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HomeMy WebLinkAboutNORTH WOODS BLK 4 LT 13North Woods Block 4 Lot 13 #051-731-18 . Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211070 PID Number: 051-731-18 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name KAYCI & STEPHEN STYLES ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22611 MCMANUS DRIVE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. NORTH WOODS 4 13 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ -_ NA Foundation F-6.5' __ LIFT STATION Manufacturer Capacity Gal. Remarks 4" OF INSULATION ADDED. *OUTSIDE SOIL BEARING PRISM. DECK SUPPORT DRIVEN TO BOTTOM OF TANK ELEV. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer JRS Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection1s' 4/6/2021 nd 4/6/2021 Location and description dates:2 3`d 4'h BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL ill Conditional Approval: Date AW I TH • . r �.. Curtis Huffman j Septic pdstem A PProve_ w•- Dateqf2 _Z1 •:� �4 �`� ��.CE128991 low iltFOPROHSSI4N Note: this approval does not include well permit requirements. (Rev 05/02/18) PID: 051-731-18 PERMIT: OSP211070 A—C=12,6' CHFCO CO fDCO JLS 982 -MT if FINAL GRADE r B—C=50.0' 1" = 30' PAGE: A—D=16,2' 97.00 B—D=51,0' "96.42 A—E=18.2' 'HDPE 8.25 TANK HDPE TANK (ia.l OUTSIDE OF SOIL BEARING -ST MT PRISM INSTALLED FOR DECK PILING DEPTH NORTH WOODS BLOCK 4, LOT 13 PREPARED FOR: KAYCI & STEPHEN STYLES 22611 MCMANUS DRIVE CHUGIAK, AK 99567 FIRST WATER CONSULTING SEPTIC SECTION SCALE, NTS 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com EXISTING FIELD SUPPORT® SERVICE —w DATE: 4/7/2021 SURVEY: JLS DRAWN: FWCS SCALE: 1" = 30' PAGE: 1 OF 1 OFAL * 9 TH rtis Huffman '00 r CE 128991 AV 4/7/21v nssio'4 ' AV MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO 6ox I5Mu 4704 FJmoM Rid Ancharega, rtilarka 99519-1305D Phone: {91)7) 343-7904 Fax: 7) 343-7i)D7 ht1p:fhwm.mun1.argfong1te On -Site Wastewater Disposal Systern Permift Permit Number: OSP211070 Worts Type: eptic%nik Upgrade Tax Code Number, 06173118000 Site Legal Address: NORTH VVQ0 DS BLK 4 LT 13 Site M a I I Ing Address- 22611 NC MANLYS DR, Chugiak Owner, STILES KAYCI & STEPHEN Deslgn Englneer: FIRST WATER CONSULTING Th is pe rrniit is for th e c unstr;rcti o n of. Effective Date: Expiration Dom: Lot Elme in Eq Ft: Total B edmo m 5: 4k3CJ}r n ry u L"—Rer 324r2-021 341022 25 a20 ❑ Disposal Field 0 Septic Ta nk ❑ Holdi rwg Tank ❑ Privy ❑ Private Wel I ❑ Water Storage All construc:tlon shall be in accordance with; 1. The attached approved design. 2. All requirements specified in Anchorage AA inicipal cede Cho piers 15.65 and 15,65 artd the Skate of Alaeka Wastewater Disposar Regulations (18AAC ) and Drinking Water Raqulatiunr�, (1$AAQW) 3. The wastewater oDde requires inspections during the installation_ The engineer shall notify the Development Servr ces Department per AMCIS, 65, Provide notlficawn by carting (,qn) 943-7844 (2417)- 4. From 00obor 16 to April 15, a subsurface soII absarplion system andeT Coriatructiian during freezing weather Shall be either_ a_ Dpened and Closed on the same day. or b_ Covered, sealed, and healed to prevent freezing Special Provisions: 1 _ The tank is to meet the required separation to the -deck supports or the Supports are to be replaced — _2� Received Ey- Date: 3125121 Issued By: - Date: 3 o Development Services Department r On -Site Water & Wastewater Section ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-731-18 Property owner(s) KAYCI & STEPHEN STYLES Day phone Mailinq address 22611 MCMANUS DRIVE, CHUGIAK, AK 99567 Site address 22611 MCMANUS DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS BLOCK 4, LOT 13 Legal description (Township, Range & Section) Lot Size 25,020 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank El Upgrade