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HomeMy WebLinkAboutNORTH WOODS BLK 3 LT 26 Municipality of Anchorage Page / of -.7 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'d-'-) c~} ~O ~ ~ c/' PID Number: ~/~ Name: ,'~/ ~'/~ A~ ~o~ /% Wastewater System: ~New ~Upgrade ~ /-I~ ~ ~ , A~ ~9%'o '~ ABSORPTION FIELD Phone: ~_ ~4/~ No. of B~rooms: ~ Deep Trench ~ShaHowTrench ~Bed Mound ~Other LEGAL DESCRIPTION so, Rating: ~,~ GPD/Sq. Ft. Total Depth from~/originai grade: Subdiv~iom Depth to pipe bosom from original grade: Gravel depth beneath pipe Township: ~ Range: ~ ~ Section~ Fill added above original grade: Gravel length: ~ New ~ Upgrade Gravel width: Numberof lines: 10istancebe~eenlines: Classification (P~C):~ Total Depth: Ft. Cased To: Ft. Total absorption~area: ~ SQ. Ft. Pipe/~ ~lmaterial: Driller: ~ DateDriHed: StaticWaterLeveh Installer: Dateinstal~ed: Yield: Pump 8et at: Oa~~ Ground: ~.u ~,. -- ~t. TANK SEPARATION DISTANCES ~ Septic ~ Holding ~S.T.E.P. Wel~' 100~ /,~r~ /~0; ~ ~:~. Material: ~ 'T:~-~ Number of CompaKment,: Sudace r Water /~ ~ ~ ¢ /~ ~ LIFT STATION Lot Line Yff /3/ ~/ Size in gallons: Manufacturer: Foundation ~/ P :/ ,7/ "Pump on':~l:~l at: "Pump off" level at: High water alarm at: ~,~ Fy,, OunainDrain ~ /~&- /~[~6~ ~OPumPO~/Make &~/ffModal,~J Electrioa[ Inspections pedormed by: Remarks: ~-Xx:'l//~ /gao C-/?~ -~:~:~ BENOH MARK /~ Inspections performed by: S&SENGINEERING Dates: 1st'*/3~ ] ~I~--~I['~)~ 17034 Eagle River Loop R.d No. 2. 2nd '?/3//~ Eagle River, Alaska ~S77I~~i~,~.~ CE - 880 i Department of Health and Human Services approval ~,~ ..,~ Reviewed and approved by: (~~~ ~ Date: C-/~-~ i,~F~:s~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO SW980224 PAGI~ 2 OF 3 Municipal, i-I; oF Anchor-aoe DEPARTMENT OF HEA~TH AND HUI"TAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 ·Anchor's§e, At~ske, 99519-6650·Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEH AND/OR WELL INSPECTION REPORT LEGAL LOT 26, BLOCK 3, NORTH WOODS P.I.D. NO. 051-731-56 A B FCO 24.8' 22.4' ST1 31.4' 18.2' ST2 35.0' 20.0' MT1 70.3' 52.0' MT2 77.0' 45.6' MT3 34.5' 59.5' MT4 47.0' 67.8' LOT 26 MT4 BED / / / ABANDONED LEACHFIELD TRENCH NEW 1250 TANK PERMIT NO SW980224 PAGE `5 OF `5 Municipal. i-I; oF' AnchoraQe DEPARTMENT OF HEAF_TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 e Anchorage, At:ska 99519-6650·Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 26, BLOCK `5, NORTH WOODS 051-7,51-56 87.3~' ST1 ST2 1500 GAL S.T.E.P. SYSTEM p. FINAL GRADE I.D. NO. N.T.S. r s. TOPSOIL & SEED MT2 / MTi MT4 ! , ~IT3 98.3'~ ltl' &92.8' WATER FOUND 88.8' B.O.H. SCALE 1" = 40' August 25, 1998 Tweed Excavating 17304 Eagle River Loop Road Suite 202 Eagle River, Ak. 99577 To Whom it May Concern: Re: L- 26 B , 3 Northwood'Pmtr~ Septic wked to Specifications and Code - completed. ROBERT J. SILVA Silvas' Services. P.O. Box 520669 Big Lake, Ak, 99652 ( 907 ) 892 ~ 2498 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 09, 1998 Expiration Date: Jul 09, 1999 Permit Number: SW980224 Legal Description: NORTH WOODS BLK 3 LT 26 Design Engineer: S & S Engineering Owner Name: RICHARD CONDIT Owner Address: 22839 NORTHWOODS DRIVE CHUGIAK, AK 99567-5461 Parcel ID: 051-731-56 Site Address: 022839 NORTHWOODS DR Lot Size: 20048 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 2. The attached approved design. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska 3. Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling 4. (907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only). From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 30, 1996 Richard A. Condit 22839 Northwoods Drive Chugiak, Alaska 99567 5461 Subject: Lot 26 Block 3 North Woods Subdivision Permit #SW950296, PID #051-731-56 ' The subject permit, issued September 27, 1995 by this office for a single family well and/or on-site wastewater system, has expired as of September 27, 1996. