Chain link fence (typ) EAST 100.00 Lot 37 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 6, BLOCK 3, 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 3rd day of APRIL , 2024, EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA &ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 23-4, pg 56 BE 907-248-1666 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. Northwoods Block 3 Lot 6 #051-731-34 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME II^^ __,(Qf _,(_ �X$xftx PHONE C7 NEW ❑ tX XXX;r,-R T&X KEN BEST <63i UPGRADE MAI LING ADDRESS LEGAL DESCRIPT,I(OON ( jj t 9 y� 1 l I I LOCATION -NDK714 (� NO. OF BEDROOMS C_ i V - 1�r) ZS Well Absorption area Dwelling PERMIT NO. DISTANCE TO:NA- 1 t Uy F- Z Manufacturer Material ( No. of compartments UJ I.- _r ee-1 N Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling PERMIT NO. J (% Z = z < Manufacturer Material Liquid capacity in gallons D DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. w = J LL Z No. of lines Length of each line Total length of lines TrenFh width 7 Distance between lines F?W 2 24 17. 17 I- 31% i(ai%inches 'L, G Top tile to finish Materia beneath tile Total effective abso tion F.- CC of grade / tt area 6i inches ! } Length Width Depth PERMIT NO. w a I F- Type of crib Crib diameter Crib depth Total effective absorption area as W W rn _ Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS _I (� P[61_5f-ice 'NrJ�+Q�r ' 7t Te_CX e– SOIL TEST RATING I ' INSTALLER �Z—)Grn04— Corm.)—, m. REMARKS �z 151) rt-�ko t I, t tS1t ill rnosf be ye W� ° 800 b l 0r hcLuled_r ° - 'VI -Ell A (� IJ' • ''y•'• �f�1 LY •'+ MAG L^ 0��•'•'+ . MUNICIPALI F T o...' .......... ENVIE: ....�.� ••• •. a.....� ... e TH40MAS R. St.11'ti�.gli '.ot 2246-E ' W APPROVED ® +4V DATE__. A- 72-013 (Rev. 3178) UNICIPALITY OF ANCHORAGE y. Department bTf Health and Environmental,irotection 825 L Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # Permit ��/�. tLV96 AND/OR ON-SITE SEWER PERMIT Applicant: ee,7 ei;pt ees-' Mailing Address: S•2 96-K W-6`ac�/� 0'7 Location: /� Phone Number: 34q- of 6 6 Legal Description: G �P �3 r10%��� Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: X Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) l 9 e The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH (6,ii AMS5_JWIDTH 3OX350 The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE 1060 GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the systemiT' accordance with codes. (3) I understand that the on, -site sewer system may require enlargement if th� I ce,i re o'deled to include more that 3 bedrooms. Signed: Issued by: Applicant Date: SWP/024 (1/81) �NOTC.' DEPTH 1�•f-�, � �-..�%Z�z 1 /� v 2 / S/LZ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS_ PERFORMED BY: 72-008 (6/79) =11� - ��o c�1�15Y 9 fAW0 r �' b WW� WAS GROUND WATER S ENCOUNTERED? L O r P IF YES, AT WHAT E DEPTH? SITE PLAN Reading Date Gross Time ❑ SOILS LOG Depth to Water Net Drop +.e DEPARTMENT MUNICIPALITY OF ANCHORAGE OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST lo SOILS LOG - PERCOLATION TEST l �I / PERFORMED. FOR: S; mac- ���7 �OA`f DATE PERFORMED:_2-2— L/ 6 9_5 i '�?4 U/001 -9`r- LEGAL DESCRIPTION: " 6/ DEPTH 1�•f-�, � �-..�%Z�z 1 /� v 2 / S/LZ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS_ PERFORMED BY: 72-008 (6/79) =11� - ��o c�1�15Y 9 fAW0 r �' b WW� WAS GROUND WATER S ENCOUNTERED? L O r P IF YES, AT WHAT E DEPTH? SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop Z- Ll7, lo �DG/I//✓ �� 3 l �I Lf IT Z,o`/cam r `L� l �" sal � rr 6/ I PERCOLATION RATE /7,'/-(minutes/inch) TEST RUN BETWEEN FT AND FT _ CERTIFIED B DA O & E ENG._.AEERING & DEVELOV,AENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 7 Performed for: Name: X.A66'Tel. No.6epl-e-e9V A Legal Description: Depth (feet) Soil Characteristics 0 2 3 4 6 ry ,-rte OVA ot c=®x 7 �= 8 9 10 11 12 13 14 15 L t� PLOT PLAN PERC. TEST 16 Ground Water Encountered: Yes No If yes, what depth�� Proposed Installation: Seepage Pit_ Drain Field— Com Performed by: �` "�� Date: Ken Best SRA 78-B Anchorage, AK Permit 4 811188 99507 January 4, 1982 Subject: L 6 B 3 Northwood 825 "L" S1 REET 1!VCHORAGE, AI_ASI<A 99,501 2G4-41 1 1 %L. +14. SUI U VAN, A OH A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Les N. BuchholzR. Program Manager Sewer and Water Program Enclosure: Copy of Permit JNICIPALITY OF ANCHORAGE Department b Health and Environmentalt_-rotection 825 L Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # # WELL AND/OR ON-SITE SEWER PERMIT� ��r �,9sc>� Applicant: (FA) / Mailing Address: < in� Location: �r.YJC Phone Number: T Legal Description: [ /� �© Lot Size:�i®8� - Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: L --Holding Tank: Maximum Number of Bedrooms: J Soil