Q Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: 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) Permit/Rush Fees: $225 Date of Payment: _� / 21 Receipt Number: © i Permit No. OSP211070 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 18, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: NORTH WOODS BLOCK 4, LOT 13 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211070, Deb Wockenfuss, 03/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211070, Deb Wockenfuss, 03/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211070, Deb Wockenfuss, 03/25/21 1 ANCHORAGE RECORDING DISTRICT, ALASKA AS BUILT OF• NOTE: Driveway locates are approximate NORTH WOODS SUBDIVISION due to deep snow and ice conditions. LUT 13 BLOCK 4 PLAT 79-195 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a 10 OF NN S .�L LAIVD physical survey of this property as shown on this drawing and that the / . • a' Improvements situated hereon are within the property lines and no Yk enchroachments exist other than noted. Under no circumstance should / .• 4 9THC� •. J any information on this drawing be used for construction of fences, '� ' a ?. ................... structures, improvements, or for establishing boundary lines. 4?A EXCLUSTON NOTES: It is the owners responsibilitt• to determine1 V ....:... ...... ...............C- the existence of any easements, covenants, or restrictions which C° JO- HN L. SCHULLER.• o do not appear on the recorded subdivision plat. ��'� LS -1048 �qJ i "1• •.,,.,,,�. ,,, @�, . , • �� A 1831 Talkeetna Street WORK ORDER NUMBER: DATE: r SCALE: E-MAIL: �Q, • ' .�:s•• • Anchorage, Alaska 99508 MAR 16, 2021 1 "= 30 schullerfak.net Ar 4� ,W _._ DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: o f �S �a1 Nw �- �' (907} 227--1455 office 2 023 JLS NW1459 210128 ®�\ sl nc (907) 274-4992 fax 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 & NEW ❑ UPGRADE MAILING ADDAo LEGAL DESCRIPTION LOCATION � ^ NO. OF BEDROOMS U Y DISTANCE TO: Well Absorption Absorption area % Dwelling !- CJ PERMIT NO. ? /®5�3 _ a ZZ w 1.. Manufacture", Mater' I Nocfrpartments n rn Liu. capacciy�n gallons IF HOMEMADE: Inside length — Width Liquid depth Y J C7 z DISTANCE T0: Well Dwelling PERMIT NO. =ZFQ- Manufa er ._ Mlateeia iquidcapacity kgal4ons---`--' OJ w= DISTANCE TO: Well;/ s�� , /c- GJ /O Foundation f Nearest lot line r PERMIT NO. W u. V P Z w No.o s _ 7 Length o each i ` Total length of lines g '%� Trench width inches Distance be ween lines G�� FTop of the to finish grade / Material beneath tile p.7- -7 -me! es Total effective absorption area o 2 Z w f7 Length Width Depth PERMIT NO. Q F LU Type of cri Cri amet r Crih Total effective absorption N area WWell DISTANCE TO: Building founda ' n .__---- 1Ue5f9t lot line �. ---'- J J Cl a �� Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS P303 y SOIL TEST RATING INSTAL ER . 66 REMARK$ D 03k ✓i/t/��i .l-Q-�-�R—C.G2�G� I APPROVED DATE LEGAL V4� 14 /G -U13 (Hev. 1//6f V ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE/ HK. 99501 264-4720 K�r--1 I ~T -G-- ��E-_ t4 F:-- F�! F:�" F:�' F --Cm Jr -1 17' PERMIT NO. ( 8105633' ) �f ���' " /�� APPLICANT STEVEN L SKHGGS CONST, PQ BOX D 99567 688-2831 LOCATION NORTHWQQDS DRIVE LE8HL L 13 B 4 NORTH WOODS S/D LOT SIZE 20000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER QF BEDROOMS = ] SOIL RATING (SQ FT/BR>= 255 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ������ E4 A �r-JC3-FH-= f--4;2 0F?F-I*w�'E�L_ ���T"H= 15 - THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIEL[\ THE DEPTH OF H 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). ��r--! k-1 11 F, FEE 01 "_:=Z E-_- F-� -F I _r F-1 P -A �I 2-f E�= -1LOC-ICE1 0"I����� 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. ­__ _T_ W Cl < ;a" > I N."Z3 F::ft F-z'#Z- 7* 1 NZI F:� Fe E-: FR. C--- C7! LJ I FR E -Z V -m ~— — 