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Si~rely, /~ Program Manager On-site Services enc: Copy of Permit cc: S & S Engineering PAGE 1 OF 1 MLrNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950296 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:CONDIT RICHARD A OWNER ADDRESS:22839 NORTHWOODS DR CHUGIAK, ALASKA 99567 DATE ISSUED: 9/27/95 EXPIRATION DATE: 9/27/96 PARCEL ID:05173156 LEGAL DESCRIPTION: NORTH WOODS BLK 3 LT 26 LOT SIZE: 20048 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM 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 (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ~-~ ~-~-~ ISSUED BY: DATE: DATE: ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. September 6, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION &FLOWTEST SiTE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 26, Block 3, Northwoods S/D Request you issue a permit to upgrade the septic system serving the three bedroom house on the referenced property. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, water was found at eight feet. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure ~IJNIcIPA/15, OF ANCHOP, A®E ENVIRONMENTAL SERVICEs DIVISION 72 1995 RECEIVED 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 40' SITE PLAN r'- N.T.$..~AL~ I PROFILE o~ D ETA t L o Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 10 11 12 13 14 15 16 17 18 19 2O 1 2 3 7 8 SLOPE SITE PLAN WAS GROUND WATER ~ ENCOUNTERED? ~.5 ~ S IF YES, AT WHAT I~ IA ~) DEPTH? p E Oeplh to Water After ~ t '~ ~ I ~Cl~'-" Monitoring? v Dale: J I Gross Net Depth to Net Reading Date Time Time Water Drop ,, PERCOLATION RATE __ TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER ~-~ ~ FTAND -5,~' FT COMMENTS PERFORMED BY: S & S ENGINEERING __ i ('~/~v~ ~u ~-3 ~ CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Read No. 204 ' t ACCORDANCE WITH AJ~J!ig~,/~'~e¥~I~I~J~ii~JJJL, I~JliJJ~UIDELINES IN EFFECT ON THIS DATE. DATE: ~'~/~ ~;~'" 72-008 (Rev. 4/85) ROBERTC. COWAN, RE. ROBERTA. SHAFER, P.E. APPROVALS SEWER&WATER MAJN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYST EM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 26, Block 3, Northwoods S/D September 6, 1995 GENERAL: 1. Se o De The scope of this project includes the installation of a 500 gallon wastewater S.T.E.P. system (septic tank) and a pressurized absorption bed to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify its integrity. If of poor integrity, the tank is to be abandoned and a new 1250 gallon S.T.E.P. system (septic tank) installed. The existing leachfield is to be abandoned in place. Construction shall be in accordance with the approved site plan and'design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 26, Block 3, Northwoods $/D September 6, 1995 0 3e e Se Se The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: me Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed-up) before gravel or sand placement. e If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. e Sewer rock shall be placed uniformly throughout the entire bed. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel depth below the distribution pipes shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. 4e The distribution piping must be as shown on the design. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet° Page Three Lot 26, Block 3, Northwoods S/D September 6, 1995 De e 7e Silt barrier material must be installed between the final gravel layer and the native soil backfill, unless insulation is used, then the silt barrier should be installed over the insulation. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed at the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom of the gravel surface. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when. the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Four Lot 26, Block 3, Northwoods S/D September 6, 1995 Se 7e A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. ~ INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: me The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. me The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Se The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspeotions required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. Page Five Lot 26, Block 3, Northwoods S/D September 6, 1995 The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER  ,~,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & 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 ~-~J EW DESCRIPTION ~ LQCATION NO. OF BEDROOMS Well Z/ -- ,~ Absorptionare~ Dwelling PERMITNO, ~ ~ Liq. capacity in gallons Inside length Width Liquid depth /~DO IF HOMEMADE: ~ ~ DISTANCET~' - ~1~' Dwi' /:PERMIT NO, cap~allons m -- ~ ~/ Liquid ~ ~ PERMIT NO. ~= DISTANCE TO: _~,~t~ ~ Foundati~/~ Nearest'°'"7~/ ~--~ ~~ No. of lin~ Length~h~~(~z / Total ,engt~7~nes ~ Trench width~coinches Distance ~ ~ Top of tile to finish grade / Material beneath tile ~ ~ ~ ~ TOta' "fl"ct[Ye ~sorotion orea Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class ~ Depth Driller Distance to Jot JJne PERMIT NO, ~ Building foundation Sewer line tank Septic Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATIN~ REMARKS VE~ DATE LEGAL 72-013t Rev. 3/78) PERMIT NO. RPPLICRNT LOCRTION LEGBL [:,EPI~RTMENT .. HERLTH RND ENV I RONMENTFtL ~:OTEC:T I ON .'" ,-- m:.', _ . YO I ' ,:,~... E. =,TREET., 264-,47~0 , I} ', 15" / x SKRGGS CONSTRUCTION PO BOX D CHUGIBK 99567 588 2832 NORTHNOOD DR L26 B]: NORTHWOOD SBD LOT SIZE 28888 SQURRE FEET TYF'E OF' SOIL RBSORPTION SYSTEM IS: TRENCH MRF-','IMUM NUMBER OF BEDROOMS SOIL RRTING <SQ F'T',,"BR)= 2±0 THE REG!UIRE[:, SIZE OF ,THE SOIL RBSORF'TION S'¢STEM IS: [:, E F' -F ~-~ == ~ ...... -'- ,.." .... .=.-- THE LENGTH D, IHENSION IS THE LENGTH (IN FEEl') OF THE TRENCH OR [:,RRINFIEL[:,. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUN[:, RND TI.-IE SOl'TOM OF' THE EXCFtVRTION (IN FEEl'). TFIERE IS NO SET WIE:,TH FOR TRENCHES. THE GRRVEL [:,EPI'H IS THE MINIMUM DEPTH OF GRR',,.'EL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE ENCRVRTION (IN FEET). PERMIT RPF'LICRNT I.-IFtS I'HE RESPONSIB!LITY TO INFORM THIS DEPRRTMENT DURING THE !NSTFtLLRTION INSPECTIONS OF FtN'¢ WELLS R[:,JFICENT TO THI~'; PROPERTY RND THE NUMBER OF RESI[:,ENCES THFIT THE NELL WILL SERVE. TI.--[C~ ,-': ;:-;-' ) I P-~:;F'EE:T I C~P-4S F: F-:E F-.'E~:-.~ LI I F..:E[:* ........ BRCKFILLING OF RNY S, YSTEM WITHOUT FINRL INSPECTION RND RPPRO',,,'RL. BY 'THIS [:,EPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R NELL RND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS ±00 FEEl' FOR R PRIVRTE WELL OR &50 'TO 200 FEET FROM R PUBLIC NELL DEPENDING UPON THE TN'PE OF' PUBLIC NELL. M!NIMLIM DISTRNCE FROM R PRIVRTE NELL TO R PRIVRTE SENER LINE IS 25 FEET RND TO R CCIMMUNtTY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRV RPF'LV. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRB~E TO INSURE PROPER INSTRLLRTION. F"E 'F-:f-1 Z T E ::---: P Z F-.:E S:: [:, E; C: E ~-I E: E F: _----': 2L .. I CERTIF'¢ THRT ±: I RM FFtMILIRR WITH THE F.:EQUIREMENTS FOR ON-SITE 'SEI.,.tERS RND WELLS RS SET FORTH BY 'THE MI..INICIPRL. ITY OF RNCHORFIGE. 2: I NILL INSTRLL THE SYSTEM IN RCCOF.:[:,RNCE WITH THE CO[:,ES. ]:: I UN[:,ERSTRND THRT THE ON-SITE SEWER S'¢STEM MFiY REQUIRE ENLRF.:GEMENT IF THE RESI[:,ENCE IS REMO[:,ELE[:, TO INCLU[:,E MORE THRN ]: BE[:,ROONS. FiF'F'L I C:FI 4~ SKFtGG:~, L.'Of.