Rating(sq.ft/br) Ta rvc The Required Size of the Soil Absorption System Is: &P alk DEPTH ___ _—� LENGTH 0RAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ 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(Z) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a p�iv4,;t8 well to a private sewer line is 25 feet and to a community sewer line),,is F,75 r;f4et. Well logs are required and must be returned to this departm�A-vviith`kin 30 days of the well completion. Other requirements may apply. Spec`lficaLons and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 80 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if ;AplicMantg e en is re eled to include more tha 3 bedrooms. Signed: Issued by: Date: SWP/024(1/81) p 7 ,mac Giy-t�G �D 1 t t=_ 1 : t-li'; 1, tl] 37"-1 UC:.: +'iP... wz:l ?v . ':2. 264-4720 PERMIT r-al_I. 810465 APPLICANT trdT l"E'vEra L. rl<:ACiGS CONST. T. POBOXD_a9C56 ' 6 :e:: -:-G 381 LOCATION FdClRTHbaOO'E".w; DRIVE LEGAL L 6 B I rdORT'HL•.aCICIE:S _/D LOT "CI=E 20000 :_QUARE FEET TYPE OF OIL._ ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF' BEDROOMS ..... _, OIL RATING (SO FT, -'BF; )= 220 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION I r THE LENGTH CIN FEET) OF THE TRENCH OR DRA I NF T EL D. THE DEPTH OF' H TRENCH OR PIT IS THE DISThir•a+=E BETWEEN 'THE SURFACE OF 'THE 13ROtJND AND THE BOTTOM OF THE EXCAVATION ::Ira FEET,"j. THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH i_IF. GRAVEL BETWEEN THE: OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION Ito FEET). ,__ IE C,m g-_1 I F-° L=: E °._,. E` Fes-° T1 1 v;: -T"' n P' -J °tee I= E7 =- 1 C-1 C-9 a.-1 9-3 F:o L_ _ I _ f-:# P -J °�-:_ PERMIT APPL I C:19NT HAS THE RESPONSIBILITY TO INFORM TH I DEPARTMENT DURING THE Ira ,TALLA"r T CIPa INSPECT IONS OF ANY WELLS ADJACENT ENT TCI THIS PROPERTY PROPER FIN THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AF'F'F:CIVAL- BY THIS ,DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHr'aCE BETWEEN A WELL AND ANY ON --SITE SEWAGE DISPOSAL E,` STEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO A PRIVATE SEWER LINE Is :25 FEET AND TCI A COMMUNITY SEWER LINE 15 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGFArlS ARE AV A I!_FiBLE 'TCI INSURE PROPER INSTALLATION. I -F F-7:--4 F" I E=° E✓. 0 E:. M E-3 E-:: V-4 flL _° _L°� a ;ra :� I CERTIFY "THAI' 1: I AM FAMILIAR WITH THE REQUIREMENT_. FOR ON --SITE SEI•,?ER' AND WELLS AS SET FORTH By THE MUNICIPALITY OF ANCHORAGE. 2: I WILL. INSTALL STALL THE SYSTEM IN ACCORDANCE WITH THE CODES. DES. : 1 UNDERSTAND D THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMEt•,.T IF THE RESIDENCE IS REMODELED Ti I INCLUDE r'jI..+RE THAN 3 BEC;ROOMS, C} AF'F'L.IC:A • STEVEN L. I.;' -;UEC: F;','_.__ _L_ _ `� _-(�' ._ f _ __-____._CAI"E_ _ ` �1._._a.__ 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1-11-62s- 1. 11-6s- 1. GENERAL INFORMATION (a) Legal Description//(include lot, block, subdivision, section, township, range) 40-r Location (address or directions) Me 14A A<,4,J (b) Applicant Name n6/%� L �2e V-,5- Telephone: Home IV 99- 941gl Business N Applicant Address z?ox /LAG MaA1.4S" Ca/u6/A-K 19L (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address N Telephone 7-• (e) Real Estate Company and Agent A'A -rW_'C �e ©2 Address Te phone P (f) the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ❑ Community ❑ PublicK Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite bH Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5, ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hee{ Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or . wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address P' - :.,f.' Date Telephone t a oe• Woos aa� Folwri A. ShaSor 0 �!� as t{o. t��57•E ,; 6. DHEP APPROVAL �/. �/1 Approved for �tt�' E' iedrooms by 4" ('" t��� Date �� i - � Approved Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 A. WELL DATA i MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: /— 0 !. zL OL/G '? Well Classification W647il If A, B, C, D.E.C. Approved 61/W Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Dth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot 2044 /;' ; On Adjoining Lots th To Nearest Edge of Absorption Field on Lot div ; On Adjoining Lots — To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA ._>vOrf- To Nearest ewer Service Line on Lot IJVA Date Date Installed - �� Size lOc� a No. of Compartments Z StandpipesaPdj Air -tight Caps,P/Nj- Foundation Cleanout (Y& Depression over Tank rDate Last Pumped of 'e- /Y Pumping/Maintenance Contract on File (Y/N) 1 ; for it! Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) "y'4 Separation Distances from Septic/Holding Tank: F - To Water -Supply Well .e> 11 r To Building Foundation To Property Line To Dis osal Field To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) r� V M To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed alga Length of Field 3Z, Width of Field ✓1 a Depth of Field -' Gravel Bed Thickness Square Feet of Absorption Area Sby Standpipes PresentMw Depression over Field Date of Last Adequacy Test %'�S-5' S _— Results of Last Adequacy Test 7—Ql' K Separation Distance from Absorption Field: To Water -Supply Well 20014-- To Property Line To Building Foundation Lot N To Water Main/Service Line / rF To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed - Size in Gallons ; On Adjoining Lots To Existing or Abandoned System on ,36+4 To Cutbank (if present j4 i 1.r- Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M A and HAA guidelines in effect on the date of this inspection. Signed r' ":'7talif:siiiidC=` Date 6 r Company Uf:,7f, f6KA xihU50' MOA NO. c�U1 AI Receipt No. Av Date of Payment Amount: $ lts6ort A. Shafer o W' No. 1457-E Page 2 of 2 ���9F °e.Dd°Dr° • ��� 72-026 (11/84) i` �1iG��f� Oir I�«G�SSI�GI DEPT. a ®F ENVIRONMENTAL Li AL CONSiGR VATRON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 a DATE: 711 n5� PWS I.D,# C 36®1 i BILL SHEFFIELO, GOVERNOR c Telephone: (907) r Address: i 274-2533 To Whom it May Concern: A dina to records on file in this office the Water System is in compliance with the State Drinking Water Regulations Sincerely, Time ' Time Date Date Date Inspector Inspector Inspector Comments Conditional Approval ( ,t r'OVE Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY. Property Owner Phone Mailing Address 7d?—/3 s Buyer Address w�' J� C Lending Institution Phone Address Realty Co. & Agent Phone Address Legal Description v V 7. jj5V Street Location %/� %��✓i%.s s /��u�' //7 5 d9 l2 eex ee e./-- .LType Type91AResidence Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply Q,Wdividual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sew isposal ❑ Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. , f . i t RUSH! � • , Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Parcel I, D. 051-731-34 1 Certificate of On -Site Systems Approval p FP y{ 4 + { � & 3 st C »,x 8 � %sY ey® ❑ 44 Expiration Date: / ;� _ l - 1 S GENERAL INFORMATION Complete legal description NorthWoods, Block 3, Lot 6 Location (site address) 22540 McManus Dr. Current Property owner(s) Linda Harris Mailing address Real Estate Agent 4795 Frankin Blvd. #7 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Waiver/Variance request for: 3 Day phone_ ene, OR 97403 Day phone RUS141 H! TYPE OF WASTEWATER DISPOSAL: ❑ Individual F1 ❑ Holding Tank ❑ SAUBMITTA ❑ Community ❑ 1)EC 0 6 /01a 0 Public Sewer ❑ _ Received by: %f -.- Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ g`l ' Waiver Fee $ Date of Payment 10,1913 Date of Payment Receipt Number (3g3rw(q Receipt Number COSA# 0s0131%34 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for � bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907)272-8218 Date 12/6/13 bedrooms, with the following stipulations: 13Y G*Original Certificate Date: / I;)- " 9 —1 3 ThaZ, ali chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet—E c If more than 1 septic system is on the lot: COSA Checklist # of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Northwoods, Block 3, Lot 6 A. WELL DATA Well type Public Date completed Parcel ID: 051-731-34 If A, B, or C provide PWSID # AWWU Well Sanitary seal (Y/N) _ Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ftft. Well production g.p.rn. WATER SAMP ESULTS: � colonies/100 mL Nitrate ug/L Date of sample: mg/L B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 11000 gal. Number of Compartments 2 Wires pr y protected (Y/N) height (above ground) in. AT INSPECTION ft. Collected by: Date installed 4/20/1982 Cleanouts(Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping / a 1 `j I -0 1 � Pumper C. ABSORPTION FIELD DATA Date installed 4/20/1982 Length 31.5 ft Soil rating (g.p.d./ftz or ftz/bdrm) Width _ 32 198 SF/BR System type Bed ft. Gravel below pipe 0.5 ft. Total depth ft. Eff. absorption area ftz Monitoring tube Y Depression over field N Date of adequacy test 12/6/13 ResultsPass/Fail PASS ( ) For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 466 gal. New depth 2 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Size in off' level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot _ Absorption field on lot Public sewer main Sewer /septic service areas Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 12/6/13 COSA brown sheet -1 0-10-1 2.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. .Y iiAA � f a # t t s # r I t , y j � } t f i t 3j�1, Ci 'V p Oil. a x � Elf.4',+rfLO.f.s't<'�".vG�'CT�✓'� - i 1. 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