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 H 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 H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. -r ���I F -"E--- _S3 �����E-�'EE F at A ���flL I CERTIFY THAT 1: I HM 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 THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2 BEDROOMS. SI13NED APPLICANT STEVEN L SKHGGS CONST. msµ,. '�'JNICIPALITY OF ANCHORAGE Department or Health and Environmental protection 825 L Street, Anchorage, AK. 99501 264-4720 # HANDWRITTEN PERMIT # # # ON-SITE SEWER PERMIT / Applicant e Mailing Address: Location: I Yt w A- Al [A (�, Phone Numb(he�r : Legal Description: L 1 N��Lh oL BOt Size: �6!?oa Type of Soil Absorption System Is: Trench: �'"Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br) aS::!S-' The Required Size of the Soil Absorption System Is: DEPTH ___ _—__ LENGTH_ GRAVEL DEPTH 67� 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 = 4:!220— 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 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 re uire enlargement if the residence is remodeled to include more hat bedrooms. Signed: Issued by: Applicant Date: SWP/024(1/81) O & E ENGNEERING & DEVELOI MENT 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: (- c�/U AJ Tel. No. 46919p'?gSl Mailing Address: • '"t ® W S-& 7 n Depth (feet) 0 Soil Characteristics Iv, eo s 3 5 6 7 8 9 10 11 /;j r c Ty67,eA flc e--zy i /v �0 i --T-/, 12 13 0&-r— 14 16 4rr�'T`%red✓` �!'�" 5./ 1 "fes % Ground Water Encountered: Yes :f:fNo If yes, what depth Proposed Installation: Seepage Pit- Drain Field !� Comments: Performed by: ,via e7� L-4`- 'T /\)O 4' -P -'CV. s O'd PLOT PLAN PERC.TEST N �ypE OF AL 9 � AeeA °POf�Ogeum mo m°000 uud--�®-F� ®moo Russell L. Oyster : Q�'o °•ao oaa0 Date: 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 Z-2,5-`66 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 07 /3 61k 4/ e3/j Location (address or directions) /� QQ 0 (b) Applicant Name �iL SCH^i OZE Telephone: Home 1906 � 3o�C7 Business Applicant Address ,2� tCL ^^° ' �3fi--a--�9 °M579 yS /l e&Mus?. sM (c) Applicant is (check one): Lending Institution ❑ ; Owner4Wj4dar(kg; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent /1O /✓F Address Telephone (f) Mail the HAA to the following address: 526 1'9bx Eagle River, dfasfia 99.,M 2. TYPE OF RESIDENCE Single -Family E�- Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ElCommunity ElPublic tg u'4 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 � 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) 1'I r i C 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 Health 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 Firrrt� & 5 Engineering S)x Telephone R Address Eaatle uivsr• Alaska 99577 Date ap da "A' s 41 nmI R4 dK 6. DHEP APPROVAL ) ,{ Approved for be '� drooms by Datex/96, Approved Disapproved Conditional Terms of Conditional Approval 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 ; MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOP., DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIS - FEB UARY,1984 j a(tOC Legal Description: !, > /Ale" r- r i i r< n 6IZ?f!t �a\C 3 A. WELL DATA Well Cjassefication �,�Ll� 16 B, C, D.E.C. Approved40/Xr, Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Dept of Grouting Static Water Level Pump Set At Casing Height Above Groundanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well To Septic/HeWiwg Tank on Lot On Adjoining Lots — a To Nearest Edge of Absorption Field on Lot z� ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments �?W.5 , 1-47 Z,►,3bol B. SEPTIC/HOLDING TANK DATA Date Date Installed Z g Size WCI0 No. of Compartments 7 -- Standpipes Standpipes &M Air -tight Caps/,kT- Foundation Cleanout 4W4 Depression over Tank L4 ate Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic)" folding Tank: f� n To Water -Supply Well z� To Building Foundation To Property Line .0 14- To Disposal Field — S-/ To Water Main/Service Line 'Ta Jf- To Stream, Pond, Lake, or Major Drainage li0Ur5e Com entsfM lle O'W6 6--7e GL ,s i T —,14 e e CJ e) � Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z5-5-� Type of System Design Date Installed 6-44P-81 Length of Field /3t Width of Field 34, Depth of Field Gravel Bed Thickness Bye Square Feet of Absorption Area Standpipes Present46* Depression over Field Date of Last Adequacy Test Results of Last Adequacy Testi/ Separation Distance from Absorption Field: To Water -Supply Well 14- 'A" To Property Line To Building Foundation Z6 t To Existing or Abandoned System on Lot Nl/� ; On Adjoining Lots 3d t To Water Main/Service Line To Cutbank (if present) �J To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons 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 MOA and HAA guidelines in effect on the date of this inspection. Signed S A S Engineering Date 2—^ 2.6 — -V 6 B 196x Company Eagle Rive_ Alaska 99577 MOA No. gs-- dD 3 Receipt No. 32 LZ& Date of Payment Amount: $ v� Page 2 of 2 72-026 (11/84) + Sial YJ "G�•a lR4Pbt"I A Sh7fe.r APO f • �n� U L BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE:n,,., Z6 H&O PWS I.D.# c21,95 WI To Whom it May Concern: According to records on file in this office the 4LALffjjjB II 4l[AkJ �C. Water System is in compliance with the State Drinking Water Regulations Sincerely, Muj\gell 41IT FNVI,?pNMFNTA4 �GTy &'RAGE PR'rEcrioN RELEIVE® MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision section, township, range) �-%�' l� � /l/cii2� `��✓moo .� s" J-�i� Locatio (ad %% or directions) (b) Applicants Name /!?///z L .5'C"!//0// (7 7` Tbleephone PS,Q Applicants Address 2 9 1/VC_ 1? (c) Applicant is (check one) Lending Institution Owner/bailder_ ; Buyer r:::j ; Other f:::j (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone 2. Tyke of Residence Single -Family rEa Number of Bedrooms Multi -Family L3 Other (describe) 3. Water Supply Individual Well Community Public c�,i ss� Al Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA(/N) 4. Sewage Disposal Onsite Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedroom (Y ) [Page 1 of 21 2-15-84 5. Engineering Firm Providing Ins2ections, lbsts, Data and Information I certify thaw ave checked, verified, or conformed to all MDA HAA Guidelines in effect on tiC d44Z- = spection. Signed Name `viz Address Signed by Date (ENGINEER SEAL) 6.DHEP Approval Approved for 3 bedrooms Approved "'A Disapproved Terms of Conditional Approval Date''%�� 40 �••,. e' .V 1 By ((k r 4"4l- Date 1�117 -r5l Conditional The Municipality of Anchorage Department of Health and Environmental Protection does' not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE ( MOA) M NICIPALRY OF ANCHoRA 4 HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTI N CHECKLIST -FEBRUARY 1984 APR 161984 A. WELL .DATA UE - Well Well Classification /7- If A, B, or C, D.E.C. Appro Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing`Height Above Ground Sanitary Seal on Casing (YM) Electrical Wiring in Conduit (Y/N) 4Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; on Adjoining Lots To Nearest Edge of Absorption Field on Lot on Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected By ; Date Water Sample Test Results Comments B. SEPTICS TANK DATA Date Install b 2 ( Size AD00 _ No. of Compartments Standpipes (Y it -tight Caps (Y Foundation Cleanout (-Y ) Depression over Tank W, ) Date Lastpumped :!Z- 9/� P in intenance Contract on File (Y ; for h✓ 'j'� �p Holding Tank High --Water Alarm (Y Temporary Holding Tank Permit Separation Distances from Septic/Holding flank: To Water -Supply Fb 11 � !'T To Building Foundation To Property Line /O 7- To Disposal Field To Main/Service L`r�ie� %� To Stream, Pond, Lake, cr Major Drainage Course Comments Z7a " Jo zl e [ Page 1 of 21 / _3 /(J 0 2 Ted W& VI -)S 2-15--5? C. ABSORPTION FIELD DATA r— Soils Rating in Absorption Strata Type of System Design NC Date Installed o� 12,61 0 Length of Field 73 Width of Field v� Depth of Field f Gravel Bed Thickness Square Feet of Absorption ea /0 2 2 Standpipes Present f` Depression over Field Gri Date of Last Adequacy 'lest 441- / -?