~S_-..TF. tUCT I ON , O &'E EN(:,-~NEERING & DEVELO~,MENT CO. Box 90, Davis St.. Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Legal Description: Depth (feet) 0__ 1__ 2__ 3__ 4_ 7__ 8__ 12__ ~5 Earl Ellis SOIL LOG 688-2280 Name: ~ /~g;'~, ~,,O :5~-,-,~_~-¢~..) Tel. No. ~ '~/ MailingAddress:~-~ ~., ~~*~/ ~, ~?~ Soil Characteristics Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: PLOT PLAN If yes, what depth Drain Field ~ /5- PERC. TEST Date: ePI., WS MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 � .. On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-731-56 Expiration Date: J 1 / " /9 1. GENERAL INFORMATION Complete legal description NORTHWOODS BLOCK 3 LOT 26 Location (site address) 22839 NORTHWOODS Current property owner(s) SEAN CLINE Day phone 232-8394 Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well (1 Private Septic ❑ Water Storage ❑ Holding Tank n Community Well fl Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment o2 jL/JI' Date of Payment Receipt Number $i-1'"D Receipt Number COSA# 05C-19/O3a 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 2/1/2019 -=` OF A� t - �V :17;4-%v oi*. /49 TM -'* / 6. DSD SIGNATURE ,s�/ . f System #1 Approved for 3 bedrooms • CHARLES G BALZARINI System #2 Approved for bedrooms r0l���s�•.. CE-13854 . �� Ar Amy Disapproved t44t.P.ROFESS0`," Conditional approval for bedrooms, with the following stipulations: 4-----1V; S¢(o4ic *-eMittC i s 2--( tlearS (91 d 14v-eko- N a 4-eaS. cQH, c --Ltmik i-; 2_0 /awl 0 I /,.�I_d ` T1404-b4A vi-c.ro 7 ev"'i 1 f id[ ' 0NsirE �t WATER q c W,srE ND m PRODA R *i j 9444,7,SERVICES By: `— ��/� _ Original Certificate Date:fr— � I —I9 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other • COSA Checklist blue sheet COSA Checklist Legal Description: NORTHWOODS BLOCK 3 LOT 26 Parcel ID: 051-731-56 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL (ND) ❑Wires are properly protected Arsenic ug/L ❑Arsenic less than MRL (ND) Casing height(above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments PUBLIC WATER B. TANK DATA C. LIFT STATION Age of tank(s) 20.5 years ❑� Required maintenance completed Tank type/material STEP Age of lift station 20.5 years ■❑ Standpipes/foundation cleanout per record drawing Lift station material PLASTIC Date of pumping 1/31/19 Comments: SEE INCLUDED FORM D. ABSORPTION FIELD DATA Which system tested (date installed) 2006 Adequacy test date 1/31/19 ❑� ALL standpipes present per record drawing Results Pass For 3 bedrooms Total measured depth from grade 4 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft(min) Water added 450 gal ❑� N/A—pressurized field New depth 0 in ■❑ Monitor tubes go to bottom of drainfield. If not, state Elapsed time 10 min depth into effective ElCode-requiredsoil cover over field Final fluid depth 0 in EI System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) Gallons introduced +975 gallons If yes, enter date NA Comments/Deficiencies:ALTERNATE SYSTEM NOT INSPECTED. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' 0 Yes if No ft ['Yes if No ft Neighboring Tank > 100' OYes if No ft Private Sewer/Septic Line >25' ❑Yes if No ft Absorption Field on Lot> 100' ❑Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ❑Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0Yes if No ft ElYes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No +5 ft Surface Water> 100' ❑✓ Yes if No ft Property Line > 5' ✓2Yes if No ft Driveway/Parking > 0' 0/ Yes if No, comment Absorption Field > 5' ✓EYes if No ft Wells on Adjacent Lots: Water Main > 10' 0✓ Yes if No ft Private Wells > 100' ✓OYes if No ft Water Service Line > 10' ✓0 Yes if No ft Community Wells >200' 2 Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ['Yes if No ft Driveway/Parking > 0' 2 Yes if No, comment Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0✓ Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' 0✓ Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS SYSTEM PRESOAKED PER 15.65.060 a ii. 0.4*(2)*65'5'.51* 7.5(GAL/CFT)=975 GAL G. ENGINEER'S CERTIFICATION r 7.....1,,,-..11/4.10.