-6 Results of Last Adequacy Test 77I-- gC 7-O v Separation Distance from Absorption Field: To Water -Supply Well AJ � n To Property Line l© To Building Foundation e Z b To Existing or Abandoned System on Lot A) D N E ; on Adjoining Lots 30 74. To Water /Service Line `-� /- To Cutbank(ifpresent) To Stream/Pond/Lake/or Major Drainage Course AJ To Driveway, Parking Area, or Vehicle Storage Area iAJ' Comments D. LIFT STATION Date Installed Dimensions FA Size in Gallons Manhole/Access MN) "Pump On" Level at 1h "Pump Off" Level at High Water Alarm Level a Vent (Y/N) Tested for ing Cycles during Adequacy Test. Meets NIDA Electrical Codes(Y/N) Comments Check Permitted Bedrocan Rating Against HAA Request ** I certify tha a',:eeqe cked, verified, or conformed to all MOA on the date/of on. (- i Signed Date Compan ly_MOA No. 3 SRO 196X KBl /d5/s P1 EFL ALASVA -U4 P .684�2y7;7 (Page 2 of 21 in effect %ObW A. +h4low 10 No. V O +�� M.M•�a.\ �1 2-15-84 5. LEGALDESRIPTION N I-\ ov� D rRECEIVED .. INSPECTIOW APPOINTMENTS` NUMBER OF BEDROOMS TIME ❑ One C1 Four Ell Other rV1 "TIME' - TIME MULTIPLEFAMILY ❑ Three ❑ Six 7. WATER SUPPLY •a '�. DATE - ATTACH WELL LOG. A well log is required for all wells drilled ' DATE DATE: INSPECTOR depth (attach log if available.) I INSPECTOR INSPECTOR INDIVIDUAL/ON-SITE** 1 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE j" /825 DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION DEPT. OF HEALTH ,& L Street - Anchorage, Alaska 99501 '- PROTECTION • ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION AUG7 181 Telephone 264.47�0 CC REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW�IG�I� MED DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days -for processing. 1. PROPER OWNER PHONE aq' \J !-O - MAILING ADDRESS - PROPERTY RESIDENT If different from above) - PHONE 2. BUYE \ PHONE MAILING ADDRESS 3. LENDINQ INSTITUTIO PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE t MAILING ADDRESS 5. LEGALDESRIPTION N I-\ ov� STREET LOCATION 1 .. 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS fl SINGLE FAMILY K ❑ One C1 Four Ell Other rV1 Two P Five MULTIPLEFAMILY ❑ Three ❑ Six 7. WATER SUPPLY •a '�. INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ' COMMUNITY since June 1975. For wells drilled prior to that date, give well PUBLIC UTILITY depth (attach log if available.) I 8;'SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** 1 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) MUMCWAUTY 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. 051-731-18 Expiration Date: — 20 23 1. GENERAL INFORMATION Complete legal description NORTH WOODS BLOCK 4, LOT 13 Location (site address) 22611 MCMANUS DRIVE, CHUGIAK, AK 99567 Current property owner(s) KAYCI & STEPHEN STYLES Mailing address Real estate agent 22611 MCMANUS DRIVE, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .550 Date of Payment � e a"�� l Receipt Number. 70 Soo5 COSA # d 5621 I l 6r Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 4/6/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to OF A these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: •' • • : 1,9 ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & 1`14H' * . TH , , , ,•:* r /I .. .... .....�.�... 6. DSD SIGNATURE I Curtis Huffman ESSO System #1 Approved for 3 bedrooms �c .CE 128991 .416/21 �l F'°ROESS�10NQ���'r System #2 Approved for bedrooms �l�\\ Disapproved Conditional approval for bedrooms, with the following stipulations: koTYtOF(����i, ,JJ/JI f7,SERVIC,��',: Original Certificate Date:Y-1Z- Z( 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 CD INAT-` �m J� m. AST_v, ATER J z o; A4 ,JJ/JI f7,SERVIC,��',: Original Certificate Date:Y-1Z- Z( 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 1. l Legal Description: NORTH WOODS BLOCK 4 LOT 13 Parcel ID: 051-731-18 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 6/26/1981 ® ALL standpipes present per record drawing Total measured depth from grade 7_1 ft (max) Measured depth to pipe invert from grade 3.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.7' ® Code -required soil cover over field ® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 3/3/2021 Results M Pass For 3 bedrooms Fluid depth prior to test 1 in Water added 600 gal New depth 5 in Elapsed time 1380 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date IN 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' Building Foundations > 10' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Water Main > 10' ® Yes Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft Q Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *6.5 ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No **5+/- ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *OUTSIDE OF SOIL BEARING PRISM. **PER MOA RECORD DOCS AND ASB — THE 1981 FIELD APPEARS TO BE 5'+/- TO PROPERTY LINE WITH NO KNOWN ISSUES OR EFFECT ON ADJACENT PROPERTY 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. OF A ' ..� ...... Curtis Huffman �f �'FG, •. CE 128991 .• �� s®' ���'s��;�• • a17121, . • •���� \ LLC co a) LO y... w t? O cm / f Z! S� P w�W 0 \ / U 0 a 10 co is O om e a�. _ -o. cP /fi Q' RS iC 02 a1 aCC C; < d' 18 O cpC� z; 45 �.LO 4• tM cm. O 0 •c, ,+ to ..a ri v •._�^^. v: m •� m uZ p O Z 3 o v m 3">.o N� W K il..-.�� O cC C W a.•O 2TS m o � �.. y � �__ l OO O ' W e�/P E-•• R O ""' y O o 4 0 6b� W ®V u 4 cG y o c. Z o t N Os� a w U aoi E s. O Z I J W u U P?fn E EE n a: O �� >.NooE Z to O THIS $IDE -FOR OFFICIAL USE ONLY 1: TYPE OF RESIDENCE NUMBER OF BEDROOMS --SINGLE-FAMILY ❑ ONE ❑ -THREE ❑ FIVE ❑ OTHER- M ❑; MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ : SIX - PERMIT NUMBER I WATER SUPPLY ❑INDIVIDUAL-- DEPTH OF_WELL COMMUNITY' DATE DRILLED - PUBLIC UTILITY Connection: Verified _ 'LOG RECEIVED I 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER - � I ❑INDIVIDUAL/ON -SITE DATE INSTALLED - I ❑PUBLIC UTILITY Connection -.Verified- INSTALLER ❑Septic Tank or ❑ Holding Tank j Size: If Tank is homemade SOILS RATING give dimensiorss: - TYPE OF TANK MANUFACTURER TOTA ABSORPTION AREA MATERIAL j 4. DISTANCES Septic/Holding To Absorption Area Sewer Line Nearest Lot Line WELL=TO: Absorption Area to nearest =Lot Lina 5. COMMENTS _ - I i i i APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE r BY I _ I 1 72.010'(Rev. 6/79)-_- P Municipality of Anchorage Development Services Department /p"` e` Building Safety Division ti' On -Site Water and Wastewater Program SAFETY 1 4700 Elmore Road P O Box 196650 / Anchorage, AK 99507 1 www.muni.org/onsite (907) 343-7904 l� CERTIFICATE OF ON-SITE SYSTEMS APPROVAL VA FOR A SINGLE FAMILY DWELLING Parcel I.D. 01$2 — 4 COSA# Expiration Date:��- 1. GENERAL INFORMATION Complete legal description NORTH WOODS BLOCK 4 LOT 13 Location (site address) 22611 McMANUS DRIVE, CHUGIA AK 99567 Current Property owner(s) DAVID & GLORIA ZEILER Day Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 22611 McMANUS DRIVE CHUGIAK AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _ Well Public Water System Day phone Day 3 HUSH! TYPE OF WASTEWATER DISPOSAL: The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Individual On-site Individual Holding Tank Community On-site El ® Public Sewer El The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply. and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC. Phone 568-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 7/22/12 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions, as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future .. occupants or can ArcTerra guarantee that no unseen ,++, encroachments, deficiencies or discrepancies exist. ,I _. 