\\\,, QF AkA% I certify that I have determined through field inspections and review j'<P' *1--es#a�of Municipal records that the above systems are in conformance with j*'49TN ..* 6 MOA COSA guidelines in effect on this date. 2/1/2019 ../.Pe.. ....... e/ l CHARLES G BALZARIINI r# f0.. CE-13854 • •.�`t/i 'k‘F2 PRO FESS10NP � COSA Checklist yellow sheet A>>»>,- MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT C-. -;7 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite —� Septic Tank Advisory Certificate of On-Site Systems Approval # OSC191032 Subdivision: Northwoods Block:3, Lot: 26 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. fir ,f ‘Alit4 Tit...- , iiiii Pwririto tbr,, ., ` .. 4(44 ..r' , ." 44^K'14'. ''j_ �'. 4 {a'. ;,:..e.,..03 `t.J 'c•'', . �_ - I i * -..J 'F do r.. �-v Lr-" ' '',..TI, 2 4a11 -... l,,,_4:-.16t, _ AIM:. , r 'la iiihraa Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE fry Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner C-L s/t/5 Street Address A.)(9 H(..tiX D Septic Tank: -Sludge level 0 inches -Pumping: required yes iS •Pumping completed no Lift station: -Pump basket cleaned 1 no •Effluent filter cleaned no mori -Control floats cleaned no •Proper float settings confirmed ts no -Operation satisfactory es no Alarm System: •Dedicated electrical alarm ci cuit es no •Audible and visual alarm inside dwelling ! ' no -Alarm system operatio satisfacto not satisfacto Manhole Riser -Ground water intrusion at riser to tank connection es u ) -Ground water intrusion around pipe penetrations es (t -Weep hole functional fm no •Manhole lid: Functional fal no Insulated eg no Properly Secured no Other -All manufacturer required inspections and maintenance completed es no Comments: Rum it tvi, r C3`Y % C7(-/AL 7 P c7 s©,4- Qualified Maintenance Provider: Technician C. 7q/---2-Al2- 4/1-T75//7 Date of maintenance Company C 401 EA-/(9 Signature Date /I Mailing Address: P. 0. Box 196650 ` Anchorage, Alaska 99519-6650 * www.muni.org MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 1.96650 Anchorage, Alaska 99519~6650 343-4744 MUNICIPALITY OF ANCHORAGE 'vIRONMENTAL SERVICES D/VISIC'_" CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D.# 0 ~-I - -7 -~1- ~ (2 1, GENERAL INFORMATION ' Complete legal description Lot 26; Block 3; Northwood~ Subdivision Location (site address or directions) 22839 Northwoods Drive Chugiak, AK .,' ~,'/ property owner :? ,_Mailing address -'~, t' '. Lending ageocy ~. Mailing address Richard Condit 22839 Northwoods Drive Day phone Chugiak, AK 99567 688-3453 Day phone Agent' Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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 STATEMENT OF INS~-:r-;CTION BY ENGINEER " ' /.,s certifiod by my seal affixed hereto and as of the valid,-'.~tion (]ate shown below, I veriF/that rr~y' investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, funct onal 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 invest_i_gation 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 17034 Ea._l. River Le~q~L~_~n,4 ~!