5. DSD SIGNATURE ' °� Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory ON-SITE Arsenic Advisory "' M)i Maintenance Agreements Supplemental Engineer's Report Other—_ By: Original Certificate Date: 7 - - / z (Rev. 11105) Municipality of Anchorage • '� Development Services Department 4 Building Safety Division e On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF Oft -SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NORTH WOODS BLOCK 4, LOT 13 Parcel ID: 051-731-18 A. WELL DATA Well type PUBLIC If A, B, or C provide PWSID # Date completed Sanitary seal (Y/N) Total depth t Cased to _ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION g.p.m. g.p.m. Coliform _colonies/100mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: mg/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 0126/1981 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) *Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6/15/12 Pumper JRs C. ABSORPTION FIELD DATA Date installed 6/26/1981 Soil rating (g.p.d./ft2 or ft2/bdrm) 255 System type Deep Trench Length 73 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth 8_5 ft. (Measured 6/15/12) Eff. absorption area 1022 If tube Y Depression over field N Date of adequacy test 6/15/12 Results (Pass/FaID Pass For 3 bedrooms Fluid depth in absorption field before test *16.8 in. below invert Water added 600 gal. New depth *2.4 in. Elapsed Time: 1420 min. Final fluid depth *23.6 in. below invert Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _in. "Pump off' level at High water alarm level _in. at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 101+ Curtain drain _50'+ (None Known) Wells on adjacent lots 2001+ F. COMMENTS 4 G. ENGINEER'S CERTIFICATION 1 certify that l 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 KENNETH M. DUFFUS Date 7/20/12 COSA Fee Date of Waiver Fee $ Date of Payment Receipt Number GyS� Receipt Number (Rev. 11105) /? 5.J%3 zaNNc pmrcr FIWxr eeeLNo sEl . zrernc I ( `a/ \ 14 2 O 90 EXISTING HOUSE p GARAGE 12 J' UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LABILITY ONLY FOR THE COST OF THE SURVEY. USTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURREY SURVEY TYPE FOUWATKN AS-RUILr SYMBOLS FINAL Sm CMK AS-R&LT ' SET RESAR DRAINAGE F ASPHALT PLOT PIAN... AS -&TILT .. ,LOT SUflVEY ... TnPOWfAPNY O FOUND RERAR A-in..m WOW FENCE CONCRETE '1TBOUILTA.DK- .5 RSMETAL FENCE I7777I anon ITIS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, TO FINISHED GRACE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAIMPROVEMENTS FROM BEING SEEN AND LOCATED. SURVEY CERTIFICATION T. ALL D157ANCES ARE RECORD UNLESS OTHERWISE NOTED. 1i Prepared by PLOT PLAN ...�E OF"•,q�y Robert E. Johns Jr. & Assoc. In..ev ewaN ewtl nw. pewwerT we,.l.r .'` •,��11 Professional Lond Surveyors T. bl 6an aq NNtl AwaeasM tlw! • w arca a a Ia mwrn • •� 1700 Brink Drive, a Mew, m M q.. wa 4 tlN MM er my %• ............. •`•• ANCHORAGE. ALASKA 99504 - FOUNDATION AS -BUILT •••• .., ..d.. • • f Scale: 1 n _ 40' Rea. Lot S.F. Rea, Plot File No. 1. Rawt E .Fh,. Y.. MOY µMY epl I naw pwwmw a A.•au vwy a % Date Surveyed: Drawn b ..... ... ...00 Y Checked ayMK am.wa. wr wwwenw,>Men -� - . 7/17/12 REJ J w• M.. wa b •,s„M,,,.,y - .. ROBERT HNS,•JR••• . Man aMrww " I A ; / a - Date Drawn: Grd: FINAL STRUCTURE AS -BUILT �j '••.• 121 ,,��! 7/18/12 1459 W'0 12-269 �Rmwt c JMir c, n..evm e"10ti.I - •I f ....••• gay Legal Descriptlan: xa.. ewA.aoa ., w,eMt e e aa.„ w�emaM. • a . Lot 13 BLOCK ••••fe+aior,6••'� NORTH WOODS