_~. ~0a. Phone Eagle Rlver~ Alaska 99577 Address ~ // ~ Engineer's signature ~')//~"~' ~*'~' Date- r~ //' /¢'£/ DHHS SIGNATURE ~" L,// Approved for ~-"/-¢/~E~ bedrooms. "'"~'~"~'~'~'~'~:~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipali~ of Anchorage Depa~ment of btealth and Human Se~ices (DHHS) issues Health AuthoriW Approval CeAificates 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 couAesy to purchase~ of homes and their lending institutions in order to satis~ ce~ain federal and state requirements. Employees of DHHS do not cor~duct inspections or analyze dat~ before a certificate is issued. The Municipsli~ of Anchorage is not responsible for errors or omissions in the professional engineeCs work. 72-0;~5 (Rev. 1/91) ~ck MOA Municipality of Anchorage AUC ' DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division "'~~L 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription:/_0T ~, ~3Lt< 3 A~0RTt~Iv~/)$ $/-'3 ParcelI.D.: 0,?1 A. WELL DATA Well type c¢~., ,,,,,,,, ~.. 7' If~ B, or C, attach ADEC letter. ADEC water, system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Dat o~fsamp e Date completed Cased to FROM WELL LO.~'~'~ ~ g.p.m. C~ght (above ground) /~ires properly protected (Y/N) AT INSPECTION Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '// ;; ! / ¢ Foundation cle~nout (~/N) 'y,¢ ..~ Date of P, umplng "~/,~ -,-',~ ~J' Pumper C. ABSORPTI°N FIELD DATA ' Date ins~lie,d -7/~)/r_-q Length "~ ~-' / · Width Effective absorption area ~1 Date of adequacy test ~'/A, Tank size )~- ~-o g.p.m. Number of Compartments % . Cleanouts(~/N). ~¢--~ Depression (Y/(~ ~' ¢ High water alarm ¢~9/N) 0 .~/ System type 9~. z~ Gravel thickness below pipe O, .t~ Total depth V Monitoring Tube present ¢(~N) Ye J Depression over field (Y~.}. ~ O Results (Pass/Fail) For ~ .bedrooms ,,Soil rating ~or fF/bdrm) Fluid depth in absorption field before test (in.); Imm~~r-added-(im);- Fluid depth (ins) Minutes later..~__ ~---~-~bsorption rate = g.p.d, If yes, give date Peroxide~tceat.rne"fi~(past 12 months) (Y/N) 72-026 (Rev. 3/96)* LIFT STATION Date installed 7 Manhole/Access(~/N) High water alarm level Cycles tested Size in gallons "Pump on" level at* z./..~ *Datum "Pump off" level at* '3 '~- E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hoMing tank on lot On adjacent lots .~ Absorption field on lot ~.~r~t lots ~ Public sewer manhole/cleanout Public sewer main .~-~- Se_we~.-/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation -7 Property line Absorption field Water main/service line. /o -1-- Surface water/drainage ? O ~ ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line __ Surface water Building.foundation ')-- -~' Water main/service line ) 0 J 7¢o .¢- ~ Driveway, parking/vehicle storage area ENGINEER'S CERTIFICATION ~',.:~ %. ..... I certifythatlhave determined thrufieldinspectionsandreviewofMunicipa' .~c(~'s that th~ ~v;~msare ,nconforman_~/~wiyCJAA~t. olinesineffectonthisdate. !'"~v~/ ,~ ~ ~f HAA Fee $_ Date of Payment Receipt Number 72-026 (Rev, 3/96)* Waiver Fee $ Date of Payment Receipt Number ~' ~ ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME -I ~-~--,,~-' )~_~. MUNICIPALITY OF ANCHORAGE ' ' ~'~ALITY OF ANCHO"AG~ ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~EPT OF  825 L Street - Anchorage, Alaska 99501 ENVIEONMENTAL E.V~RO.~E.TAL SA.~TAT~O~ 9~WS~O. OCT 2 ~ 1981 Telephone 264-4720 .o. o. DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing. MAILING ADDRESS PROPERTY RESIDENT (If different from above) ~ PHONE 2. BUYER ~ ~ PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ ~ ~ PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION~.~ STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four I~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY PUBLIC UTILITY * ATTACH WELL LOG. A well lo§ is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY ,, . 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY E3 ONE [] THREE [~ FIVE [~3 OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size:. If 1-ank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTAI~CESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS I~fAPPROVED FOR ~.~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ~ 72 010 (Rev. 6/79)